Neurosurgical Evaluations
of the Carolinas
Independent and Complex Evaluations and Medical Management of Cranial, Spinal, and Peripheral Nerve Injuries
Information for Case Managers and Schedulers Page
General information
Please note that all new patient appointments for medicolegal cases (worker's comp, personal injury, disability, etc.) are scheduled with Dr. Curling as independent medical evaluations (IMEs). Whether the evaluation is being requested for the purpose of obtaining a second surgical opinion, additional opinion on a rating, or to address causality issues, work status, or other specific issues, all new appointments will be scheduled as an IME. The only exception to this policy is for a rating only evaluation for North Carolina workers' compensation cases, for which Dr. Curling does have a separate service to accommodate for this designation in the NC statutes (this issue is discussed in more detail in the commitment letter referenced below that will be sent to the payor as part of the scheduling process). Dr. Curling approaches all patients with the same degree of attention and thoughtfulness, irrespective of the issue involved (or of the referral source). Even if the evaluation is "just for a second opinion on a rating", in order to conduct an appropriate and accurate impairment assessment, it must be first determined if the patient is indeed at MMI before that rating can be rendered. Being able to determine that a patient is at MMI requires a thorough understanding of the correct diagnosis, as well as an assessment of whether or not appropriate diagnostic studies and treatment options have been rendered in the case. Therefore, although the subsequent report of the evaluation may only address the rating (or other requested issues), the same thorough process has been carried out as would have been done to assess all of the appropriate issues--including diagnosis, prognosis, diagnostic and treatment recommendations, work status, work restrictions, causality, MMI, and PPI.
All new patient appointments are for "evaluation only". No treatment will be initiated at the time of the initial appointment. However, in specific circumstances, Dr. Curling may be available to facilitate obtaining additional studies and further non-operative treatment that he may have recommended. This may be an option in cases where the patient has been released by the treating physician and additional studies or treatment are felt to be appropriate to help the patient move towards MMI. In all cases, further treatment will be limited and is provided mainly for the purpose of facilitating closure, when appropriate. Dr. Curling will not be available for long term maintenance treatment, with rare exceptions. In no case will treatment be initiated prior to completion of the IME report and review by all appropriate parties of the final recommendations contained therein. If following review of the report, additional treatment in this office is desired, then you may contact our office to determine if this can be arranged. If the patient is felt by Dr. Curling to be a candidate for surgical treatment, he can assist with referral to an appropriate operating neurosurgeon (or other spinal surgeon) if requested.
Also note carefully that Dr. Curling strictly limits his practice to the realm of neurosurgery--i.e., brain, spine, and peripheral nerve injuries. He does not perform general occupational injury evaluations, nor will he address issues that he deems to be outside of his area of expertise. If multiple injuries are present in an individual patient, he will only address those relating to neurosurgical injuries. For example, he will evaluate a patient with neck and shoulder pain and will render an opinion regarding the diagnosis and other appropriate issues as able and appropriate. If the source of the patient's pain is felt to be the cervical spine, then further recommendations will be offered; however, if the source is felt to be the shoulder joint and not the spine, then orthopedic evaluation will be recommended. If it is unclear whether an evaluation of a particular patient by Dr. Curling is appropriate, we would recommend that you contact us to discuss the specifics of the situation. While Dr. Curling does not routinely require that records be submitted for review prior to requesting an appointment, he may do so in these situations in order to determine the appropriateness of a referral.
Dr. Curling realizes the importance of communicating with case managers, adjustors, attorneys, and others involved with medicolegal cases. However, in order to complete the most objective evaluation possible while also encouraging the patient/claimant to feel comfortable and to enjoy the appropriate amount of privacy and confidentiality during the evaluation, Dr. Curling does not allow these individuals to accompany the patient during the evaluation. However, if you choose to accompany the patient to the appointment, he will gladly sit down with you and the patient in the conference room immediately following the evaluation to review the initial findings and impressions and to address any questions that you may have. Please note that Dr. Curling's new patient appointments are lengthy, and probably quite a bit longer than those to which you are accustomed. As a general rule, if you wish, you can plan to arrive about an hour after the scheduled appointment time in order to minimize your wait time while Dr. Curling is with the patient. As an alternative, you are welcome to wait in the privacy of our conference room while Dr. Curling is with your patient, during which time you can catch up on a little work, reading, calls, sleep, etc.
Dr. Curling generally does not honor requests that stipulate that the results of the evaluation are not to be shared with the claimant/patient. He considers the patient to be the most important participant in the process and considers such requests to be inappropriate. Time is actually allotted each week in his schedule for these purposes.
Dr. Curling recognizes that all patients/claimants seen for IMEs are potentially cases that will require legal testimony at some point in the future. He is available for consultation with attorneys, deposition, or other sworn testimony upon request, and will attempt to work with the requesting attorneys to accommodate these needs should they arise. Time is actually allotted on his schedule each week for these activities.
It is Dr. Curling's goal to publish the reports of initial evaluations as expeditiously as possible following the appointment and ideally within 48 hours. Obviously, however, that is not always possible, particularly if additional information (either records or studies) is necessary in order to provide a complete and useful evaluation. However, in most cases, you can count on the report being released no later than 10 business days following the appointment date. If the necessary information is not available at the time of the appointment, preliminary impressions will be shared with the patient (and the case manager following the appointment if present) and the report will be produced after the additional information has been provided.
Scheduling an evaluation
Adjuster (or other payor) approval and prepayment is required before any new patient appointment will be confirmed. To start the scheduling process, you should provide us with the general information regarding the case, including all contact information for the patient, case manager, attorneys, and adjustor. Our standard information request sheet that highlights the required information can be obtained by contacting our office and requesting that the form be faxed or emailed to you, or you may access the form via this website (click here for a Word version or here for a pdf version of a request form that can be completed and returned--either print and mail/fax/scan to email or complete on your computer, save, and email to the address noted on the form). Following receipt of that information in our office, we will fax or email our standard commitment letter and memorandum of understanding to the identified payor for the service, who must complete that memorandum and return it to us, along with prepayment for the evaluation. Once that information has been received in our office, the requesting party will be contacted to establish an appointment date and time. After an appointment time has been established, an information packet will be mailed to the patient from our office, which will include general information about the visit, a registration form, and directions to the office.
Note that Dr. Curling will address all appropriate issues in his reports, as outlined in the commitment letter. If specific information is requested, it is important that all parties communicate with each other to ensure that you all have the same expectations for the evaluation, and that those expectations are conveyed in a cover letter.
There is a charge for no show or late cancellations; should such occur, the appointment will not be rescheduled until that payment has been received in our office. These policies are detailed in the commitment letter.
[Home] [Introduction] [Education] [Location]
[Information for patients] [Information for case managers and schedulers]