4-Attachment B Scope of Work.docx

Scope of Work #KK26-10 Attachment: B

1. Introduction The purpose of this solicitation is to provide Independent Medical Examiners to provide professional medical review and examination services (IMEs). These services will support the timely evaluation of injury-related claims and associated medical expenses. The goal of this agreement is to reduce unnecessary litigation costs and improve claims resolution efficiency.

The Contractor(s) will review medical records, perform independent medical examinations, and deliver written expert opinions regarding the necessity, reasonableness, and relatedness of medical treatments or procedures to reported injuries. Services will be provided on an as-needed basis, with response times aligned to Eligible Users case requirements.

2. Background Currently, most Utah governmental entities secure IME services through external legal counsel, either retained attorneys or the Attorney General’s Office, after a claim advances to litigation. This approach delays access to critical medical opinions and often results in increased costs.

By contracting directly for IME services, Eligible Users will gain timely access to expert medical evaluations before litigation becomes necessary, particularly in cases where liability is clear. This strategy aims to:

a. Improve claims handling efficiency

b. Reduce legal expenses

c. Support earlier and more cost-effective resolution of claims

3. Scope of Work The Contractor(s) shall provide IME services that may include, but are not limited to:

3.1 Medical Record Review:

Analyze medical records and billing statements to determine the necessity and appropriateness of treatments and charges.

3.2 Independent Medical Examinations:

Conduct in-person or virtual examinations of claimants when required, adhering to applicable medical and ethical standards.

3.3 Written Expert Reports:

Provide written reports detailing findings, professional opinions, and recommendations, including whether treatments or expenses are causally related to the reported incident.

3.4 Testimony:

Provide deposition or courtroom testimony, if requested, regarding the findings in the IME report.

3.5 Consultation:

Provide expert guidance to state agency claims staff regarding treatment plans, injury causation, and projected recovery timelines or permanent disability.

4. Requirements

4.1 Contractor Responsibilities:

a. Maintain all necessary professional licenses, certifications, and insurance required to practice in the State of Utah.

b. Provide IME services through qualified physicians and healthcare professionals with relevant specialties.

c. Complete all record reviews and examinations within timeframes agreed upon with Eligible Users, typically within 14 business days of referral unless otherwise approved.

d. Ensure reports are thorough, unbiased, and compliant with applicable standards for admissible medical opinions.

e. Maintain secure handling and confidentiality of all claimant and case information in accordance with HIPAA and State data privacy laws.

4.2 Agency Responsibilities:

a. Provide referral information, relevant medical records, and any specific questions or issues to be addressed in the IME.

b. Coordinate claimant scheduling and access to examination sites (if not performed at contractor’s facility).

5. Compliance

a. All work must comply with the Utah Medical Practice Act, HIPAA, and any other applicable state and federal laws.

b. Reports must follow a standardized format to be agreed upon by the Eligible User and the contractor and include sections for case history, examination findings, medical opinion, and supporting rationale.

c. Contractor must maintain documentation supporting their opinion for a minimum of 7 years after case closure.

d. Contractor performance will be evaluated on timeliness, completeness, and clarity of reports, as well as responsiveness to State of Utah agency requests.

6. Project Deliverables

a. Written IME reports delivered electronically to a secure file location in PDF format by agreed deadlines.

b. Detailed invoice with corresponding case numbers and services provided by line item.

c. Attendance and participation in witness testimony.

7. Project Timeline

a. Typical Review & Report Turnaround: Within 14 business days of receiving complete case materials.

b. Testimony and deposition scheduling as mutually agreed.

8. Project Budget This will be an as-needed, price-agreement contract with no guaranteed minimum usage.