7 Steps to IMC success: A guide for Case Managers
Early intervention is pivotal to successful claims outcomes, but sometimes it can be difficult to determine exactly what treatment has been undertaken, what the response has been and the treatment strategy that will be implemented moving forward.
That’s when you need an IMC!
IMCs can provide valuable advice to help you move forward when there has been little or no progress with a claim, and can liaise directly with NTDs and treating healthcare practitioners to discuss and negotiate treatment approaches and recovery goals. But with so much potentially valuable information at your fingertips, how can you ensure you are getting the answers you need through your IMC request?
Below are some recommendations to help you achieve the best possible outcomes for your claimant.
1. Know what you want to achieve
There are a number of proven approaches taken to obtaining information from an IMC. Referrals frequently seek advice on aspects such as:
a) Ability to return to pre-injury duties
b) Availability/appropriateness of suitable alternative work
c) The number of hours they can work
d) Timeframe to upgrading in hours and/or duties, and
e) The availability of suitable or alternative work
Many referrals have check boxes asking the IMC to “obtain an upgraded certificate” or to “assess the worker”.
And when peer to peer liaison between the IMC and the NTD/treating healthcare practitioners are requested, a question such as this can be of high value:
Q: Please discuss the following with the NTD and Specialist:
a) Developing a return to work plan in line with Ms Smith’s current ability to work and the plan to upgrade in capacity
b) Any recommendations to change Ms Smith’s current certificate of capacity
c) Any recommendations to cease, change or commence reasonably necessary treatment to assist with return to work and recovery
There are many standard templates listing high-value, commonly asked questions of an IMC, but the most important thing to note is that if there’s something specific you’d like to know, ask the question. Furthermore, some patients have multiple claims or body parts injured, so if you can indicate which parts you want assessed and the ones that liability has been accepted for, that is very useful.
2. Clearly state who you’d like the IMC to contact and why
Often, a list of 6 or more providers will be given. To get the answers you need, specifically list the information you need from each. For example, “Please discuss the vocational options with the rehab provider” or “The surgeon has recommended a spinal fusion. Could you please discuss other treatment options?”
3. Ensure the contact details are correct
To get your answers promptly, make sure the names and numbers of contacts are correct and up to date. This may sound obvious, but IMCs frequently encounter scenarios where an NTD has been contacted and the receptionist will say “They left 6 months ago!” Providing an email address is also helpful as sometimes phone contact can be difficult.
4. Alert the NTD and other practitioners that an IMC will be calling
Even though the IMC system has been in place for over 20 years, many practices and practitioners, especially ones who don’t see a lot of work injuries, are unaware of what an IMC is, or why they are calling. Common responses include:
a) Who are you?
b) What’s an IMC?
c) Are you an insurance doctor?
d) Why are you calling?
e) Dr XX doesn’t normally speak to people, can you fax/email the questions?
An email or fax sent to the NTD/treating practitioners prior to the IMC’s call will pre-empt most of these questions and greatly improve the quality and quantity of relevant information obtained. This communication should: briefly outline the role of the IMC; advise that Dr XXX will be calling in the next week to discuss treatment progress, RTW status etc.; and set the expectations that the call will only take a few minutes of their time which they can bill for. While this may involve a little extra work for the Case Manager, the payoffs are significant. Preparing the call in this way is also especially important for file reviews where the IMC will not physically see the patient.
5. Complete documentation
Receiving relevant and complete documentation is pivotal to receiving a well informed and timely report. Many times, an IMC will receive 100 pages of documentation, of which 95 are medical certificates. Other times, crucial documentation is missing which then needs to be requested, delaying the final report delivery.
While not exhaustive, this list provides a guide to what an IMC needs to properly assess a patient:
1. All relevant investigation reports – MRI/Ultrasound etc
2. Specialist letters
3. Operation reports
4. Vocational/Functional assessments
5. Previous IME/IMC reports
6. Job description/task analysis
7. Relevant medical certificates, i.e., has there been a downgrade
8. Physiotherapy/psychologist reports
6. Good communication
IMCs often want to speak to Case Managers or are requested to do so as part of the examination. Some Insurers provide direct numbers and emails for their Case Managers. Others require a message to be left on a general phone number or email address which often goes unanswered. Whilst it’s understandable that Case Managers may not want their direct email address/phone number circulated, for the purposes of the IMC it can be vital.
And if you only work on certain days, please document this on the referral so the IMC can contact you on the appropriate day.
7. Right timing/right IMC
Don’t request an IMC too early, too late or at an inappropriate time. For example, if a patient is about to go in for spinal surgery, issues such as work capacity, time to return to pre-injury duties, etc, are impossible to assess. It’s better to wait until after the post op period to assess. For some psych cases, people are referred many months after lodging a claim, and have often had minimal or no treatment. In these cases, early referral either for a file review or Stage 3 can be critical.
In summary, IMCs can be a Case Manager’s greatest resource if the process is managed well. Following these simple 7 tips will help you get the information you need sooner to effectively manage your claims. What other tips do you have?