Independent Medical Exams (IMEs) Flashcards
What is the claims communication standard for contact with injured workers about an IME appointment?
Contact the injured worker prior to scheduling an IME appointment to discuss the purpose of the appointment and to address any scheduling conflicts or potential travel concerns and transportation needs.
How many days’ notice do you have to provide to an injured worker for a scheduled IME appointment?
10 days prior to the IME appointment.
At a minimum, how many days prior to the scheduled IME appointment should your cover letter and medical records be sent to the IME physician?
Seven days prior to the appointment date.
An IME with multiple examiners must be completed within what period of time in order to be considered one IME examination?
72 hours.
When should you consider using a panel of IME physicians?
Consider using a panel on claims with distinctly different conditions requiring different types of medical expertise.
What two claims processing steps can you NOT do if the worker fails to attend an IME appointment?
▪Unilaterally stop paying time loss benefits.
▪Deny the claim.
What could you do if a worker fails to attend the IME?
Request suspension of benefits from WCD, or request a penalty.
What should a worker do if he or she objects to the location of the IME appointment? What is the timeframe to do this?
The worker can appeal the location of the IME appointment to the Director of WCD within six days from the mailing date of the notice of appointment.
Is the order issued by WCD regarding IME location appealable?
No
What should you do if the IME report does not address the questions in your cover letter?
▪Contact the IME provider to discuss concerns and ask for an addendum.
▪Contact the SAIF IME liaison to assist with any concerns with the vendor.
In what situations would an IME report be given deference over a report of the attending physician?
▪When it is well-reasoned and provides a better explanation than the medical opinion from the attending physician.
▪When the exam is done by a specialist and the AP is a general practice physician.
If an injured worker does not believe he or she was treated appropriately during the IME examination, what should the worker do?
▪The worker can file a complaint with WCD.
▪The worker can talk with you. You should involve your supervisor and IME liaison in the discussions.
What are some SAIF resources that can help you compose questions for the IME physician?
▪Nurse consultant ▪Attorney ▪Supervisor ▪Team staffing ▪Job coach
