You Win If Your IME Doctor Shows Up At The Comp Board

Picking the correct doctor for your Independent Medical Examination (IME) can determine whether you win or lose your workers’ compensation case. This is based on a number of factors, which hinges on the ability of the examiner to prepare a persuasive report based on the facts provided to them. Sadly, this is an area when claims management teams and other interested stakeholders defending workers’ compensation claims often cut corners.

Now is the time to change your thinking and be open to using the right medical examiner for the case. The IME is one of the few points where the outcome of the claim can be influenced, and you want to know that you have the right expert to WIN.

Preparing for the IME

In most jurisdictions, the employer and insurer get only one opportunity to have the employee seen and examined for purposes of the IME. Due to the nature of the examination in the adversarial process, it is important to treat it with upmost importance. A number of factors go in the examination, which often include:

• The education and training of the expert. The practice of medicine is highly competitive. Choosing a doctor with a reputable background is important. It is also critical your expert has an updated Curriculum Vitae (CV) that includes information on their ongoing education training and reputation within the medical community.

• Specialization is key. This is especially important in today’s cases where medicine is specialized and medical care and treatment is scrutinized by experienced compensation judges or members of the compensation board; and

• Independence is essential. Your medical expert will be asked to give an opinion on issues regarding causation, the nature and extent of injuries, reasonableness and necessity of medical care and treatment, and need for future care. The judge or hearing officer will view your expert as a more objective witness if he is truly independent and does not have any financial ties to the client/employer or vendor that is setting up the IME.

Show Up & WIN

In addition to the factors mentioned above, it is important to work with an independent medical examiner that adds value to the defense of the case. This includes adding certain intangibles when the case boils down to a “battle of the experts.”

One such area an IME doctor adds value is the time they spend on a case. IME physicians are paid a flat rate for their services. A low fee paid to the provider means he will be unlikely to spend significant time reviewing the medical records and history, seeing and examining the employee, preparing their report, or being available to show up at a hearing to defend the case.

On the other hand, high quality IME service providers fairly compensate the right physicians to offer a meaningful opinion, and be available to show up at a hearing to defend their position. While this may increase the cost of the IME, the dividends can pay off significantly in future savings when settling cases. Other benefits of working with service providers who provide a higher quality IME expert include:

• A higher degree of accuracy and precision in the findings and opinions contained within the IME report;

• Better familiarity with the file and its materials. This allows the doctor to develop their medical theory on direct examination and guard against losing credibility on cross examination; and

• It avoids the wrongful perception the IME report is merely “bought and paid for” by the insurance carrier.

Conclusions

Workers’ compensation cases are often won or lost with an IME. If service providers hinder the ability of their medical experts to do a complete job, the results may be disastrous to your file load. When medical experts are fairly compensated for their time, they are able to reduce workers’ compensation costs and move your cases toward a reasonable settlement.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment system and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaches injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.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.