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Independent Medical Exam (IME)- 10 Ways To Harm File

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Independent Medical Exam (IME) Can Easily Blow Up A File

An Independent Medical Exam is one of two-edged swords in WC Risk Management.  One of the most controversial and fund-leaking Risk Management techniques for Workers Compensation is the Independent Medical Exam (IME).

Picture Of Clip Paper Touch Independent Medical Exam Paper
123RF

This list is not just for adjusters.  Anyone that comes in contact with the process should keep the following list in mind.  IME’s are a great tool when used properly.  IME’s are also one of the riskier techniques to control WC costs.   A few considerations before scheduling an IME are listed below.   The most detrimental to the WC file is an IME that:

  1. Can backfire if :the claim is from a state that allows directed medical care.
  2. Is performed on a very old claim with no prior IME’s
  3. Is not discipline-specific
  4. Takes the claim on a tangent
  5. Starts with one of those form letters – not good
  6. The physician may not like the fee schedule and wants to be paid more than the CPT code allows – touchy subject

    Stethoscope Independent Medical Exam Picture
    StockUnlimited
  7. The court has seen reports from the same physician too many times
  8. The treating physician is not informed an IME has been requested for a 2nd Opinion
  9. Does not have all the medical records included with the IME request letter
  10. Is rushed so heavily the IME physician is not given time to review records and do a full report

This article was going to be an all-in-one analysis.   The article would have been too long if each was of the 10 was enumerated now.  There will be two follow-up articles as this is a very important WC risk management consideration.

An Independent Medical Exam can be the most expensive and time-consuming risk management techniques on a Workers Compensation file.   Following the above list should help in avoiding the pitfalls.

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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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