TOGA Benefits LLC
Contact Benefit Management Services of Ohio to assist you with a national independent medical exam & provider network. Email us at bcarr@bmsoinc.com, or call us at (330)-856-6270 to receive more information.
An IME is a medical examination conducted by a physician or other medical specialist in response to a request for benefits, address medical determinations, evaluate and measure physical ability or to address legal questions. In addition, IMEs are performed to provide information for case management and as evidence to be used at hearings and other legal proceedings. IMEs are an invaluable resource in the decision making process on how to proceed with the medical case management process and understanding the medical facts of the claim and the necessity of on-going treatment.
The Initial Examination (IME) is a targeted independent medical examination preferably conducted within 21 days of an alleged occupational injury. The IME can provide employers answers relating to questionable treatment while at the same time, knowing a medical expert is watching out for their interests, from the beginning of the claim process. The benefits of an IME are numerous:
Benefits:
IMEs are performed by an expert physician trained to understand work-related injuries and the workers’ compensation system.
The exam provides a solid medical basis from which to approve and/or deny a claim.
An IME may be used to identify any of the possible 25 handicap diagnostic codes allowed by the Ohio BWC.
The exam can define and expedite better care for the injured worker.
IMEs can identify fraudulent claims before they get started.
The exam may determine inappropriate and redundant allowances in a claim.
An IME may result in substantial savings in medical and compensation costs.
The exam provides independent documentation of legitimate work injuries.
IMEs serve as a valuable reference and protect the employer from future liability by establishing early medical documentation of the correct allowances and prognoses.
The 90 day examinations (SDES) are required by statute and are conducted when an injured worker has received 90 consecutive days of temporary total disability. The exam addresses a number of issues, including continuing compensation, return-to-work issues and necessity of treatment. 90 Day exams are conducted by BWC and may be requested by the employer.
A qualified physician performs the SDES. The SDES features are similar to the IME, with the addition of the review of medical files pertinent to the claim. The SDES is a more detailed, comprehensive examination, primarily used to establish if an injured worker has reached Maximum Medical Improvement (MMI).
MMI is a treatment plateau that is static or well stabilized, at which no fundamental functional or physiological change can be expected within reasonable medical probability regardless of continuing medical or rehabilitation procedures.
An independent expert physician, skilled in the diagnosis and treatment of work-related injuries performs the exam.
A 90 Day exam can expedite the resolution of the claim.
The exam reduces the use of unnecessary tests and treatments, thus reducing costs.
A 90 Day exam can identify and eliminate fraudulent claims.
The exam can stop inappropriate and unnecessary disability payments.
A 90 Day exam can result in recommendations for more effective treatments for worker injuries.
The exam may prevent additional allowances of a claim.
The Medical FCE report is “a unique product offered by PCN”. The Medical FCE is an objective, interdisciplinary assessment of:
✓ Functional capacities (ability to move) | ✓ Medical recovery status | ✓ Readiness for return to transitional or full duty work |
✓ Symptom magnification or fraud | ✓ Appropriateness of ongoing treatment for allowed condition(s) |
The Medical FCE is a cost-effective, unique tool in the occupational and non-occupational disability marketplace. In one comprehensive report, the employer profits from the expertise of an experienced disability consultant with the objective determination of functional capacity by an experienced therapist and ergonomist.
Benefits:
Objectively defining the physical capabilities of the injured worker, rather than relying entirely on the opinion of the treating physician.
Facilitating a more rapid transition to
full duty employment
Facilitating a speedy disposition
of the industrial injury claim.
Assist in identifying the non-complaint or fraudulent worker.
Reducing time-lost claims and temporary total compensation.
Reducing the “on again, off again” work patterns of many injured workers.
Providing objective data that empowers employers at Industrial Commission hearings through the impact of an independent physician review combined with an objective physical capacity evaluation.
The physician file review consists of a comprehensive review of medical documents submitted to the physician for review and assists employers, and/or their representatives, with an evaluation of any medical and/or compensation issues that may arise during the management of an occupational claim, including fraud, treatment issues, disability questions and/or inappropriate pharmaceutical use.
Address: 400 Niles Cortland Rd. SE Suite G
Warren, OH 44484