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Emperion OnPoint-1

Seven Simple Reasons You May Need an IME

A Review of the Basics: Why Request an IME?

As workers’ compensation professionals deal with increasing complex claims, they may become uncertain about specific determinations on a case. For example, they may wonder about the true cause of a claimant’s condition. They may be unsure of the best course of treatment. They may think that a degree of symptom exaggeration exists. In other situations, the case can be complicated by other medical issues—such as diabetes, hypertension, or depression—which can hinder the injured employee’s recovery.

Due to these types of challenges, adjusters will often request an independent medical examination (IME) to help determine the next step in the claims, medical management, or return-to-work (RTW) process. In some jurisdictions, specific medical review is required to close or advance a claim. Here are some areas where an IME can provide useful information:

  • Diagnosis. Adjusters may want to ensure that the initial diagnosis was complete and accurate. Diagnosis is often one of the most important factors regarding a case.
  • Causation. Adjusters may want to determine if the condition, pain, or other symptoms experienced were in fact caused by the work-related injury—or another underlying issue or previous incident.
  • Treatment. Claims staff may want to determine if a suggested treatment plan falls within the best practices, such as those outlined in the Official Disability Guidelines (ODG). For instance, they may want to get a second opinion on whether a certain procedure or surgery should be performed.
  • Apportionment. Depending on the jurisdiction, an employer may be allowed to assign some portion of the disability to a pre-existing injury or condition, which may reduce the benefits for the workers’ comp injury. An IME can help in assigning appropriate apportionment.
  • Impairment. Depending on the jurisdiction and the relevant nomenclature, adjusters may want to ascertain if the injured employee has reached maximum medical improvement (MMI), if a permanent or partial impairment exists and, if so, what is the impairment rating?
  • Return to Work (RTW). An adjuster may want an estimate on when the injured employee will recover and return to work or determine if there might be temporary or permanent work restrictions. For example, can the injured employee return to light, modified or full duty?
  • Prognosis. The adjuster may require a simple statement that projects medical treatment needs into the future. It can be as simple as the prognosis is “good” or “poor.” This helps to determine whether or not there will be future medical considerations.

In these situations, an IME can serve as an outstanding tool to help claims staff make decisions, while also providing significant benefits to both the employer and injured employee.

Conclusion: Next up in our On Point Series: "Not Just Another Doctor’s Visit — What You Need to Know" - An IME delivers a neutral, expert evaluation—what will it reveal?

If you are ready to explore further, download the entire IME eBook here: Emperion eBook.

If now is the time to request an exam, visit our online referral form.