Independent Medical Review Results

Subsidiary of a Fortune 500 international company that manufactures consumer automotive supplies and parts. Its 1,800 employees are located in virtually every state of the U.S.

Prior to Work & Well, the parent company had entered into an extensive Business Partner Outsourcing (BPO) agreement with a large, national human resources outsourcing corporation. However, that corporation did not offer leave management. Work & Well currently provides the subsidiary with integrated leave management for all medical leaves.

Claiming an allergic reaction to chemicals, an employee filed a claim for short-term disability benefits.

Action Taken
While reviewing the medical documentation, Work & Well’s case manager discovered the employee and her physician were attributing the allergic reaction to exposure to chemicals in the workplace, although the employee had not filed a workers’ comp claim.

We discussed the case with the company’s human resources (HR) contact, who assured our case manager the claimant was a “very good employee” who was “very ill” and could not return to work. Our case manager recommended an independent medical examination (IME) for another opinion on the employee’s health status, assessment of her work capability and whether the case was work-related.

The IME refuted the employee’s claim of inhalation exposure to workplace chemicals and any disability. Originally written out of work for the entire six months of short-term disability, the employee returned to work full-duty within a week of the IME.

The employer saved the cost of approximately 16 weeks of disability benefit payments. The employer’s potential liability was dramatically lessened with the refutation of the work-related claim