Medical professionals play a critical role in workers’ compensation claims. Doctors diagnose injuries and work-acquired medical conditions. They establish functional limitations and recommend appropriate interventions. They also identify when people might have stopped responding to treatment or when they have made a sufficient recovery to return to work.
In some cases, physicians can even help settle disputes between workers and their employers. In scenarios where there are questions about the treatment plan proposed and the restrictions on a worker’s job functions, an in-depth medical evaluation might be necessary.
An independent medical review (IMR) can help validate that a treatment plan is appropriate. An unrelated medical professional can look over medical records to evaluate the situation. Who chooses the physician who conducts the review of a worker’s condition?
A specific organization oversees IMRs
When an IMR is necessary due to questions about a workers’ compensation claim, working with a neutral medical professional is of the utmost importance. Doctors chosen by employers might allow bias to affect their final determination. A physician with a pre-existing relationship with a patient might prioritize their perspective when evaluating their condition.
The state helps prevent pre-existing relationships or financial incentives from affecting an IRM. When an IMR is necessary, the Division of Workers’ Compensation arranges the review with a private organization. Currently, an independent medical review organization, Maximus, holds the state contract for providing these evaluations.
Specific medical professionals with knowledge related to the worker’s diagnosis can perform the IRM on behalf of the company. Their name is generally confidential. This helps prevent outside parties from contacting and influencing the doctors.
Their review helps determine whether or not a specific treatment plan is appropriate and necessary given the worker’s diagnosis. An IMR may determine that the treatment plan is unlikely to prove successful or that certain forms of treatment may not be appropriate. The report provided by the medical professional can help settle treatment disputes during a claim.
Understanding the rules that apply during a workers’ compensation claim can help employees get the benefits that they need. Workers who have to undergo an IMR may need help navigating that process and any other complications that they face during their claims, and that’s okay.