In this session at the 2018 WCI conference, Dr. Repp moderated a discussion among leading IME physicians and from the claims/legal side of the industry about the appropriate techniques, correspondence skills, and medical skills necessary to obtain the most effective IME.
The panel included:
Cori Repp, MD, Florida Director of Medical Operations,Concentra (moderator)
Jorge Trujillo, MD, PhD, Concentra
Robert Haight, MD, Concentra
Kristy Sands, CWC, CWCL, Assistant Vice President, Gallagher Bassett
An IME is an independent medical exam. This is an objective examination conducted by someone who is separate from the person’s care and not involved in the patient’s case. Unfortunately, Google states that these independent medical examinations are most often obtained by the defense with the purpose of defeating an injured person’s medical exams. This already puts a bad taste in the injured workers’ mind before they have even had an exam. Remember that everything you read on the internet is not always true.
What steps should you go through before deciding to order an IME? Ask yourself the following, if yes, then an IME would be beneficial. If no, then the IME is not necessary.
– Is there a medical dispute on the claims file? Main disputes topics include mechanism of injury, major contributing cause/apportionment, overutilization, disability status, functionality, and MMI/permanency rating.
– Have you seemed out a conference with the treating doctor? Seek out clarification on the injured worker’s case. This doctor is familiar with the case and should be able to clarify any concerns you have about the case. Establish with this specialist that there will be an open line of communication.
– Have you used an IME on this case already? Some states say you can only use one IME per case or per body part. Need to check and explore this statute before you move forward.
So now it looks like an IME is what you need. How do you proceed? First gather all the medical documentation which includes treating physician notes, operative notes, diagnostic testing, films, investigation materials, and job description. This information will be able to help you answer the question at hand appropriately. Then compose your letter to the IME physician. Make sure this letter is comprehensive, nature of the dispute, IME objective and material index. Send the materials well in advance of the IME to avoid cancellation and additional costs. Finally, send a timely notification to the injured worker/attorney and provide adequate notice and clearly explain what the injured worker can experience from that visit.