After Department of Health psychologist Saul Podhorzer blacked out at the State Hospital in 2008, he filed a workers’ compensation claim, saying the incident was related to two previous workplace injuries, including a 2004 episode in which he collided with a co-worker responding to an emergency, smashed his head against a brick wall, lost consciousness and suffered a seizure.

A neurologist hired by the state to do a so-called independent medical examination, or IME, concluded that Podhorzer’s blackout was not linked to the previous injuries, but was a new one that likely resulted from a congenital heart condition. His claim was denied.

When Podhorzer filed a new claim based on that evaluation, the state hired another independent medical examiner, who concluded that Podhorzer’s 2008 injury was not new, but similar to the two previous injuries. That was essentially what Podhorzer argued — and the state disputed — in 2008.

His second claim was denied as well.

The contradictory evaluations illustrate what Podhorzer’s attorney, Jeff Taylor, and other advocates for injured workers say is an unfair system in which employers or their insurance carriers frequently "shop" for doctors to get favorable IME opinions to challenge claims.

The state, through the Department of Human Resources Development, which represents state agencies in claims cases, declined comment.

Companies and government agencies often hire the same employer-friendly physicians again and again, creating lucrative IME practices for them, the workers’ advocates say.

"It’s a crazy system," Podhorzer said.

But employers, insurance carriers and others say the system is fair, ensuring that injured employees receive sufficient care while providing checks and balances to guard against abuse and excessive costs.

"It’s not a perfect system, but it sure has worked well for some time," said Jim Tollefson, president and chief executive of the Chamber of Commerce of Hawaii. "I guess what it comes down to is, if it ain’t broke, why try to fix it?"

The IME controversy came to a head at the Legislature this year, with lawmakers debating a bill that would have required employees and employers to agree on the selection of IME physicians in workers’ compensation cases. The measure, House Bill 466, died last week in the Senate.

It was supported by injured workers, occupational treatment specialists, labor unions and others, including Dwight Taka­mine, director of the Department of Labor and Industrial Relations, which oversees the state’s workers’ compensation system.

But the legislation also attracted powerful opponents, including the chamber, the Hawaii Insurers Council and major employers, such as the city.

IME providers typically are hired when disputes arise over whether an injury is work-related or whether treatment is reasonable and necessary. The employee is able to pick a treating physician, but the employer selects — and pays for — another doctor to evaluate the case.

Although the Senate Ways and Means Committee killed HB 466, the panel advanced another measure calling for the legislative auditor to study the issue, gather data on IME usage and report back to the Legislature before next year’s session.

"It’s difficult to make policy changes when we don’t have the statistical basis to do it," Sen. David Ige, Ways and Means chairman, told his fellow committee members in recommending the auditor bill.

Employers and injured workers’ advocates acknowledge that the majority of workers’ compensation cases proceed without major snags.

But when disputes arise, they often involve cases that are the most complicated — and therefore the most costly. Medical bills easily can reach six figures, with workers sometimes remaining out of work for months or years.

If care is denied or delayed, the ramifications can be huge, advocates say, especially for injured workers whose income is stopped or substantially cut.

Attorneys and physicians who treat injured workers say they have had clients who became homeless, had their marriages fall apart or suffered other life-altering setbacks because of financial problems stemming from what they consider biased IMEs.

"It’s devastating when you see the tragedies that these people have to endure," said Dr. Scott McCaffrey, who has been treating injured workers in Hawaii for years.

McCaffrey estimated that roughly 30 percent to 40 percent of the 1,000 injured workers he and his fellow practitioners treat annually at the WorkStar Injury Recovery Center have disputed IMEs.

Employees in Hawaii long ago gave up the right to sue their employers over workplace injuries in exchange for having employers paying for their care, as long as the injury is work-related. Hawaii law was revised to include a presumption that an injury is work-related unless the employer provides sufficient evidence to the contrary.

Rep. Karl Rhoads, who heads the House Labor and Public Employment Committee, said employers don’t seem to be keeping their half of the agreement. The current process in effect provides an incentive for insurers to try to limit the number of claims they have to pay for, leading to disputes with injured workers, Rhoads said.

"It’s setting up a confrontational system when the whole idea was to get away from a confrontational system," he added.

Allison Powers, executive director of the Hawaii Insurers Council, disputed the notion that employers or insurers seek biased IME evaluations.

A biased evaluation can easily be overturned on appeal, and that wouldn’t serve the interests of employers, Powers said.

Hawaii law already weighs heavily in favor of injured workers, according to written testimony in opposition to HB 466 submitted by Noel Ono, the city’s human resources director.

In addition to the presumption clause, disputed issues that go to hearings before the Department of Labor often are resolved in favor of workers, Ono said.

By requiring mutual agreement for IME physicians, the employer would lose the ability to conduct an independent evaluation and to control the cost of a claim, and the system would become even more favorable to employees, opponents of the bill said.

"We see it as a matter of fairness," the chamber’s Tollefson said of keeping the current process.

Opponents of the mutual-agreement requirement also noted that workers get copies of the IME evaluations, can hire their own experts to dispute them and always have the option of appealing a decision.

The "dueling doctors" approach probably is used by the majority of states, according to Dr. Richard Victor, executive director of the Workers Compensation Research Institute in Massachusetts.

Injured workers and their advocates, however, say employees typically don’t have the resources to pay for a prolonged fight with deep-pocketed insurers.

"It’s a system that’s completely one-sided," said attorney Bill Lawson, who stopped taking workers’ compensation cases several years ago because of that.

The bill that died in the Senate — it was passed last year by the House — would have given the labor director the authority to select an IME doctor if the employer and employee were unable to agree on one.

Attorney Joseph Zuiker, who represents injured workers, said employers and employees already have proved that the mutual-agreement method works in Hawaii.

In the second half of workers’ compensation cases, the two sides typically agree on IME doctors who rate employees’ permanent impairment.

"That half works majestically well," Zuiker said.

Podhorzer, 58, the state psychologist, remains unconvinced.

For the past several years, he has been on leave without pay, and the appeal of his denied claim is still unresolved.