OLYMPIA, Wash. – A growing number of retired physicians are finding a lucrative second career in Washington’s workers’ compensation system, conducting medical evaluations that can determine the fate of injured employees’ claims. These Independent Medical Exams (IMEs), designed to provide third-party assessments of workplace injuries, have become both an essential part of the system and a source of controversy.
A Florida Doctor’s Routine Trips to Washington
Once or twice a month, Dr. Steven Nadler, a 79-year-old retired orthopedic surgeon from Boca Raton, Florida, boards a flight to Washington. His purpose: to spend long days examining injured workers on behalf of the state’s Department of Labor & Industries (L&I).
Nadler performs as many as nine exams a day, often reviewing records and completing detailed paperwork afterward. He first began the work in 2018, when a contracting company recruited him. At the time, his daughter was a student at the University of Washington, giving him extra incentive to travel.
Although he stopped performing surgeries years ago and retired from regular patient care in 2024, Nadler continues making the trek, describing it as both an income source and a way to stay active.
“We are experienced doctors,” Nadler said in an interview. “Even though we aren’t actively practicing, our experience is invaluable.”
Million-Dollar Exams
The money adds up quickly. According to L&I records, at least two dozen doctors have billed more than $1 million each since 2020 for performing IMEs and related paperwork. Most of them are in their 70s, and many have retired from seeing patients.
Nadler himself has billed L&I roughly $2.8 million over the past five years, making him the program’s second-highest earner. His busiest year was 2020, when he performed 816 exams, bringing in about $690,000.
Today, L&I pays $728 for a standard IME and $1,319 for psychiatric IMEs. But because examiners are contracted through private “panel companies” that take a significant cut, Nadler says he typically nets about $350 per exam.
Critics Say Exams Favor Employers
The system, however, has vocal critics. IMEs carry significant weight: examiners’ reports can close claims, deny treatments, or reduce wage-replacement benefits.
Workers and their attorneys argue that the exams often feel adversarial. Elizabeth Lepley, a workers’ compensation attorney, described IMEs bluntly: “This is a wonderful way to make six figures saying no to injured workers.”
A Cascade PBS investigation revealed that some workers distrust the independence of examiners paid by the state or by self-insured employers. Dozens of complaints have been filed against IME doctors, accusing them of dismissive practices and questionable conclusions.
Big Business for Contractors
From 2020 to 2024, Washington’s workers’ compensation system spent nearly $100 million on IMEs. Roughly half of that went to just two firms: Medical Evaluation Specialists, based in Massachusetts, and Mitchell MCN of Seattle.
These companies recruit, schedule, and pay the doctors—while keeping about 50% of the fees billed to L&I, according to physicians who work with them.
“IMEs are useful in our system,” said Brenda Heilman, assistant director for insurance services at L&I. “They get us information that we need to make decisions about benefits for workers.”
Still, the heavy reliance on private contractors and semi-retired physicians fuels concerns about fairness and oversight.
When Age Becomes a Factor
One recurring issue is the age of the examiners. The top earners average 74 years old, and many stopped treating patients years ago.
Some workers say that makes them uneasy. Dru Lorick, a 55-year-old truck driver, said he gets nervous before every IME. “It’s always old guys, always retired guys,” he explained.
Lorick’s anxiety deepened during his most recent exam in 2024. A recording of the session shows his examiner—an IME veteran in his late 80s—apparently urinating on himself mid-exam. The doctor briefly left the room before returning to finish.
Lorick’s attorney, David Lauman, argued the incident was evidence the doctor was no longer competent. Despite this, the doctor later determined Lorick’s shoulder pain was unrelated to his workplace injury, cutting off his treatment. Lorick has since filed a complaint with L&I.
Agency spokesperson Matt Ross said the complaint is under investigation but defended the program’s standards: “It’s against the law to discriminate against providers based solely on their age, and L&I doesn’t do it. Furthermore, there’s no evidence that age alone prevents a doctor from providing care at a high standard.”
Top Earners in the System
The highest IME earner in recent years is Dr. Charles Peterson, licensed in Washington since 1974. Peterson retired from treating patients in 2018 but continues to perform IMEs, billing $720,000 last year alone. Since 2020, he has earned a total of $3.8 million from the program. He declined multiple requests for comment.
Other top earners include Dr. Shalom Seltzer, medical director for the panel company Corvel, who billed $2.3 million over the past five years. Seltzer, who splits his time between Yakima and New Orleans, defended his work.
“I have been aware sometimes of subtle or not-so-subtle pressure,” he acknowledged in an email. “But I either totally ignore it, or I will walk away from that company. The most important thing I have professionally is my integrity. Would you sell yours for $350?”
A System Under Scrutiny
While L&I stresses that IMEs represent just a fraction of the nearly $10 billion the state has spent on workers’ compensation benefits in the past five years, the exams remain a flashpoint.
Supporters argue that independent evaluations are necessary to prevent fraud and ensure fair settlements. Critics counter that the exams too often tilt against injured workers, especially when conducted by doctors no longer practicing in modern clinical settings.
For Nadler, however, the work is straightforward. “There is absolutely no pressure,” he said. “Doctors are allowed to make their own decisions.”
Looking Ahead
The debate over IMEs reflects a larger struggle within workers’ compensation systems nationwide: how to balance efficiency, fairness, and cost. As Washington continues to rely on semi-retired physicians and multimillion-dollar contractors, questions about transparency and accountability are unlikely to fade.
For workers like Lorick, who say their lives and livelihoods hinge on the outcome of these exams, the stakes remain deeply personal. “They make me nervous,” he admitted. “But what choice do I have?”
Leave a Reply