3 Takeaways on Intermediate & Advanced IME Concepts
- The Physician Perspective. If claims staff work with a high-quality IME vendor, injured employees are likely to be referred to highly qualified physicians skilled in IMEs. When an IME physician gives an opinion, it must be based on medical evidence and within a reasonable degree of medical certainty.
- Understanding Objective Findings. IME physicians must utilize objective, observable information that cannot be distorted by emotion or personal aim. To be truly objective, findings must not rely solely on an examinee’s perceptions of pain or other factors. And where physicians must rely on subjective input, they should try to find at least one way to validate that information.
- Fraud vs. Flags. It’s not the intention of an IME to detect fraud, abuse, or malingering, but in some cases, it can indicate “red flags” that can be brought to the attention of claims adjusters. These red flags can produce added benefits. They can indicate a rare instance of fraud or abuse, but the more common benefit is that injured employees receive the care they need for other conditions covered outside the workers’ comp system.
We hope you enjoyed The Case Resolution Series. If you haven't already, download the entire IME eBook here: Emperion eBook.
Stay tuned for our next series: 26 in '26
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