Defense Base Act Defense Medical Examinations: Rewriting the Report

Posted by defensebaseactcomp on November 23, 2011

As a Defense Base Act Claimant you are required to submit to an examination by a physician the insurance company chooses for a second opinion.  These examinations are often improperly (fraudulently ?) referred to as Independent Medical Examinations which are something very different under the LHWCA/DBA.

Doctors who will do this work for insurance companies are generally known to write reports favorable to the insurance company.  Otherwise they would not continue to reap the large fees they receive for a single visit and much larger fees for being deposed under oath or testifying live at an ALJ hearing.

On occasion a DME Doc will actually acknowledge the claimants true diagnoses or simply not deny it vehemently enough to suit the insurance company that hired them.  So the insurance company or their attorney or their TPA asks them to rewrite the report, sometimes even telling them exactly how they want the report worded.

When the DME Doctor does not comply some insurance companies via their attorney and/or TPA will go so far as to have another physician who has never even seen the patient, rewrite the report in their favor, and without your permission to use your private medical records.  This may be referred to as a Peer Review.

We know they do, we have some of the emails and the reports.

Add to your DME preparation list a signed HIPAA form directing the DME Doctor to provide your treating physician with any and all medical reports regarding you.  Your treating physician will have these forms and prepare them for you.

You are entitled to any and all reports, lab results, test results, regarding your medical.  You will probably have to have your attorney subpoena these but never ever allow them to not provide them.

One thought on “Defense Base Act Defense Medical Examinations: Rewriting the Report

  1. WFAA – TV in Dallas wrote this about Workers Comp :

    “a remarkable number of Texans committed suicide because they could no longer endure the pain caused by their injuries and they had been repeatedly turned down for worker’s comp care. Some insurance companies send peer review doctors medical files “stripped” of records important to the possible approval of workers’ comp claims.”

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