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 erica@integraconnects.com or angie@integraconnects.com.
Celine Grosch, Team Lead, Reports & Quality Assurance
Celine comes to Integra with significant experience from working at a full-service law firm in the Okanagan as a Trial Coordinator and Legal Administrative Assistant. Her scheduling experience together with her attention to detail, organization skills and multitasking abilities are strong assets for her position to facilitate quality assurance, to coordinate report deadlines, and to support Integra’s administration team.
Based out of Integra’s Kelowna office, Celine prides herself on working hard to meet all requests and needs from clients and medical professionals. Her goal is to organize and assist others to make obtaining reports as seamless as possible.
In her spare time, you will find Celine hiking, biking or running – anything to get outside and enjoy all the Okanagan has to offer.
Claire is our Operations and Client Services Manager for Ontario and Atlantic Canada. Claire brings 12 years of industry experience throughout Ontario, Alberta and British Columbia with her to this role.
Claire has a B.A. in English from McMaster University and has completed the Human Resources Management Certificate Program through Mohawk College.
Professionally, Claire has a passion coaching, team building, problem solving and providing excellent customer service. Personally, she is an avid yogi and certified yoga instructor who loves meditating, going for long walks, and enjoying the little things in each day.
Susan Liu, Senior Manager, Accounting
Susan joined Integra in the spring of 2018, following a one-year hiatus in her hometown in China. Susan has extensive accounting experience, having worked for several IME companies over the past ten years prior to joining Integra.
Susan is responsible for ensuring accurate and timely invoicing to clients, on time and accurate payment to medical professionals; managing accounts receivable and payable and general cash flows.
Prior to her time in the IME industry, Susan worked as a file coordinator at a medical office in Vancouver, and prior to that spent time working in a tax preparation business.
When not working, Susan enjoys spending time with friends and family and introducing Integra staff to dim sum experiences in and around Vancouver. Integra counts on Susan (no pun intended) to ensure our accounting systems are accurate and up to date.
Winnie Keji, Senior Manager Operations, & Client Service BC & Alberta
Winnie is Integra’s Manager of Operations & Client Service. She ensures smooth and efficient day-to-day operations of all Integra offices. In addition, she is responsible for oversight of People & Culture.
She graduated from Thompson Rivers University with a Bachelor of Tourism Management and Marketing. Prior to joining Integra, she worked in the different sectors of the Tourism, and Retail Industries.
Winnie is an avid reader, hiker, and traveller. She is passionate about mentoring, and volunteering. She is currently a volunteer at Dress For Success (DFS) and also at Black Women Connect Vancouver (BWCV.)
Elisa Hemmati is one of our Report Quality Assurance Technician.
Elisa graduated from Simon Fraser University in 2020 with her Bachelor of Science, major in Kinesiology, minor in Archaeology. At Integra, Elisa is responsible for reviewing medical-legal expert reports to ensure they are clear and concise. She is also part of the weekend clinic team where she is responsible for facilitating assessment services on Saturdays.
Prior to joining the team at Integra, Elisa was focused on gaining experience in the health and rehabilitation aspect of her degree through volunteer work. She is passionate about teaching and has experience as a teaching assistant in Kinanthropometry and a peer tutor in anatomy. She believes that her work at Integra will further expand her knowledge in the medical field.
Rachel Park, Clinic & Documents Coordinator
Rachel works in customer support at Integra as a document and clinic coordinator. She organizes documents received by third parties and submits them to healthcare professionals, in addition to coordinating a very busy clinic setting. Every day, her goal is to demonstrate excellence and professionalism in customer service.
Rachel acquired her education in Marketing and Event Management and has diverse work experience in Administration, Sales, Hospitality, Event Planning, and Catering. Her passion is learning new things that inspire her and boost her energy; she enjoys working out, playing tennis and squash, snowboarding, reading, and watching Ted videos that fill her day with inspiration and blessings.
Working in the healthcare industry is Rachel’s newest adventure and she’s excited to embody Integra’s core values of transparency and integrity as she applies her amazing customer service skills towards every client interaction. When not at Integra, Rachel enjoys organizing events for her family and friends. Prior to joining the team at Integra, Rachel worked as a corporate catering and events planner.
Kaede Hislop, Reports Coordinator
Prior to joining Integra, Kaede spent two years at an Arts startup, helping with business development while also teaching children and young adults how to carve stone. Prior to this, she worked for an IME company as both a clinic coordinator and then a reports coordinator.
Kaede has a Bachelor of Fine Arts from Emily Carr University and a love for art history and travel. When she isn’t trying to get her fix of the two, you can find Kaede indulging in as many TV series as possible or practicing as an amateur pasta maker.
Kaede strives to understand the needs of all the different departments at Integra so she can lend a helping hand wherever one is needed. Her patient and kind demeanor is a great welcome for examinees who may be distressed about the IME process.
Kaede loves to work with people and loves the work that Integra offers her. And if you don’t know how to pronounce her name? Just rhyme it with Friday!
Cara Kendrick, Team Lead Reports & Quality Assurance
Cara’s handles report coordination duties and provides support to Integra’s clinic administration team. Cara enjoys organizing and assisting others to make their roles function smoothly and efficiently, so these responsibilities are well suited to her skills and experience.
Before arriving at Integra, Cara studied in Ireland, graduating with an MA in International Tourism, and subsequently spent two years working in the tourism industry arranging and coordinating travel down to the minute detail for highly demanding golf travelers. Cara also has a keenness for travel, and has spent time backpacking around South America and Asia prior to relocating to Vancouver. This move to Vancouver has allowed Cara to seek a new career path, which brought her to Integra.
In her free time, Cara is an avid reader. She also loves trying out new restaurants, and more recently, exploring the beautiful scenery that BC has to offer.
Ali Knowsley, Accounting Coordinator
Ali joined Integra as a career change, after working many years in the cosmetology industry. Her positions prior to joining Integra’s team focused on scheduling, maintaining client files and ensuring smooth operational delivery of excellent client service. Her passion for detailed, information-based work makes her a great fit for Integra’s team.
Ali takes pride in her meticulous attention to detail, ensuring both efficiency and accuracy in our accounting department. In addition, Ali supports our reports team, receiving reports and documents, communicating between medical professional and quality assurance team members, and ensuring quality throughout the process.
In her spare time, Ali enjoys attending live shows within the Vancouver music scene and working on cross stitch projects. Ali recently started online courses to learn American Sign Language.
Angie Arkwell is Managing Director and Co-Owner of Integra.
Angie has over 20 years experience in the legal, insurance, financial and risk management sectors having worked with Personal Injury, Insurance and Civil Litigation Law firms in a variety of roles, including Senior Law Clerk, Adjuster and Examiner (all lines), and Licensed Broker with a special interest in Legal Cost Insurance.
For the seven years prior to joining Integra in July 2020, Angie was a Director at BridgePoint Financial Services, where she was instrumental in developing and implementing various programs for plaintiff law firms and their clients, as well as experts, assessment companies and treatment providers.
Angie has in-depth knowledge of claims from intake through to trial and specializes in Tort, Accident Benefits, LTD, Employment, Medical Malpractice, Occupier’s Liability and Personal Injury claims. Because of her vast experience and knowledge, Angie is a trusted adviser to law firms and healthcare professionals, and her guidance is routinely sought throughout the claims process. She builds strong, lasting relationships many of which become friendships based on trust, honesty, integrity, and expertise.
Angie is an avid fundraiser for many community support initiatives including food banks, women’s shelters, the Alzheimer’s Society and Sick Kids Hospital and is known to create online and social media challenges for her friends and colleagues to increase awareness and donations. Angie also runs a non-profit community soccer league for 150 children each summer, which is funded through local business donations, allowing children to play without cost impediments.
When she is not working or fundraising, you can find Angie lost on a hiking trail, playing sports with her children, practicing her golf swing, or staying up too late reading a good book.
Erica Enstrom, Managing Director, British Columbia & Alberta, Founder & Co-Owner
Many of you have known Erica over the course of her twenty-year career in the medical assessment business, where she worked as a clinical evaluator with Viewpoint Medical early in her career and subsequently as a business developer with Medisys IMA and its successor Cira Medical. Prior to starting Integra, Erica was the President of IMA Solutions, a business unit of ExamWorks, before leaving to briefly work in the financial services and risk management sector with BridgePoint Financial Group. Erica has her Masters of Business Administration in Organizational Behaviour and Marketing, as well as an undergraduate degree in Kinesiology. Erica is also a trained Functional Evaluator.
Over the past twenty years, Erica has demonstrated a loyalty towards clients and medical professionals that is unmatched. Legal and insurer clients know of her desire and capacity to build strong, lasting relationships based on trust and mutual benefit. Physicians and allied health professionals come to her for clinical and business advice because she works transparently and honestly, without exception, as she keeps client and medical consultant priorities top of mind.
Erica is a court-qualified medical legal expert, a clinical consultant, and an evaluator in the areas of functional capacity and cost of future care. She advises clients in the areas of clinical triage, medical assessment and assessor suitability, quality assurance, and overall litigation and claims support.
Erica and her team at Integra support many community initiatives. For the past seven years, Erica has been a board member of the Women in Insurance Cancer Crusade (WICC), the Canadian Cancer Society’s largest corporate-affiliated donor. Since its inception in 2002, the BC Chapter of WICC has raised $2 million dollars in donations. Erica is also a donor to the BC Children’s Hospital Foundation as well as a volunteer and donor with the Children’s Wish Foundation. In 2017, Erica provided fundraising support to both the Trial Lawyers Association of BC Public Affairs Committee and the Alberta Civil Trial Lawyers Association Women’s Legal Forum.
DR. Chris Watt, Medical Director
Dr. Chris Watt is a certified Sports Medicine Physician through the Canadian Academy of Sports Medicine since 1994. He is a Certified Independent Medical Examiner through the American Board of Independent Medical Examiners (ABIME.) Dr. Watt has acted as an independent medical consultant with expertise in musculo-skeletal and occupational medicine since 2002. He has served as an expert witness in the Supreme Court of BC on many occasions. Dr. Watt provides a wide variety of occupational medicine and disability evaluation services including return to work assessments, independent medical evaluations and pre-employment exams. He has also provided executive medical exams with fitness and stress testing and exercise prescriptions through Executive Health programs to the private sector.
As Integra’s Medical Director, Dr. Watt is available to the staff, clients and assessors for clinical guidance as it relates to file triage, clinical suitability and assessor credentialing and training.
Dr. Watt is a peer article reviewer for the Canadian Family Practice Journal. He has a special interest in and has made multiple presentations on topics related to Sports Medicine, health promotion for BCMA, lifestyle interventions for chronic disease management, and the management of mood disorders. Dr. Watt is an avid athlete and has participated in IronMan, has cycled the Great Divide Mountain Bike Route, and and was a part of a team completing the Race to Alaska.
Siobhan O’Sullivan, Team Lead, Intake and Medical Documents
Siobhan comes to Integra via another medical enterprise, having been responsible for scheduling and reporting of occupational services in her previous role. Siobhan grew up in Limerick Ireland, and graduated with a Bachelor of Arts in Public Administration, following which she came to Vancouver on a one year work travel visa.
Over six years later, having fallen in love with Vancouver, she’s still here! Siobhan prides herself on her focus on customer service, building strong relationships with clients, while coordinating services in a very busy clinic environment. Outside of work, Siobhan loves to try out the latest vegetarian recipes, scouring cook books and blogs for interesting dishes. Siobhan is responsible for scheduling appointments and teleconferences, trial attendance and other services for our many legal and insurance clients.
Nikki Kirkland, Trial Coordinator
Nikki has ten years’ experience as a Legal Administrative Assistant. Her strong work ethic has allowed her to assist both Senior Partners and Associates in law firms of all sizes, including the largest law firm in B.C. With this experience, Nikki has had the pleasure of working with diverse groups of people with different working styles. She has developed excellent organizational skills, effective approaches to problem solving and the ability to meet deadlines while maintaining a high standard of work.
Nikki works remotely for Integra as our team’s Trial Coordinator. Her responsibilities include scheduling of expert testimony, coordinating of trial preparation by phone and office meeting, attending trials to solicit experiential feedback from experts and clients, ensuring financial matters are tied up post-settlement, and other administrative tasks as required.
In her spare time, Nikki enjoys spending time with her family, attending dance classes, and preparing and savouring delicious food. She is an avid reader and hopes to beat her partner in a round of golf one day.
Don-nel Heppner, Intake and Documents Coordinator
Don-Nel joined Integra at the beginning of 2020 as an accomplished Business and Administrative Manager with significant experience in the health care industry. Her strong organizational and administrative skills come with superior capabilities in planning and attention to detail. She is an innovative problem solver, able to proactively develop solutions to challenges in a variety of work environments. Don-Nel is responsible for ensuring the operations in Kelowna run smoothly, while also facilitating intake and documents management for a variety of clients across BC & Alberta.
Don-Nel came to Kelowna 7 years ago from Saskatoon where she was born and raised. The Okanagan’s beauty stole her heart. Don-Nel takes a great deal of pride in connecting with her community and clients on a personal level, with a focus on building lasting relationships.
Outside of work Don-Nel loves trying out new recipes and adventures with her husband, gardening, crocheting and of course boating… the lakes in the Okanagan are amazing. Most importantly, family is Don-Nel’s top priority, including her first grandchild who has Don-Nel wrapped around his little finger.
Saima Alam, Intake and Documents Coordinator
Saima joined Integra at the start of 2020 as intake and documents coordinator for the Edmonton office. Some of her responsibilities include ensuring consistent communication with clients, organizing and distributing medical briefs, and facilitating appointments with examinees. Her role also requires her to keep the Edmonton office organized and orderly, while ensuring all stakeholders – clients, examinees and medical professionals – are having their needs met.
Prior to joining the Integra team Saima attained her paralegal studies diploma. Through her participation in the program, Saima had an opportunity to complete a practicum at Court of Queens Bench. This provided her with the experience to work with many diverse groups of people, keeping up with a fast paced environment, and got to work both independently and as part of a team.
During her free time Saima enjoys cooking up new recipes, spending time with friends and family, and watching murder mysteries.
Ashlea Mok, Report Quality Assurance Technician
At Integra, Ashlea is responsible for reviewing medical legal expert reports to ensure they are clear and concise. Ashlea graduated from the University of British Columbia Okanagan with a Bachelor of Human Kinetics. Prior to joining the team at Integra, Ashlea was working for another medical company in the role of Kinesiologist. During her six years in that role, Ashlea had a number of responsibilities, including conducting medical testing and assessment, and reviewing medical reports for content and clarity. Ashlea prides herself on her attention to detail and strong interpersonal skills.
Ashlea grew up in a small town in the West Kootenays of British Columbia. She believes her upbringing has inspired a lifelong appreciation for all things outdoorsy. She has a passion for camping, hiking and exploring the beautiful outdoors of British Columbia with her family. Ashlea is also an avid crafter and loves trying her hand at making anything and everything she is inspired by on Pinterest, from cooking the newest recipe to sewing projects for her daughter.
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