IME or an independent medical examination typically involves a physical examination as well as a review of relevant medical records by an independent medical examiner. Independent medical examinations are used in various settings and systems such as workers’ compensation claims, social security administration claims, motor vehicle and other types of insurance claims, return to work evaluations, short-term / long-term disability evaluations, and lawsuits among others. IME and its associated medical record review are conducted for various purposes – to evaluate causation of an injury/illness, to determine whether the treatment was medically necessary, to decide how long a temporary impairment is likely to continue, to assess permanent impairment, and to determine if the claimant has achieved maximum medical improvement.
In a workers’ compensation case, this medical examination will help determine whether the injured worker is ready to return to work, and decide the extent of disability for a benefit award. With regard to automotive claims, IME helps in evaluating a claimant’s injury for severity and legitimacy, determining if there is a pre-existing injury, and identifying complications in the light of the current injury. If the independent medical examination is to determine disability, the review of related medical documentation should help establish the degree of impairment and the degree of functionality of which the claimant is capable. It would help to evaluate the claimant’s return to work status and the extent to which his/her daily living is affected.
An independent medical examiner would generate a report detailing the medical condition of the claimant. The major components of an IME are:
- Medical record review that is to be performed before the physical examination
- Physical examination
- Present history taken through interview
- Opinion report
A reliable medical record review company can assist independent medical examiners with the following services.
- Categorize relevant information from each record with details of the date of service, service type, service provider, and place of service
- Organize and index the medical records, review and summarize them, and classify data appropriately
- Obtain accurate medical information from the records as required
- Ensure completeness, compliance and accuracy of the information
- Missing records are identified by looking for tests that had been ordered but for which records are missing
- Highlight referrals made to another medical provider
- Identify consultation notes that may be addressed to or contain the name of the referring medical provider
- Provide details of each treating professional. To have an accurate picture of all the attending providers, nursing notes and social workers’ notes from inpatient admissions and hospital emergency departments will be reviewed
- Prepare the final report ensuring that a list of all the records reviewed is included along with it. This will help eliminate any doubt regarding the information source on which an opinion or conclusion is based
- Prepare a chronology of the medical records to attach along with the IME report
Medical review services come in useful for all IME types:
- Functional capacity evaluations
- Independent medical evaluations
- Scheduled loss of use evaluations
The IME provides the information an insurance company or attorney needs to proceed further – whether to go for a settlement, proceed to trial or drop the case. The medical evaluation must be unbiased so that all medical facts are available in the right perspective. Objective, clinically informed medical reviews help verify the validity of the claims. The right medical record review services will help evaluate claims, fraudulent representations and excessive costs. It will help insurers and other agencies fight fraud and waste in the procurement and use of medical services.