MCN

What is an Independent Medical Exam (IME)?

An Independent Medical Exam (IME) is an objective medical evaluation performed by a qualified physician who has no prior treatment relationship with the injured party. IMEs are used in Workers' Compensation, auto injury, and disability claims to establish causation, assess medical necessity, determine maximum medical improvement, evaluate disability ratings, and resolve disputes about diagnosis or treatment.

What is a Peer Review?

A Peer Review is a comprehensive analysis of medical records, treatment plans, and provider recommendations conducted by a physician in the same specialty as the treating doctor. Peer Reviews determine whether treatment is medically necessary, causally related to the claim, consistent with evidence-based guidelines, and appropriate in scope and duration.

What is a Functional Capacity Exam (FCE)?

A Functional Capacity Evaluation (FCE) is an objective, performance-based assessment that measures a worker's physical abilities and limitations to determine safe return-to-work capacity. FCEs evaluate lifting, carrying, pushing, pulling, sitting, standing, walking, and job-specific tasks, then compare results against the injured worker's actual job requirements.

What is an Independent Review Organization (IRO)?

An Independent Review Organization (IRO) is a neutral, third-party entity that conducts evidence-based medical reviews to support fair and objective healthcare coverage decisions. IROs evaluate cases involving medical necessity, experimental or investigational treatments, and plan policy interpretation, providing unbiased clinical determinations that align with federal, state, and accreditation standards.