Conducting Independent Medical Examination (IME) – Tips To Consider

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An Independent Medical Examination (IME) is considered an integral aspect for litigation in various settings and systems like workers compensation claims, personal injury litigation, social security administration claims, motor vehicle claims and other short-term and long-term disability evaluations. In many injury cases, the defendant (usually through an insurer) wants the injured claimant to attend an independent medical examination. In simple terms, an IME typically involves a physical examination as well as review of relevant medical records by an independent medical examiner. It is an examination conducted by a third party medical professional who is not the claimant’s treating physician. Generally, in most injury cases, the independent medical examination is mainly done at the request of the defendant and is used to gain information regarding the plaintiff’s injuries. Medical record review plays a significant role while conducting independent physical examinations as it involves a detailed interview with the claimant and a review of file documentation. As part of the medical evaluation, medical examiners may provide a medical-legal opinion based on a detailed review of the relevant medical records and other pertinent information. Need for an Independent Medical Examination Generally, the insurance company requests an IME when it disagrees with a decision by the treating physician about the course of medical treatment recommended (especially if they recommend any specific surgery or other expensive procedures) or the extent of any permanent disability. However, in some cases, the judge or hearing officer assigned to deal with the injury case may also order an IME to resolve a disputed issue related to the case. There is a bevy of information that can be ascertained from a medical examination of the plaintiff, much of which can relate to the requisite elements of the claim. An IME can uncover not just the scope of the injuries, but also lead to important conclusions regarding the type of severity of damages (permanency of injuries, loss of future earning potential, pain and suffering), as well as whether the defendant’s alleged breach of care proximately caused the injuries. IME and associated medical chart review are conducted for various purposes – • To evaluate causation of an injury/illness • To determine whether the treatment was medically necessary • To decide how long a temporary impairment is likely to continue • To assess permanent impairment • To determine if the claimant has achieved maximum medical improvement In case of an independent medical evaluation, it is important to be aware about the fact that a formal physician-patient relationship does not exist between the plaintiff and the medical examiner. Therefore, it is important for a claimant to get fully prepared when going for an independent medical examination. Likewise, from the defendant side, there are certain qualifications an examining physician should possess in order to prepare an unbiased or complete report. Here discussed are some key aspects that need to be considered throughout the medical examination or evaluation process – • Verify that the Independent Medical Examiner is Qualified – It is important to verify that the physician entrusted with the task of performing the independent medical examination should be qualified in the specific area of medicine that relates to the claimants injuries. The medical examiner should be a licensed, practicing physician. If the medical examiner is not well-versed in all the necessary specialty and sub-specialty areas applicable to the case, it does not affect either parties of the case. For instance, a plaintiff suffering from injuries related to the spinal cord area would benefit from being examined by a neurologist or neurosurgeon whereas a general practitioner would be less qualified in that area. Choosing a truly neutral medical expert is the safer and more ethical approach, which can help manage any legal challenges down the line. • Obtain Medical Records – During a medical examination, the claimant need to be fully prepared with all the necessary medical records regarding the diagnosis, testing, and treatment related to the injuries. It is important for the claimant to ensure that the physician is obtaining a complete picture of their injuries. In addition, evaluating correct medical records can help medical examiners identify whether the claimant is in any way trying to conceal or hide any specific aspects of their medical history. Any qualified medical examiner should take all aspects into account when drafting a medical report and stating the findings. • Clearly Communicate with the Physician – An independent medical examiner’s primary responsibility is to determine the scope of the injuries for the purpose of determining issues like - potential causation, degree of disability, scope of injury permanency or other damages. This does not mean that the medical examination should be rushed or incomplete. It is important for the plaintiff to communicate in detail all the pertinent information related to the injury to the medical examiner. In all general cases, medical examiners are fully trained to recognize misrepresentation or exaggeration of injury facts. However, this does not mean that the claimants should shy away from vocalizing the extent of their injuries, pain, or limitations. In certain cases, depending on the complexity or severity of the injury, a follow-up examination or a referral to another specialist may be warranted. • Ensure that the Medical Examiner’s Report is Complete – Once the medical examination is completed, the physician needs to prepare or draft a detailed report (which is provided to both the parties). Typically, the medical report must outline the diagnosis, the extent and severity of the injuries, objective findings such as diagnostic testing and medical imaging studies and other related findings. On the other hand, more subjective manifestations of an injury, such as a plaintiff’s pain level rating, should not be overlooked, as they can form an important piece of the medical record. The report can be supplemented if additional medical records are obtained or if the plaintiff is examined again. As this report may be quoted throughout the litigation process, and can form the basis of the physician’s future deposition or trial testimony, it benefits all parties to have a complete and accurate report. • Adhere to Ethical Guidelines – Physicians are bound to follow a specific code of conduct and ethical standards when acting as an expert for a medico-legal case. However, it is a hard to ignore fact that IMEs are conducted by professionals compensated by the defendant side. In order to avoid a potential ethical dilemma (and a slew of unnecessary motion practice), both parties should be fully aware of the ethical standards governing IMEs. For instance, the American Medical Association (AMA) has set forth the code of conduct governing physicians offering medical testimony which states that – the physicians have an obligation to assist in the administration of justice. The AMA requires that all physicians must correctly represent their individual qualifications, testify honestly, and not allow their opinions to be influenced by financial compensation. On the whole, it is important to understand the fact that an independent medical examination can have consequences on a medico-legal case. As such, both parties should ensure that the examination is conducted as thoroughly as possible by a qualified medical expert. The medical evaluation must be unbiased so that all medical facts are presented in the right perspective. In fact, objective and clinically informed medical reviews help verify the validity of the claims. The right medical record review services will help evaluate claims, fraudulent representations, and excessive costs.