9 Mistakes to Avoid when Preparing an Independent Medical Evaluation Report

9 Mistakes to Avoid when Preparing an Independent Medical Evaluation Report

An independent medical exam report is a medical-legal report required by insurance companies or third-party administrators looking to resolve workers’ compensation and personal injury claim disputes. Among the various issues and disputes related to a claim are: determination of return-to-work restrictions, injury ratings, establishing causation, whether maximum medical improvement has been attained, and whether the treatment provided has been appropriate.

An independent medical exam must be truly independent and totally unbiased if it is to serve its purpose. For this, the independent medical examiner must be well-qualified and experienced; medical record review provided for the examiner must also be thorough, professional and objective, which is ensured by a provider of dedicated medical record review services. The reports prepared are read and utilized by judges, plaintiff and defense attorneys and hearing officers to determine and settle various claims. The physician preparing the report is often called to attend hearings, depositions, and trials to justify and support what they have written.

Independent medical exams can act as a great claims management tool in the present healthcare scenario which is witnessing an increasing number of questionable workers compensation claims. The National Insurance Crime Bureau conducted a study in 2013, which revealed that the number of questionable workers’ compensation claims increased by 28% in 2012 even though the overall claim numbers have fallen. It is believed that filing of claims based on earlier injuries unrelated to the workplace, increase of claimant fraud, and malingering are the main reasons for the increase in the number of disputed claims.

Considering the huge significance of the independent medical evaluation (IME) report, it is important for physicians to avoid costly mistakes when preparing their reports. Here we look at some of the common mistakes that reduce the value of an IME report.

1 Providing opinions that are beyond their area of expertise -- Physicians sometimes give opinions in areas with which they may not be very familiar. They sometimes use terminology including legal terms with which they may not be very conversant. The best way to avoid this is to confine themselves to their particular area of expertise. The reports must be checked for terminology that they are unable to define.

2 Failing to list the medical records they reviewed -- Physicians should have a clear idea regarding the medical records they did/did not review. This problem can be avoided with the support of medical record review services that will organize and index the medical records and prepare a definitive list of the records reviewed.

3 Providing no specific answers to the questions asked – Physicians sometimes stray from the actual requirements expected of them. They must check and recheck their report to ensure that they have answered all the questions put forth by the referring client, and that only those details are included in the report.

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Failing to document the findings of the physical examination – This is a serious issue. Physicians need to make sure that their report contains details of all the tests performed and all the findings.

5 Failing to document an accurate history – This will result in confusion and the physician may be required to answer many questions regarding the incorrect or insufficient history during hearing, deposition, and trial. To prevent this issue from having a negative impact on the physician’s opinions, physicians must take care to include a detailed, accurate history in their IME report.

6 Inadequate wording – An IME report that falls short of appropriate wording becomes practically useless. The opinion expressed must be in a legally sufficient and justifiable manner. Physicians should be knowledgeable in legal terminology they can use to express their opinions that are either based upon a reasonable degree of medical certainty, or upon a reasonable degree of medical probability.

7 Improper formatting – This again is a real issue because lack of proper formatting will create a report that is difficult to read, and of little value.

Topic headings, short, clear paragraphs and font size that is easy-to-read can be used to avoid this problem.

8 Not proofreading the report – Mistakes in the report reduce its value and throw doubt on the efficiency and reliability of the examiner and his/her opinions. It is vital to proofread the report and correct mistakes such as wrong spellings, errors in grammar, and transcription errors if any.

9 Lack of persuasive, powerful language – If the language of the report is not powerful enough and contains a lot of evasive terminology such as “I think,” “It appears,” “seemingly” and so on, it lessens the force of their findings and opinions. Physicians should use language that can have a powerful impact and persuade those listening to the report to believe what they are saying.

As mentioned earlier, independent medical examiners can have a thorough understanding of the case in hand and an accurate medical case summary by utilizing medical record review services from a reliable provider. Professional medical record reviewers will review all available medical records and analyze the actual medical events and care provided. They can get the records sorted, indexed and categorized appropriately. The information from the records is extracted to the required level of detail, and it is reviewed for accuracy, completeness and compliance. They can also develop a detailed chronology and timeline of the events. With all the required medical information in hand, the independent medical examiner can focus on and put all effort in preparing a highly reliable, flawless medical report.

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