Know when to call on an IME in comp

Failing to identify the right independent medical exam expert or when to bring one into the process may hinder an injured worker’s recovery, make apportionment more difficult and delay return to work, according to a new white paper released Wednesday by the Risk & Insurance Management Society Inc.

IMEs are often called upon by adjusters to verify initial diagnosis, causation of the injury, treatment, prognosis and ability to return to work. Workers compensation insurers in recent years have been establishing preferred lists of IME companies, said the report, ensuring that IMEs that make the list are objective, skilled at performing medical examinations, able to efficiently coordinate with others to look at all critical data required to make a medical determination, have jurisdictional knowledge and are accredited.

When a workers comp adjuster is unsure about a claimant’s pain, the report suggests bringing on an IME early, which can prevent a situation where an employee had been receiving benefits for years when the claim should never have been accepted. The adjuster should also have a clear objective in mind and inform the IME of what he or she needs to evaluate.

Finally, the white paper urges adjusters to ensure IMEs have all of the relevant background on a worker — including a complete medical record, diagnostic test results, job description and statements — prior to the exam.