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workmens comp

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Trisha Reyes:
what is the acronym IME  I think it has something to do with a denial and the pt. reaching the maximum medical improvement, but the dr. continues to treat because he does not agree that the pt. is fully recovered.

Michele:
IME stands for Independent Medical Exam.  If charges are being denied due to IME, that means that the Dr who performed the IME felt that the patient reached maximum medical improvement, or at least that further treatment would not be beneficial.  If the treating Dr disagrees, they can continue to treat.  The patient needs to get a lawyer and have a hearing.  The judge will either side with the independent medical examiner or the treating dr based on the evidence.  If the treating dr continues to treat they should submit notes and any other supporting documentation so when the hearing comes, the information is available.

Michele

LW5689:
Hi Michele,
I have been reading your "Secrets to Signing Up Your First Doctor."  Its great!  I have a question regarding something I read regarding filing a worker's comp. claim.  I recently sent out a wc claim for a provider but I did not send a copy to the wc board.  The provider said that he has never done that before.  Is that policy still in affect?  Thank you.

Michele:
Absolutely.  That provider is lucky.  He must not have had many or any patients that have gone to a hearing.  Everything is online now and lawyers for both sides look up claims to get info to use while in front of the judge.  It is very important that a copy of all WC claims filed get sent to the board.  If a patient is being treated and goes to a hearing, but no claims were filed that could seriously jeopardize their case.

Michele

LW5689:
Michele, Thank you so much for that clarification.

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