What Is An Independent Medical Exam (IME) In A Workers’ Compensation Case?

Independent Medical Exam

In a workers’ compensation case, independent medical examination (IME) has a key role to play. Also referred to as independent medical evaluation, independent medical examination (IME) is the evaluation of the injured worker’s current condition, performed by an independent doctor who does not work for the employer or the insurer. The treating doctor will make decisions about – what medical treatment the injured worker need, when he can return to work, and whether he has a permanent disability.

If the reports prepared by the candidate’s treating doctor are not supported or accepted by the insurer, judge or hearing officer, the candidate will be asked to undergo a medical evaluation with another doctor who stays neutral or independent. IMEs can significantly affect a workers’ comp case and how much the plaintiff receives in benefits. Accurate medical record review for independent medical examiners helps decide whether the treatment provided to the injured worker was medically necessary or unnecessary on the basis of a comprehensive medical records review.

During an IME, the worker’s medical records and any other documents relevant to the injuries (such as the injury report or statements the claimant has given in your case) will be sent to the IME doctor. Documents are reviewed before or after the examination, based on the provider’s decision.

Medical record review is done along with independent medical examination for diverse purposes such as – to evaluate the factor that caused the injury/illness, to determine the medical necessity of the treatment, to decide the period of the temporary impairment and to evaluate the permanent impairment, and to mainly to decide whether the claimant has achieved maximum medical improvement. To ease the review process and to obtain an accurate review, many providers and attorneys utilize professional medical review services.

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How Medical Record Review Is Important For Independent Medical Examiners

Reasons for an Independent Medical Examination

Lawyers, insurers and employers may refer employees to an IME for diverse reasons such as –

  • the information from their doctor is unavailable, inadequate or inconsistent
  • when an additional assessment of permanent impairment is required
  • to assess the degree of the worker’s impairment
  • to determine whether the employee is fit for pre-injury work
  • to establish the need for medical treatment, especially if the treatment is expensive

An IME helps the defendants responsible for paying for the injuries to know the extent of any injuries before a jury makes them compensate the victim for their damages. In complex cases, the insurance company may write a letter to the examiner explaining the worker’s injury, summarizing the course of treatment to date, and posing specific questions about the medical condition. Nolo discusses some such questions, which include, “Has the condition been correctly diagnosed?” “Did a work-related accident or exposure actually cause the current symptoms?” “Does the worker need additional medical treatment or testing for the condition?” etc.

States have different rules on who chooses the doctor to perform the IME. In certain states, the insurance company will choose the doctor or examiner, while in others the doctor will be randomly selected from a list. An experienced medical record review company can assist medical examiners in classifying relevant information from each record (referencing the date of service, service type, service provider, and place of service information), sort and index the records, decipher and summarize them, and categorize data appropriately, obtain information to the required level of detail, review information for completeness, accuracy and compliance, tabulate information from the provided documents and lay them out in an easy-to-follow format, and develop chronology and timeline.

In certain cases, the plaintiff may have to undergo more than one IME, when more than one aspect of a plaintiff’s health is at issue. For instance, if the worker is being treated by a neurologist, orthopedic surgeon, or an expert in physical medicine, the defense may seek an IME performed by its own specialists in each of those fields. Independent medical exams can assist in resolving the claim approved in a timely and efficient manner.

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