The independent medical examination is one of the most important components of a successful workers’ compensation claim. This is because in most jurisdictions, the defense gets one opportunity to see and examine the injured employee by a medical expert of their choice. One of the most important factors to consider in selecting the correct service provider is seeking out only those that add value to your claim.
Selecting the Right Medical Expert
An important component when selecting an IME service provider is the panel of medical experts they offer. In the modern workers’ compensation system, there are a whole host of injuries. This gives rise to the need to work with a service provider that has a wide variety of medical experts. This also includes connections with specialists in a number of fields. Some of these areas include orthopedics, neurosurgery, psychology, and psychiatry.
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“The 6-Step Process To Determine Workers’ Comp Injury Causation”
Before selecting the right IME doctor, it is also important to know the background of the expert. Part of this investigation includes and understanding of the doctors medical training, professional experience and other specialties. It is also important to consider an expert who has written peer-reviewed articles for medical publications and/or hold distinguished lecturing credentials.
How Much Time Are Doctors Spending On Your IME?
It is also important to understand the physician’s perspective performing an IME. The demands on a physician’s day are well documented, and increasing administrative requirements and changes in health care have only made the job more difficult. An important question to ask is how much time are doctors spending on your IME? In many instances, providers will fill the doctor’s schedule with appointments, which does not allow the doctor adequate time to complete a thorough exam and determine a thoughtful conclusion. This detracts from the final and most important product when defending a case—the IME report.
Best practice dictates the physician to be fairly compensated, and allowed additional time to complete the exam and IME report. The end result is a thoughtful report in which the medical opinion becomes a material element in your claim.
A second necessity for adequate time from the IME doctor is providing and receiving additional information as required by the adjuster and/or nurse case manager. A high quality physician that will render a high quality opinion needs to be fairly compensated for this additional time. However, the investment can often lead to a significant return as the opinion is based on adequate information and all parties are able to agree on the proper course of action on the claim.
Preparation and Turn-Around Time
The final element to consider in the relevance of time to your IME is in preparation and turn-around of the report. There must be the ability for the IME providers to access medical records and reports for review by attorneys and claim handlers prior to the examination. It is also important to have a reliable point of contact to handle issues as they arise throughout the process.
Important matters to consider include:
- Turnaround times for the completion of reports; quick turnaround time is important, however, not at the expense of report quality. Waiting a day or two extra for more a comprehensive report that substantiates all requested issues would most likely impact the potential exposure of a case then getting a report back a day sooner;
- Quality assurance measures that include a review of the report for typographical errors; and
- Superior customer service.
Conclusions
The independent medical examination is one of the most important parts of defending a workers’ compensation claim. The main question asked at the deposition or hearing is whether the medical expert has adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty. Increasing demands on physician’s time, along with increased pressures on lower fees often creates a low quality IME report. Ensure your IME physicians are fairly compensated and have adequate time to complete a high-quality, meaningful report.
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: [email protected].
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.
