An independent medical examination (IME) [also known as an independent medical evaluation in some jurisdictions] is one of the best tools available to the employer or the adjuster in confirming the nature and extent of an employee’s workers’ compensation injury. The IME can be used to verify compensability, to confirm a diagnosis, to evaluate the appropriateness of the current medical treatment, to establish the need for future medical treatment, and to assess the amount of permanent impairment when the employee has reached maximum medical improvement.
IME is Best Way to Verify Accuracy of Diagnosis
In jurisdictions where the employee selects the medical provider it is often difficult to know if the extent of the employee’s injury is as severe as claimed, especially if the employee has been treating with a “claimant friendly” doctor selected by the employee’s attorney. An IME is the best way to verify the accuracy of the diagnosis and the necessity of the current medical treatment regime. IMEs can also be used in states where the employer controlled the selection of the doctor if there is any reason to believe the medical treatment is off track or the impairment rating is incorrect.
When the adjuster or employer determines there is a need for an IME, the selection of the IME doctor should be undertaken with care. Adjusters and employers sometimes fall into the trap of thinking ‘the employee hired a radical doctor who is over treating and gives enormous impairment ratings, therefore I have to hire a doctor who is overly conservative and sends everybody back to work immediately with no impairment rating.’ There are two problems with this approach:
1. It defeats the purpose of the IME – to know the true extent of the employee’s injury, to know the future medical treatment needed, and/or the actual level of permanent impairment the employee will have.
2. The plaintiff attorneys, defense attorneys and the work comp Board know the reputations of the doctors as well and will discount any opinion from a doctor with known bias.
Own Experience or Doctor Specialty Good Ways to Select IME Doctor
Frequently adjusters and nurse case managers will know from experience which doctors will perform an objective IME, and will select the IME doctor based on prior experience. When the employer or adjuster does not know which doctor they should call on for an IME, they can often consult with the nurse case managers they use or with defense counsel.
If prior experience or other resources are not available, you can still obtain a good IME. To properly select a doctor for an IME, the adjuster or employer needs to knows not only a doctor’s specialty (for example: orthopedics), but also the doctor’s sub-specialty needs to be known (for example: knees). A copy of the doctor’s curriculum vitae, board certifications, lectures and publications can be utilized to establish the doctor’s expertise in his sub-specialty.
Provide IME Doctor With Proper Documentation
When the IME doctor has been selected and an appointment for the IME has been set, the adjuster or employer needs to timely provide to the IME doctor all the information available to assist the doctor in preparing for the IME. This would include:
• All medical reports related to the injury medical treatment, in chronological order
• All medical records of any pre-existing condition whether a comorbidity or a prior injury that has affected the medical treatment
• All treatment notes from physical therapy, acupuncturists, chiropractors, etc.
• All MRI, CT, x-ray or other diagnostic test results
• A copy of the employee’s recorded statement
• A copy of the First Report of Injury
• A copy of all surveillance tapes and reports
The documentation should be provided to the IME doctor with plenty of time for the doctor to review all the documentation prior to the IME.
A cover letter should be sent to the IME doctor when the above documents are provided to the doctor. In the cover letter, the adjuster or employer should ask questions to address the reason the IME was requested. The questions posed to the IME doctor should include:
• What is the nature of the employee’s injury?
• Is the injury:
o A new injury?
o An aggravation of a pre-existing injury?
o A reoccurrence of a prior injury?
o Not an injury, but some other medical problem?
• If an injury, was the injury a result of the described work accident?
• If an injury, is the opinion that the injury is work related based on the history provided by the employee, or is there objective medical evidence to support or to confirm the cause of the injury?
• Was the medical treatment of the injury reasonable and necessary?
• Has the employee recovered from the injury?
• If the employee has not recovered from the injury, what is the recommended course of future medical treatment?
• If the employee is at maximum medical improvement, will there be any level of permanent partial disability?
• If there is a level of permanent partial disability, what is the impairment rating?
• What restrictions, if any, will the employee have upon returning to work?
After the IME is completed; the doctor will write an IME report outlining the doctor’s findings. The IME report should be reviewed and compared with the medical reports from the employee’s doctor. Based on the findings of the IME doctor, the adjuster or employer can better determine the future activity needed on the worker’s compensation claim to move the claim forward to a conclusion.
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, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: firstname.lastname@example.org.
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