Solution

Independent Medical/Psychological Examinations

When an employee is on leave for a physical or behavioral health issue, assessing their condition or recovery status may not be black and white. The employee may have different providers who do not agree on the diagnosis, treatment, or functional capabilities. And sometimes, the motivation of the employee or their claim may be in question. How do claims managers make accurate decisions when they do not necessarily have accurate or complete information?

 

An independent medical examination (IME) can provide the answers you and your claims managers need. The IME, a specialized, formal medical-legal examination, assesses the employee’s level of functioning and provides objective, timely, and thorough information to help you resolve a claim.

 

At R3 Continuum, IMEs are conducted by a member of our extensive nationwide panel of state-licensed and board-certified psychologists, psychiatrists, neuropsychologists, as well as physicians representative of most physical medicine specialties.

 

When should you use an IME?

If you have a difference of opinion between attending providers or peer reviewers on an employee’s functional status, treatment, or prognosis; need clarification on a diagnosis; have concerns about the appropriateness of the treatment plan; or are concerned about an employee’s motivation regarding a claim, an IME can provide much-needed clarity.

 

An IME typically consists of:

 

  • A face-to-face, clinical interview of the employee
  • Review of employee medical records
  • Psychological, neuropsychological, or medical testing, as appropriate
  • Physical examination (physical medicine IMEs) or mental status examinations (behavioral health IMEs)
  • Diagnosis, treatment plan, and estimated time for recovery
  • Clinically supported restrictions and limitations
  • Conferring as needed with treatment providers

 

Clarifying a confusing benefits claim

Mark Lopez typed onto the form, “Regina Goodwin is able to return to work immediately.” Satisfied, he saved the document on his desktop computer. As a claims manager for five years, Mark had seen his share of challenging cases, but this one was particularly difficult. Regina was a 36-year-old lab technician who was out on short-term disability because of panic disorder. The insurance company wanted her evaluated to determine if she required continued disability benefits, as her psychologist indicated the need for additional time on disability leave, while her personal physician suggested she could return to work. Mark had repeatedly asked for more information from both providers to determine if there was common ground, but to no avail.

 

Mark was stymied. He didn’t want to make the wrong decision. Which provider had given the accurate opinion? He knew he didn’t have the medical credentials to decide an employee’s health and work status.

 

Because of the inconsistent opinions, Mark updated his manager on the dilemma. The company contacted R3 Continuum to arrange for Regina to have an independent medical examination. R3 identified a licensed psychologist who practiced near Regina’s home, and the IME was scheduled. The IME consisted of a face-to-face clinical interview, mental status evaluation, and psychometric testing. Based on the information gathered during the IME, the psychologist determined that Regina’s panic disorder was not impairing or significantly interfering with her ability to function and that she had no functional limitations or activity restrictions.  

 

Before the IME, Mark wasn’t sure how to proceed with the claim. But after reading the clear and detailed report, he felt confident in making a fair and accurate decision.

 

A commitment to quality

R3 Continuum provides clear and concise statements of medical opinion—determinations that are supported by sound clinical rationale and can withstand vigorous scrutiny in court should a claim be litigated.

 

When you have a claim that needs an objective, expert opinion, an R3 independent medical examination can help you make a confident, informed claims determination.

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