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Independent Medical Exams (IME)

Utilization Review Services - Workers Compensation

Independent Medical Exams (IME)

URAC Accredited Independent Review Organization

Independent Medical Exams are examinations of an injured worker by a doctor that that has not been previously involved in the claim. An opinion is provided based on review of the medical documentation and a physical examination of the patient. The doctor addresses questions as posed by the requesting party.

Overview

Often, the insurance company requests an IME because it disagrees with a decision by the treating doctor about the course of medical treatment that involves surgery or other expensive procedures or the extent of any permanent disability. In some cases, the judge or hearing officer assigned to a case may also order an IME to resolve a disputed issue related to a case.

Example

The rules about IMEs are nuanced  and vary from state to state. When an insurance company requests an IME, it also selects the doctor who will perform the evaluation. SFUR physician panelists are impartial and credentialed under the highest of standards. The physicians  who receive their payment from the insurance companies and often rely on them for referrals may not always be impartial.

IMEs are critical in obtaining a second opinion and the costs which tend to be very competitive pale in comparison to the prevention of unnecessary surgical procedures