The Organization's Guide to achieving full value from Independent Medical Examinations

What constitutes an appropriate IME? When and why to use IMEs? How to select and work with IME health professionals? How do you evaluate an IME's quality and value to your organization? KOHC offers this guide to enhance your understanding of the end-to-end process and the true value you should expect from an IME.

Why use IMEs in the disability management process?
Did you know?
Key Terms for IME
Role of IMEs in disability management
When to use IMEs in the disability management process
Inconsistent or incomplete general information on file
Inconsistent or incomplete medical information on file
Incomplete information for return to work (RTW)
Incomplete information for HR planning
Incomplete information for dispute resolution
Developing effective referral questions and packages
Effective Referrals
Preparing the Referral Letter
Referral Enclosures
Referral Enclosures may include
Key Terms
Employee's informed consent
Selecting the examiners - Screening considerations
Examiner competence - What to ask.
Examiner service responsiveness - What to ask
Examiner reporting standards - What to ask
Associated costs - what to ask?
Choosing Between Specialties (driven by original referral questions)
Clarification of Diagnosis
Assessment of treatment
Return to work (RTW)
Claims adjudication and formal disputes
Clarification of causation
Features of effective reports
Effective IME reports provide.
Quality and value indicators of an IME
Did You Know… ?
  • From 1997 – 2000, absenteeism and overall disability costs increased by 27%, and from 2% to 4.2% of payroll.
  • Canadian employers pay between $11 – 12 billion/year to cover workers’ disabilities.
  • Short-term disability (STD) costs doubled between 1997 – 2000.
  • Without early intervention on STD cases, the costs of Long-term Disability (LTD) TD cases are 50% higher.
(Mercer Report 1999; Watson Wyatt Staying @ Work 2000; Sun Life Report 2001)



Key terms for IME
  • Independent. Completed at arm's length from employer and treating practitioner; examiner has no prior relationship with the individual being assessed.
  • Medical. Not necessarily medical; may include a combination of disciplinary experts, depending upon your referral questions.
  • Examination. Direct assessment, not paper review; may be conducted off-site or at the employment setting.
  • Restrictions. Externally imposed by treating practitioner; linked to specific impairment or disability.
  • Limitations. Internally imposed by individual.




Role of IMEs in disability management
  • To provide information for adjudication of WSIB claims.
  • To provide guidance in managing medical care, disability and rehabilitation.
  • To provide information for compliance with requirements of the claims adjustment process.
  • To serve as a source of expert medical opinions.




Inconsistent or incomplete general information on file. IME to.
  • Distinguish health issues from HR issues influencing absenteeism.
  • Clarify diagnosis and medical status.




Inconsistent or incomplete medical information on file. IME to.
  • Provide rationale for delayed recovery/extended absenteeism.
  • Confirm the appropriateness of current treatment and/or provide recommendations for alternative options.




Incomplete information for return to work (RTW). IME to.
  • Determine fitness for safe return to work.
  • Define disability & level of disability as this relates to job demands, and/or alternative vocational options.
  • Identify objective restrictions and specific accommodation requirements.
  • Develop RTW strategy.




Incomplete information for HR planning. IME to.
  • Plan appropriate benefits stream
  • Estimate length of time off work to determine HR replacement resource needs and costs.




Incomplete information for dispute dispute resolution. IME to.
  • Provide second opinion for the dispute resolution process
  • Confirm impairment and its causal link in the case of workplace injury




Effective Referrals.
  • State clearly the purpose of the referral to establish context for the examiner(s).
  • Frame specific questions focused around the purpose of the referral and specific issues or problems that are unclear or in dispute.
  • Indicate when report is required, how the report will be used and by whom.




Preparing the referral letter
  • Profile of person - work history, employment status, history of absenteeism
  • Narrative description of the case to date
  • Purpose of the referral and specific questions
  • Contact information in the event of further questions
  • Referral Questions
  • Diagnosis
  • Treatment
  • Return to Work
  • Miscellaneous referral enclosures




Referral enclosures
  • Provide the examiner with a solid background and the facts in the cases.
  • Provide context for the opinion requested.
  • Provide primary source documents where appropriate (e.g., test results, surgical notes, radiographic films, medical records from the initial, post-injury
    visit and acute injury period).
  • Grouped by document type to facilitate efficient review.




Referral Enclosures may include:
  • WSIB forms
  • List of incidents
  • Attendance reports
  • Correspondence with treating practitioner
  • Observations of manager
  • Results of previous medical examinations and investigations in chronological order
  • Alternative job types available
  • Job demands analysis




Key Terms
  • Job Description. Role, accountabilities, responsibilities, qualifications.
  • Physical Demands Analysis. Physical requirements of the job.
  • Job Demands Analysis. Detailed description of Analysis; physical, psychological, cognitive and environmental demands.




Employee's informed consent
  • Purpose of IME & benefit to employee
  • Consent to release medical information to IME provider
  • Consent to participate in IME
  • Access to IME report




Examiner competence - What to ask.
  • Examiner qualifications and clinical practice.
  • Experience in health problems and body systems involved in the case.
  • Experience in the delivery of IMEs generally and for employers specifically, including disability determination.




Examiner service responsiveness - What to ask.
  • Access to immediate appointments?
  • Access to additional investigative services?
  • Geographic location of office?
  • Willingness to visit work site?
  • Hours of operation?
  • Accessibility of facility (i.e. disabled accessible, public transit, parking, proximity to work setting)
  • Availability for follow-up consultation?




Examiner reporting standards - What to ask.
  • Report format?
  • Specific to case - not "boilerplate"?
  • Will provide sample report(s)?
  • Will issue addenda if required?




Associated Costs - What to ask
  • Fee structures?
  • No show fee?
  • Follow-up consultation?




Clarification of Diagnosis (Body system and health problems)
  • Musculoskeletal?
  • Neurological?
  • Mental Health & Addictions?
  • Respiratory?
  • Psychological/Neuropsychological?
  • Cardiovascular?
  • Endocrine System?




Assessment of treatment
  • Appropriateness of medical treatment
  • Disability determination (e.g., standardized guides)
  • Examiners with relevant qualifications and clinical practice experience




Return to Work
  • Appropriateness of rehabilitation treatment & RTW strategy?
  • Need for work modifications/accommodations?
  • Other factors influencing delayed recovery?




Claims adjudication and formal disputes
  • Existing opinions to be challenged?
  • Examiner's ability to testify clearly, logically and in an informed manner at a disposition or hearing?




Clarification of Causation
  • Ability to assess work and home exposure to ergonomic factors, chemicals and other sources of work-related problems?
  • Thorough knowledge of evidence linking exposures & adverse health effects?




Effective IME reports provide.
  • Clear and definitive responses to referral questions
  • Clarification of diagnosis
  • Treatment assessment and recommendations
  • Return to work
  • Internally consistent
  • Neutral language
  • Answers readable and understandable by end-user
  • Objective clinical findings
  • Clear and reasonable rationale for conclusions about causation, impairment, prognosis, disability, and current or future work capacity
  • Feasible and practical recommendations that reflect an understanding of the work setting




Quality and value indicators of an IME
The value of the report should not be measured by the number of pages! Value rests in the quality, not the quantity, of the content.
Process
Timely
Responsive
Appropriate
Neutral
Reproducible
Results
Actionable
Effective
Value - ROI