A Coalition of Independent Medical Exam Providers and Panels
Our Successes Include
Ensuring the new credentialing rules include provider qualifications that emphasize experience and knowledge -- not just active practice​
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Increasing communications between the Department of Labor & Industries and the independent medical exam provider community -- including regular meetings to discuss administrative issues.
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A voice and visibility at meetings of L&I regulatory advisory committee meetings such as the Workers' Compensation Advisory Committee and the IME Business/Labor Advisory Panel.
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Monitoring of new regulations and laws that impact independent medical exams and providing input to mitigate negative impacts.
Independent Medical Exams (IMEs) are an integral part of the workers’ compensation system in Washington state. They are an objective, independent, third party review that may be used for the following:
To establish a diagnoses or clarify a controversial or ill-defined diagnosis.
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To outline a treatment program if progress is slow, treatment is controversial or has been going on for an extended period of time.
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To examine and evaluate the conditions related to the injury or disease.
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To determine whether an industrial injury or occupational disease has worsened or has worsened a pre-existing condition -- and the degree of the worsening.
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To establish when the injury or disease has reached maximum medical improvement.
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To rate any impairment based on loss of bodily function, or rate the extent of total impairment if maximum medical improvement has been reached.
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To determine the workers’ ability to return to work after an injury (performing physical evaluations and reviewing job analyses).
Doctors and providers who perform IMEs must maintain a current license to practice in Washington state. They must either have board certification in their specialty or have an active practice involving direct patient care outside of IMEs.
The specificity of what is being reviewed during an IME means that the doctors and providers who perform them must be well-versed in how to do the necessary activities. This requires extra training and knowledge beyond that of the standard practicing physician. IMEs are a specialty by themselves.
Doctors and providers can either contract with the Department of Labor & Industries or the self-insured employer directly or they can work through a panel company. The panel companies help coordinate panels, do scheduling and provide administrative assistance to the doctor, the self-insured employer or the Department. They also provide locations for IME exams and help coordinate many aspects of the process – including report review and record review to ensure the doctors have the right information for the exam and the report coming back is a quality report. Fees are capped and represent a very small portion of the total dollars being spent in the workers’ compensation system.
What are IMEs?
The Benefits of IMEs
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The goal for all IME providers and companies in the workers’ compensation system is to first ensure that injured workers are receiving best care possible. IME providers are medical providers first and patient care is paramount.
IME providers and panel companies see outstanding value to workers, the Department, and employers in the IME process. In the survey, the IME providers and panel companies all emphasized that their main goal is to ensure the injured worker gets the best care possible – they are, first, medical providers and patient care is paramount.
For workers, the IME provides clear identification of the injury, assesses the impairment and validates treatment options provided to date. An IME can also be beneficial in identifying more appropriate treatments to stabilize, or resolve, work-related injuries. In many cases, an IME serves as a “critical second opinion” protecting patients from missed diagnoses, incomplete diagnoses or erroneous care. Ensuring that the proper treatment and care is provided is vital to returning the worker to work, or otherwise resolving the claim in a beneficial manner for the injured person – and occasionally, even saving a life.
For employers, an efficient and effective IME process that better evaluates treatment and care can be important to returning a worker to the workforce who has been properly treated and is ready to work. In addition, an IME can help verify the injured worker is taking the appropriate steps to recover from the work-related injury or disease to minimize impact on the time loss costs. IMEs can reduce over-utilization of the system which reduces the cost of a case –thus reducing premiums.
The Department benefits from the IME process in that it can help ensure injured workers are receiving the appropriate treatment and assist with cost containment. By ensuring that there is the ability for quality, objective IME reviews, the Department should be able to reduce the number of appeals which reduces administrative costs.
The work of the panel companies also helps reduce the Department’s administrative burden through their work with identifying providers, scheduling exams and helping to ensure quality reports. Doctors who specialize in IMEs are not only more efficient but far better educated on how to rate impairments and analyze worker treatment objectively. Of all the “stakeholders” in the process, they have the smallest financial stake of all. Their voice is not only the most objective, but the least financially interested.