It is hard to have spent any time in the workers’ compensation industry without having faced an Independent Medical Evaluation report that simply doesn’t deliver. From unsubstantiated diagnoses to late delivery, IME outcomes never cease to surprise. This can leave a mess for the claims handler or employer/carrier representatives to clean up and lead to misdirected treatment or delayed Maximum Medical Improvement for the injured worker. However, by keeping an eye on the details while maintaining a targeted overall claims management strategy, we can avoid these mistakes and ensure an IME report that concretely addresses the important issues at hand.
Selecting the Expert
The first step in ensuring an objective and accurate Independent Medical Evaluation is to select the appropriate expert. This goes beyond simply pairing an injured worker with a physician of the correct specialty. The expert that you select, in most jurisdictions, will be the only physician who is allowed to perform an independent medical evaluation for the specific body part in question for the lifetime of the claim. This means that there is a lot riding on the choices you make at the very beginning of the IME process. Without a national panel of vetted experts, selecting your IME physician can be a risky and challenging task.
While many providers verify that a doctor is board certified and clear of any criminal charges, ongoing suits, or demerits, it is important to go above and beyond this in the vetting process. A competent IME vendor will conduct thorough interviews with their panel physicians to ensure that they are experts in their fields, make diagnoses based on objective findings, are willing to consider the facts of the case, and can strongly defend their reports during deposition or trial testimony.
The Forgotten Elements
Once an expert of the appropriate specialty and experience is selected the next important step is ensure that he/she has the facts to work with. This means collecting all the pertinent medical records and drafting a detailed cover letter outlining the specific issues the expert should address.
It is important to define what we mean by “pertinent records.” These include, but are not limited to, the medical reports related to treatment of the current alleged work-related injury. They should also include the job description at the time of injury, any records from prior injuries to the same body part, ISO reports identifying any possible previous related injuries, any surveillance you may want the doctor to review, and the actual films or digital copies of relevant diagnostic imaging. Without these important records, your expert may only rely on his physical examination of the injured worker and the injured worker’s verbal history of events.
However, review of the medical records and interview/evaluation of the patient is not enough. Your expert also needs to know the history of the case and the specific issues that need to be addressed. These should be developed by considering the issues at hand and the overall claim resolution strategy. Without specific direction, your expert will be unsure what to address and may actually comment on items outside of the scope of what is needed.
Scheduling and Facilitating the Examination
Concurrently with obtaining the records, the IME appointment should be set, respecting jurisdictional requirements for notice of the exam to the injured worker. This is another area where IME reports typically fail. Often times, if an exam notice is sent improperly, the exam itself is void. For example, in federal jurisdiction cases at the Associate Law Judge level, an appointment requires 30 days written notice to be provided to the injured worker and his/her attorney. If 30 day notice is not provided, then then the injured worker can object to attending. In New York State jurisdiction, all notices must be copied to the state workers’ compensation board. If the board is not copied, then the examination and report issued are invalid. Your IME scheduler should be fully versed in IME notice requirements and able to coordinate medical transportation, interpreter services, and special requests with the examining physician.
Clarifying the Details and Expediting the Report
By selecting a qualified expert, obtaining all the relevant medical records, drafting a detailed cover letter, and properly noticing the examination, you have completed much of the heavy lifting prior to the actual IME appointment. At this point, your expert has all the information he/she needs and all that is left is to examine the patient and issue a timely report. Your expert should already be informed about any report deadlines and willing to issue the IME report within two weeks at the very latest.
After the report is issued, a workers’ compensation subject matter expert should review it to ensure that all relevant questions have been answered with respect to your overall case strategy as well as jurisdictional and legal requirements. Once any issues have been corrected, what is left is the ultimate IME report, backed up by objective findings, and fully addressing all pending issues.