According to a doctor in North Dakota’s workers’ compensation program, maybe not all is well in Prarie-dise. Dr. Luis Vilella is the medical director of Workforce Safety and Insurance (WSI) and wrote a letter to the program director, Bryan Klipfel, where he complained about the misconduct and judgment on the part of lawyers who review work injury claims.
He said that lawyers seemed to override medical opinions or not even bother to seek them out. He specifically referenced Anne Green, a lawyer for the WSI, as interfering with his medical review of claims cases.
“How can the WSI impartially adjudicate a medical claim when its own Director of Legal Services, Attorney Green, disregards litigation support that WSI’s Medical Director offers on matters of disease and injury causation?” he wrote in the letter.
Vilella alleges this occurred on multiple cases and has been going on for several years. When he brought this behavior to the North Dakota Board of Medical Examiners in 2012, they told him that as a physician, he could get in trouble for letting others direct his decisions. The WSI denied that they were doing anything of the kind.
But it appears that since that attempt in 2012 by Dr. Vilella not much has changed.
Vilella said he was being ignored on purpose and excluded from meetings regarding medical issues or from meetings with auditors of MSI. The auditors are investigating WSI’s use of independent medical examinations, where they pay an outside doctor to inspect the injured worker. Critics have said that WSI is increasingly utilizing these outside evaluations on purpose so they can deny medical claims.
The use of independent medical reviews is seemingly a big part of Vilella’s troubles. When he had his most recent job performance review, the resulting report suggested that he often clashed with managers over the extent of his “independence” for these medical examinations, and that he was the one who was recommending these outside reviews. Villella does not agree that he is the source of WSI’s increasing rate of independent examinations, saying most of the requests come from WSI’s lawyers. He says his performance review was misleading.
Doctors are supposed to have a duty to their patient first, not their employer. If these allegations are true and Vilella was getting unfavorable ratings for not being a “team-player” on behalf of his employer that could mean bad news for the WSI.
The firm conducting a review of WSI will look at things like use of fraud investigations, claims processed, administrative appeals and use of independent medical evaluations .They will release the results next year.