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How to select the right IME partner based on types of claims

For insurers and other parties involved in the claims litigation process, Independent Medical Evaluations (IMEs) play a pivotal role. Selecting the right IME can be crucial in reaching a positive outcome for the case.

Published on:
September 7, 2023

For insurers and other parties involved in the claims litigation process, Independent Medical Evaluations (IMEs) play a crucial role. IMEs play a key part in the future of insurance: they are the physicians, psychologists or other medical professionals who make objective medical decisions on a patient’s case. Independent medical evaluations are done by an expert enlisted by the insurance company or involved organization in matters of worker’s compensation, disability, or a personal injury claim. In essence, they’re meant to be an objective third party offering their professional opinion on the patient’s health status or mental state. 

Selecting the right IME can be crucial in reaching a positive outcome for the case. Just like insurance cases, IMEs cover a wide range of medical practices and specializations. With such direct involvement towards the final outcome of a case, finding the right IME firm is crucial. 

IME Categories

For each category of insurable injury or insurance claim, there are IMEs that focus on specific areas of medicine and evaluations. Since the field of medicine is so specialized, IMEs aren’t usually ‘one size fits all’ - instead, they cover off a range of the most common injuries seen across insurance. These include:

Musculoskeletal IMEs: Fractures, joint injuries, or back problems are all common causes for a claim. Even what seems like a minor accident (such as a car hitting a tree at low speed), can cause permanent back pain and damages - which is why settlements for these kinds of injuries range from $10,000-$50,000 per claim. Musculoskeletal specialists understand the intricacies of these kinds of injuries, from the probability of a slipped disc from being sideswiped to a fractured bone. 

Neurology IMEs: Brain and nervous system related injuries make up a large portion of claims requiring IMEs, and 17% of ‘mega claims’ - the claims with the highest payouts. With such specialized advice required, it’s no surprise that neurology IMEs are in high demand. Organizations seeking an IME for a nervous-system or brain related injury need to be able to rely on high quality (and accurate) assessments. 

Psychiatrists and Psychologists: Mental health claims are one of the fastest growing categories in WCB and other insurance fields. This encompasses the assessment of psychological injuries or conditions like PTSD or depression following an accident, as well as existing mental health conditions. 

Rheumatologists, Cardiologists, Pulmonologists, and Others: Heart attacks, conditions like fibromyalgia, or blood clots can also occur after an injury or accident. As you look for the right IME partner at your firm, make sure to find one that has specialists in this area if these are the kinds of cases you might see. More specialized decision-making in one of these fields could be the difference between winning and losing a case. 

Factors in selecting the right IME partner

Choosing the right IME partner will depend on your industry, your claims pool, and your organization itself. Like any kind of professional partner, you’ll need to focus on finding the perfect fit for your business. Here are some factors worth considering:

Specialized medical knowledge

Availability of specialist advice is paramount when selecting the appropriate IME partner. If your firm sees mainly musculoskeletal cases as a result of car accidents, an IME partner that has mostly musculoskeletal specialists would be a good call. Of course, you should also make sure that they (or you) have other resources available if you’re working on a complex neurological claim. With the qualifications and expertise they have,  IME providers are in high demand, and  your firm probably doesn’t want to be seeking out other professionals at the last minute. 

Another factor to consider is the depth and breadth of your claims - as well as the amount of money they cost you out of your claims pool overall. As previously mentioned, neurology claims make up almost a fifth of the ‘mega-claims’. If you think one of these ‘mega claims’ could be headed your way (or something similar in another field, such as cardiology), it’s wise to consider seeking out an IME partner with a good neurologist on board. 

Experience and communication

An excellent neurologist might not necessarily be an excellent medical examiner if they have little to no experience in conducting IMEs. Keep in mind the firm’s level of experience and reputation in the industry: clear communication is critical for a successful IME. The company’s reputation within the industry as an examiner should be established enough for you to feel confident in their ability to deliver a successful report or testimony,  in addition to their ability to provide objective medical opinions. 

Availability and size

For larger organizations, it might be worthwhile to select an IME with not only the capacity for lots of different medical evaluations (such as a large network of medical providers), but also with the accessibility you need. A small firm might have the best pulmonary specialists in the industry - but if you’re an organization seeing a high volume of different kinds of claims, you might enlist a firm with a more general scope for the majority of assessments. 

Finally, you should consider other factors like legal experience (or comfort with appearing in court as a witness), price, and consistency. Like any professional service, the right IME partner is someone that not only meets your needs, but keeps showing up to the task.

Kristen Campbell
Content Writer

Kristen is the co-founder and Director of Content at Skeleton Krew, a B2B marketing agency focused on growth in tech, software, and statups. She has written for a wide variety of companies in the fields of healthcare, banking, and technology. In her spare time, she enjoys writing stories, reading stories, and going on long walks (to think about her stories).

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