Independent Medical Evaluations (IMEs) for workers’ compensation and personal injury claims are examinations performed by a physician not involved in the person’s care for the purpose of clarifying medical and job issues. The IME may evaluate issues regarding causation, diagnosis, treatment, return to work, and impairment. IMEs are typically requested by workers’ compensation insurance companies, governmental agencies, or attorneys. Independent Medical Exams involve review of medical records and other claim related information, an extensive visit with the physician to determine relevant history, and a comprehensive report. In some cases, additional medical or environmental testing may be requested in order to address specific IME questions.
Occupational diseases stem from workplace factors that contribute to, or cause, an individual’s ill health over time. Occupational Disease (OD) Evaluations are thorough assessments of all aspects of a worker’s pre-existing conditions and working environment. A physical examination, diagnostics studies when appropriate, and medical literature research are utilized to finalize a complete report of the occupational factors (if any) contributing to the worker’s condition. OD evaluations provide evidence-based treatment recommendations and address specific questions posed by the requesting party.
Once an individual is considered to be at maximum medical improvement from an injury or occupational disease, an impairment rating may be requested. The impairment rating is based on functional limitations and is calculated according to the American Medical Association Guides to the Evaluation of Permanent Impairment, 6th Edition.
A Records Review involves assessment of an individual’s medical records and other relevant information are examined regarding the injury, treatment, or other issues. During a records review, the physician does not physically examine the individual.
Toxicology is the study of the adverse effects of chemical substances on living organisms. Dr. Hewitt is board certified by the American Board of Toxicology and has more than twenty-five years of experience evaluating exposures to harmful substances in the workplace, home, and environment.
REOH provides utilization & treatment guideline file review services for the industries of workers’ compensation, auto, liability, and group health. File reviews use an evidence-based approach and can uncover excessive treatment and expenses pertaining to a claim. Examples of cases that would benefit from a file review are questions pertaining to medication usage/costs and/or appropriate treatment/overutilization. A REOH physician will objectively review a maximum number of 25 pages and provide guidance.
REOH’s Utilization & Treatment Reviews are beneficial when one or more of the following exists:
Excessive claim costs
More than reasonable number of visits to the same provider with no functional improvement
Questionable relatedness of treatment to a specific claim
Questionable reasonableness of treatment
Potential pharmacy overutilization
Aggravated or exacerbated pre-existing condition(s)
Catastrophic or permanent injuries
Frequent specialty consultations/diagnostic testing with no definitive diagnosis
Establishing causation in cases of delay in reporting an injury or delay in seeking treatment for a specific claim
Lack of medical documentation or evidence-based treatment plan
Turnaround time is a maximum of four business days from medical record submission.
REOH cannot review files regarding: Medicare supplement, disability income, hospital indemnity, specified accident, credit, long term care, and non-governmental self-funded plans.
A Job Analysis (JA) is a summary of the duties and physical requirements of a job and is provided by a certified rehabilitation consultant. As part of the IME, REOH physicians may review specific JA’s to determine whether the person can perform the described job. This may include the person’s original job or alternative jobs. Specific work restrictions may also be recommended as part of this review.
An authoritative and knowledgeable medical expert witness can provide the insight and expertise necessary to successfully support litigation involving workers’ compensation and personal injury claims, toxicology issues, and occupational and environmental exposures. REOH physicians have over forty years of combined experience in litigation support acting as medical experts.