Independent Medical Exams (IMEs) can be a highly effective tool for looking at what is happening on a claim and help provide a strategy for timely and cost-effective claim resolution. But how do you know if your claim could benefit from an Independent Medical Examination? Outlined below are 20 reasons you should consider an IME.
From clarification of diagnosis to return to work, an IME can bring clarity to your claim.
1. Provider is not addressing whether diagnosis is related to injury of record
2. Treatment plan appears outside of usual and customary guidelines
3. A second surgical opinion is needed
4. Patient has requested a second opinion
5. Diagnosis is not supported by objective findings
6. Provider has not given a definitive diagnosis
7. Experimental treatment is being recommended
8. Provider has not provided a prognosis for recovery
9. Provider is treating an unrelated body part
10. Provider is not addressing the individual’s functional capabilities
11. Provider will not release the individual to RTW
12. The anticipated disability duration exceeds the usual and customary guidelines
13. Provider is not addressing permanent impairment
14. Permanent impairment seems excessive
15. Opioids are prescribed and the provider will not provide a timeline for discontinuation or weaning of narcotics
16. Opioids are prescribed and the provider is unwilling to perform drug testing
17. Consideration of alternative complementary medicine for pain relief is not being explored
18. Patient’s functionality is not increasing with use of opioids
19. Provider agreed to a weaning program but is not following through
20. Provider declined a peer-to-peer discussion to address drug utilization recommendations
