Tips for Workers’ Comp Independent Med Exams

January 29, 2014 Insurance Topics 3
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Independent medical exams (IMEs) can be an effective way to determine an injured worker’s medical status. But too often, they turn out to be a waste of money.

I asked my colleague, Daniel R. Miller, senior consultant for ClaimDocs, to give me some quick tips. I’ve known Dan for nearly 20 years and his career background includes national consulting firms.

Here are Dan’s tips:

1)   Before scheduling an IME, the claims manager and exam doc must know its purpose. Be specific about the details. Whether the issue is misdiagnosis, causation or degree of disability, provide medical reports, witness and injured worker statements, and other supporting materials.

2)   Find out the state’s laws and applicable treatment guidelines. Make a checklist of what needs to be done, how and when. Follow it to the letter. Some states dictate timing and conditions of the IME. More often than not, IMEs occur too late in the process. Therefore, starts considering an IME when the medical pieces of a claim are not fitting together and/or “red flags” are showing up.

3)   To ensure credibility, hire well qualified and highly respected doctors. Those with a relevant specialty tend to get more weight than generalists. Docs with successful private practices, are affiliated with teaching hospitals or are involved in research are generally given more credence.

4)   IMEs related to returning an injured worker to the job should include specific job requirements according to the employer, physician input and the employer’s efforts to assure return to work. Providing the job requirements on video is generally very helpful.

5)   Communicate clearly to appropriate parties throughout the claims process. No matter how much you follow the other steps, miscommunication can cause something to go wrong.

For more information, you can contact Dan directly by writing dan@claimdocs.com.

If you have other good tips or feedback, please add a comment.

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