The Organization's Guide to achieving full value
from Independent Medical Examinations

Did you know?
Key Terms for IME
Role of IMEs in disability management

Inconsistent or incomplete general information on file
Inconsistent or incomplete medical information on file
Incomplete information for return to work (RTW)
Incomplete information for HR planning
Incomplete information for dispute resolution

Effective Referrals
Preparing the Referral Letter
Referral Enclosures
Referral Enclosures may include
Key Terms
Employee's informed consent

Examiner competence - What to ask.
Examiner service responsiveness - What to ask
Examiner reporting standards - What to ask
Associated costs - what to ask?

Clarification of Diagnosis
Assessment of treatment
Return to work (RTW)
Claims adjudication and formal disputes
Clarification of causation

Effective IME reports provide.
Quality and value indicators of an IME

• From 1997 – 2000, absenteeism and overall disability costs increased by 27%, and from 2% to 4.2% of payroll.
• Canadian employers pay between $11 – 12 billion/year to cover workers’ disabilities.
• Short-term disability (STD) costs doubled between 1997 – 2000.
• Without early intervention on STD cases, the costs of Long-term Disability (LTD) TD cases are 50% higher.

• Independent. Completed at arm's length from employer and treating practitioner; examiner has no prior relationship with the individual being assessed.
• Medical. Not necessarily medical; may include a combination of disciplinary experts, depending upon your referral questions.
• Examination. Direct assessment, not paper review; may be conducted off-site or at the employment setting.
• Restrictions. Externally imposed by treating practitioner; linked to specific impairment or disability.
• Limitations. Internally imposed by individual.

• To provide information for adjudication of WSIB claims.
• To provide guidance in managing medical care, disability and rehabilitation.
• To provide information for compliance with requirements of the claims adjustment process.
• To serve as a source of expert medical opinions.

• Distinguish health issues from HR issues influencing absenteeism.
• Clarify diagnosis and medical status.

• Provide rationale for delayed recovery/extended absenteeism.
• Confirm the appropriateness of current treatment and/or provide recommendations for alternative options.

• Determine fitness for safe return to work.
• Define disability & level of disability as this relates to job demands, and/or alternative vocational options.
• Identify objective restrictions and specific accommodation requirements.
• Develop RTW strategy.

• Plan appropriate benefits stream
• Estimate length of time off work to determine HR replacement resource needs and costs.

• Provide second opinion for the dispute resolution process
• Confirm impairment and its causal link in the case of workplace injury

• State clearly the purpose of the referral to establish context for the examiner(s).
• Frame specific questions focused around the purpose of the referral and specific issues or problems that are unclear or in dispute.
• Indicate when report is required, how the report will be used and by whom.

• Profile of person - work history, employment status, history of absenteeism
• Narrative description of the case to date
• Purpose of the referral and specific questions
• Contact information in the event of further questions
• Referral Questions
• Diagnosis
• Treatment
• Return to Work
• Miscellaneous referral enclosures

• Provide the examiner with a solid background and the facts in the cases.
• Provide context for the opinion requested.
• Provide primary source documents where appropriate (e.g., test results, surgical notes, radiographic films, medical records from the initial, post-injury
  visit and acute injury period).
• Grouped by document type to facilitate efficient review.

• WSIB forms
• List of incidents
• Attendance reports
• Correspondence with treating practitioner
• Observations of manager
• Results of previous medical examinations and investigations in chronological order
• Alternative job types available
• Job demands analysis

• Job Description. Role, accountabilities, responsibilities, qualifications.
• Physical Demands Analysis. Physical requirements of the job.
• Job Demands Analysis. Detailed description of Analysis; physical, psychological, cognitive and environmental demands.

• Purpose of IME & benefit to employee
• Consent to release medical information to IME provider
• Consent to participate in IME
• Access to IME report

• Examiner qualifications and clinical practice.
• Experience in health problems and body systems involved in the case.
• Experience in the delivery of IMEs generally and for employers specifically, including disability determination.

• Access to immediate appointments?
• Access to additional investigative services?
• Geographic location of office?
• Willingness to visit work site?
• Hours of operation?
• Accessibility of facility (i.e. disabled accessible, public transit, parking, proximity to work setting)
• Availability for follow-up consultation?

• Report format?
• Specific to case - not "boilerplate"?
• Will provide sample report(s)?
• Will issue addenda if required?

• Fee structures?
• No show fee?
• Follow-up consultation?

• Musculoskeletal?
• Neurological?
• Mental Health & Addictions?
• Respiratory?
• Psychological/Neuropsychological?
• Cardiovascular?
• Endocrine System?

• Appropriateness of medical treatment
• Disability determination (e.g., standardized guides)
• Examiners with relevant qualifications and clinical practice experience

• Appropriateness of rehabilitation treatment & RTW strategy?
• Need for work modifications/accommodations?
• Other factors influencing delayed recovery?

• Existing opinions to be challenged?
• Examiner's ability to testify clearly, logically and in an informed manner at a disposition or hearing?

• Ability to assess work and home exposure to ergonomic factors, chemicals and other sources of work-related problems?
• Thorough knowledge of evidence linking exposures & adverse health effects?

• Clear and definitive responses to referral questions
• Clarification of diagnosis
• Treatment assessment and recommendations
• Return to work
• Internally consistent
• Neutral language
• Answers readable and understandable by end-user
• Objective clinical findings
• Clear and reasonable rationale for conclusions about causation, impairment, prognosis, disability, and current or future work capacity
• Feasible and practical recommendations that reflect an understanding of the work setting