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Moore: Recommended Paragraph for IME Cover Letter

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One of the most confusing parts of the IME cover letter is what information to request from the independent medical examiner.

James Moore

James Moore

I have seen many claims managers, supervisors and adjusters just crank out their system’s IME cover letter that often leads to having to call the physician’s office (sometimes not allowed) or write a follow-up letter. Nothing makes an IME physician more frustrated than having to write another opinion letter.

You have to stop and ask yourself if there any extra items you want the physician to cover. One of the best ways is to use a familiar IME physician, but then again, the workers' comp courts do not like to see a physician repeatedly on your files.

Easy way to find an IME physician

One easy way for assistance is to ask the rehabilitation nurse assigned to the file for recommendations. You do have a rehab nurse assigned to the file, right? 

Unless it is for a permanency rating, assigning a field case manager usually saves 6-to-1 over the amount that you spent over the life of a file. Check with your supervisor/manager on your company’s internal rules on assigning rehab nurses.

As an example, in a group of files I am reviewing, an adjuster resigned and the supervisor took over the files. One thing he/she did immediately was to assign case managers to all files where the injured employee was going to be out of work for more than 30 days.

Sometimes, the rehab nurses/field case managers can assist with the letter. Why? Because they are familiar with the nurses who work in the IME doctor's office. That's my secret to you. 

IME cover letter paragraph

I usually use:

Please forward your opinion on (xxxxx).

Please also include your opinion on the history, diagnosis, prognosis, treatment plan, length and degree of disability, light-duty work recommendations and any other important medical findings.   

Why would you ask these terms?

  • History: Sometimes you may find out a different history of the accident, or having the injured employee explain the past events in the claim can help your assessment.
  • Diagnosis: Current health status.
  • Prognosis: What the future looks like for the injury.
  • Treatment plan: Agreement or disagreement with the current treatment plan, including future surgery.
  • Important medical findings: This leaves open any medical info the IME physician wants you to know from the examination.

One very important matter is that you copy the attorney who represents the claimant.  Not copying the attorney is showing a lack of common courtesy that can affect resolving the claim later.

IME cover letter might be dictated by state

Your cover letter should follow the 3-3-3 rule that I invented, taught and copyrighted for workers' comp letters, phone calls, emails, etc. Always keep the 3-3-3 rule in mind.

Check your state laws on any requirements of an IME cover letter. Some states have a form to send to the IME physician. I have included the above same clause on the form.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

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