Compliance Corner: What Ohio Disability Evaluators Perform

Alliance, OH (WorkersCompensation.com) -- Physicians providing workers' compensation related services under the Ohio Bureau of Workers' Compensation's imprimatur must apply to perform evaluations.

The bureau draws from a pool of contracted physicians providing one or more of the following services:

PPD impairment evaluations. The examining physician reviews the medical records, obtains a history and
performs an examination based on the diagnoses allowed in the claim. Physicians must use the most current edition of the AMA Guides to the Evaluation of Permanent Impairment as a guide while performing an objective unbiased estimate of the percent impairment of the whole person. There is a CME requirement of the physician to provide this DEP service.

Independent medical evaluation (IME). The examining physician reviews medical records, obtains a history, and performs an examination to answer clinical questions as requested by BWC staff responsible for management of the claim. The questions relate to medical treatment issues or claim allowance issues, but do not address the maximum medical improvement (MMI) question. There is a clinical practice requirement to provide this DEP service.

Disability management IME. This IME allows better management of the disability from work but also
ensures appropriate and timely medical treatment. The examining physician reviews the medical records, obtains a history, and performs an examination to answer clinical questions as requested by BWC. The physician asks questions related to continuation of treatment and makes a recommendation for future treatment appropriateness. There is a clinical practice requirement to provide this DEP service.

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90-day IME. The examining physician reviews medical records, obtains a history, and performs an examination to answer clinical questions as requested by BWC. Questions pertain to continuation of treatment, recommendation for future treatment, appropriateness of current treatment, recommendations for vocational rehabilitation, and responding to the question has the injured worker reached maximum medical improvement. There is a clinical practice requirement to provide this DEP service.

Alternative dispute resolution IME. The examining physician reviews medical records, obtains a history,
and performs an examination to answer clinical questions as requested by BWC alternative dispute resolution (ADR) staff to provide direction for medical treatment issues in disputed cases. Established national treatment guidelines are used as a baseline standard for treatment decisions. There is a clinical practice requirement to provide this DEP service. Note: An ADR IME requires an exam within seven days of the BWC request with a 48-hour turnaround for reports.

PPD medical file review. The physician conducts a review based on the medical records and diagnoses allowed in the claim. Using the most current edition of the AMA Guides to the Evaluation of Permanent Impairment, the physician provides an objective unbiased estimate of the percent impairment of the whole person. This function generally requires the physician to be on site at the local customer service office. There is a CME requirement of the physician to provide this DEP service.

Alternative dispute resolution file review. The physician reviews the medical records to answer clinical
questions as requested by BWC ADR staff to provide suggestions for medical treatment direction in disputed cases. Established national treatment guidelines are used as a baseline standard for treatment decisions. There is a clinical practice requirement to provide this DEP service. Note: on-site review is desired but not required. This review requires 48-hour report turnaround.

Online medical file review. The physician conducts a review of the information in the file to provide medical opinion on questions provided by BWC staff responsible for management of the claim. The questions or issues are medical in nature. It is a BWC requirement that you conduct these reviews online, in the physician’s office or home. There are clinical practice (review of the file review instructional CD) and system requirements (high-speed internet access and an email address) to provide this DEP service.

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