6 Steps to Maximize Your Independent Medical Exam (IME)

1. IME Scheduling

It is important to address these key points when scheduling and preparing for the independent medical exam:

• Language preference:  Let the IME company know in advance to arrange for an interpreter, if necessary.
• Body parts involved: Clearly state all body parts that you will be asking about. Communicate any additions as soon as possible to avoid last-minute cancellations.
• Preferred specialty: Specify the preferred medical specialty for the examination. If you are unsure of the specialty needed for a specific condition, ask the schedulers. They are very knowledgeable of the physician's strengths and the conditions they address.
• Multiple claims and special notes: Inform the IME company if multiple claims are involved and provide any special notes. E.g. the claimant being a physician, having mental deficits, a history of being combative, or requiring special accommodations like a wheelchair. 
• Deadlines: Communicate any specific deadlines related to decision dates, hearing dates, or scheduled surgeries.
• Turnaround time and reporting preferences: Clarify any specific turnaround time needed for reports, and whether rush reports or verbals are required because of specific deadlines. Keep in mind that not all doctors have the same turnaround time with their dictation and report.

Upon scheduling, the IME company will typically mail the worker an appointment notice and map of the location two weeks before the IME. A copy is also sent to the adjuster, as well as the attorney if represented.

2. Medical Records

The goal is to avoid unnecessary addendums. Frankly, no one likes them. That is why it is important to minimize this occurrence, particularly due to late records or diagnostics.

• Timeline: Receiving records ideally 10 business days in advance of the exam will help the IME staff organize the records to the physician's specific request to give the physician ample time to prepare for the IME.
• Additional Records: Additional records received less than 1 week before the IME may not be included. It is important to note that some physicians have implemented a cut-off rule, after which they will no longer accept records. Records sent in after the cut-off will potentially need to be treated as a supplemental report.
• Cover Letter: Cover letters should be received at least 5 business days before the independent medical exam. Most providers will not review the medical records without the cover letter.

• Electronic vs. Paper Records: When submitting medical records, it is strongly recommended to opt for electronic submission (email, fax, or online). Secure upload through the website is instantaneous. Traditional mail is not recommended for sending records as this method can significantly prolong the processing timeline.
• The Challenge of Uncertainty: The IME company often operates in the dark, not knowing the quantity or nature of files and diagnostics expected. Understanding the completeness of the provided records is crucial, as it allows for a seamless transfer to the reviewing physician.

3. Cover Letters

A well-written cover letter provides the basis for a strong IME report.

• Conditions: What is being addressed in this IME? Be sure to list all conditions, including accepted, denied, and claimed conditions. The IME provider needs to know what conditions are involved in the claim and what conditions need to be evaluated.
• Intro: Provide a brief summary of the claim.

• Who/What/Why/When/Where: What is the purpose of the independent medical exam (medical management, surgery request, provide closing information, etc)? Do you have any concerns that need to be addressed, such as conflicting histories regarding the mechanism of injury, delay in seeking treatment, treatment for the same conditions before the work event, unwitnessed work injury, or other factors that may be prolonging the recovery?
• Questions: Be specific. "Canned" cover letter questions can be an easy way to get the cover letter done and to the IME company. However, these questions are not appropriate for all claims. Be sure the questions fit the specialty of the IME provider and the claim. Do you want the physician to address any conditions related to the work event or specific conditions? The physicians are trained to answer the questions exactly as posed in your cover letter.
• Panel: When several doctors are seeing the worker separately, you must tailor your cover letter to each provider’s specialty. It is important to indicate what exactly you want each provider to address. This can be done by writing a separate cover letter for each provider, or you can write one cover letter with a subset of questions for each individual provider.

4. The Exam

Exams take place at the IME company's clinic location or the provider's office.  The IME staff will check in the worker and provide intake forms to be completed. The physician evaluates the worker and dictates their report. If a worker no-shows, you will be notified to ask if a file review is preferred or if a reschedule is necessary. All of the necessary information must be included in the cover letter, as the provider will default to that information if the IME company is unable to reach you.

5. Quality Assurance

The QA team goes through an extensive training process to ensure they are familiar with the workers’ compensation system, laws, and rules, and how they apply to each report they review:

• Comparing the report to the medical records: The QA team compares the records against what has been transcribed in the report to ensure the date of service, name of the provider, and the information provided is accurate. This includes spelling and grammar.
• Cover letter questions typed exactly as posed: The cover letter is not the IME company’s document to change and therefore, the questions for the providers will be transcribed into the report exactly as they are posed in the cover letter, typos and all.
• Questions and concerns outlined in the cover letter are addressed completely: Did the IME provider address the questions as posed in their entirety and was the correct injury/OD theory applied to their responses? If not, the IME company will ask the provider to provide additional information or to clarify their responses.
• Contradictions: The IME company will never ask the provider to change their responses but will make sure there are no contradictions. This also applies to panel reports. If there is a contradiction between physicians, the IME company may ask each physician to expand and explain their opinions more extensively.

6. Report Delivery

The final report will be sent to you after going through a rigorous QA process which typically takes 7-10 days, unless a deadline or hearing date was communicated at the time of scheduling. It is the goal of the IME company to provide the highest quality report that addresses each claim completely and appropriately. We encourage you to contact the IME company directly with questions you have regarding a report you have received.

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