As I discussed in my prior article, one of the regular tools used by insurance companies to terminate benefits of their insureds is the insurance company doctor. These doctors typically perform a one-time exam of the insured lasting anywhere from 15-20 minutes and then render a report which outlines their cursory examination and their medical opinion that the person either is not injured or is capable of working or that the injuries present are not the result of the automobile accident or work injury but rather some other event. The next thing the insured knows is that they are receiving a letter from their insurance company terminating all of their medical benefits on the basis of this one time evaluation. Even though in most cases, this one time evaluation and the opinions of the insurance company doctor are in direct conflict with the opinions of the treating physicians who have treated this individual for many months and, in some cases, years and who relate the treatment to the injuries sustained in the traumatic event. Is this fair? Not even close.
I think the general public would be surprised as to the credentials and background of some of the more infamous doctors used by the insurance industry here in Michigan. One of the favored neurologist of auto insurance companies such as State Farm, AAA and Allstate is a neurologist at the University of Michigan. His resume shows that he obtained his under graduate degree at the University of Pennsylvania, but did his medical studies at the Municipal University of Amsterdam in the Netherlands. The first couple times I deposed this doctor, he would go on about this prestigious European institution of higher learning where he obtained his medical degree. I took the liberty of securing a copy of his medical licensing file here in Michigan through the Freedom of Information Act. In a sworn statement on his medical license application from the 1960s, it showed that he had attended Jefferson Medical College and the University of Pennsylvania for 11 months prior to attending the University of Amsterdam. The funny thing was, he never mentioned attending this medical school on his resume or made reference to it in depositions when asked where he received his medical training. When this neurologist was pressed on the issue under oath, he admitted to me that not only did he attend medical school for one year here in the United States, but that he had failed out of medical school here in the United State including the class of neurology. This is the "expert" that the auto insurance company was using when they needed a reason to cut off further neurological treatment in cases involving a neurological injury in auto accident claims. How upset would you be if your benefits were terminated based on the expert opinion of a neurologist that failed out of medical school, including neurology?
Another favorite physician of the insurance industry here in Michigan is an orthopaedic surgeon who is licensed in Michigan, Texas, California, New York, Nevada and Indiana. While this sounds impressive on paper, when you begin to dig into his background, you find out that this doctor is no doctor at all, but rather, a medical incompetent who will say anything for the right price. He currently resides in Texas and travels to Michigan for one week per month for the sole purposes of performing examinations for insurance companies. He does the same thing one week per month in the State of California.
In 2004, he made almost $420,000 simply doing workers’ compensation exams for workers’ comp insurance companies in the State of Texas. For the two years that he practiced in Michigan, he was successfully sued five times for malpractice and the Plaintiff won every case. There have been no less than 15 malpractice suits filed against him in the State of Texas. His track record in Michigan was so bad that Attorney General Michael Cox filed an administrative complaint against this quack to revoke his license. Not only that, this orthopaedic surgeon was arrested in August of 1997 for driving to his soon-to-be ex-wife’s attorney’s office in his hospital scrubs with $10,000 cash in his car whereupon he parked and through a rock at the window of the law office and ran back to his car. He was arrested by the Houston Police Department at gunpoint for assaulting the office of his soon-to-be ex-wife’s divorce attorney.
During the divorce, the wife obtained a million dollar judgment against him for assaulting her during the marriage including choking her and shoving a rag down her throat. His own son even testified at the divorce trial that he watched his dad beat up his mother. Further, during the second deposition that he gave in his divorce in October 1997, he admitted to lying under oath during the first deposition as to the extramarital affairs he had been having. It just doesn’t seem fair to me that an insurance company can use a one-time doc such as this individual who is an admitted perjurer who clearly has a mental and /or behavioral disorder and whose competence as a doctor is in question in numerous states. Yet, your insurance company can use him to deny all further medical care and treatment in your particular claim.
Our next insurance company doctor has, on at least two occasions that the State Attorney General is aware of, wrote reports indicating that he had performed both a nerve conduction study and an EMG and later is was documented that he did not perform either of those exams on the particular patient. These were cases where he had been asked by an insurance company to examine an insured, issue the report indicating that he had performed these tests which were negative (when he had performed neither of the tests) and on that basis, the insurance company denied medical care and treatment. The State Attorney General filed an administrative complaint against him alleging that he:
1. Wrote reports indicating he performed tests that he hadn’t and came to medical conclusions based on tests never performed;
2. That he was negligent in the performance of these exams;
3. That he was incompetent;
4. That he lacked good moral character;
5. That he engaged in unethical business practices; and
6. That he engaged in unprofessional conduct.
To get the State to drop four of these counts, he plead no contest (admitted the allegations were true) to the allegations of negligence and was reprimanded by the State of Michigan.
Lastly, to show a type of financial bias is in play for these insurance company doctors, the last doctor I will discuss has testified under oath that 100% of his current income comes from performing these evaluations for insurance companies. He earns in excess of 1.2 million dollars per year in fees from these insurance company examinations. He travels to Gaylord, Lansing, Flint, Grand Rapids, Southfield and Kalamazoo to perform these one time exams for insurance companies and has been doing so for 15 years.
Records indicate that in 1997 he performed over 3,200 exams at the request of insurance companies. Not only that, this doctor was successfully sued by a person he examined on behalf of an insurance company because he injured them during one of his insurance company exams. The insured told him that his treating physicians ordered him not to lift his arm up over his shoulder level, but this doctor forced his arm above his shoulder level, tearing out his shoulder and causing even more damage to the poor man. Not only did this doctor lose at the trial court level, but lost at the Court of Appeals and the Michigan Supreme Court levels and ended up having to pay the person he injured for the damages caused during this incompetent insurance company examination.
Lastly, during this doctor’s divorce deposition, he was asked if he had any disabilities by the attorney for his wife, to which he testified, "I have peripheral neuropathy, difficulty walking, difficulty feeling things and a number of problems in regard to those disabilities". This particular doctor is hired by insurance companies as a physical medicine and rehab physician. His 15-20 minute exam of the insured includes palpating the skin, feeling and sensing things through his hands on the person’s body such as muscle tonicity, trigger points and spasms. How can a person who has testified under oath that he has "difficulty feeling things" complete a competent physical examination of someone when he admittedly is suffering from a peripheral neuropathy? Quite simply, he can’t.
So, if you have a medical claim pending and your insurance company wants to send you to their "specialist". Stay on your toes. Odds are, the "specialist" they’ve sent you to is simply an agent of the insurance company and their got-to-guy when it’s time to start denying benefits.
Mr. Smith has practiced as a trial attorney since graduating Notre Dame Law School in 1992. He has litigated cases across the country including cases from Ventura County, California to Middlesex County, New Jersey. He practices in both State and Federal courts.