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Traverse City, Michigan

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Tim Smith
Tim Smith
Attorney • 231-946-0700

Regulating Insurance Company Doctors here in Michigan

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Earlier this year, the Michigan Department of Energy, Labor and Economic Growth, together with the Office of Financial and Insurance Regulations issued rule revisions for the rules regarding mental or physical examination of insurance claimants here in Michigan.

For years these examinations have been referred to as “independent medical examinations” by the insurance industry. For those of you who have been through one of these exams you know that it is anything but independent. The insurance company hires a doctor whose retention was for the sole purpose of cutting off the your medical medical benefits. Because of the abuses that have occurred over time in the insurance industry as well as their collusion with these insurance doctors, Michigan has begun to regulate the industry and set certain parameters for these exams.

One of the many complaints by those who have been sent to these medical examinations by their insurance company is that the doctors in many cases are no longer involved in the active practice of treating patients and have effectively retired from medicine to perform these independent medical examinations as a lucrative hobby. Too often they are out of touch with current standards of care and have failed to stay updated or current on the present state of medicine.

Now there are particular requirements placed upon the physician or health professional hired by the insurance company to exam their insured. The medical examiner must at a minimum meet the following standards:

1. Hold a license as a physician or health professional in the State of Michigan or another state of the United States.

2. Have no history of disciplinary actions or sanctions including loss of staff privileges or participation restrictions that have been taken or pending by any hospital, governmental agency, or unit, or regulatory body that raises substantial question as to his or her physical, mental or professional competence, or moral character.

3. Have the same or a higher level of education, certification, and if applicable board certification as a physician or health professional treating the subject of the independent medical examination.

4. Have devoted a majority of his or her professional time for the year immediately preceding the date of the examination to active clinical practice and/or instruction of students in an accredited health professional school or credited residency or clinical research program within the medical specialty most relevant to the subject of the independent medical examination.

Since I started practicing law here in Michigan some 18 years ago, there have been numerous medical examiners who were favorites of the insurance industry who would fail to meet these new minimum standards. I’ve written and published prior articles regarding this very issue and discussed doctors who had lost their staff privileges, who no longer had an active clinical practice, who had lost their license to practice here in Michigan, who were being investigated by the State Board for fraudulent medical reports, as well as fraudulent billing practices.

The new rules will also specify that the person to be examined is not to have any out of pocket expenses including the cost of the exam, production of medical records relating to the examination, or travel expenses. This is important as here in Northern Michigan there are very few of these hired gun physicians who actually live and practice up north. More often than not, insurance companies who are dealing with claimants in Northern Michigan end up sending their insured to Grand Rapids, Lansing, or Detroit where the majority of these cutoff doctors are located.

I think it is important for the courts, as well as attorneys practicing in this area of law to keep in mind that these rule revisions which took effect May 1, 2010, are simply the “minimum standards” that insurance companies and their hired doctors must adhere to when contracting a policy of insurance with individuals and when sending them out for examination. I would hope that the State and the regulatory bodies in charge of overseeing this activity, continues to shine a light on and regulate this highly suspect and highly lucrative area of medical practice.