Firms Can Turn WC Independent Medical Exams Their Way

By Don Talend October 11th, 2023

Like a typical Workers’ Compensation (WC) claim itself, the outcome of an Independent Medical Examination (IME) — an evaluation conducted by a different doctor from one treating a claimant — might seem out of an employer’s control. But it doesn’t have to be that way, according to attorney Brian Koch, a partner with Wiedner & McAuliffe Ltd. During Captive Resources’ September Risk Control Webinar, Koch showed attendees from group captive member-companies how they can improve IMEs and make them key factors in WC defense strategies.

Employer’s Incident Details Are Critical

Koch said the employer serves as the risk manager and critical first line of defense within a larger WC team. An insurance adjuster is invariably involved in WC claims. The rest of the team includes, but is not limited to, a nurse case manager for complicated medical scenarios, an investigator to monitor the claimant’s physical activity, and an attorney. The team depends on the employer to provide information such as:

  • The incident location and time.
  • The names of witnesses who could provide detailed statements.
  • Video of the incident.

According to Koch, this information is crucial in forming the basis of a defense. The team might dispute that an accident occurred or a possible causal connection between the mechanism of injury and the claimed pathology. Alternatively, the defense might be based on the need for, or the extent of, medical care.

The team also depends on the employer’s information in deciding whether or not to conduct an IME as part of the defense strategy.

Use IMEs to Resolve Claims Efficiently

Koch advised employers that if their defense teams decide to conduct an IME, they use it to resolve a claim as efficiently as possible. The IME report can provide leverage to negotiate a compromise to a drawn-out, costly claim, he said. The information the employer provides is also essential to the IME — the report’s conclusion and details will depend on it, should the team decide that an IME is necessary or prudent, Koch added.

“The purpose of an IME, in my opinion, is not to lengthen or encourage litigation but to minimize litigation,” said Koch, who estimated the cost of a typical IME at $1,500 to $4,000. “I want to use an IME to provide us with a basis to dispute a claimant’s claim of injury, medical treatment, or time off so we can close the matter and save us all time, effort, and aggravation.”

How an Attorney Can Help Ensure IME Quality

Koch, who primarily practices law in Illinois, pointed out that WC laws vary by state. For purposes of IME physician selection, he urged employers to rely on the expertise of an attorney specializing in WC law in the jurisdictional state.

The attorney can:

  • Help identify a recognized expert in the appropriate area of pathology.
  • Provide information the physician needs to render the most informed opinion.
  • Ensure that the physician aligns its IME focus with the basis of the defense.

Koch added that the claimant will be a new patient for the IME physician, who needs more information than what the claimant might provide. To make the IME report as favorable to the defense as possible, the employer should ensure that the attorney provides the IME physician with several items:

  • The accident claimed.
  • Medical treatment incurred.
  • Diagnostic studies, as the IME physician’s records could be subpoenaed to determine the basis for its conclusions.

Also, the attorney should pose detailed questions to the physician based on:

  • The physical examination of the claimant.
  • The claimant’s medical records.
  • Details of the incident the employer provided.
  • Non-leading but clear questions about the alleged injury causation based on the circumstances.

Koch added that the employer should be aware that surveillance of the IME might be an option. In cases where the claimant’s credibility might be an issue, surveillance could be helpful to the defense, he said. Typically, a third-party administrator (TPA) would be responsible for selecting a surveillance vendor for a group captive member-company.

About the Webinar

This presentation was part of Captive Resources’ Risk Control Webinar Series — regular installments of webinars to educate the group captive members we work with on topics like workplace safety, organizational leadership, and company performance. The thoughts and opinions expressed in these webinars are those of the presenters and do not necessarily reflect Captive Resources’ positions on any of the above topics.

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