Independent Medical Exam (IME) Dozen Mistakes To Avoid

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Independent Medical Exam (IME) Mistakes – Dozen Blunders

An independent medical exam can make or break a WC file. Yesterday, I wrote a list of the Top 10 Ways that IME’s can harm a WC file.  The first five from the article are covered more in-depth today.      These Independent Medical Exam suggestions may not fit all files in all states.

Logo of independent medical exam Medical Company
(c) 123rf
  1. Can backfire if the claim is from a state that allows directed medical care.  If you have an employer-directed care state, then the IME is basically a 2nd opinion on your own opinion.   Obtaining a 2nd surgical opinion is a different matter.   Establishing a physician treatment network and using it will avoid IME’s on your own directed care.   The injured employee should be receiving treatment from your approved medical providers when using the treatment network to its fullest.
  2. Performed on a very old claim with no prior IME’s.   Waiting for years to schedule an IME will lessen the validity of the exam.  How can one expect to question a physician’s opinion or treatment plan with a single out-of-date IME?   The treating physician has been seeing this patient for years.   How can one appointment question a long-established treatment plan?  The WC courts usually detest seeing these and will usually rule with the treating physician’s opinion.
  3. Not discipline-specific – if the treating physician is, for example, a neurosurgeon, the best IME will be provided by another neurosurgeon.   An orthopedic opinion may not necessarily hold the same weight.  There are so many IME physicians available in most parts of the country.
  4. Picture Of Nurse Independent Medical Exam Writing On Paper
    Wikipedia – goodcatmum

    Takes the claim on a tangent – there are files where the IME physician identifies non-related medical conditions and has other incorrect info that is actually written in the IME report.  See #5 for how to avoid having an IME actually causing more problems than it helps prevent overall.   These do happen now and again and are sometimes unavoidable.

  5. Starts with one of those form letters – not good.   Spending a large amount of time and money can be easily fettered away by using a form letter.   The specific information needed may not be enumerated in a pre-filled form letter.  As there is so much on the line with an IME,  a letter that covers the file and medical history is a great idea.  The physician should not be solely relied upon to come up with a report without some input in the IME appointment letter.   Sending a form letter for an IME will raise the risk of #4 occurring on the file.  Ask the questions you want to be answered by the IME physician.
  6. The IME physician may not like the fee schedule – some states allow the fees to be negotiated directly without using the fee schedule.   This may be a good idea as nothing can sour a relationship with an IME physician that feels shorted in what they were paid to see the injured employee.  Do not assume the IME physician will just accept a set amount.  This should be negotiated upfront and please do not wait 60 days to pay for the IME appointment.
  7. The court has seen reports from the same physician too many times.  WC umpires, judges, and commissioners are very adept at noticing a trend where a certain employer, carrier, or TPA (Third Party Administrator) sends all of their inured employees to the same IME physician.  That is not a trend you want to establish overall.  There are so many IME physicians to choose from in most areas. 
  8. The treating physician is not informed an IME has been requested for a 2nd Opinion.   An act of great courtesy is to inform the treating physician that you are requesting an IME.   Almost all physicians will not take offense, especially if the IME is a surgical second opinion.  In fact, the treating physician’s office may even recommend an IME physician.  The relationship between the carrier/TPA/employer and the treating physician is very important to return the employee to work as soon as practical. 
  9. Does not have all the medical records included with the IME request letter.  This is a big potential mistake as the IME physician is going to base a large proportion of their opinion on a review of the medical records.  One of the most overlooked types of medical records is the radiological studies.   The review of the medical records that accompanies the IME appointment letter is beyond crucial.  Leaving out one report can take a file down the incorrect path very quickly.  
  10. Is rushed so heavily the IME physician is not given time to review records and do a full report.  An appointment should be scheduled far enough in advance to give the IME physician record review lead time.  Copying/scanning the records and writing the proper IME letter (an art) takes time if done properly.

    Picture of physician and Man Mistakes To Avoid on IMEs Concept
    123RF
  11. Bonus – Not involving the rehabilitation nurse– Most rehab nurses will know who the best physician in the area for the type of IME that you have requested for the injured employee.   The rehab nurse is invaluable in these instances.  If she/he has a working relationship with the IME physician’s office, that is golden for having successful IME.   The injured employee will also likely heavily trust the rehab nurse’s recommendation. 
  12.  Bonus –  Sloppy records- See #9 above – the easier you can make the review of the medical records for the IME physician, the better the results for all involved.   Ordering the notes from oldest to newest is a great idea.  Using tabs will also result in a better IME appointment.
  13. Bonus – Not following up for the results – in some of our recent file reviews, we noticed that the adjuster may forget to follow up to discover the results of the IME.   Waiting for the report to arrive may delay any file developments for 4 – 6 weeks.    We have noticed that many adjusters are not diarying the IME follow up actions such as reviewing the IME report or even requesting it.  Do not rely on the IME physician’s office to forward the report.  

Please note that each state has its own rules on Independent Medical Exams that should be followed.  These two lists were just general recommendations. 

©J&L Risk Management Inc Copyright Notice

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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:

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