Your IME Doctor Selection Can Make or Break Your Case

A common error I notice in work comp files are adjusters choosing the wrong IME doctor.

Sure this doctor may be a seasoned IME physician, but if you need something strong to stand up in a deposition and this IME doc is a known loaded gun for insurance carriers, then you may be in trouble.

Best IME Doctor is a Practicing Specialist

It’s not to say that this doctor is a bad one, they just may not be the best choice to uphold your defense of the file. For example, if you need a comment on a tough wrist surgery to see if the need for surgery is related to your comp case, using a general orthopedic doctor that no longer performs surgery or is not board certified may not be the best choice. You would want an opinion from a practicing physician that still performs many surgeries, possibly one that only does wrist and hand as a specialty, and is up to date on the latest techniques and practices.

This common error is usually due to adjusters not being familiar with their territory. They may be in another state, new to claims, or just have a common habit of letting the IME marketer choose the doctor for them, when the marketer may know nothing about the case. Later on down the road when this claim goes in to litigation, your defense attorney may cringe when they see your choice of IME doctor. This will hurt your own defense on the compensability of the case.

If your goal is merely to get a post-op employee back to work and all you need are work restrictions, than many IME doctors would suffice. A lot of times the treating doctor is hesitant to put their post-op patient back to work, based on the verbal history the claimant is giving them while at the appointment. If you have not educated this treating doctor on the light duty program your insured has, then you have little luck at a return to work light duty position. This brings in the need for the IME.

An IME is a valuable tool for the adjuster. To get the best outcome, you need to choose the correct one early on and stick with them. Other issues can arise such as MMI or to perhaps comment on other invasive treatment recommendations given by the treating doctor.

Use a Nurse Case Manager When Not Familiar With Area IME Doctors

I recommend using a nurse case manager in situations where you are not familiar with the area of the IME doctors. Chances are these nurse case managers have seen a lot of these doctors because that is the territory they work. The nurse is a great tool for not only helping you choose the right IME doc, but to also attend the IME, and to follow up with the IME doctor after the appointment to make sure all of your questions are addressed. Plus if the IME doc has questions about light duty or work duties in general, they can ask the nurse to get something in writing to help them, such as a job description.

You may not even need the IME if a nurse is on the file. They can hound the treating doctor with the same information, and get them to comment and save you the IME cost. But, if the treater refuses to comment, then you can come in with your IME and get those work restrictions you need.

For whatever reason, some adjusters just are not thinking about what path their file will take in the future. They could be quick to IME with their ultra-aggressive IME doc that they like, because this doctor only does IME exams and basically puts everyone back to work as long as they have a pulse and can physically get to work at their employer.

I blame this habit again on time. Adjusters are not taking a step back and really plotting out the future of the claim. They are overloaded with files, and just want their claimant back to work, so they use their IME hatchet doctor.

The Wrong IME Opinion is Not Worth the Paper It’s Printed On

What about 3 months from now when litigation starts, and your IME isn’t worth the paper it is printed on because that IME doctor has zero credibility? If your treating physician on the case is very well respected, and a specialist in the body part they are treating, you are in trouble.

I see this all the time. If your IME doc is a general occupational medicine doctor, and they are up against a well-respected specialist, that is not a solid defense. So take the time when you choose that first IME doctor. Look for specialists that still treat, still operate, and still are up to date on current techniques and trends. You will thank yourself later on when you have a solid medical opinion that gives you a real defense. Now you have an expert that can go toe-to-toe with any other treater in that field. That is properly helping to defend your insured against a costly claim they may not responsible for.

Author Michael B. Stack, CPA, Principal, 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: [email protected].

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