The Importance of Medical Record Review

Medical record review is one of the most important components of a QME’s practice. Why? Well, think of it this way: Would you date someone who you knew nothing about? Would you go into business with someone who you knew nothing about? Of course not, because knowledge is everything. Same with medical record review. QMEs are burdened with making decisions on behalf of injured workers – decisions that could be life-changing for the worker. That’s a scary proposition, which is where the importance of record review comes in. Why review medical records? Consider this scenario: You are a QME who has been assigned to evaluate an injured worker (applicant). You interview the applicant extensively and you examine them. But at the end of the eval you still really know very little about the person. They seem credible, their injuries seem real – but are they? You need to know more before making an important decision on behalf of the applicant. So, you read the records that the defense attorney has sent you and suddenly an entirely new picture emerges. Suddenly you are learning about a work-related injury that occurred ten years ago, and that motor vehicle accident five years earlier – and in both instances the applicant sustained injuries to the same body part(s) he/she is alleging in their claim. That doesn’t mean that the work-related injuries they sustained are invalid – of course they are. But it does mean that the 100% apportionment you were inclined to assign to the work-related injury should now be, say, 40% industrial and 60% pre-existing. That is a huge difference. What if you hadn’t reviewed the applicant’s medical records? And I get it, reading through ten years’ worth of records is tedious and time consuming. But they provide you, as a QME, with the applicant’s whole story. That is invaluable, and here’s why. As a QME, your credibility – and reputation – is on the line every time you make a decision regarding causation and apportionment. Make an incorrect decision based on insufficient information and your career as a QME may be short-lived. Review yourself or hire a reviewer? Let’s face it: Hiring someone to review medical records isn’t cheap. But it is worth the cost in the long run, and in the short term as well. A good, professional record reviewer knows exactly what to look for in records. Subjective complaints? Check. Objective findings? Check. Previous diagnoses that are similar to those the applicant is currently claiming? Double check. Deposition testimony that contradicts what the applicant reported to you? Triple check! While you, as a QME, are trying to balance your personal practice with your job as an assigned evaluator, what a relief it is to turn the task of record review to someone else – someone who makes their career out of reviewing records. Someone whose reputation depends on reviewing records ethically and thoroughly. So, consider hiring Medical-Legal to review your records. You’ll be glad you did! #QME #qualifiedmedicalevaluator #injuredworker #applicant #recordreview #medicalrecordreview #recordreviewer #medicallegal #legalrecordreview