Workers' Comp

IME Referral Tip Sheet

September 30, 2016
1 MIN READ

Save time and avoid addendum requests by following these helpful IME referral submission tips! By providing this comprehensive information, you’ll ensure a more thorough report in return. 

  1. Include the compensable body part(s) accepted on this claim.
  2. Include the specific recommended surgery or diagnostic study to be addressed.
  3. Provide all pertinent medical records.
  4. Provide a job description (if applicable).
  5. Request the specific service(s) you need (IME, peer review, etc.).
  6. Specify a preferred physician whom you would like to use (if applicable).
  7. List any specialties you prefer to use. If a requested specialty is unavailable, list alternative specialties you would consider.
  8. Provide the contact information for the attorney on the case (if applicable).
  9. Identify the specific issues to be addressed such as RTW, MMI, impairment rating, etc.
  10. Note if a mileage check is to be issued by Genex and sent on your behalf.
  11. 11. List any recently approved surgery and/or diagnostic test that should be reviewed for causal relationship. Be sure to provide the specific surgery or diagnostic requested.
  12. Include any special circumstances regarding the case that should be brought to our attention.
  13. If applicable, provide the assigned case manager’s contact information who should receive correspondence related to the IME or peer.
  14. If NY WC Claim: designate Genex as a party of interest to obtain medicals from the WCB
IME Referral Tip Sheet