Are you getting the most from your IMEs?
An independent medical examination (IME) is a valuable tool to set your claim up for success. However, like all tools, the ultimate value of an IME will depend on how you use it. To get the most value out of an IME, it is important to think critically about: (1) the specialty of the IME doctor(s) needed; and (2) what to include in your IME cover letter.
Choose the right specialty
There are a variety of medical specialties; it is important to match your medical issue with the correct specialty. Orthopedic surgeons, probably the most common specialty, focus on bone and joint problems (e.g., lumbar degenerative disc disease, rotator cuff tear, sprained ankle, etc.). Neurologists treat the brain and nervous system (e.g., thoracic outlet syndrome, strokes, etc.). Physiatrists are a broader specialty who treat pain and movement disorders (e.g., some musculoskeletal disorders, chronic pain conditions, burns, etc.).
There are also specialties within specialties. For example, orthopedic surgeons may specialize in a certain area such as the spine, knees or shoulders. If possible, try to obtain an IME with the correct sub-specialty. If you ever have questions about an IME provider’s specialty, you can look up the provider on the Department’s Find A Medical Examiner tool. You can also ask the IME panel company for a provider’s curriculum vitae and/or a prior report.
Include these elements in your IME cover letter
In general, IME cover letters have three main sections.
1. Introduction: Tell the IME provider about the claim. Note the date of injury, the mechanism of injury, surgeries provided under the claim or outside of the claim, and any medical conditions allowed or segregated via final and binding Washington Department of Labor and Industries or Board of Industrial Insurance Appeals orders. Do not state that a condition is allowed or accepted unless there is a final and binding Department or Board order stating so. Also, be very clear about the purpose of the examination (i.e., allowance, closure, reopening, etc.) because IME providers will focus on different things depending on the purpose of the examination.
2. Medical summary: Include a summary of relevant medical records. Be objective. Emphasize important facts, but do not hide bad facts. We want the IME provider’s opinion to be a truly objective opinion, based on all of the relevant facts.
3. Questions: Include questions relevant to your claim. You will include different questions depending on the purpose of your IME cover letter (i.e., allowance, closure, reopening, etc.). Note that most IME cover letters will include questions on claim-related conditions, medical fixity (including a question on any proposed treatment or surgery recommendations), permanent partial disability, and restrictions, because these issues are generally always relevant.
The attorneys at Reinisch Wilson Weier are here to help if you have any questions on IMEs, including what specialty is the most appropriate for your issue, or how to draft specific questions for an IME cover letter.
For more information about recent enacted IME rules, please review Attorney Shawna Fruin’s blog, “So where are we at with Washington’s new IME rules?”