Maximize Use of IMEs in Work Comp Cases

The independent medical examination (IME) is an important tool that is often not used correctly when defending a workers’ compensation claim.  Common mistakes include not timing the examination correctly, failing to ask the correct questions, or selecting the right medical expert.  When this occurs, members of the claim management team lose the ability to best direct litigation and move it toward an amicable resolution.  Practical steps need to be taken related to the use of an IME to avoid unnecessary litigation and expenses.

What is an IME?

An IME is the one time the defense interests in a workers’ compensation claim get to have the injured employee seen and examined by a medical expert of their choice.  There are usually constraints when it comes to this examination.

• Time limitation after the filing of the employee’s claim in litigation;

• An examination can only take place once. Additional examinations must be performed at the consent of all parties, or under a court order;

• Various limitations on how far the employee may be required to travel; and

• Payment of various expenses incurred by the employee such as missed wages from work, mileage, and meal expenses.

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Attorneys representing the employer, insurer, and the claim handler need to prepare with care.  This preparation includes taking the deposition of the employee and locating all relevant medical records.  Preparation is key.

Preparing an Effective IME Cover Letter

It is imperative the IME cover letter is factual.  It needs to provide the medical expert with background information on the claim, and ask relevant questions related to the claim.  It should also outline what medical records and documents are being attached to the letter for review.  Failure to have an effective IME letter can impede and effective defense to any workers’ compensation claim.

The cover letter to the medical expert should also be sent to the expert at least 10 days in advance.  This will allow the examining doctor adequate time to prepare and clarify an issue.  Common questions the doctor should be asked include:

• The amount of time spent examining the employee and records reviewed as part of the evaluation. The helps establish the expert’s foundation;

• The diagnosis and prognosis of the employee’s claimed work injury, its etiology, and the substantial contributing cause of any diagnosis. It is also important to ask the doctor if the claimed mechanism could result in the injury being claimed;

• The nature and extent of the work injury – whether it is temporary or permanent in nature;

• If the employee is at Maximum Medical Improvement (MMI). If not, when the employee would expect to reach MMI;

• If the employee sustained any ratable permanent partial disability, and if so, citations to the specific rule sections in the permanency guidelines; and

• If the medical care provided to the employee was reasonable and necessary, and if the employee should undergo any additional medical care;

It is important to encourage the doctor to provide an explanation for his or her response.  This adds to the credibility of the medical report as these experts often do not provide live courtroom testimony.  It will also help the defense attorney evaluate whether a deposition of the medical expert is necessary when preparing for a hearing on the merits.

IME reports generally take a few weeks to receive.  Once it is received, it is important to review the letter to ensure the doctor performing the examination responded to each question asked.  Do not hesitate to follow-up with the doctor performing the examination if it is determined they did not answer a question, or provide an adequate response to the question.

Common IME Pitfalls

There are numerous pitfalls that can occur with the IME.

• Doctor credibility. IMEs are often attacked as being “bought and paid for.” Ensure your medical expert is credible, and is not known for issuing boilerplate reports;

• Doctor expertise. It is important to know beforehand that your medical expert practices in the area you are seeking an opinion.  If your claim involves surgery, be sure to know if the IME doctor performs these same types of procedures in their practice; and

• Doctor bedside manner. Your expert may be required to give courtroom testimony.  If they do not have a good rapport with patients, they might not win over the judge.

Conclusions

The IME is an important component of every workers’ compensation claim.  It is important to obtain information about the work injury and the employee, and time the examination correctly.

It is also important to avoid common pitfalls that can be costly to your claim.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center , which offers the Certified Master of Workers’ Compensation national designation.

Contact: mstack@reduceyourworkerscomp.com.

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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.