IME DOCTOR NOT RESPONSIBLE FOR CLAIM DELAY

On Behalf of | May 9, 2024 | Firm News

In Kirk v. Anderson, 2021 UT 41, 496 P.3d 66 (Utah, August 5, 2021), the Utah Court held that an IME doctor who performed an IME regarding workers compensation benefits did no have a duty to not contribute to delaying the claim benefits.

In this case, the injured employee made a workers compensation claim.  The TPA requested an IME performed by Dr. Mark Anderson.  Dr. Anderson performed the IME in October 2016.  During the IME process, Dr. Anderson specifically advised Kirk that Dr. Anderson was not Kirk’s doctor.  In November 2016, Dr. Anderson issued his IME report.  Based on the IME report, the TPA denied Kirk workers comp benefits.  This resulted in a delay in claim payment.  After going through the workers comp process, the Utah Labor Commission finally ordered payment of the medical expenses incurred for the conditions that Dr. Anderson believed were not related to the industrial accident.  Thereafter, Kirk sued Dr. Anderson for negligently performing the IME.  The Utah Supreme Court held that Dr. Anderson did not owe a duty of care to the employee.

The Utah Supreme Court held that doctors performing IMEs do not have a physician-patient relationship with the examinee.  The purpose of an IME in a workers comp setting was to provide independent information to the insurer.  The purpose did not include diagnosis or treatment.  Additionally, the employee and the IME doctor did not have an express or implied agreement to provide healthcare services.  There simply was no doctor-patient relationship.

Regarding the employee’s claim of delay as the workers compensation benefit process moved forward through appeal, the Court rejected the claim on the basis of public policy.  The Court noted that there would be no principle limiting such a duty if it were imposed.  Experts across the board would be subjected to liability when their opinions could cause a delay in a party obtaining relief.  Such a practice/duty would chill expert testimony to the detriment of society.  In the workers comp setting, the statutes provide safeguards to protect claimants when there is delay in paying benefits.

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