Frequently Asked Questions
The decision by an employer or carrier to refer an individual into medical case management early in the recovery process has clear benefits for all involved parties. Some of those benefits include:
- The individual benefits by having a Case Manager who acts as an advocate fostering maximum medical recovery. This may allow the individual to return quickly to work and regain his or her status as a contributing member of the employer’s staff.
- The employer benefits by re-acquiring the services of an experienced employee without incurring the expense of hiring and training a replacement.
- The payer benefits from reduced expenditures associated with decreased recovery time and elimination of inappropriate treatments.
There are many reasons for referring an individual into case management, whether it is to obtain a definitive diagnosis, coordinate services to achieve a timely conclusion, or establish a causal relationship between a work-related injury and a current condition.
Case management may also be appropriate if the individual:
- Appears to be showing no sign of progress
- Is treating with several physicians simultaneously
- Has an extended disability without apparent medical cause
- Makes frequent visits to the emergency room
- Has prolonged medical care when he or she appears able to return to work
- Has multiple or complicated diagnoses, such as: spinal cord injury, traumatic brain injury, burns, severe orthopedic injuries, and amputation/reattachment of limbs
A medical review may determine that an individual is receiving treatments which are unrelated to his or her diagnosis, or that charges are being inappropriately billed by a provider.
Consequently, two distinct benefits may be derived from a thorough and comprehensive medical review:
- The individual may achieve a shorter recovery period if a more focused approach to his or her treatment can be implemented.
- Substantial savings for the payer may be realized from a more focused treatment regimen, from the shorter recovery period that may ensues, and from the identification and correction of any inappropriately charged fees.
How we conduct a medical review depends entirely on your needs. You might need a review that targets just one specific area of an individual’s care, or one that involves a thorough and comprehensive analysis of every detail of his or her care — the choice is yours.
Because Laurel Rehabilitation Services, Inc. maintains a large network of health care specialists, we are able to conduct medical reviews for most medical issues.
An IME is an objective medical assessment of your claimant to assist you in determining claim compensability and/or liability, restrictions and limitations, employability or disability status.
The evaluation is “independent” because the physician who conducts the evaluation is a private practitioner who is neither the examinee’s treating physician nor an employee of the insurer who requests the evaluation.
Laurel Rehabilitation Services, Inc. will arrange an IME conducted by one or more physicians, depending on your needs. We can even coordinate a panel evaluation for you if you have a complex case requiring the perspectives of different specialties.
We will manage every detail of this complex process, including scheduling the claimant’s appointment with the physician, Physical Capacity Evaluations (PCE), and quality control of the report. Our prompt turnaround time ensures timely claim resolution and avoidance of questionable payments.
Laurel Rehabilitation Services, Inc. is a Certified Peer Review Organization (PRO) under Act VI of the Commonwealth of Pennsylvania.
A peer / PRO / utilization review conducted by Laurel Rehabilitation Services will always consist of:
- A thorough, third-party analysis of medical records by a board certified specialist to determine the appropriateness of treatments.
- An unbiased, comprehensive report stating the conclusions of the specialist.
Laurel Rehabilitation Services, Inc. utilizes Board Certified Radiologists to review studies such as X-rays, CT Scans, and MRIs.
The reviewing physician may confirm or refute the findings of the original study. Clear recommendations will be provided by the reviewer for denial or appropriateness of the study.
Before it is sent to you, the reviewing physician’s report is carefully evaluated by one of our Registered Nurses to assure its quality and clarity.