You Win If Your IME Doctor Shows Up At The Comp Board

comp-board-imePicking the correct doctor for your Independent Medical Examination (IME) can determine whether you win or lose your workers’ compensation case.  This is based on a number of factors, which hinges on the ability of the examiner to prepare a persuasive report based on the facts provided to them.  Sadly, this is an area when claims management teams and other interested stakeholders defending workers’ compensation claims often cut corners.

 

Now is the time to change your thinking and be open to using the right medical examiner for the case. The IME is one of the few points where the outcome of the claim can be influenced, and you want to know that you have the right expert to WIN.

 

 

Preparing for the IME

 

In most jurisdictions, the employer and insurer get only one opportunity to have the employee seen and examined for purposes of the IME.  Due to the nature of the examination in the adversarial process, it is important to treat it with upmost importance.  A number of factors go in the examination, which often include:

 

  • The education and training of the expert. The practice of medicine is highly competitive.  Choosing a doctor with a reputable background is important.  It is also critical your expert has an updated Curriculum Vitae (CV) that includes information on their ongoing education training and reputation within the medical community.

 

  • Specialization is key. This is especially important in today’s cases where medicine is specialized and medical care and treatment is scrutinized by experienced compensation judges or members of the compensation board; and

 

  • Independence is essential. Your medical expert will be asked to give an opinion on issues regarding causation, the nature and extent of injuries, reasonableness and necessity of medical care and treatment, and need for future care.  The judge or hearing officer will view your expert as a more objective witness if he is truly independent and does not have any financial ties to the client/employer or vendor that is setting up the IME.

 

 

Show Up & WIN

 

In addition to the factors mentioned above, it is important to work with an independent medical examiner that adds value to the defense of the case.  This includes adding certain intangibles when the case boils down to a “battle of the experts.”

 

One such area an IME doctor adds value is the time they spend on a case.  IME physicians are paid a flat rate for their services.  A low fee paid to the provider means he will be unlikely to spend significant time reviewing the medical records and history, seeing and examining the employee, preparing their report, or being available to show up at a hearing to defend the case.

 

On the other hand, high quality IME service providers fairly compensate the right physicians to offer a meaningful opinion, and be available to show up at a hearing to defend their position. While this may increase the cost of the IME, the dividends can pay off significantly in future savings when settling cases.  Other benefits of working with service providers who provide a higher quality IME expert include:

 

  • A higher degree of accuracy and precision in the findings and opinions contained within the IME report;

 

  • Better familiarity with the file and its materials. This allows the doctor to develop their medical theory on direct examination and guard against losing credibility on cross examination; and

 

  • It avoids the wrongful perception the IME report is merely “bought and paid for” by the insurance carrier.

 

 

Conclusions

 

Workers’ compensation cases are often won or lost with an IME.  If service providers hinder the ability of their medical experts to do a complete job, the results may be disastrous to your file load.  When medical experts are fairly compensated for their time, they are able to reduce workers’ compensation costs and move your cases toward a reasonable settlement.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC.  . He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

Can You Authorize Up To $6,000 For A Winning IME?

doctor-imeThe cost of litigation in workers’ compensation is a driving factor that can impact a claim.  Most claim management teams require defense attorneys to submit detailed litigation budgets and hold their counsel to it.  While budgets are unavoidable in today’s marketplace, flexibility can be given in certain situations when it comes to costs associated with an Independent Medical Examination (IME).

 

 

Why Are IMEs Important?

 

The IME can make or break your case.  It can determine the direction of your claim and is used to defend issues concerning causation, the reasonableness/necessity of medical care, treatment parameters or other medical related issues.

 

Failing to use the right IME service provider will impact your claims based on a number of important issues.  These include:

 

  • Available panel selection of medical experts;

 

  • Quality control issues; and

 

  • Customer service issues, including the timeliness of IME reports.

 

 

Developing Trust with an IME Service Provider

 

When dealing with these matters, it is important to evaluate an IME service provider on how they perform in the following areas:

 

  • Service support during the examination process. This includes turning around reports in a timely manner and superior customer service;

 

  • Their panel selection and variety of medical experts. This is important in many instances where an area of specialization is vital to defending a claim; and

 

  • Other intangibles. This includes “best in class” service, the ability of medical experts to clarify issues and add value during all aspects of the examination process.

 

Having confidence in your IME service provider is paramount.  The IME service provider can assist attorneys, members of the claim management team and other interested stakeholders when it comes to evaluating their case and selecting a medical expert.  This is especially important in high exposure cases.

 

 

High Exposure Cases Require Trust & Flexibility

 

An IME cost will range between $500 – $1,800 depending on the provider and the state. This can include a review of all medical records and other documents pertinent to the employee’s background.  In most instances, this includes a summary of the employee’s deposition that has a description of their everyday work activities and specifics concerning the mechanism of injury.

 

Some cases, however, are not average cases and require more than the average IME, with potentially more than one expert opinion.  It is these situations where flexibility and a trusted IME provider relationship is paramount.

 

 

Can You Authorize Up To $6,000 To Get This Done?

 

The timing and execution of an IME requires a medically sensitive determination, and the selection of the right physician expert to make this determination is critical.  The best IME vendor relationships will be trusted and authorized to spend additional funds when necessary to select the right expert from their physician panel at the right time in a high exposure case. This expertise and specialized knowledge makes the IME vendor an invaluable partner to the claims management team.

 

This can be the case when you are dealing with the following issues:

 

  • Cases that include claims for mental/mental or physical/mental injuries. In cases involving a mental component, IME’s will often include multiple medical experts and an array of tests and procedures;

 

  • Instances where the employee has suffered significant physical injuires to multiple body parts. In other matters, future surgical procedures that are complex in nature often drive the cost of an IME; and

 

  • The prior claims history of the employee is also important to consider. When dealing with “experienced claimants,” it may be imperative to select an IME doctor who is not hindered by a budget and can go the extra mile to drive the matter toward settlement.

 

 

 

Conclusions

 

Litigation budgets are an important component of workers’ compensation cost containment.  When it comes to an IME, it can be an invaluable asset to allow for flexibility when defending a high exposure claim.  Develop a trusted relationship and leverage the expertise of your IME vendor as an invaluable partner to your claims management team.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

How Much Time Are Doctors Spending On Your IME?

doctor tabletThe independent medical examination is one of the most important components of a successful workers’ compensation claim.  This is because in most jurisdictions, the defense gets one opportunity to see and examine the injured employee by a medical expert of their choice.  One of the most important factors to consider in selecting the correct service provider is seeking out only those that add value to your claim.

 

 

Selecting the Right Medical Expert

 

An important component when selecting an IME service provider is the panel of medical experts they offer.  In the modern workers’ compensation system, there are a whole host of injuries.  This gives rise to the need to work with a service provider that has a wide variety of medical experts.  This also includes connections with specialists in a number of fields.  Some of these areas include orthopedics, neurosurgery, psychology, and psychiatry.

 

Before selecting the right IME doctor, it is also important to know the background of the expert.  Part of this investigation includes and understanding of the doctors medical training, professional experience and other specialties.  It is also important to consider an expert who has written peer-reviewed articles for medical publications and/or hold distinguished lecturing credentials.

 

 

How Much Time Are Doctors Spending On Your IME?

 

It is also important to understand the physician’s perspective performing an IME. The demands on a physician’s day are well documented, and increasing administrative requirements and changes in health care have only made the job more difficult.  An important question to ask is how much time are doctors spending on your IME?  In many instances, providers will fill the doctor’s schedule with appointments, which does not allow the doctor adequate time to complete a thorough exam and determine a thoughtful conclusion.  This detracts from the final and most important product when defending a case—the IME report.

 

Best practice dictates the physician to be fairly compensated, and allowed additional time to complete the exam and IME report.  The end result is a thoughtful report in which the medical opinion becomes a material element in your claim.

 

A second necessity for adequate time from the IME doctor is providing and receiving additional information as required by the adjuster and/or nurse case manager.  A high quality physician that will render a high quality opinion needs to be fairly compensated for this additional time. However, the investment can often lead to a significant return as the opinion is based on adequate information and all parties are able to agree on the proper course of action on the claim.

 

 

Preparation and Turn-Around Time

 

The final element to consider in the relevance of time to your IME is in preparation and turn-around of the report.  There must be the ability for the IME providers to access medical records and reports for review by attorneys and claim handlers prior to the examination. It is also important to have a reliable point of contact to handle issues as they arise throughout the process.

 

Important matters to consider include:

 

  • Turnaround times for the completion of reports; quick turnaround time is important, however, not at the expense of report quality. Waiting a day or two extra for more a comprehensive report that substantiates all requested issues would most likely impact the potential exposure of a case then getting a report back a day sooner;

 

  • Quality assurance measures that include a review of the report for typographical errors; and

 

  • Superior customer service.

 

 

Conclusions

 

The independent medical examination is one of the most important parts of defending a workers’ compensation claim. The main question asked at the deposition or hearing is whether the medical expert has adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty. Increasing demands on physician’s time, along with increased pressures on lower fees often creates a low quality IME report. Ensure your IME physicians are fairly compensated and have adequate time to complete a high-quality, meaningful report.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Is A Cheaper Doctor Better For Your IME?

The independent medical examination (IME) is one of the most important parts of defending a workers’ compensation claim.  Part of the IME process includes selecting the correct doctor.  There are a number of other factors to include in this decision making process.  Part of this important decision includes the cost of the examination.  However, picking the doctor based solely on cost can have an adverse impact on your claim.

 

 

What is an IME?

 

An IME is an examination conducted by a medical doctors selected by the defense in a workers’ compensation case.  This is something recognized in all workers’ compensation systems and is one of the few instances where the employee and their attorney have limited grounds to object.

 

There are some constraints to this examination which members of the claim management team should be aware.  While these limitations vary in each jurisdiction, some common themes include:

 

  • The timing of the examination and when it needs to take place;

 

  • When the report following the IME needs to be served and filed with the state industrial commission and/or the claimant;

 

  • The distance in which the claimant needs to drive in order to attend an IME;

 

  • Reimbursement of reasonable costs for the claimant to attend the examination; and

 

  • What documents are discoverable following the IME. This can include correspondence between the defense attorney/claim management team and the IME doctor.

 

Statues and regulations typically define the parameters of the IME process.

 

 

Factors to Consider When Selecting an IME Expert

 

There are numerous factors to consider when scheduling an IME.  Failure to consider these factors can impact your case.  A main example that will be questioned at deposition or hearing is whether the medical expert has adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty. The quality and relevancy of the doctor issuing the report is a significant factor during litigation.

 

Before selecting a doctor, it is important to review the following items concerning your expert:

 

  • Medical training and board certifications;

 

  • The nature of their practice and degree of experiences with injuries at question in your claim;

 

  • Professional accomplishments, including scholarly publications and professional lecturing;

 

  • Credibility of the expert within the local medical and legal community; and

 

  • Bedside manner and the professionalism they exhibit should the case become a “battle of experts.”

 

 

Should the Cost be a Consideration?

 

The cost of litigation has become a significant focus within the claims management industry over the past decade.  This has required teams to analyze the services they receive, which includes the use of medical experts.  While the cost of an IME is fair game, attempting to ‘save’ in this category will often have adverse claim affects as one will get what they pay for.

 

The higher-end doctor whose opinion will carry the most weight in court, is also the doctor whose time is most in demand.  Attempting to pay a discounted fee for an IME report will more likely gain interest from discount doctors.

 

Instead of focusing on the cost of an IME, claims management teams should look at the big picture of the claim and evaluate the experience of an IME service provider and the composition of their doctor panels.  They should also evaluate the other services a company can provide that give them a competitive advantage by offering a holistic approach to IME services.  These additional services should include:

 

  • Medical Peer Review & Record Review;

 

  • Expert Witness Evaluation / Review;

 

  • Diagnostic Review; and

 

  • Other medical evaluative claims services.

 

 

Conclusions

 

The IME is an important component for properly defending a workers’ compensation claim.  While the cost of the IME doctor can be looked at as an expense, it should not be an area to look for discount pricing.  Making a slightly higher investment in a higher quality doctor can be the difference between winning and losing your case.  Companies should look for service providers who offer a variety of additional services to complement a high quality doctor panel.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Write a Great Workers’ Compensation IME Letter

Members of the claim management team are often called upon to write a cover letter to a doctor for purposes of an independent medical examination.  This is sometimes an overlooked part of a claim handler’s job.  Care should be taken to writing an effective letter as it will help at later points of the claim, including future litigation.

 

 

Important Points of Consideration

 

The cover letter for an independent medical examination is an important part of a claim.  The person drafting the letter should consider the following matters:

 

  • The cover letter sent to a medical expert is subject to discovery protocols. Make sure the letter is free from bias, written in a manner respectful of the injured worker and completely factual;

 

  • Letters to medical experts should be clear and concise. Avoid adding unnecessary information and your personal opinions; and

 

  • Make it clear as to the procedural posture of the case and let the medical expert know what findings and opinions are seeking.

 

 

Laying Proper Foundation

 

In order for expert testimony to be accepted, the examining doctor needs to have the requisite medical background.  They also need to demonstrate they have seen and examined the injured worker and have a complete set of facts.  A great IME cover letter will help the expert do this.

 

  • Provide the doctor with a complete background of the case on the body of the letter; and

 

  • Provide the expert with a complete set of medical records. List the records you are sending to the doctor in the body of the record.  It is also important to request the doctor re-state the records they reviewed in the final report.

 

 

Issues of Causation and Need for Medical Care

 

Remember that workers’ compensation cases typically have a lower threshold of compensability when compared to other personal injury cases.  Consider asking the expert the following questions:

 

  • What is your diagnosis and prognosis of the Employee’s complaint(s)?

 

  • What is the substantial contributing cause of any diagnosis you make? Further, what is the etiology of any diagnosis you make?

 

  • In your opinion, did the claimed events of DATE OF INJURY HERE, aggravate, accelerate or otherwise substantially contribute to the onset and progression of the Employee’s diagnosed condition?

 

 

Always Ask About Maximum Medical Improvement/End of Healing Period

 

Maximum Medical Improvement (MMI), or “end of healing period” is an important threshold in workers’ compensation cases.  In most jurisdictions, it can signal the end of a claimant’s temporary total disability (TTD) benefits.  It can also serve as a basis for rating any permanency.

 

Here are some suggested questions to consider:

 

  • In your opinion, has the Employee reached Maximum Medical Improvement for all diagnosed conditions? If so, when did the Employee reach Maximum Medical Improvement?  If not, when would you expect the Employee to reach Maximum Medical Improvement for all diagnosed conditions?

 

  • Do you agree or disagree with Dr. NAME HERE’s opinion, found in the medical records from PROVIDER NAME, dated DATE HERE, which the Employee reached Maximum Medical Improvement on DATE HERE? Why or why not?

 

 

Be Careful When Asking About Permanency Rating

 

Asking about a permanency rating can be detrimental to a case when asked in the early phases of litigation.  Be sure to consult with your attorney or others on your team when asking the following:

 

  • Did the Employee sustain any ratable permanent partial disability, pursuant to the STATE NAME Workers’ Compensation Permanency Guidelines as a result of the work injury of DATE HERE? If so, please state what would you attribute any permanent partial disability, citing the specific section in the STATE NAME Workers’ Compensation Permanency Guidelines?

 

When in doubt, simply ask the examining doctor to evaluate for this issue, but defer stating these opinions in writing.

 

 

Other Questions to Consider

 

There are also other matters to consider when obtaining an independent medical examination.

 

  • The reasonableness/necessity of prior medical care and treatment;

 

  • Whether all prior medical care was in conformance with any applicable treatment guideline;

 

  • Any future medical care and treatment that maybe related to the work-injury;

 

  • Issues regarding appropriate medical restrictions on the employee’s activity;

 

  • Matters concerning future employability and permanent total disability issues.

 

Before asking these questions, consider your case and the purpose of the examination.  Asking non-germane questions may open matters for additional claims.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

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