Independent Ladies

Many disability and workers compensation insurance payers have used independent medical examinations (IMEs) for years to make payment determinations about disability and workers compensation claims. Yet many payers today are finding that a more effective alternative is to use an independent medical review from an IRO.

Why this shift? An independent medical examination isn’t as objective and unbiased as you might believe. When an IME is performed, the patient has an opportunity to convey their own personal viewpoint on what ails them to the doctor or doctors. Doctors are in the business of being apathetic with their patients and may a patient’s claims at face value without necessarily looking at the medical facts. When a patient says, "My back hurts and I can’t stand up straight," the doctor might not substantiate this through an examination. So if the patient does a good job of faking an illness or an ailment, it's very easy for the doctor to concur with what the patient says.

An independent medical review, on the other hand, allows an objective review of the medical chart notes to arrive at a decision based only on the evidence present without being prejudiced by a patient’s comments.

Independent medical reviews are also excellent alternatives to independent medical examinations when disability and workers compensation insurance carriers need to adjudicate claims quickly. When a person files a claim, the carrier is obligated to start paying benefits immediately… but oftentimes it can take several weeks, if not months, to arrange for an independent medical examinations. An independent medical review can be sent out immediately and turned around in a matter of three to seven business days instead of the three to four weeks it takes to schedule an independent medical exam. The speed of independent medical reviews means that the insurance payer can save weeks and weeks of not paying premiums if a patient is not eligible for coverage on the basis of medical necessity.

So, an independent medical review can help adjudicate claims more quickly and cost effectively, as well as save the disability and workers comp carrier significant premiums for falsified claims. That’s why it makes sense for disability and workers comp carriers and payers to use an independent medical review as an alternative to IMEs.