Disability Medical Review
January 07, 2020
IME, or independent medical examination, is a process that takes place when a licensed physician conducts an examination of an individual (patient) to review that person’s condition. Often confused with peer or independent medical reviews (IMR), an IME is utilized for a second opinion, often after a peer review has already occurred. A key difference between IME and IMR is independent medical review does not involve an in-person examination of the patient.
IME services often are performed in workers’ compensation or disability cases. For example, if an employee injures himself or herself on the job, he or she usually receives treatment from a physician. However, the insurance company involved in the claim may dispute that doctor’s findings about the extent of the injury. The payer then requests an IME to determine the severity of the injury and if and when the employee in the claim can return to work. The desired outcome is an evidence-based settlement between both parties.
At this point, the selected physician reviews the paperwork surrounding the case to educate himself or herself about the specifics of it before conducting the examination. This part of the process is very similar to a peer review. The doctor has access not only to the case notes but also any test results and medical records relevant to it.
There are important steps to ensure the IME process is unbiased and accurate. For one, the physician chosen for the IME should be a specialist in the field of medicine in which the patient has been treated. Also, the doctor should not have ever previously treated that person. If these lines are crossed, a conflict of interest occurs, possibly rendering the process biased. The physician paired with the case is usually within a 60-mile radius of the claimant, although transportation is arranged for the patient and/or doctor if the individual resides in a very rural area.
IMEs are typically short examinations because the physician isn’t treating the patient. Rather, he or she is simply providing an expert opinion on the patient’s injury and whether or not the treatment fits the diagnosis. In IMEs for workers’ compensation cases, the doctor states his or her opinion on whether or not the injury happened on the job and when and if the patient should be able to return to work.
After the examination, the examining physician develops a report on it and submits it to the party that scheduled the exam. For insurance companies, the report is used to determine whether or not the claim should be paid. For employees, it provides documented evidence of the injury or lack thereof and verifies whether or not the employee should be compensated accordingly.
The IME process gives all parties involved in the case the confidence that the patient was examined in-person by a licensed physician. It eliminates conflicts of interest and offers an unbiased recommendation on the case. Plus, it removes lingering questions about whether or not a patient should return to work and/or receive the initially recommended treatment.
Like peer reviews, the IME process includes a report but also adds to its efficacy by having the claimant examined by a physician.
Independent medical examination companies like MLS have experience in complicated cases and are an advantageous resource for both payers and employers. Because they specialize in IME services, they have access to all the resources necessary to handle even the most complicated cases.
At MLS, we work with insurance carriers, third-party administrators and self-funded employers to deliver IME services that meet unique and specific service standards. We employ a nationwide network of licensed physicians from hundreds of various specialties and sub-specialties and utilize a nurse-driven quality assurance model that ensures all our IME reports are accurate, objective and comprehensive. Contact us to learn more, or find out about the other services we offer.
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