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An IME Cover Letter alone can determine the difference between a great report and a mediocre report. The best choice for authoring the cover letter is always the claims handler who is dealing with case-related issues on a daily basis, reviewing medical records as they come in, and maintaining regular contact with the employer and employee.  NO ONE KNOWS THIS CASE BETTER THAN THE CLAIMS HANDLER—which means no one can do a better job of conveying the facts than you!By following the steps below, you can help ensure that you receive a complete and accurate IME report:
  • Be specific—Ask specific questions in order to receive specific answers about your claimant’s injuries.  Cover letters should never contain generic, check-box questions that are asked of every type of injury; this will only lead to generic answers and may not accurately reflect this situation.
  • Be proactive—If there are certain records or a specific aspect of the claimant’s history you would like the doctor to address in his report, ask him to discuss them specifically in the report! We rightly assume all IME doctors thoroughly      review case documentation, interview the claimant and conduct a complete physical examination.  In many cases we are probably correct.  But, with a single bullet in our case defense chamber can we take the chance that the IME doctor is indeed taking all the proper steps to evaluate the claim?
  • Be time sensitive—If you have a deadline, take another chance to remind the doctor of this date in your cover letter and be sure to send the cover letter at least a week in advance of the IME.
  • Be clear—Make sure the questions you pose to the doctor are actually asking what you mean. Well thought out questions, which are easy for a medical professional (who is NOT an attorney), to understand are imperative to avoid misunderstandings and answers to questions you did not ask.
Do you have any other suggestions for a strong IME Cover Letter? Let us know! Email LeighAnn@MedicalSystemsUSA.com or contact us through our website at www.MedicalSystemsUSA.com.]]>
10/12/2012 in Treatment, Medical Conditions
Spinal degeneration is a normal part of the aging process. Research shows that 90% of males over the age of 50, and 90% of females over age 60 have radiographic evidence of degeneration. This degeneration progresses with age and occurs in all of the structures comprising the spinal unit, including intervertebral disks, facet joints, and the connectingligaments. Other factors can influence the rate of spinal degeneration. Among those are environmental factors (such as cigarette smoking or disk injury), and physiologic factors (genetics). Areas of degeneration are likely to be dispersed across the spine and generally correspond to the mechanical stresses produced by spinal motion and posture. Research indicates that the process of spinal degeneration can be hastened by performing tasks involving heavy labor. On the other side of the spectrum, lack of activity can also hasten the degenerative process. Statistically, there is an increased frequency of spinal pain and disk herniation in heavy laborers. It appears that regular moderate exercise is important to slowing down degenerative affects. DEGENERATIVE EFFECTS ON BACKINJURIESSpinal degeneration can contribute to the severity or slow down the healing process of a back injury. Likewise, a back injury can also hasten the degenerative process. Fortunately, the advancement of diagnostic technology has greatly enhanced the ability to determine the length of presence and severity of spinal degeneration. This makes it easier for doctors to determine how the symptomatology and healing process of the injury is affected by the degenerative process. DETERMINING PERMANENCYIn cases where the claimant has sustained permanency for an injury with diagnostically documented degenerative changes, it is important that the doctor assessing permanency delineates between any preexisting degeneration which may be present and the claimed work injury. This becomes more complicated in cases where claimants are performing heavy labor. Degeneration could be prematurely caused or accelerated beyond its normal progression depending upon the length of time the heavy labor was performed. Often, this is dependent upon the type of work performed and the length of time it was performed. The medical professional also needs to consider the role environmental factors, physiological factors, and the claimant's age play in the degenerative process.THE IMEWhen obtaining IME's for back injury claims, it is important to address any preexisting conditions and/or occupational exposure in your cover letter to the evaluating doctor. Point out any preexisting degeneration you may be aware of, let the doctor know if the claimant has a history of performing heavy labor (make sure you let the doctor know if it was for your employer, or a previous or subsequent employer). Also let the doctor know of any environmental or physiological factors you are aware of. These important dynamics will assist the IME doctor in the determination of causation as well as permanency issues.Providing medical documentation is imperative. If you have any records which discuss preexisting degeneration or previous back injuries, those need to be specifically highlighted for the IME doctor in the cover letter. It would be extremely beneficial if those records could be obtained an provided for the IME. Typically, these types of cases are scheduled with orthopedic surgeons; however, neurosurgeons are qualified to conduct IME's for back injuries as well. For most cases, it would be suggested to schedule with an orthopedic surgeon unless it is an injury to the cervical spine. For more information about the reasoning behind this go to www.MedicalSystemsUSA.com or call 1.800.261.3278.]]>
10/12/2012 in Medical Conditions, Treatment
How many of us have either heard of or suffer from Restless Legs Syndrome (RLS)? The numbers are probably low on both counts. People suffering from RLS may experience an urge to move their legs followed by an uncomfortable feeling such as a creeping or crawling feeling or even tingling, cramping, burning or flat-out pain. And for those of you wanting a good night sleep, that might be a problem, because RLS often takes place late in the day or at night. Let's look more closely at the seldom heard of ailment, Restless Legs Syndrome. What is Restless LegSyndrome?RLS is a neurological disorder that is characterized by unusual sensations in the thighs and calves. The sensations may feel like insects crawling on the skin, burning or tugging. The abnormal sensation may be bothersome, irritating and even painful. The best way to alleviate these sensations is to move the legs in a rapid and repetitive fashion.Activity seems to lessen the symptoms and many times, the symptoms are worse at night. How common is RLS?About eight percent of all Americans suffer from RLS, which equates to about 12 million people. This figure may be low, as this is a fairly common condition that may go undiagnosed and unreported. It is interesting to note that there is a hereditary factor associated with RLS and that 50 percent of all cases have a genetic association among family members. What causes RLS?There continues to be research into the causes of RLS and several answers are speculative.There are no known specific causes. As previously noted, there is a hereditary predisposition. It has been shown that patients with RLS may suffer from anemia and low levels of iron. There may be some underlying medical conditions that contribute to the symptoms such as kidney disease, diabetes, Parkinson's disease and peripheral neuropathy (numbness). During pregnancy, women may experience the symptoms during their last trimester. Lastly, certain cold medications, anti-seizure medications, psychiatric medications, some blood pressure medications and anti-nausea medicines may also worsen the condition. How is this diagnosed?At present, there is no specific diagnostic test that will confirm RLS. A patient must have a comprehensive history taken and a physical examination by a health care provider. There are no blood tests that will aid the diagnosis. After all underlying medical conditions have been ruled out; four basic criteria must be met. These criteria include: 1) desire to move limbs when there is an associated unusual sensation 2) symptoms that are worse at rest and improved with activity 3) motor restlessness 4) symptoms that are worse at night when trying to sleep. The International RLS Study Group has developed these criteria important to develop a regular pattern for sleep, avoid exercise just prior to bedtime, avoid the use of alcohol, and be sure to allow for relaxation at bedtime, avoiding complicated mental tasks.For more information visit www.MedicalSystemsUSA.com or email LeighAnn@MedicalSystemsUSA.com]]>
10/12/2012 in News
Check out these interesting work related facts:1. Up to 25% of hospital keyboards carry the MRSA infection.2. Apples are more effective at keeping people awake in the morning than caffine.3. On an average work day, a typist's fingers travel 12.6 miles.4. By law, employees do not have to wash hands after sneezing.5. More American workers (18%) call in sick on Friday as opposed to any other day of the week. Tuesday has the lowerst percent of absenteeism (11%).6. The state with the highest percentage of people who walk to work is Alaska.7. More than 50 million Americans said they had a disability; for 32.5 million of them, the disability was severe.8. The rate of fatal and major injuries in firms employing fewer than 50 employees is over twice the rate in firms employing more than 1,000 people.9. About 60% of fatal injuries to workers occur in construction, transport and storage, agriculture, forestry and fishing.For more information visit www.MedicalSystemsUSA.com
An informative weekly series for the benefit of those managing claims of injuryThank you for allowing us to share this educational series with you. As we've seen, cost of service, years of experience and training are not always good indicators of a successful case manager.People-skills are really the key to cost-effective and successful case management. Look for the following skills and abilities in your next case manager:
  • The ability to evaluate and coordinate
  • Follow-up and follow-through
  • Excellent communication skills
  • Good interpersonal and intra personal communication
  • An outstanding talent for negotiating and motivating
Sometimes, something as simple as feeling an instant rapport with the case manager can be an excellent sign that they will be successful.We hope you enjoyed this series. Look for a new series coming your way soon!For more information visit our website at www.MedicalSystemsUSA.com or call 1.800.261.3278
An informative weekly series for the benefit of those managing claims of injury.Last week's issue spoke of communication being directly tied to the success of the case manager. This week we will learn more about why the success of case management largely depends on the case manager's communication abilities.Doctor(s): Case managers should attend as many doctor appointments as possible so that progress in relationship to the established care plan can be discussed. Afterwards, written correspondence to the doctor recapping the conversation assures communication is clear and care stays are on track.Claimant - When the claim is initially referred to the case manager, it is highly recommended that initial contact consist of checking on the claimant to see how they are feeling and when they anticipate returning to work. The plan of care should be discussed with the employee because getting them to buy into it will go far toward gaining cooperation and compliance. In general, including the injured worker in the process will serve to promote healing and the desire to get life back to normal.Claims Manager - Finally, the claims handler is the captain of the ship and as such should always remain in control with the direction of the claim. In order to effectively direct the claim, the claims handler must be kept fully informed of case progression. Choose your tool of communication (i.e., email, phone, and fax) and make sure the case manager is aware of your preferences.If the case manager has good communication skills, the claimant will stay on the path to recovery, return to work quickly and the claim will be closed at a faster rate.Next week's edition will provide some closing tips for getting the most of your case management dollars.For more information please visit www.MedicalSystemsUSA.com
An informative weekly series for the benefit of those managing claims of injury.Last week's issue talked about the concept of developing a plan for closing claims. This week we will discuss the importance of well-coordinated care.A good plan of care involves the creation of a "team" consisting of health care professionals, case manager, claimant, and claims handler (the boss). The case manager coordinates medical resources and makes sure excellent communication is maintained between all parties.The goal is to assure the agreed upon care plan is adhered to and modified only when necessary. The case manager must remain the center of communication for all care givers, claimant, and claims handler so if treatment gets side-tracked it can be quickly put back on course. This is how claims remain on the proper course toward closure and no dollars are unnecessarily spent.Much of what happens in this phase will be dependent upon the case manager's communication skills, and their ability to develop and maintain a positive working relationship with the treating physician and claimant. The success of your case manager can easily be judged by the rapport you have developed with them and if understanding them is effortless.Next week's edition will further underscore the importance of good communication to the success of the case manager.For more information please visit our website at www.MedicalSystemsUSA.com
An informative weekly series for the benefit of those managing claims of injuryOnce the medical case manager has properly evaluated the medical condition and determined the assigned diagnosis is correct, they are ready to assess whether the claimant is seeing the appropriate type of doctor(s), and develop a plan of care.The plan of care should be designed around the claimant's current status and the response they had to previously provided care (if any). It should be an aggressive (not abrasive) plan with the goal of reaching a finite end of healing date within a reasonable amount of time.The case manager should communicate the plan of care to you before presenting it to anyone else. You should expect to receive a written step by step plan with a verbal explanation of each step in the process. Before any plan is implemented, it should have your "stamp of approval."How do you go about knowing the plan is a good one? One way is to assure it includes a well-coordinated use of all medical resources available. Look for next week’s edition on coordinating medical resources. Next week, we will learn the importance of staying on course.For more information visit our website at www.MedicalSystemsUSA.com
An informative weekly series for the benefit of those managing claims of injuryLast week, we talked about medical case management as a collaborative process. This issue will talk about how a case manager begins by familiarizing themselves with the case. The methods most widely used include:
  • Discussion with the claims manager about the course of      the claim
  • Review of medical documentation
  • Chatting with the claimant (if possible)
  • Conversation with health care providers
After the review process is complete, the case manager is ready to evaluate medical aspects of the claim (such as the appropriateness of treatment, relationship of care to work injury, and return to work issues). Following that, cost issues such as what it will take to close the claim and/or return the injured worker to work as quickly as possible need to be considered.After these assessments have been made, the case manager is ready to develop and implement a custom-designed plan of care that takes all issues of the claim into consideration and works toward closing the claim. Next week, we will learn the importance of staying on course.For more information visit our website at www.MedicalSystemsUSA.com
An informative weekly series for the benefit of those managing claims of injuryLast week, we discussed the elements of good case management. This week we will talk about medical case management as a collaborative process, involving all health care providers, the injured worker, and the claims manager. The purpose of using a medical case manager is to facilitate the treatment plan in order to expeditiously bring the injured worker to an end of healing in the most cost-effective manner possible.As such, the medical case manager's role is to assess the care-plan for:
  • Appropriateness in relationship to the claimed injury,
  • Cost-effectiveness,
  • Methods to return the claimant to work, and
  • Bring the worker to an end of healing as quickly as possible.
In order to accomplish these goals, the case manager must have excellent medical assessment abilities, great communication skills and be a good motivator. Next week, we will discuss tips for assuring adequate evaluation of a medical condition.For more information visit our website at www.MedicalSystemsUSA.com

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