OUR MEDICAL LEGAL SERVICES

(IME) Independent Medical Evaluations: Independent Medical Evaluations (IME) render impartial opinions to help determine cash, medical, and/or rehabilitation benefits for claim's cases. Causality of injury or illness and a return to work status are determined as well as the claimant's impairment rating, if requested. Efficacy of treatment and the time frames for medical recovery are all addressed. The medical experts performing independent medical evaluations must know the criteria and context of the client's request since different independent medical evaluations are looking for different things. The issues in most independent medical evaluations are: 1) diagnosis, 2) causal relationship, 3) prognosis, 4) maximum medical improvement, 5) % impairment rating, 6) work capability, 7) appropriateness of care, 8) recommendations with possible functional capacity assessments, 9) treatment is never rendered.

Legal Deposition & Live Testimony:  After conducting services, our medical experts are able to provide oral pre-trial testimony for use in court or serve as expert witnesses. Our experts come with impressive credentials and experience.

Nurse/Physician Chart Review:   Our experienced healthcare professionals will assure you a knowledgeable review by an active up-to-date healthcare provider. With a critical eye, they will identify, organize, review, and summarize the essential records. Addressed will be issues such as appropriateness of treatment and compliance.

Legal Nurse Consulting (LNC) / Expert Witness:   We have nurses on staff with both medical expertise coupled with training in the law and legal procedures who can add a whole new dimension to your case. With their knowledge and experience they can help you sort out the complex medical issues, focus your case, identify issues, and make recommendations to minimize loss, saving time and money.

Malpractice Case Evaluations & Workup  Both medical and nursing experts in several specialty areas are available to review any medical related cases for merit and offer bottom line opinions. Elements of duty, breach of duty, causation and damages will be addressed as well as the strengths and weaknesses of your case which will help you best prepare. Our experts will define relevant standards of care and determine whether there was deviation/adherence, vital factors in the outcome of your case.

The primary interest is to address causality, mechanism of injuries, extent of damages, prognosis, appropriateness of treatment, degree of disability and potential for recovery.

Medical Case Discovery   A medical specialist reviews the records to determine the compensibility of the case and focuses on termination or mitigating for resolution.

Medical Research & Education   Over 30 years combined experience in our medical-legal research department will help to strengthen your position and add credibility to your case/claim. Our staff will also educate you on the complex medical aspects of your case so you can go to deposition prepared to win, addressing all pertinent issues.

Peer Review   We will provide you with a competent medical specialist who will review the medical records and address such issues as whether treatment was medically necessary and reasonable, the efficacy of treatment within the specialty and over use/under use of the medical options.

Medical Illustration   Illustrates the anatomy, physiology, and pathology of all major body systems. Through full color illustrations and visual explanations, issues such as pathology and mechanism of injury will be simplified and understood.

Disability:

• Disability benefits are provided under the Social Security Act to those persons expected to be totally disabled for at least 12 months.
• Individuals can also purchase private short-long term disability insurance
• Employers may provide disability benefits such as short-term benefits (typically from the time of injury up to a few weeks) or long-term benefits (typically with a waiting period of sixty or ninety days).

To qualify, a claimant must have a “medically determinable” impairment. The impairment must have a demonstrable anatomic, physiologic, or psychological abnormality. To meet the definition of disability in the Act, the claimant’s impairment must be of such severity that they are not only unable to do the work done previously, but also can not perform any kind of substantial gainful employment.

An independent exam from a medical doctor must cover statements which details what a claimant can do despite of their impairments.

Issues that need to be addressed in order of importance are:

• The diagnosis that is causing the disability
• Causal relationship to the disability (what caused them to be rendered incapable of performing work)-Causation is frequently a critical issue in workers’ compensation and liability cases
• Is this a temporary or permanent condition
• What is the Prognosis-This gives the probability and predicted in time of recovery. The recovery could be strongly influenced by factors other than the diagnosis. Such factors include attitude, social environment, concurrent problems, and probable future risks.
• Has the claimant met maximum medical improvement-This is when further recovery and restoration of function can no longer be anticipated to a reasonable degree of medical certainty.
• Work capability or Functional Capacity-Parameters contained in the U.S. Department of Labor’s Dictionary of Occupational Titles, which are primarily lifting requirements.
• Appropriateness of Care-Or issues of missing records that need to be obtained, additional diagnostic studies or consultations are addressed
• Impairment Rating-Impairment is not synonymous with disability
  • Impairment is a measurable decrement in health status evaluated by medical means. AMA Guidelines are most often the criteria used.
  • Disability is assessed by the consideration of non-medical issues such as the person’s educational and vocational skills, experience and age
• Recommendation-include unnecessary and/or omitted diagnostic evaluation and inappropriate, excessive, and/or omitted treatment.

Worker's Compensation: The employer is questioning whether the injury is a direct result of the claimant’s employment.  As causality is the most important issue, restrictions for return to work or a disability status. A percentile of disability may be required by certain states and special criteria to be addressed. Previous history is important and the current treatment along with further treatment is addressed. A job description is helpful to the physician when a return to work status is one of the requirements for the exam.

Auto No Fault:  The carrier is currently paying medical expenses and/or wage loss benefits and/or assistance for activities of daily living (i.e. assistance with household chores or assistance with personal hygiene.) In many auto accidents a pre-existing condition is exacerbated. The report must give a projection of an end plate or time frame for treatment and what services are or are not needed and a time frame of how long. This could be either an individual who is seeking compensation from the insurance carrier of the responsible party (a third party case) or an individual who has been denied benefits by his/her own insurance carrier and is disputing the denial.

Auto Tort: The carrier needs an expert to sort out the injuries of the accident to determine who was at fault. The exam by the experts often determines who will pay the medical bills and attorney fees. Physicians will testify live in court if the dispute of the case is challenged.

Independent Medical Opinion: Individual may set up these exams to verify if their treatment is reasonable and necessary and or if surgery is indicated. Insurance companies will also use these exams to assist the claimant in finding appropriate treating doctors. Litigation is not an issue. Many of the second opinion physicians may resume treatment after the exam if the individual so desires.

Long / Short Term Disability: In this instance, a person is collecting short or long term disability benefits for a non-work related injury or illness. The most important issue in these cases is whether the person can return to work in either his/her regular position or in a restricted position. These policies are insurance benefits paid by the employer and are the company's choice to offer these policies. The insurance will cover wages as long as the employee cannot work. Some policies have time frames for these benefits.

Family Medical Leaves: The Federal Government regulates family medical leaves. Wages may or may not be covered by this leave. All companies that have over 25 employees are eligible for this leave with or without pay. The law gives any employee (12) weeks of leave based on a family emergency or an individual health need. Up to 24 weeks can be taken if an individual qualifies for this leave. Our physicians make the determination if the employee qualifies for this benefit. Often times it is not the employee that is evaluated, but a spouse or child. It is important to question this leave if it goes beyond (12) weeks. The law states that employers must keep a job for this employee.

General Liability: In these cases, the claimant is seeking compensation for an injury, which generally occurred on the property of another party. Generally, there is no relationship between parties prior to the incident. A complete history of the injury, a current diagnosis, any treatment needed for the injury sustained, medical history prior to the incident, restrictions for return to work or disability status and more important, cause and relationship of the injury to the incident are all addressed in final report after review of all data and evaluation.

Malpractice: Is negligence and or a breach of standards of care. It constitutes gross and flagrant action by the professional that has caused harm to a patient. Injury to the individual is evaluated and facts of how it affected their life style, what was the cost of the damages and how is the damage going to affect their future. Pain and suffer is also considered in the damages. The expert is usually of the same specialty. The plaintiff is the one that was damaged by the act and will hire a plaintiff attorney to represent the case. The defense attorney represents the malpractice insurance carrier or the doctor in question.  Our experts explore all avenues of the case and come to a detailed conclusion based on guidelines of Standard of Care and harm to the patient.

Early Assessments: IME, Inc., has a copyright on the first document that addresses all issues needed to determine causation, diagnosis, efficacy of treatment and projection of further treatment of claim. Employers can set up an exam within the first 10 days of the employee absence from work. Insurance carriers also may get an opinion early in the claim on that diagnosis that are miss managed and assigned for the gain of the claimant.

Legal Nurse Consultants (LNC): Like physicians, nurses have different specialties in their field. IME, Inc. has nurses on staff with both clinical knowledge and experience coupled with the law and legal procedures. These nurses can help you sort out the complex medical problems, focus the case, identify missing documents and make recommendations to manage the expense of your claim. The LNC also testifies in court on professional issues that may have caused harm to a patient by another nurse. The standards of care and negligence of a patient is determined. The LNC also saves attorneys money in screening malpractice, workers compensation and any personal injury case for merit. See the section on Legal Nurse Consultants to understand the resources the nurse can contribute to focusing the direction of your case.

Peer Review:  Professionals of the same specialty review the medical records and CPT codes of the bills. Issues are approached such as medical necessity and reasonable care for the condition of the claimant. The efficacy of the treatment being rendered is also assessed. The medical records and diagnostic test results are compared with the CPT, ICD-9 codes for the appropriate billing codes that document the treatment rendered.  Excessive treatment and under care are also reprimand. The peer reviewer will also comment on the correct area of expertise needed to bring the case to a close.

Nurse / Physician Chart Review:  The most important element of the case is the medical records. Nurses who are trained with a critical eye can identify, organize, review and summarize the essential records. Missing data can be brought to provider’s attention. The focus is on the facts of the case and the total file of the claimant will tell the story. A complete organized file saves the costumer money by decreasing the physician’s time of putting in order the medical records. The organized file by the nurse also makes for a chronological detailed report.

Phone Consultations / Consultations / Medical Case Discovery: The experts are available for phone consultations after the review of the file. Discovery of the facts early in the case help the attorneys and insurance carriers manage the file. It is through knowledge and direction that makes the difference in the administration of the case. This phase of the investigation is called the discovery phase. File reviews with no reports are also a tool for attorneys who are using a new doctor and do not feel at ease in knowing how the expert will present himself or herself.

Medical Illustration: Illustrations of the anatomy, physiology, and pathology of the human body. All major injuries are made visual and explanations of the mechanism of damages are demonstrated. The illustrations become alive, leading to more universal understanding of a non-medical audience.

Medical Research: Some cases may require on going study with the latest or newest refine treatment that may make a difference in the final outcome of your case. Research also gives extended knowledge to the customer to better understand the needs of the case. Research assists the insurance carriers in proper direction, influences the appropriate treatment and cost, which directly impacts the claimant’s recovery.

Deposition: When a case is in dispute of benefits or settlement, a deposition is set up with the attorneys involved and the expert that evaluated the claimant. Our experts have over 30 years in testifying. The attorneys cross-examine the physician to determine the diagnosis and causality of the incident on the claimant. A resolution is drawn from the facts presented at the deposition. 

Live Testimony:  Certain states and types of cases may require a court hearing. In this case the expertise will provide oral testimony at trial. The judge determines if the individual qualifies as an expert. Our physicians come with impressive credentials and experience. Many are dual degreed and are certified with SEAK, ABIME, AADEP. These are all companies that educate and certify physicians in the medical/legal field.

Drug Testing: NIDA Lab Approved: IME, Inc. administrates the Department of Transportations regulations enforced by the Federal Government to individuals with CDL and meet the Rules that were put into effect in 1992.  All drivers operating over the road vehicles that weigh over 26,000 lbs must conform to the rules for drug testing. Companies must test new employees before allowing them to drive. Random drug testing needs to meet 25% of all operators and 10% random alcohol in order to meet the audit and regulations of the DOT, Federal Regulations. In the case of an accident with the vehicle the driver has 2 hours to be alcohol and drug tested. IME, Inc. assists trucking companies in administering the program. We also write policies that spell out the regulation for the personnel file. IME, Inc. also keeps records to meet the DOT regulation in case of a governmental audit. If any company is not compliant with the Federal rules, a $10.000 fine is issued per citation of non-compliance. Companies also have to keep up on the changing regulations. It is wise for these companies to use an outside source like IME, Inc. to keep up on the regulation and administer the program with record keeping on all companies.

DNA-Parental Testing: Determining the identity of your true biological parent or child is a major life event. Child support is totally dependent on the biological parent. This test stands up in a court of law.  You can trust IME, Inc. with this important issue in life. The test has 99.99% probability of paternity or non-paternity. Reports are issued in 10 working days after receipt of samples. The test is used for identifying the father for child support. It has been used for inheritance (estate claims).

Educational Seminars: IME, Inc. provides opportunity for tailored educational programs to meet the need and topic of our audience. The company brings the knowledge right to your office. The seminar is informal and open for participation of the learner. Nurses and physicians are available to provide seminars on difficult medical issues and will give you knowledge in ways to understand and better supervise the claim.

Anatomy & Physiology Seminars: IME, Inc. has developed a curriculum to assist attorneys and claims adjusters in understanding the human anatomy and physiology. Professional credits are available on request. Understanding the normal human anatomy, the and abnormal pathology can assist the attorney in a better simulation of their case. Those interested in the course should e-mail the corporate office at info@imei.com. The curriculum can be tailored to meet the individual law firms or insurance claims adjusters. Let us know what your interests are so IME, Inc. can meet all of your needs and exceed your goals. A Doctor in Anatomy and Physiology brings the program to you with a history of teaching at a major University. Our professor also is a practicing Orthopedic Surgeon. This program is made available because the professor and Orthopedic Surgeon have moved on to DePaul University to continue his education in law. The curriculum that is offered to you the same information presented to the medical students at DePaul University.

Product Liability: A trend of injuries may develop from many different products. The liability insurance over the product is responsible to investigate the case and determine if the product is causing the injuries. Many of our specialists resolve the dispute between the parties by giving a solution to the cause of the injuries. The product is also researched for similar incidents.

American Medical Association (AMA):  Evaluations may require the use of the AMA Guidelines to determine the % of impairment of the whole body and the body part. The regulations have been revised into the 3^rd, 4^th and 5^th Edition. The date of the claimant’s injury determines which edition the expert needs to apply the rule to. These exams take the expert three to four hours to apply the criteria needed for each case. The customer informs the evaluator which edition to apply the rules. Other states have their own criteria that differ from the AMA Guidelines.  These rules will then be applied by the evaluating physician and are supplied by the customer requesting the exam.  

Family Medical Leave (FMLA): may be found in the regulations (29 CFR Part 825) An employer may, at its own expense, require the employee to obtain a second medical certification from a health care provider. The employer may choose the health care provider for the second opinion except that in most cases the employer will call an independent company. If IME's medical provider's opinion differs from the employee's physician, a third medical certification can be requested again at the employer's expense. This third opinion shall be final and binding. The employer can at anytime request the employee to be evaluated if the leave is in question.

The Federal Government regulates family medical leaves. Wages may or may not be covered by this leave. All companies that have over 25 employees are eligible for this leave with or without pay. The law gives any employee 12 weeks of leave based on a family emergency or an individual health need. Up to 24 weeks can be taken if an individual qualifies for this leave. Our physicians make the determination if the employee qualifies for this benefit. Often times it is not the employee that is evaluated but a spouse or child. It is important to question this leave if it goes beyond 12 weeks. The law states that Employers must keep a job for this employee.

Medical Fraud Investigation:  Fraudulent claims occur after motor vehicle accidents, slips and falls, and job accidents. Such claimants use abnormal illness behavior; including fake accidents, contrived histories of injury, embellished complaints, false examination responses and prolonged ineffective treatment, to establish a “sick role” for social and monetary gain.  Rewards are derived from insurance claims, lawsuits, federally funded medical care, federal and state workers’ compensation and Social Security. This cannot be accomplished without the assistance of a doctor whose contribution to the collusion may include incompetent evaluation and unfounded diagnoses; prolonged ineffective treatment and unnecessary surgery; false claims, reports, and testimony about a contrived injury and disability. An attorney commonly orchestrates this scheme. Medical records are usually evaluated by an insurance investigator and a medical expert as part of an independent medical examination. Our legal nurse consultants and other medical experts are trained and possess the knowledge needed to assist our customers with the facts needed to defend fraudulent claims.

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Independent Medical Evaluations, Inc. Corporate Office
IME, Inc.
Lee Plaza, 3881 M-72 East
Williamsburg, MI 49690
Phone: (231) 929-1474
Toll-Free: (800) 968-4637
Fax: (231) 929-4356
Email: info@imei.com