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Independent Medical Exams (IME) For Workers Comp Claims – Are They Worth It?

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Independent Medical Exams (IME)

Independent Medical Exams (IME’s) are usually one-time exams requested by the insurance carrier, TPA, injured employee, attorneys or an Industrial Commission. They are akin to a surgical second opinion. The IME Dr. will likely never treat the injured employee.

Picture Of Physician Independent Medical Exams Holding Stethoscope
Wikimedia Commons – Alex Proimos

For many years IME’s seemed to hold more weight with the Industrial Commissions than they do today. Decision after decision from Industrial Accident Boards has pointed out the treating physician has seen the injured employee many times and possibly had possibly operated on him/her. IME’s can be very costly as usually the requesting party may likely pay much more than the fee schedule allows for the exam.

IME’s can cover compensability, permanent impairment rating, necessity for surgery, general treatment plan by the treating physician, medication management, and many other facets of medical treatment. The two that I have seen most are for a surgical second opinion and/or permanent impairment rating.

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One of the trends that I have seen from Industrial Accident Boards or Industrial Commissions is to rule against the necessity of the IME or the conclusion of the IME if the jurisdiction allows the employer to choose the initial treating Dr. Would you expect a Deputy Commissioner or Judge to allow an employer or carrier to question the medical opinion of the employer-chosen physician?

Used properly, an IME can be a very good claims or risk management technique to keep treatment costs in check. They can also assure the injured employee they are receiving the proper medical care. Presently, I think that the Workers Comp adjuster or risk manager must be much more selective on the situations where an IME would be deemed necessary than in the past.

Bottom line – IME’s are worth it, but not in all situations where they once were seen as appropriate.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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