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A Comprehensive Independent Medical Exam Guide

It is now commonplace for companies large and small to encounter disputes in the areas of workman’s compensation, personal injury and workplace accidents. Everyone involved in these unfortunate situations wants to do the right thing. Unfortunately, sometimes obtaining the true facts in order to settle the claim may become a challenge. If your corporation has become involved in an injury or accident claim, you have the right to an independent medical exam (IME) of the person making the claim, referred to as the claimant.

The process of an IME may not be familiar to you, so we would like to take you through the process so you know what to expect. Understanding the process will also help you obtain the most beneficial results.

What Is an Independent Medical Exam?

An IME is defined as “the evaluation of an injured party that utilizes a third party, independent medical professional to issue an unbiased opinion on the injury.”

For example, if there’s a disagreement over a workers’ compensation allegation, an IME provides an opportunity to get insurance professionals, employers, attorneys and physicians on the same page. Independent medical exams frequently assist in resolving the claim in a timely and efficient manner.

They also provide services to legal and insurance organizations if a corporation encounters conflict with the following issues:

  • Liability injury situations. If someone suffers an injury on the property you own, you are often liable for some level of compensation. This can range from slip-and-fall incidents to food poisoning at a restaurant.
  • Personal injury. Many personal injury cases involve traffic accidents, accidents in a home or product defect accidents, also referred to as product liability.
  • Disability claims. According to the U.S. Social Security Department, “The definition of disability states that an individual must have a severe impairment that has either lasted, or can be expected to last, for a minimum of one year.” In these specific cases, medical records must clearly demonstrate that the individual will be disabled. In these instances, an independent medical exam can be vital.
  • Occupational danger claims. If you’ve heard of OSHA (Occupational Safety and Health Act), you’re likely aware that employers are required to provide a safe and healthy workplace. An occupational hazard is defined by the Business Dictionary as “a danger to the health, limb, or life that is inherent or associated with a particular occupation, industry or work environment.” This classification includes accident risks and the potential of causing a disease.
  • Environmental hazard claims. These can include health issues from exposure to toxic waste, consequences from chemical spills and so on.
  • Nursing home negligence claims. As people age, many seek residence in long-term care facilities, and authorities believe this category of claims will rise considerably. If a loved one is neglected or abused on the premises of the nursing home, or if an employee of the business causes harm to a resident, the facility can be held responsible.

These incidents are far ranging, which is a primary reason it’s critical for the company or homeowner to have insurance.

To clarify any disputes in the degree of the injury, illness or damage to a person, an independent medical exam can be requested.

Who Performs an IME?

An IME is performed by an impartial, third-party contractor who is qualified to provide medical examinations. Unlike a regular or family physician, these doctors are simply consultants and are contracted to supply an objective medical evaluation for a specific case. Consider the following information about these contractors:

  • They are not responsible for a patient’s long-term health or treatment.
  • The doctor-patient confidentiality privilege does not exist in these specific situations.

Why Would a Company Need an IME?

IMEs are engaged when there is dispute or need to clarify the cause, extent and medical treatment of a work-related or other injury where liability is an issue.

An IME is primarily requested by the employer, the insurance carrier or legal counsel. These entities are searching for information on whether or not the person’s medical condition is related to a compensatable event.  This will decide if and how the insurer must reimburse the patient or if they can deny the claim.

It sounds much more complicated than it is. The key is to choose a reputable independent medical exam center.

When Do You Need an IME?

There is a great deal at stake in workmen’s comp and other injury cases.

One of the most famous counterfeit claims involved a postal worker from North Carolina. A postal worker claimed she injured her shoulder on the job and could no longer lift mail trays into the postal trucks. She had been collecting benefits for four years.

This postal worker found the time and energy to actually appear on the game show The Price is Right. She was selected as a contestant and used her upper body, including her shoulders, to spin the show’s famous big wheel, twice.

She had also gone zip lining and posted a photo on her Facebook page that showed her exciting adventure sailing through the air.

Eventually, she pled guilty to fraud in connection with a workers’ compensation claim against the US Postal Service.

This may be an extreme example of how a claim can be disproven, and the majority of people are honest, but it is critical to assure the legitimacy of claims against businesses, property owners and individuals.

Types of Claims

Types of IME Claims

Controversy in claims filed by individuals or business establishments can originate from a multitude of conditions. Here are three of the most common:

  • Job injuries. Injuries at the workplace are not always simple. When a workers’ compensation dispute arises, an independent medical examination can help resolve the charges quickly, fairly and without prejudice.
  • Car accidents. Victims of automobile collisions may suffer damage ranging from property loss and physical impairment to the loss of income. An independent medical exam can clarify the situation without bias.
  • Personal injury claims. Personal injury is a legal term defined as “an injury to the body, mind or emotions, as opposed to an injury to property.” In these events, there may be contention over fault. An impartial analysis of the situation often leads to an agreeable conclusion.

What to Expect at an Independent Medical Exam

If you’re required to get an IME, you may feel a bit apprehensive. But there is no need to worry. Consider these tips on how to prepare for an IME, which will help take the mystery out of the exam:

 Prepare for IME Exam Prepare. A few days before your exam, get organized so you can respond to any question in a concise manner. You will likely be asked about any previous injuries, how the incident occurred, your symptoms and current prescriptions or over-the-counter medicines you’re taking.
 Arrive Early For IME Arrive early for your appointment. You’re entering an unfamiliar environment, so give yourself a little extra time to relax in the waiting room and gather your thoughts. Arriving early will also give you adequate time to fill out any forms.
Understand IME Examiner Understand the role of the examiner. It’s important to remember that the medical expert performing the exam is classified as a consultant and not your personal care physician.
Positive Attitude at IME Maintain a positive attitude. Remember, this is an independent doctor examining you as part of a claim. His investigative exam and questions are simply part of the standard procedures. Try not to take anything personally.
Honesty at IME Honesty and respect. It’s absolutely inexcusable to lie about your injury or its consequences during the examination, or at any point. Be respectful and polite during the IME and your cooperation will go a long way.
Be Prepared for IME Be prepared. Practice talking with someone about your injury ahead of time, describing the topics listed above and explaining how the injury has affected your life. This will allow you to be calmer during the IME.
Date and Time of IME Note the date, time and place of your exam. Also know the name of the doctor who will examine you. Get any directions you need well ahead of time.

How Do You Choose an IME Facility?

Selecting a credible, reliable and honest IME center is critical in each and every situation. The exam is always scheduled by an insurance company, law firm or corporation, and the IME will have a direct effect on the case’s resolution. Selecting a trustworthy and responsible facility is of the utmost importance.

Choosing an IME center should include at a minimum the following qualifications:

  • Have a pristine reputation in the industry
  • Employ accredited medical personnel
  • Assist in coordinating the medical files for the consulting physician in advance
  • Ensure the actual examination focuses on the area of the body that is indicated in the report
  • Provide the ability for testimony at both depositions and in the courtroom
  • Publish a final and detailed report including issues addressed such as return to work status, disability status and identification of work limitations
  • Provide a conclusion of the injury or harm caused by the event
  • Develop direct lines of communication and easy access to all IME information including medical records, claim history and all records and statements
  • Be HIPPA compliant

IME Care Center

When you require a reliable and respectable IME, turn to The IME Care Center. You’ll not only received prompt and customized attention, you’ll also experience our comprehensive, one-stop organization.

Our services and features range from simple cases to even the most complicated and convoluted situations. Here is what we offer:

  • Customer service. Every client receives prompt service and scheduling to expedite and resolve the pending issues. We pride ourselves on constant communication and meeting your every need to ensure the case can be closed as expeditiously as possible.
  • Physicians. Our medical professionals are experts in their field, are board-certified and are in good standing with their medical boards. The IME Care Center offers a full-spectrum of support including a comprehensive group of physicians representing a variety of medical specialties. At The IME Care Center, you will have access to licensed professionals in the areas of cardiology, general surgery, neurology occupational medicine, ophthalmology, orthopedics pain management, pediatric orthopedics and much more.
  • Record reviews. The first step in many consultations is the medical record review. A certified physician or certified healthcare professional from The IME Care Center will evaluate the status of the claimant based upon the existing medical records.
  • Exams. We ensure our exams are thorough, objective, detailed and in-depth. During the exam of the claimant at The IME Care Center, our physicians remain neutral and act as an unbiased third party.
  • Reports. The statements generated by our care facility include careful review of all relevant medical reports. After the exam and review, we will deliver a quality and objective narrative. If additional medical records are required, we will assist you in obtaining the necessary information to complete the process in an efficient time frame.
  • Video/oral depositions. A medical deposition is pivotal in all cases. A deposition is a sworn testimony that takes place before all parties and their legal counsel. They’re usually in-person, but they may also occur via video. The IME Care Center team is composed of board-certified physicians, so our credibility is well-established. Most questions during a deposition focus on the independent medical examiner’s experience and knowledge of the injury. Our healthcare professionals are prepared to objectively discuss the medical status of the claimant in-depth.
  • Addendums. Our professionals are available to provide written addendums as necessary to clarify the report.
  • Cold case resolution. At The IME Care Center, we can act as detectives, too. Don’t let old incidents backlog your workload. We can help you resolve cold cases and get them off your books.
  • Functional capacity evaluations. This may topic may sound complicated, but it won’t be with our professionals. We realize that one of the most important evaluations of claimants is whether or not they are capable of accomplishing their job requirements. When the claimant’s ability to perform work tasks is in question, our experts will provide an impairment rating evaluation in addition to completing necessary forms relating to assessment of disability.
  • Narrative letters. Workers’ compensation claims often generate a large amount of paperwork. The IME Care Center can provide you with independent narratives and relieve you of the time and energy it requires to manage these documents.
  • Miscellaneous form completion. Contested injury situations can require specialized and detailed forms, and we can help with them. The IME Care Center understands which forms are necessary and when they are required. And we can also complete all necessary forms for you.

The instances that may affect your insurance over the life of your corporation or personal life can be numerous.  We at The IME Care Center are proud of our reputation and the range of our support.

Trust The IME Care Center to do the job correctly the first time. Contact us now and let us know how our professionals can help.