The IME — It’s not just a second opinion

Section 12 of the Illinois Workers’ Compensation Act is commonly referred to as an IME (Independent Medical Examination) and it is a key resource available to claims professionals who must make sensitive determinations regarding the current medical condition of an injured worker.

In an IME a qualified medical practitioner who has not previously treated the worker, reviews the medical records pertaining to the alleged injury and conducts an objective examination of the individual, producing an unbiased final report that details findings.

Specifically, the IME report addresses issues of impairment, disability, causation, appropriate treatment, return-to-work restrictions, and whether maximum medical improvement has been reached. It is also used to determine if the treatment to that point in time has been appropriate or if there may be potential abuse of the system.

Ultimately, for the employer the IME has the potential to save thousands of dollars in unneeded medical treatment, costly administrative expenses and potential legal fees. To the injured worker, the IME may be an opportunity to see a specialist for the type of injury he/she may have. However, it is important to note that during an IME there is generally no expectation of a traditional physician/patient relationship. In fact, the communication between the physician and the examinee is not privileged, nor protected in any manner.

Typically, IMEs are requested by employers, insurance claims adjusters, nurse case managers or defense attorneys. They are less commonly ordered by the attorney for the plaintiff (examinee), judges and/or arbitrators in the process.

An IME may be beneficial when:

• There is a significant lapse of time between the date of injury and treatment

• The causal relationship between the treatment and the injury is in question

• Medical reports lack objective findings linking complaints to the specific injury

• A time frame for return to work or physical capacity information is needed

• Recommended treatment is unusual, unconventional or excessive

• The current treatment plan has failed

• Medical Treatment costs are escalating

• Physical Therapy/Chiropractic care is not showing measurable improvement

• Surgery is recommended

The resulting final report carries legal weight. It can clarify and resolve disputed issues, determine whether to take the case to trial or to negotiate a settlement, and it can be used as evidence at a hearing. Based on this, choosing a qualified physician to conduct the IME is essential.

It is best to choose a board-certified physician who has advanced medical specialty training related to the area of injury. The chosen physician must also understand the vital role he/she plays in the process and the critical importance of providing the documentation in a time-sensitive manner.

Once an IME physician is selected, the requesting party will provide all relevant medical records with a cover letter outlining facts and posing specific questions pertaining to the alleged injury. The physician reviews the records, conducts a detailed physical examination and produces a thorough report. The IME report should conclude with a comprehensive summary of the physician’s opinions within a reasonable degree of medical and surgical certainty, and overall conclusions.

Within the occupational health arena there are multiple studies pointing to the detrimental effects of time away from work. There is a direct correlation between inactivity and permanent disability, and to an increase in depression and anxiety. When best applied, an IME provides the information and documentation necessary to map a course that will safely return the individual to the workforce.

This article was first published by Daily Herald.

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