Tips for Workers’ Comp Independent Med Exams

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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3 thoughts on “Tips for Workers’ Comp Independent Med Exams

  1. Bob Malooly says:

    Dan is right on target. Be specific about your questions. If you think you need an IME, you probably do. Waiting will not help. I like his final comment, focus on return to work, it is a win for everyone.

  2. Paul Jahn says:

    I generally agree with your recommendations but I don’t think it is a good tactic to necessarily share witness statements or other independent investigations with the IME doctor prior to the exam.

    In NY, all materials submitted to an IME doctor must be immediately shared with plaintiff’s counsel and submitted in to the official record. Furthermore a materially false statement given to an IME doctore is considered fraud under our statute. Defense attorneys generally contend that no investigative material be given to the IME doctor prior to the exam. If the claimant’s history is contradicted by either investigation or surveillance results, the doctor can alter his finding either by a clarifying addendum or while he or she is testifying.

    Otherwise I thought this was an excellent article

    • dmillerymd says:

      Paul

      Thanks for the outstanding feedback. You raised a great point from a legal/technical point about sharing witness/or investigative statements with an IME provider. The top IME docs tell me they want as much information as possible prior to the exam. Statements by claimants such as “need to walk with a cane 24 hours a day” etc can often be verified by IME. One of the top IME docs I know actually will watch a claimant in the parking lot coming and going from his office. He often sees things that contradict statements given to an adjuster.

      You are also on target that all statements, medical reports, IME requests and reports etc are discoverable by plaintiff attorneys and work comp commissions. So by all means be careful what and how you state requests in an IME because it can and will get back to an attorney representing the claimant.

      All a key part of communications. Thanks for the input.

      Dan Miller

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