Checklist For Adjusters

When sending an IME (Independent Medical Evaluation) to a physician specialist, there are some things that you should consider so that your IME is something that will benefit your claim, not hinder it. Well written reports can help get a case resolved in a timely manner. Poorly written IME’s not only waste time because your questions have not been adequately answered but they can cost the employer/insured extra money.

Here is a checklist to follow when sending a physician specialist an IME.

● Make sure you have a complete set of the medical records and all the pertinent x-rays, films, MRIs, CT scans, prior surgical notes, physical therapy notes, and records from outside physicians, etc.. Notify patient to bring imaging to appointment if necessary as well as identification.

● SENDING MEDICAL RECORDS: One sided and no duplicates in date order with the oldest records on top. Depending on the physician office, You may be charged by either the amount of records (per inch, ½ inch) or by the physician's time. Putting records in date order will also help you see if you are missing any records and will also help you to “tell the story” of your claim . It can also help you become more familiar with the case (especially if you inherited the case from another adjuster)

● Make it clear to the physician, what jurisdiction the claim is from. Laws are different in each state. It is important the physician knows the state the injury took place. The physician office will also need the date of injury, claim number and body part.

● Follow the physician office guidelines for IMEs laid out in the IME policy such as any prepayment needed, number of days records/films need to be received by the physician office. Also, make sure the physician office has the patient’s cell number so they can also send an appointment reminder.

● ALWAYS SEND A COVER LETTER and Clearly state the questions you want answered. Number OR or bullet point them. Make sure you include which body part you want the physician to address. Sometimes a patient will come in complaining of multiple body parts and the physician may address those multiple body parts unless otherwise specified. An IME on multiple body parts could increase your costs.

● The day before the appointment, remind the patient as well as the address of the physician office. Many times, the physician will want the patient to arrive 30-45 minutes or prior to the appointment to complete paperwork and get settled. Inform the patient they will need to show their identification at the appointment. If they have an attorney, remind the attorney to remind the patient. If a patient is late or misses an IME appointment, any pre-payment that was paid up front may not be reimbursed. If you still need the IME, you may have to pay for it again.

● If a nurse case manager is involved in the claim, make sure the physician office is aware of this so that they do not see the patient without the knowledge of the nurse case manager. Nurse case managers should bring their business cards to the appointment so that it can be attached to the file and the physician knows you are attending the appointment. Nurses should arrive timely as well.

● Be clear and concise with the questions you want the physician to answer.