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.
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: firstname.lastname@example.org.
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