What You Wanted to Know About IMEs, But Have Been Too Busy to Ask!
April 15, 2025 - Posted on WorkCompWire Leaders Speak
By, Randy McKinney, SVP of IME and Peer Review Operations, Emperion
Independent Medical Examinations (IMEs) play a pivotal role in the realm of claims processing, serving as a helpful tool for claims professionals to assess the validity and extent of an injury or illness claim. When done right, these examinations are conducted by unbiased medical professionals who provide an objective evaluation, ensuring that all parties involved in a claim have access to an impartial medical opinion. IMEs can help mitigate fraudulent claims and ensure that compensation is granted based on evidence-based medical assessments.
In the intricate world of claims management, understanding the role and significance of IMEs is indispensable. They offer claims professionals a comprehensive overview of the claimant’s medical condition, thereby assisting in making informed decisions. By providing an external viewpoint, IMEs help validate the existing medical findings or offer new insights that could influence the outcome of a claim. For claims professionals, leveraging IMEs effectively can lead to more accurate and fair resolutions, ultimately contributing to the integrity of the claims process.
Why a Comprehensive Review of Medical Records Matters
One of the foundational elements of an IME is the thorough review of medical records. This step is crucial as it sets the stage for the entire examination process. Claims professionals should ensure that the IME partner is furnished with all pertinent background information, including accident reports, complete medical histories, and chronological documentation of any injuries or treatments.
Typically, the documents provided by the claims professional are not organized in any particular fashion, which is where the IME partner should play a supportive role. For the IME to be truly effective, it is essential that the IME provider receives meticulously organized medical records from the IME partner coordinating and scheduling the examination. This sorting and organizing ensures that the documentation is chronological and indexed for ease of review including all relevant historical medical data that might provide context to the current condition.
Ensuring that the medical records are complete and accurate can significantly impact the outcome of the IME, as they form the basis for the physician’s evaluation. Proper documentation and clear communication of accepted conditions and disputed elements are paramount for a successful IME process. Last, but not least, a thorough list of the questions to be answered is critical. This will ensure you get the right answers, the first time, and should help you avoid having to go back and request more information – which takes additional time.
Should I Send the Diagnostic Testing Results?
Diagnostic tests are a critical component of the IME process, providing concrete data that can substantiate or refute a claimant’s reported conditions. These tests, ranging from MRIs and CT scans to more specific evaluations like pulmonary function or hearing tests, offer tangible evidence of the claimant’s health status. For claims professionals, ensuring that all relevant diagnostic tests are included in the IME package is vital to obtaining an accurate assessment.
The inclusion of diagnostic tests enables the IME physician to make informed comparisons between pre- and post-injury conditions. For instance, in cases where respiratory issues are claimed, pulmonary tests can highlight any changes in lung function. Similarly, baseline and current hearing tests can show the impact of a noisy work environment on a claimant’s hearing. By providing these diagnostics, claims professionals help facilitate a thorough and precise evaluation, which is essential for determining the legitimacy and extent of a claim.
Be Crystal Clear about the Compensable or Questionable Conditions
Determining which conditions are accepted by the workers’ compensation insurer is a critical aspect of the IME process. Claims professionals must clearly communicate the conditions that have been accepted and those that remain in dispute. By clearly indicating which conditions are under review, claims professionals can help streamline the IME process, avoiding unnecessary examinations and focusing on the most pertinent health issues. This targeted approach not only saves time and resources but also enhances the accuracy of the IME’s conclusions.
Come back next week to better understand what to look for in an IME partner and how to identify best practices when you need an IME.
About Randy McKinney
Randy McKinney is senior vice president of IME and Peer Review Operations, where his duties include overseeing Emperion’s nationwide independent medical exam and peer review programs for workers’ compensation, auto and disability payers. He is also responsible for the organization’s Independent Review Organization (IRO) for health care payers nationally.
McKinney began his journey with Genex in 1996 and has broad industry experience earned through his increasing responsibilities. His strong competencies exhibited as area sales manager, regional account executive, and regional manager serve as an excellent foundation. Genex IME became Emperion in April 2024 allowing the company to dedicate the resources and attention necessary to deliver the highest quality services in this specific sector.
Before serving in his current position, McKinney was southeast region vice president, where he incorporated a best-practice approach to yield superior medical and financial outcomes in telephonic and field case management. McKinney holds a bachelor’s degree in finance from the University of Oklahoma.
About Emperion
Emperion is a national provider of outsourced clinical review services including Independent Medical Examination (IME), Peer Review (PR), and Independent Review Organization (IRO) solutions. The company manages a national network of approximately 25,000 providers across a broad range of medical specialties. These capabilities promote patient recovery, return to employment, and successful claim outcomes across Workers’ Compensation, Automobile, Disability, and Health benefit systems.
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