When to order an Independent Medical Evaluation

There are five things an IME does best:

  1. Establish a diagnosis

  2. Determine causality

  3. Recommend or affirm treatment

  4. Determine medical fixity

  5. Rating.

Of course, that’s not to say that there are no other reasons to order an IME.

They can be helpful in second opinions for surgery, work ability, establishing treatment benchmarks, gaining knowledge of a claim or for understanding the impact of underlying, unrelated conditions on curative treatment and ability to work.

However, remember, IME’s are not legal weapons or legal tools. They are, by definition independent and not to be used as medical-legal opinions. IME’s are never best utilized in a legal setting. The proper legal tool is a medical-legal or forensic evaluation.

Early is Better 

An IME is most effective when it occurs as early as possible in the claim. This is for several reasons:

 

Diagnostic Error

Frequently, in  modern medicine, attending physicians are so overburdened and forced to cram so many patients into a single day, they don’t have the time to take more than a cursory history and direct their exam to the primary complaints.  This frequently overlooks other possible explanations, which may reveal underlying, undiagnosed and heretofore untreated diseases or conditions.

 

Casualty

Again, an attending physician rarely has the time, training or inclination to take the kind of detailed history necessary to establish causality. Frequently, a sentence or two extracted from a short interview or intake form take the place of a complete medical review of the mechanism of injury or disease. This takes time an attending physician, whose income is determined by the number of patients seen in a day, just does not have.

Benchmarks

It can be hard to know how  the progress of recommended treatment should be assessed.  Without objective medical benchmarks, it is nearly impossible.  Asking for an IME to establish benchmarks allows you to track the progress of treatment and have early and reliable warning when progress is not proceeding as planned.  An early IME allows you to track the progress of treatment with confidence, monitor treatment for effectiveness and accurately plan for the medical needs of the case.

 

Second Opinion

Sometimes, in the event of a repeat surgery or a controversial treatment recommendation, a second opinion is necessary to determine the best course of action.  Frequently an attending physician or surgeon does not grasp the full extent and intent of the demands of industrial insurance law. Concepts like “curative” treatment and “maximum medical improvement” are frankly alien to routine medical practice.   Sometimes, a consultation directly including the AP is also indicated. Again, the earlier these    questions can be addressed and brought to rest, the more successful the outcome.

 

Return To Work

Every evidence based study indicates the sooner return to work is instituted the more positive the long term outcomes.  A solid diagnosis, with a precise treatment plan outlined with exact benchmarks is the most likely course to  facilitate a successful return to work.  

 

Specialty Referral

A multi-examiner evaluation*  (panel) offers a team-medicine approach, which is becoming more widely accepted as standard practice for complex cases throughout medicine. A unified, coordinated opinion with all the specialists conferring and agreeing on the final recommendations ensures a coordination of the best possible medical expertise brought to bear on the diagnosis, treatment and benchmarks.  This ends “serial consultation” with a myriad of contrasting and contradictory ideas, none of which create a coordinated or usable conclusion.

What a Great IME needs from YOU

 

Complete records, in our offices at least 10-15 days prior to the IME.

  1. A clear, concise cover letter.

  2. A statement of the accepted conditions.

  3. A statement of the contended conditions.

  4. All studies, preferably in a readable and usable format. This includes, all radiographs and study results.

  5. Good contact information for the examinee.

  6. Knowledge of the exact language and dialect of the examinee.

  7. Job analyses presented prior to the examination with clear, understandable job descriptions and demands.

Panels

 

How do I know what doctor to choose?

If you are not sure what specialist to request for a team evaluation (panel) please feel free to forward the file to us. We will have our medical director review it, contact you and discus the specialists needed to provide you with a comprehensive opinion.  We are here to answer your medical questions, call or email us at any time.