How to Manage Independent Medical Examinations to Control Costs

Independent Medical Examinations (IME) [also known as Independent Medical Evaluations in some jurisdictions] is a major tool used by workers compensation adjusters and defense attorneys to control medical treatment cost. An IME is the utilization of a medical specialist to examine the employee, to review the employee’s medical history, to provide a diagnosis, and to provide a prognosis. The medical specialist will give an unbiased opinion as to the nature and extent of the employee’s injury. An IME will establish the true level of the employee’s disability and permanency level. This makes the IME an important method of controlling medical treatment cost as well as a way to limit unnecessary lost time.

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“The 6-Step Process To Determine Workers’ Comp Injury Causation”

The states vary in the number and type of IMEs that can be had. In some jurisdictions, the employer/insurer is limited to one IME throughout the entire course of the claim. In other jurisdictions, the employer/insurer can have as many IMEs as they are willing to pay for. With an IME costing $500 to $1500 depending on the location and the specialty, the employer or insurer does not want to waste money having needless IMEs performed. [WCx]

The IME doctor will need all the available information on the medical condition of the employee. The IME doctor needs to be provided all medical reports from prior medical providers, all diagnostic testing results (MRIs, CT scans, EMG studies, x-rays, etc.), a complete job description of the employee’s duties including all physical requirements, and the employer’s first report of injury stating exactly how the employee was injured. If the employee has aggravated a preexisting condition, all medical records for treatment of the preexisting condition should be obtained prior to the IME and provided to the IME doctor.

The adjuster, employer, or defense attorney requesting the IME should draft a letter to the IME doctor stating the concerns about the employee’s medical situation, and outlining the medical questions that need to be answered. The letter should be kept objective, clear, and to the point, as in some jurisdictions it can become a part of the evidence in the claim.

The various industrial commissions, workers compensation boards, departments of labor, and bureaus give different levels of credence to the opinion of the IME. In some jurisdictions the opinions expressed in the IME hold equal weight with the medical opinion of the primary treating physician. Other jurisdictions consider the IME but normally give greater credence to the primary treating physician, as the primary medical provider has normally seen the employee many more times than the IME doctor has.

Overcoming the bias of the commission / board / labor department / bureau requires the selection of a highly skilled and well respected doctor. Many adjusters (and employers on self-insured programs) make the mistake of using the same conservative doctor over and over for every IME. The opinions of these well qualified, conservative doctors, while often are accurate, are discounted by the hearing official because the hearing official knows the reputation of both the plaintiff attorney’s favorite doctors as well as the reputation of the adjuster’s/employer’s favorite doctor.

To be successful in the use of IME, the employer or adjuster should select a doctor in the appropriate specialty that has a reputation for telling it exactly the way it is. The hearing official will pay closer attention to the medical opinions of the doctors known to be unbiased.

As an employer, if the reputation of the possible IME doctors is not known, ask an experienced workers compensation defense attorney who has attended hundreds of hearings for IME doctor recommendations. Stress to the defense attorney that you are not looking for the most conservative doctor around, but for the doctor that has the reputation for being the most objective.

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Of course, there are exceptions to the rule on finding the most objective IME doctor. In some jurisdictions like Georgia and New York, the administrative official hearing a contested disability rating will normally split the difference between the disability rating the claimant has been given by his chosen doctor and the disability rating given by the employer’s IME doctor. In those situations, where it is assumed the employee’s doctor will be providing a high rating and the IME doctor will be providing a lower rating, the use of a conservative IME is the better approach. Therefore, it is very beneficial to know how the system works in your state. (See our state by state guide for Laws and Regulations Here.)

After the IME, if there are still questions about the employee’s medical condition that have not been answered, it can be beneficial to follow-up with the IME doctor and ask those questions. Also, the IME doctor may be able to direct you to research on the particular medical condition of the employee that can be used at the administrative hearing.[WCx]

In order for the IME to be used as evidence in the claim, you must share it with the employee and/or employee’s attorney. Consult with your defense attorney as to the best time to share the IME information.

See also our Insurance Dictionary of Terms and Abbreviations Here

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

Editor Michael B. Stack, CPA, Director of Operations at Amaxx Risk Solutions, Inc. is an expert in employer communication systems and a part of the Amaxx team helping companies successfully reduce Workers Compensation Costs by 20% – 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com Contact:mstack@reduceyourworkerscomp.com

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

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