The cost of litigation in workers’ compensation is a driving factor that can impact a claim. Most claim management teams require defense attorneys to submit detailed litigation budgets and hold their counsel to it. While budgets are unavoidable in today’s marketplace, flexibility can be given in certain situations when it comes to costs associated with an Independent Medical Examination (IME).
Why Are IMEs Important?
The IME can make or break your case. It can determine the direction of your claim and is used to defend issues concerning causation, the reasonableness/necessity of medical care, treatment parameters or other medical related issues.
Failing to use the right IME service provider will impact your claims based on a number of important issues. These include:
- Available panel selection of medical experts;
- Quality control issues; and
- Customer service issues, including the timeliness of IME reports.
Developing Trust with an IME Service Provider
When dealing with these matters, it is important to evaluate an IME service provider on how they perform in the following areas:
- Service support during the examination process. This includes turning around reports in a timely manner and superior customer service;
- Their panel selection and variety of medical experts. This is important in many instances where an area of specialization is vital to defending a claim; and
- Other intangibles. This includes “best in class” service, the ability of medical experts to clarify issues and add value during all aspects of the examination process.
Having confidence in your IME service provider is paramount. The IME service provider can assist attorneys, members of the claim management team and other interested stakeholders when it comes to evaluating their case and selecting a medical expert. This is especially important in high exposure cases.
High Exposure Cases Require Trust & Flexibility
An IME cost will range between $500 – $1,800 depending on the provider and the state. This can include a review of all medical records and other documents pertinent to the employee’s background. In most instances, this includes a summary of the employee’s deposition that has a description of their everyday work activities and specifics concerning the mechanism of injury.
Some cases, however, are not average cases and require more than the average IME, with potentially more than one expert opinion. It is these situations where flexibility and a trusted IME provider relationship is paramount.
Can You Authorize Up To $6,000 To Get This Done?
The timing and execution of an IME requires a medically sensitive determination, and the selection of the right physician expert to make this determination is critical. The best IME vendor relationships will be trusted and authorized to spend additional funds when necessary to select the right expert from their physician panel at the right time in a high exposure case. This expertise and specialized knowledge makes the IME vendor an invaluable partner to the claims management team.
This can be the case when you are dealing with the following issues:
- Cases that include claims for mental/mental or physical/mental injuries. In cases involving a mental component, IME’s will often include multiple medical experts and an array of tests and procedures;
- Instances where the employee has suffered significant physical injuires to multiple body parts. In other matters, future surgical procedures that are complex in nature often drive the cost of an IME; and
- The prior claims history of the employee is also important to consider. When dealing with “experienced claimants,” it may be imperative to select an IME doctor who is not hindered by a budget and can go the extra mile to drive the matter toward settlement.
Litigation budgets are an important component of workers’ compensation cost containment. When it comes to an IME, it can be an invaluable asset to allow for flexibility when defending a high exposure claim. Develop a trusted relationship and leverage the expertise of your IME vendor as an invaluable partner to your claims management team.
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.
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