Theres more to being a medical-evaluation company than drawing blood and asking questions of someone who is buying life insurance.


While thats a good bit of business for the dozen concerns that do such medical examinations here, the scope of their services often is much wider, and can include everything from investigating workers compensation claims to doing legwork on medical-malpractice cases.


The first exam we ever did was a fellow at a fast-food restaurant. He was robbed at 2 a.m. and hit over the head. He had a heart attack, says Dick Nelson, chairman of Seattle-based Objective Medical Assessments Corp., which has an office in Spokane.


They (the restaurants insurer) brought us in to find out what his situation was, and what his impairment was going to be, says Nelson. We had a cardiologist, a neurosurgeon, an orthopedist, and a psychologist to find how much post-traumatic stress he had. They concurred that he had had a heart attack.


They recommended he have more physical therapy, and post-traumatic counseling. Its a typical situation to determine the level of injury.


Insurance companies, self-insured employers, and attorneys hire medical-evaluation companies to deliver an independent report on the overall medical condition of an individual whos seeking a workers compensation claim, benefits from auto accident insurance, or other types of disability or injury compensation.


Insurers and attorneys pay companies such as Objective Medical to produce an unbiased report for a variety of reasons, including ferreting out fraud, determining the extent of an injury, and recommending the long-term care necessary to treat an injury, says Nelson.


Such evaluations help determine how much money a person might receive from an insurance claim, what workers compensation benefits theyre eligible for, or how much should be sought in damages in a lawsuit or settlement.


Some of the businesses that offer evaluations here are locally based, while others are regional or national companies. Some perform a variety of testing and investigation, while some offer only insurance physicals when applicants seek coverage.


The competition is fierce, says Cheryl Rogge, branch manager here for Portamedic, a unit of Hooper Holmes Inc., of Basking Ridge, N.J. Thats the good thing about corporate backing. We have a marketing force, and theyre constantly upgrading our equipment and software.


Portamedic operates 300 branches nationwide and claims to provide 40 percent of the physical exams associated with life insurance policies nationally.


Medical-evaluation companies generally have small staffs, and rely on contract labor and independent doctors for much of the work they do, say those in the industry.


In the world of claims there is a need for medical expertise that lies with the physicians, says Objective Medicals Nelson. Were seeking medical truth through a series of complex relationships.


Despite what some might think, companies that do such work dont necessarily provide the answers that their paying clients want to hear, he says.


There is no temptation to cater to the desires of insurance companies, or lawyers, says Nelson. The quickest way to be out of business is not being absolutely objective.


Its a fascinating business, he adds. Its quite a puzzle.


Objective Medical operates 11 clinics across the state, and employs 50 people overall. It works with nearly 500 independent physicians to perform examinations.


The company performs between 400 and 800 workers compensation evaluations a month. Nelson declines to disclose the companys revenues, or what it charges for the tests.


A difficult business


When it comes to investigating workers comp claims or medical malpractice lawsuitswhich usually is required as part of the legal or regulatory processhiring an independent doctor can be difficult.


Medical-evaluation companies need specialists like orthopedic surgeons, neurologists, cardiologists, and psychologists to do their evaluations, and finding them can be tough because competition for their time is keen.


The amount of money doctors are paid for such evaluations is a closely guarded secret, say those in the industry.


Also, not every doctor is good at making independent evaluations, writing reports, and making recommendations for care, says Dick Nelson.


You have to think on two or three different levels, and make a good opinion on where the case should be, says Nelson. You need good doctors to do these cases so that the claimant gets a fair shake.


Practicing physicians usually are extremely busy, and fitting evaluations of individuals who arent regular patients into their schedules can be quite a trick, says Brenda Hotchkiss, manager of Independent Medical Services of Washington, of Tacoma, which has an office in Spokane.


Hotchkiss earlier had operated her own medical-evaluation company here, but that business merged with Independent Medical Services of Washington about a year ago.


The Tacoma-based company does about 100 evaluations a month from its offices in Spokane and Tacoma.


Its a tough market out there, she says. We have to fly semi-retired doctors in from Seattle and the Tacoma area. Many of the ones in Spokane are too busy.


Many individuals who are involved in a workers compensation claim, or a malpractice suit insist on seeking alternative practitioners such as naturopaths and chiropractors, says Steffen Nelson, president of Objective Medical Assessments. We have those types of (practitioners) available for a second opinion.


Those evaluations are quite different from the medical evaluations done when someone applies for life-insurance coverage.


In those more simple assignments, medical-evaluation companies use nurses or laboratory technicians to perform basic tests on people who are trying to buy a life insurance policy. A persons medical history, age, height, weight, and blood or urine tests will help determine if he or she is eligible for life insurance, say Rogge.


Usually, nurses and lab technicians travel to an individuals home or business to perform such an exam.


They ask the individual a series of questions about his or her overall health and medical history, take blood and sometimes urine samples, then send the samples to a lab to be analyzed. Afterwards, they prepare a report for the insurance agent.


The insurance companies hire medical-evaluation companies on a case-by-case basis for an undisclosed amount.


Were doing twice as many as 10 years ago, says Rogge. The industry has changed its guidelines. Theyre not as detailed a tests as they used to be. Now its a blood, urine, or saliva specimen. We just send them to a lab.


Many in the industry say its hard to find nurses and lab technicians to perform the tests because the wages the industry pays arent worth the amount of time it takes to travel to a persons home or business, administer the tests, and fill out the paperwork.


Also, insurance agents are demanding more of the companies that perform the tests, say some in the industry.


One small medical-examination company here says it has struggled to make a profit because insurance agents are pressuring it to do the tests cheaper, and in some cases penalize examination companies when reports are late, incomplete, or contain a minor error.