Provider Comp Network

An IME is utilized for determination of issues such as;

Diagnosis
Prognosis
Causal relationship
Appropriateness of treatment
Necessity of treatment
Maximum medical improvement
Impairment ratings
Ability to return to work
Transitional work ability
Work restrictions and limitations
Mechanism of injury
Pre-existing conditions
Additional allowances
Handicap conditions
Permanent total disability
Temporary total disability
Assessment of prescribed medications
Use of drugs or alcohol
Determination of liability
Discovery of evidence
Evaluation of treatment

What is an IME?

An IME is a medical examination conducted by a physician or other medical specialist in response to a request for benefits, address medical determinations, evaluate and measure physical ability or to address legal questions. In addition, IMEs are performed to provide information for case management and as evidence to be used at hearings and other legal proceedings. IMEs are an invaluable resource in the decision making process on how to proceed with the medical case management process and understanding the medical facts of the claim and the necessity of on-going treatment.

Initial IME Examinations

IMEs are performed by an expert physician trained to understand work-related injuries and the workers’ compensation system.

The exam provides a solid medical basis from which to approve and/or deny a claim.

An IME may be used to identify any of the possible 25 handicap diagnostic codes allowed by the Ohio BWC.

The exam can define and expedite better care for the injured worker.

IMEs can identify fraudulent claims before they get started.

The exam may determine inappropriate and redundant allowances in a claim.

An IME may result in substantial savings in medical and compensation costs.

The exam provides independent documentation of legitimate work injuries.

IMEs serve as a valuable reference and protect the employer from future liability by establishing early medical documentation of the correct allowances and prognoses.

Examples of Issues to be Determined:

90 Day Medical Examinations (SDES)

The 90 day examinations (SDES) are required by statute and are conducted when an injured worker has received 90 consecutive days of temporary total disability. The exam addresses a number of issues, including continuing compensation, return-to-work issues and necessity of treatment. 90 Day exams are conducted by BWC and may be requested by the employer. A qualified physician performs the SDES. The SDES features are similar to the IME, with the addition of the review of medical files pertinent to the claim. The SDES is a more detailed, comprehensive examination, primarily used to establish if an injured worker has reached Maximum Medical Improvement (MMI). MMI is a treatment plateau that is static or well stabilized, at which no fundamental functional or physiological change can be expected within reasonable medical probability regardless of continuing medical or rehabilitation procedures.

IMEs are performed by an expert physician trained to understand work-related injuries and the workers’ compensation system.

A 90 Day exam can expedite the resolution of the claim.

The exam reduces the use of unnecessary tests and treatments, thus reducing costs.

A 90 Day exam can identify and eliminate fraudulent claims.

The exam can stop inappropriate and unnecessary disability payments.

The exam may prevent additional allowances of a claim.

A 90 Day exam can result in recommendations for more effective treatments for worker injuries.

Medical Functional Capacity Evaluations (FCE)

The Medical FCE report is “a unique product offered by PCN”. The Medical FCE is an objective, interdisciplinary assessment of:

Functional capacities (ability to move)
Medical recovery status
Readiness for return to transitional or full duty work
Symptom magnification or fraud
Appropriateness of ongoing treatment for allowed condition(s)

The Medical FCE is a cost-effective, unique tool in the occupational and non-occupational disability marketplace. In one comprehensive report, the employer profits from the expertise of an experienced disability consultant with the objective determination of functional capacity by an experienced therapist and ergonomist.

Physician File Reviews

The physician file review consists of a comprehensive review of medical documents submitted to the physician for review and assists employers, and/or their representatives, with an evaluation of any medical and/or compensation issues that may arise during the management of an occupational claim, including fraud, treatment issues, disability questions and/or inappropriate pharmaceutical use.

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