Independent Medical Examinations and Other Experts
The use of the independent medical examination (IME) is usually the sole opportunity the employer/insurer has to defend a claim with a medical expert of their choice. This is a right governed by the pertinent workers’ compensation act and must fit into specific parameters. Some of the more important guidelines include:
- Distance an employee can be required to travel for the evaluation;
- Reimbursements that must be made prior to or immediately after the examination; and
- Timing of the evaluation and service/filing requirements of the report.
Not every case will require an IME, so it is important to properly evaluate the case and make sure all pertinent documents are received prior to scheduling the evaluation.
Click Link to Access Free PDF Download
“How Do I Get My Adjusters To Follow My Account Handling Instructions?”
Use of Vocational Experts
Other vocational experts often are used when evaluating an employee for return to work, work hardening, job search efforts and retraining. They can also be used when the employee claims entitlement to permanent total disability (PTD) benefits. Laws regarding the use of vocational experts vary and may be subject to other statutory or regulatory guidelines. Before scheduling a vocational examination, it is important to check into the following matters:
- The qualifications, training, and expertise of a vocational expert;
- Investigation into the claims being made by the injured worker and whether such an evaluation is ripe for additional scrutiny; and
- The ability of the vocational expert to give credible live courtroom testimony, if permitted.
The use of a Functional Capacity Evaluation (FCE) is also important. A FCE is defined by some as a “set of tests, practices and observations that are combined to determine the ability of the evaluated to function in a variety of circumstances, most often employment, in an objective manner.”
During an FCE, the injured party will typically meet with a neutral vocational expert or one chosen by the employer/insurer and perform a series of tests. This can include written tests to measure the claimant’s cognitive and educational functions. In other parts of an FCE, the employee will undergo a battery of physical tests to assess the appropriateness of work restrictions in place by medical doctors and evaluate their ability for participation in work hardening, retraining or other rehabilitation efforts.
Telephonic Case Management or Intervention
Changes in technology are creating new opportunities to reduce the costs of managing a workers’ compensation claim. Due to the increase in accessibility of technology, claim management teams can reduce costs of handling claims. While some laws have been slow to adapt, technology will continue to evolve for how claims professionals can provide injured claimants with the care they deserve while efficiently managing costs.
Conclusions
Claims management teams seeking efficiency need to evaluate their programs and adapt to changing times in order to remain competitive. These changes can be made without sacrificing the rights of injured workers.
Contact: mstack@reduceyourworkerscomp.com.
Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/
©2023 Amaxx LLC. All rights reserved under International Copyright Law.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.