Selecting the Right Doctor for Independent Medical Evaluations

One of the most important parts of the Independent Medical Evaluation (IME) process is selecting the right IME physician. On the surface, this does not appear to be a difficult task. Most will simply pick an appropriate specialty, ensure a doctor is board certified, and then narrow their choice by geography. A claims adjuster, case manager, or attorney will incorporate any feedback they’ve gotten from others on the doctor [their perceived reputation] into their decision making process.

Unfortunately, this standard approach does not address many components of the IME process that should impact your decision. Relying solely on the reputation of a doctor does not translate into quick scheduling, quick turnaround of the report, or a medical opinion expressed in a way that meets the requirements of a defense attorney, arbitrator, or commissioner.

For many workers’ compensation claims, picking the right specialty is relatively straightforward, as is limiting the search based on geography. This article will address the more overlooked steps of the IME doctor selection process – after specialty and geography have been identified.

Referrals

While past performance is no guarantee of future performance, obtaining referrals is an essential part of the process. Speaking to others about their experience with a doctor can provide insight into the quality of both the medical opinion provided by a specific physician as well as how efficiently that opinion was obtained. Understand that there is very rarely a consensus on any individual physician, so soliciting referrals from multiple sources is recommended. Look to your colleagues, attorneys, physicians, as well as IME vendors for insight and suggestions.

Also, please understand that each adjuster, case manager, and attorney tends to have different criteria they use to evaluate an IME doctor. Simply because a colleague recommends a particular doctor does not mean that doctor will meet your criteria. As a result, there are several additional steps you must take to ensure the right selection.

Initial Contact

Once several options have been identified, those doctors should be contacted to solicit additional information. It is important to determine:

1)   What experience does the doctor have with IMEs? Do they understand the Illinois Workers’ Compensation system?

2)   What do they charge for IMEs? Do they require prepayment of that fee? What if the exam is cancelled or the claimant does not show? What if an addendum needs to be requested or deposition scheduled?

3)   How far out do they typically schedule?

4)   How far in advance do they require the medical records? What happens if they do not receive them in time? Will they cancel the exam [with a fee] or address the records in an addendum?

5)   Will they issue a quick report within 24-hours of the exam?

6)   How long after the exam do they dictate their report? How long does it take to have it transcribed, reviewed, signed, and sent out?

7)   Does the doctor have any upcoming vacations or time out of the office scheduled that could impact the time it takes to issue their report?

While most are primarily interested in the quality of both the IME physician and his/her medical opinions – cost does play an important role for many. Selecting an IME physician based solely on the flat fee he/she charges for an IME without considering all of these other factors is short sighted as they can all have a dramatic impact on the overall cost of the IME.

Credentials

A physician’s curriculum vitae (CV) can provide some insight into how appropriate a specific IME doctor is for a case. Keeping in mind that a physician’s background can play an important role in litigated claims, reviewing their educational background, additional training, and areas of interest [via published work and speaking engagements] is vital.

While it may be rare to come across a physician that does not have an active medical license, it is worth the few seconds it takes to request a copy from his/her office or to search for it online.

Another often-overlooked step is requesting proof of a doctor’s liability insurance. This also helps to shed light on whether a doctor is actively practicing medicine. A doctor that is retired [from seeing patients] and who derives the bulk of their income from medical-legal work may not carry malpractice insurance. Requesting a doctor’s proof of liability insurance will help to indentify who those doctors are.

Sample Report

Doctors do not receive formal training on IMEs. The format and quality of reports, as a result, vary a great deal. A physician may have an excellent reputation. He/she may be a skilled surgeon. They may be an excellent communicator and very knowledgeable. However, none of that may translate properly into their IME reports. The only way to truly evaluate the quality of their IME reports is to request and review sample reports.

In reviewing the sample, it’s important to note:

1)   Is the report definitive? Is the language the doctor used strong? Or does it leave you wondering how confident the doctor was in their opinion?

2)   Is the report medically sound? If you have the medical background necessary to evaluate the report – does what the doctor writes make sense?

3)   Is the report thorough and well explained? Are all the questions answered adequately? Are the opinions well supported? Could someone with little or no medical background read the report and understand it? Does it leave you asking more questions?

4)   Are there unnecessary typos and grammatical errors? Does it appear that the report may not have been reviewed closely prior to being finalized?

Interview

If possible, the doctor should also be interviewed. In person is preferred, however, over the phone is acceptable. This interview will provide a great deal of insight. You will get a feel for how they might depose should the case go that direction. Their willingness to speak to you will highlight how responsive and easy to work with they are (or aren’t). You can also use this as an opportunity to present them with a scenario to gauge their understanding of Illinois Workers’ Compensation as well as determine their approach to workers’ compensation injuries (both from treating and IME standpoint).

While this process might seem time consuming, it is essential when working with an IME doctor you have limited experience [or no experience] working with. You may be unable to complete each part of the process, based on the physician’s willingness to participate, however, attempting to gather all of this information will dramatically reduce the risk and cost associated with the IME.

If time constraints make this process impossible, there are service providers that can assist you. You must first determine what value acquiring higher quality opinions from better doctors more quickly means for your employer or client. If you need any assistance performing an audit of your IME process to determine what savings may be available when implementing this process, please contact Chris Rocks at Woodlake Medical.

About the Author

Chris Rocks currently oversees physician recruiting, business development, and client service in Illinois, Missouri, and Iowa for Woodlake Medical.  Prior to joining Woodlake, Chris spent 12 years in the technology and financial services sectors in an executive level capacity with a focus on sales, marketing, and client service.  Chris’s mission is to partner with physicians and physicians’ staffs to deliver highly efficient IME services that result in definitive, medically sound IME reports.