Dealing with a worker’s compensation claim is a challenging process in many cases. To make things a little easier, we will look at the role played by a third-party administrator (TPA), an independent review organization (IRO), and an independent medical exam (IME) when dealing with such a claim.
The Third-Party Administrator
A TPA refers to an independent organization that handles and processes all medical insurance claims. This they need to do following a set of drawn up laws. Very often, when an insurance company finds themselves unable to expedite a claim, they will work with a TPA to do so. Although the TPA may handle the claim, the paying of the claim is in the hands of the insurance company or self-insured employer.
How The Third-Party Administrator And Independent Review Organization Collaborate
When you, as an employee, submit a workers’ compensation claim, you would usually have to undergo an insurance medical examination. This examination would check on the severity and breadth of your injury. A TPA, in assessing the claim, would usually partner with an independent medical review organization that would carry out the medical view process. These organizations have a network of qualified physician reviewers who work at assessing workers’ compensation claims.
Why The Need For An Independent Medical Examination?
If you are injured while at work, a doctor does a medical examination to find out what kind of treatment to administer. An insurance company may, however, need more information about your injury. In some cases, they may even dispute your doctor’s conclusion about your medical injury or its extent. They would thus ask for an independent medical exam. These exams are done by qualified, practicing physicians who give an unbiased medical opinion.
The Importance of Peer-To-Peer Reviews
Part of the workers’ compensation review process sees a specialty-matched physician taking a close look at your case. He will assess the nature and proposed treatment of your injury. These reviews often help in stopping the need for unnecessary, expensive treatments if found not necessary. In so doing, a healthcare body can rather use the money saved in bettering safety standards as well as focusing on the development of preventive health initiatives. A peer review can thus help with claims management as it helps determine impairment ratings and whether you, as an employee, can return to your work. An IRO thus helps speed up the process of getting an employee back to work.
In Conclusion
A third-party administrator when partnering with an independent review organization may help expedite claims and help an employee return to work faster. This smooths the process and helps both employees and employers.
