December 15, 2017

Quality IME: A Vital Claims Management Tool

When a complex injury case is in dispute, an Independent Medical Examination (IME) has long been the tool in our claims management arsenal to bring about resolution. IMEs help resolve a number of issues. They can assist in determining if the claimant’s condition was caused by the workplace incident; if a recommended course of treatment is appropriate, or whether an injured employee has reached maximum medical improvement—as well as other medical and claims-related concerns.

In recent times, however, the industry has become suspicious of IMEs. Are they truly objective or are they simply ordered to support both sides of a case? Do they waste time and resources in the claims process? Or can they provide sound guidance?

Experts from Genex Services—Michael Valasek and Steffen Nelson—reviewed the latest developments in the IME market and authored a thought leadership article outlining the key challenges surrounding IMEs—and presented best practices on how to establish a quality IME process.

Key Ingredients for Quality IMEs
In this Genex article, objectivity and medical expertise are distinguished as critical factors. When an IME is needed, it’s not as simple as calling on a physician from an insurer’s regular staple of providers. Most of these physicians are skilled at providing care, but not experienced in performing these specialized types of exams. Claims professionals can spend significant time trying to identify the right expert on their own, and still not end up with a quality, objective report.

Enter the IME company.

These service providers are skilled at connecting organizations and their injured workers to the best, most qualified IME physicians. In recent years, the demand for quality IMEs has prompted the industry to further evolve. In the past, IMEs were ordered in a highly fragmented market, populated with a significant number of small, unsophisticated players. Today, with pressure to meet jurisdictional requirements and new standards, consolidation has occurred, enabling cutting-edge IME companies to emerge.

To ensure a quality approach, insurance companies must choose IME vendors carefully. Delays in the IME process can result in added costs and stalled treatment. Injured worker may not receive the care they need as promptly as possible. As such, insurers should select best-in-class IME companies that have national geographic reach, a breadth of medical expertise, clinical coordination, quality assurance processes, efficient workflows and advanced technology platforms. This unique blend of benefits enable an IME company to promptly schedule an appointment and obtain a prompt, quality result.

Most importantly, a sophisticated IME company, like Genex, has relationships with a broad pool of medical experts. It evaluates and credentials these physicians to make sure that they’re skilled at performing IMEs. It has fostered relationships with these providers, so it’s familiar with their areas of specialty, board certifications, and expertise on specific body parts.

It has also established systems and processes that enable it to work efficiently with the claims and provider communities. Its clinical coordinators help to organize medical records and identify the items that should specifically be reviewed and considered by the examining physician. The final IME report is vetted through a clinically-focused process to ensure a quality end-result.

As we look to the future of IMEs, changing jurisdictional requirements and an ongoing demand for quality will continue to drive change. The most successful companies have adapted to meet today’s most stringent standards.

Read Genex’s thought leadership article to ensure you have all the right components for a quality IME process—which will ultimately help your injured workers get the care they need to recover and return to work.

 
Partner Post:
This is a sponsored post from WorkCompWire marketing partner Genex Services.

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