by Lindy Z. Kerr, Esq.

Increasingly, third party vendors are used to coordinate medical care in workers’ compensation claims. They have become fairly common place for scheduling diagnostic tests and physical therapy. We are now seeing them used more and more for independent medical examinations. However, the stakes involved with an independent medical examination are much higher, since this report is often used as evidence to defend against a claim at a hearing, as persuasive evidence to provide to the authorized treating physician, or as leverage in settlement. The Georgia Workers’ Compensation Act also outlines a specific procedure that must be followed to constitute valid notice of the examination. Therefore, it is particularly important to determine the scope of the vendor’s role up front, and to use a vendor that is knowledgeable about Georgia Workers’ Compensation law.

Considerations:

  1. Under the Georgia Workers’ Compensation Act, the claimant must be given 10 days advance written notice of the appointment and the claimant must be paid his mileage upfront. In addition, the appointment must be at a reasonable time, place and location (do not set it with a doctor in Atlanta if the employee lives in Columbus). If any one of these requirements is not met then the claimant has no legal obligation to attend the IME. This may lead to a no show and a cancellation fee charged to the employer/insurer. To ensure valid notice, it is important to determine up front which of these actions will be completed by the vendor and which, if any, will not be.
  2. Who is contacting the claimant to provide notice of the appointment? The State Board has not commented on whether direct contact between the vendor and employee is permitted. Regardless, many claimant attorneys will object to such communications.
  3. Is the vendor, adjuster or defense attorney compiling the medical records and diagnostic films to send to the IME physician? It is important for the IME physician to have a complete picture of the work-related medical care and any relevant pre-accident medical treatment.
  4. Also, aside from the procedural requirements involved with an IME, one must also be mindful of what the IME is being used for. It is important for the doctor to know exactly what he should be looking for in the examination. Is it causation of injury, whether a particular treatment is medically necessary, whether the claimant is capable of full duty, an assessment of the permanent impairment rating, or something else? The questions the IME physician should address are not the same in every case and the report is going to be much stronger if the IME physician understands the purpose of his role.

Using a third party vendor to set up medical care may be efficient in some circumstances. However, for an IME, there may be serious repercussions to the validity and quality of the IME if the scope the vendor’s role is not clear at the outset.