Wong and Hannon: Are You Getting the Most From Your IMEs?

Wednesday, June 23, 2021 | 0

An independent medical examination is a valuable tool to set your claim up for success. However, like all tools, the ultimate value of an IME will depend on how you use it.

Mary Hannon

To get the most value out of an IME, it is important to think critically about the specialty of the IME doctor(s) needed and what to include in your IME cover letter.

Choose the right specialty

There are a variety of medical specialties. It is important to match your medical issue with the correct specialty. Orthopedic surgeons, probably the most common specialists, focus on bone and joint problems (e.g., lumbar degenerative disc disease, rotator cuff tear, sprained ankle, etc.).

Neurologists treat the brain and nervous system (e.g., thoracic outlet syndrome, strokes, etc.).

Physiatrists are in a broader specialty and treat pain and movement disorders (e.g., some musculoskeletal disorders, chronic pain conditions, burns, etc.).

Sara Wong

There are also specialties within specialties. For example, orthopedic surgeons may specialize in a certain area such as the spine, knees or shoulders.

If possible, try to obtain an IME with the correct sub-specialty. If you ever have questions about an IME provider’s specialty, you can look up the provider on the Department of Labor and Industries' Find a Medical Examiner tool. You can also ask the IME panel company for a provider’s curriculum vitae and/or a prior report.

Include these elements in your IME cover letter

In general, IME cover letters have three main sections.

• Introduction: Tell the IME provider about the claim. Note the date of injury, the mechanism of injury, surgeries provided under the claim or outside of the claim, and any medical conditions allowed or segregated via final and binding L&I or Board of Industrial Insurance Appeals orders. Do not state that a condition is allowed or accepted unless there is a final and binding department or board order stating so. Also, be very clear about the purpose of the examination (i.e., allowance, closure, reopening, etc.) because IME providers will focus on different things depending on the purpose of the examination.
• Medical summary: Include a summary of relevant medical records. Be objective. Emphasize important facts, but do not hide bad facts. We want the IME provider’s opinion to be truly objective, based on all of the relevant facts.
• Questions: Include questions relevant to your claim. You will include different questions depending on the purpose of your IME cover letter (i.e., allowance, closure, reopening, etc.). Note that most IME cover letters will include questions on claim-related conditions, medical fixity (including a question on any proposed treatment or surgery recommendations), permanent partial disability, and restrictions, because these issues are generally always relevant.

Mary Hannon and Sara Wong are litigation attorneys in Reinisch Wilson Weier PC's Washington practice group for workers’ compensation defense. This column is republished with permission from the firm's website.