Can an IME deny care if a claimant fails to show improvement while receiving treatment that is listed as “needed” in the guidelines?
An IME cannot deny care. The IME can evaluate and opine based on that evaluation. It is the carrier who may deny payment for care. Care is not listed “as needed” in the Medical Treatment Guidelines. The Medical Treatment Guidelines contain recommendations that are the mandatory standard of care for injured workers for the body parts covered by the Medical Treatment Guidelines. An IME may opine on whether the care requested is consistent with the Medical Treatment Guidelines recommendations. This means that the care must comply with the Medical Treatment Guidelines recommendations and general principles. If a patient fails to demonstrate a positive response to a treatment, defined in the general principles as functional gains which can be objectively measured, treatment that is continued will not be consistent with the Medical Treatment Guidelines. If asked to opine on this matter, an IME may state that the care requested was not consistent with the Medical Treatment Guidelines.
Related Questions
- What is needed from an attorney or claim adjuster to release the amount medicaid paid for medical treatment to a beneficiary who was involved in a vehicular accident?
- What is needed for the Demolition cost to display separately from the Site Improvement cost on the DD1391, ENG3086, and CA1391 forms?
- WHAT PREPARATION IS NEEDED BEFORE THE TREATMENT?
