An independent medical examination also known as an IME is one of the most abused tools available to the workcover case manager in confirming the nature and extent of an injured worker’s injury and its compensability.
The IME can be used or abused to verify claim/injury compensability, to, ahh, confirm a diagnosis, to evaluate the appropriateness of the current medical treatment, to establish the need for future medical treatment (of course), and can also be used or abused to assess the amount of permanent impairment when the injured worker has reached maximum medical improvement.
Independent Medical Examination – problems with radical, conservative & biased IMEs
IME ‘s are the best way to check the injured worker’s diagnosis
According to our insider, a former workcover case manager, when the injured worker is allowed to choose their own medical treater(s) it is often very difficult to know if the extent of the injured worker’s injury is as severe as claimed, especially if the injured worker is being treated with an “injured-worker- friendly” doctor. OMIGOD! To be honest, I am (and know of quite a few others) quite fearful of one of my own treating specialists! And what about hard evidence such as x-ryas, CT scans, MRI’s? And, also would this mean that all our treaters would be lying (i.e surgeon, physio, GP, shrink?)
The same is true, says our informer, if the injured worker has been sent to a doctor or specialist selected by the injured worker’s lawyer (for purposes of serious injury application etc).
And so it is that our case managers are of the belief that an IME is the best way to verify the accuracy of the diagnosis and the necessity of the injured worker’s current medical treatment plan. How interesting, especially considering they will routinely send us to an IME with no experience whatsoever in the field of our injuries! Rather they will send you to a general surgeon if you suffer from a complex orthopedic injury, or to an occupational physician when you suffer from a head injury.To properly select a doctor for an IME, the case manager really needs to know not only a doctor’s specialty (for example: orthopedics), but also the doctor’s sub-specialty (for example: knees). A copy of the doctor’s resume, certifications, lectures and publications can also be used to establish the doctor’s expertise in his sub-specialty. So, no excuse really!
The selection of the IME doctor should be undertaken with care
When the case manager determines there is a need for an IME again, the selection of the IME doctor should be actually undertaken with great care.
Most pathetic case managers fall into the trap of thinking ‘the injured worker has radical doctor who is over-treating and gives heaps of time off, or the injured worker is definitely malingering, therefore I have to use an IME doctor who is overly conservative and sends everybody back to work immediately preferably with no impairment rating.’
There are at least two problems with this way of thinking and using biased IMEs:
1. It really totally defeats the purpose of the IME – to be independent, to know the true extent of the injury, to know the future medical treatment needed, and/or the actual level of permanent impairment, if its about a permanent impairment assessment.
3. It costs them money, which is ultimately wasted.
Insurer’s Own Experience
It is well known that case managers (and insurers) know from experience which IME doctors will perform an objective IME, and those who will not, and will select the IME doctor based on prior experience. Many insurers also have lists of certain IMEs! And they can always ask their defense counsel too, duh!
It is hard to believe insurers continue to send injured workers to known radical, conservative and biased IMEs. It plainly shows that they have no morals, no ethics, no standards and will do whatever it takes in an attempt to deny a benefit.