Independent Medical Evaluations (IME) Long considered the backbone of the independent medical examination consulting industry, IMEs were routinely ordered whenever questions arose in medical claims cases. However, over the years, IMEs have lost their initial importance, turning from a valuable asset into nothing more than a negotiation tool for settlement. As a result, the average dollar value of claims has risen while premium rates have declined. Why traditional IMEs have lost credibility: ● ● ● ● ● ● ● ● ● ● ● ● ●
“Doc in a Box” patient processing – often 1525 patients are seen per day, per examiner, averaging 20 minutes or less per evaluation. Poor medical records processing – Inaccurate and/or incomplete data gathering, poor documentation, lack of access to records by examiners prior to seeing the patient. Lack of understanding – examiners often aren’t familiar with the different types of insurance claims and so ask the wrong questions. Some are expected to evaluate conditions and illnesses for which they are not trained. “Clear the desk” mentality – overworked and underpaid examiners often skew IME findings to give clients what they want to hear, coloring or even ignoring the actual facts and merits of the case. Poorlyprepared reports – all of the above can result in a superficial, poorly documented report that simply does not stand up under scrutiny.
The TPN Model We’ve worked hard to completely redefine how independent medical evaluations are performed and utilized. It starts with viewing them as a tooloflastresort, employed only after other methods, such as record evaluation, interviews, and indepth discussions have failed to yield the proper results. Often an IME is not even necessary, saving time and money. When one is appropriate, they can and should be done at different stages of a claim, depending on the merits of each individual case. In response, we have created a threetiered IME program: Early Intervention, Standard, and Extended. The TPN Difference: ●
We select the right medical expert for the right evaluation
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We assist you with preparing the pertinent documentation for the expert
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We view thorough historytaking as vital to the evaluation of a claimant
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We ensure that the expert knows and thoroughly understands the type of coverage
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involved and the State of Loss to which it pertains.
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We provide whatever educational information is needed for the expert to prepare
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and submit an indepth, credible report, consistent with the regulations of the state
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in which the claim is filed.
As a result, our methodology often uncovers preexisting medical conditions, discovers subsequent accidents, and obtains the names of medical care providers previously unknown to the claims professional, to name a few deciding factors that can dramatically affect exposure to a claim.