Independent Medical Evaluations (IME) are routinely ordered whenever questions arise in medical claims. Over the years, in many circles, IMEs have lost their ability to impact the course of a claim. The IME report has gone from a valuable asset into little more than a negotiation tool for settlement purposes only because of the way they are conducted. This has contributed in part to the average dollar value of claims rising, in spite of claim severity declining!
Where traditional IMEs have lost credibility:
- Doc in a Box patient processing – often 15-25 patients are seen per day, per examiner, averaging 20 minutes or less per evaluation.
- Poor preparation of the expert by the IME vendor. Incomplete data gathering, poor documentation, lack of access to records by examiners prior to seeing the patient.
- Lack of understanding – examiners often aren’t familiar with the different types of insurance claims and as a result ask the wrong questions of the claimant during the IME. Some medical experts are expected to evaluate conditions and illnesses for which they are not trained or have little to no experience diagnosing and treating.
- Clear the desk mentality – examiners with high caseloads simply do not have the time to review every case, yet are expected to stay on top of the claims.
As a result, IME’s are too often ordered without clear purpose, and are used more as a way to get a general overview of the case, which renders the value of the IME to nearly useless. With good preparation, an IME can be turned into a valuable asset for properly managing the claim.
This is why TPN offers pre-screening! The TPN Model:
Our objective is and always has been to add value. We believe that it is more important to be complete, accurate and thorough, even if that means that it takes a little longer or costs a little more than our competitors, rather than to provide a report that is of little or no value, or one that may actually hinder our client’s ability to properly adjust the claim in a timely manner.
The TPN Difference:
- We work with our client to select the right service and the best medical expert for the service, based upon many factors.
- We assist you with preparing the pertinent documentation for the expert.
- We view thorough history-taking as vital to the evaluation of a claimant, which most often requires more than a 10 minute “doc-in-box” exam.
- We ensure that the expert knows and thoroughly understands the type of coverage involved and the State of Loss to which it pertains.
- We ensure that the expert has all of the documents well in advance of the examination allowing for proper preparation.
As a result, our methodology often uncovers pre-existing medical conditions, discovers subsequent accidents, and obtains the names of medical care providers previously unknown to the claims professional, to name a few deciding factors that can dramatically affect the value of the IME report.
Still not sure what service is appropriate for your claim?
Fill out the Pre-Service Consultation form below or call TPN toll-free at 800-777-6160.
Just send us a quick synopsis of the case and a member of our staff will contact you shortly.