Workers’ compensation cases can be won or lost on the independent medical examination results. While most IME’s are scheduled and the cover letter written by attorneys, it is sometimes the responsibility of the claim management team. As a result, it is important for claim handlers to understand the importance of this examination and use their medical expert wisely.
What is an Independent Medical Examination?
The definition of an IME varies by jurisdiction. Sometimes these examinations are referred to as “adverse examinations.” Regardless of what they are called, this is an opportunity of the insurance carrier to select a medical expert to have the injured party examined as part of the claim.
Prior to scheduling an examination, it is important to understand the applicable law and other requirements. In most states, there are limits as to the timing of this examination. There are often parameters as to how far a party can be expected to travel. Another common requirement is the reimbursement of reasonable costs to attend.
When Should I Schedule an IME?
There are a number of factors a claim handler should consider prior to scheduling the IME.
- Statutory parameters for when the examination can take place and when the report needs to be filed;
- The number of examinations an injured party is required to attend. As a general rule, only one examination is permissible. This can vary due to factors such as the nature and extent of injuries and if litigation is prolonged;
- The list is endless…
The timing of the IME is key. Before you schedule the examination, it is important to ask why you are having it take place. It can be used to evaluate the strength of a primary liability denial, determine if certain medical care and treatment is appropriate, or move a case toward resolution via litigation.
Preparing for the IME
Not having adequate medical foundation can result in an expert and their report being disqualified at the time of hearing. Due to this important factor, it is essential you have as much information as possible prior to the examination.
- Depositions testimony from the injured party. It is important for medical experts to understand the mechanism of injury and hear it in the employee’s own words under oath.
- Medical records. A complete medical picture is important. This includes information on the employee’s prior medical history, records from the injury, and all post-injury care and treatment.
- Other information. In order to provide your expert with foundation for their opinions, it is also important to provide them with other demonstrative evidence such as pictures of an accident scene or video of the injury.
Writing an Effective IME Letter
The letter you write to your medical expert should be free of bias. Always remember that this letter is discoverable. It is important the letter is 100% factual. Never go out of your way to cast the injured party in a negative light.
It is also important to consider other factors and understand what you are trying to accomplish with the examination. When writing your letter it is important to ask often for the following findings and opinions within a reasonable degree of medical certainty:
- The length of time the doctor spent on the physical evaluation and what they did to prepare;
- Their diagnosis and prognosis of the employee’s condition along with the contributing cause of any diagnosis they make;
- The nature and extent of any work injury they find—g. temporary or permanent. If they find a permanent injury, it may be appropriate to ask for a PPD rating;
- Whether the employee is at maximum medical improvement/end of healing period;
- The reasonableness and necessity of medical treatment related to the work-injury; and
- Any additional medical care the employee might need in the future and what the duration of the care.
Conclusions
Planning for the IME and using it effectively is essential in every workers’ compensation cases. By not taking appropriate steps in the defense of a claim, you are jeopardizing your chances of success.
