The key to meeting (and exceeding) client expectations
An Independent Medical Examination is one tool that Lawyers, Claims Advisors and Adjudicators, and Employers and Unions use to help move rehabilitation and recovery forward and claims towards resolution.
Clinical and Administrative Quality Assurance is an integral component of the IME process and report.
In this blog post, Erica Enstrom and Angie Arkwell, co-owners of Integra, explain why a strong Quality Assurance program is vital to Integra’s success as a service provider.
Angie: Let’s get started, Erica. As a clinical expert, why do you think a Quality Assurance process is so important?
Erica: Thanks, Angie. You and I both know that Integra’s Quality Assurance process helps meet our client’s needs and expectations and, that our client, in turn, whether a lawyer, an insurer, or an employer, will have stakeholders with their own expectations. Generally, our Quality Assurance process ensures that all stakeholder expectations are met and exceeded. But, from the outset of the IME process first and foremost, we need to understand what our client’s needs and expectations are.
Angie: Each of our client markets has distinct needs. For instance, the needs of our legal clients are partly driven by geographical location and provincial legislation.
In Ontario, motor vehicle accident claims have a Threshold, a Deductible as well as under the SABS (First Party/No Fault Accident Benefits); the M.I.G. (Minor Injury Guideline); and a Catastrophic designation to contend with.
In Alberta, there is a Minor Injury Guideline with a Cap, and Section B benefits, Certified Examinations, and Tort claims.
In BC, we see significant changes on the horizon, with our clients and healthcare professionals needing to be familiar with both Part 7 and Tort claims.
Each Atlantic province also has minor variations in their legislation for Minor Injury Guidelines and Caps, with the Maritime Provinces having a Cap on damages while Newfoundland itself does not.
Each province’s legislation varies with respect to tort and accident benefits claims.
Erica: Imagine, Angie, this is only one client segment! When working with our disability insurer clients, we know that the contract language is important in determining the definition of disability, and language and definitions can vary greatly amongst insurers.
And then we have Employers and Unions. Some Human Resource and Union professionals may only ever order one IME over their entire careers, and yet we can also work with employers who have a full Occupational Health team. In each instance, there may be legal, regulatory, collective agreement and specific policy requirements which must be followed and adhered to, and in some instances, we may encourage employers to speak to legal counsel before engaging our services.
Angie: Don’t forget about Medical Malpractice claims, where Standard of Care and Causation are the foundations for establishing these types of cases, While generally consistent across Canada, from a case law perspective, the Standard of Care certainly is not standard across geographies
So, of course, it’s important that Integra has a robust Quality Assurance process. Our process is one of transparency, wherein we provide guidance but ultimately ensure the content of the report is exclusively that of the healthcare professional. So much of our industry has come under fire due to the absence of transparency in report quality and pricing, not to mention ghost writing. Integra is mindful of these issues, and we consider ourselves the antithesis of the ghost-writing, behemoth IME agency.
Erica: Yes, Angie, as a clinician and court-qualified expert, I would never want our team to be seen as influencing the opinion of our healthcare professionals. Our clients don’t want that, and our healthcare professionals don’t expect that. Ultimately, we always steer clear of such behaviours.
Angie: I think it’s pretty clear we understand the different lines of business. Having worked as an claims adjuster, broker and law clerk prior to Integra, I was drawn here by the expertise we have within our team. Our Quality Assurance readers cover many geographical areas and market segments. We have paralegals, law clerks, physiotherapists, kinesiologists, and many other groups represented within our Quality Assurance team. Our team lead assigns Quality Assurance reads based on the unique client and healthcare professional needs. This expertise is an important differentiator between us and our competitors.
Angie: The QA team checks to ensure the healthcare professional’s responses in the report are corroborated by the medical evidence presented. It is also important to ensure sure the professionals remain within scope of practice in their reporting. Our QA readers also ensure that all referral questions are addressed and that the report is consistent and congruent throughout. Factual administrative information such as date of loss, date of birth, claim number, etc., are verified within the report. We use a Quality Assurance checklist to ensure the report meets our internal standards.
Erica: I definitely think it’s important to loop back to the fact that quality is a holistic process. We look for quality from intake, through to medical documents, reporting, and Quality Assurance and even with accounting. Any breakdown in the workflow will result in a less than high quality report. So, early steps in the process, like having clinical oversight of intake and having our medical documents team confirm no records are missing from the file, are just as important as the later steps of our Quality Assurance process.
Angie: One of the things we do really well is that we ask the right questions at intake. When a referral is received, it is reviewed to ensure there are clear questions submitted by the referral source. I love being able to refer things to our healthcare professionals for complementary review where necessary.
Erica: Yes, and I think it’s important to point out that we have a medical director involved in reviewing referrals and reports to ensure a high level of quality. And you and I, as clinician and technician respectively, are involved in the workflow from start to finished.
Throughout the entire IME process, as business owners, we are always paying close attention to choosing the right specialty and asking the right questions. This is fundamental to our overall Quality Assurance program. For more information please contact us at email@example.com or firstname.lastname@example.org.