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Understanding the Independent Medical Examination Process

 

A man shakes hands with an independent medical examiner.An independent medical examination, or IME, is an evaluation of a person’s medical condition to assess whether they are eligible for disability benefits or compensation. An IME provider is typically a doctor or other qualified health professional.

An independent medical examination can serve several purposes. IME providers often evaluate workers’ compensation claims according to an insurance company’s eligibility criteria. The provider may also assess a person’s eligibility for federal disability benefits. An IME could also play a role in litigation involving psychiatric or physical injuries. For example, a person who sues their employer over a traumatic brain injury sustained on the job may undergo an independent medical examination. 

If you are a mental health professional who treats bipolar, posttraumatic stress (PTSD), chronic pain, or other disabilities, your client may undergo an independent medical examination at some point. Understanding how these evaluations work can help you offer emotional support during this process. Psychologists or psychiatrists interested in becoming an independent medical examiner can learn more about the job below.

WHAT IS AN INDEPENDENT MEDICAL EXAMINER?

An independent medical examiner is an expert who examines a patient to assess their health. Lawyers and insurance companies often hire them in the context of litigation or when a worker makes a workers’ compensation claim. 

Car insurance companies, workers’ compensation insurers, and self-insured employers paying workers’ comp claims have a right to request an independent medical evaluation. In the context of litigation, an IME may be a tool to prove a plaintiff’s claim in a lawsuit as a way to encourage a defendant to settle a lawsuit. It could also support a defendant’s claim that a plaintiff is not as injured as they claim to be. 

In the context of mental health, independent medical examiners are licensed mental health professionals—often psychiatrists or psychologists—who assess whether a person has a mental health diagnosis eligible for insurance payouts or other benefits. Examiners are supposed to provide independent, objective evaluations. They are not directly involved in patient care, and they do not order treatment or provide ongoing care to the person they evaluate. A professional who has previously cared for an individual may not serve as the independent medical examiner. 

There is no therapist-patient relationship and no confidentiality. So unlike a traditional medical exam or psychiatric evaluation, one of the examiner’s goals may be to poke holes in the patient’s story. Their job is to assess whether a person’s claims of injury or disability are true, as opposed to offering treatment. 

Some questions an independent medical examiner may answer include:

  • Does the person have the illness or injury they claim to? 
  • Who or what caused the illness or injury? 
  • How severely impaired is the person? 
  • Can the person work? 
  • What treatment does the person need? 
  • Can the person recover from their illness or injury?

WHO CAN BE AN INDEPENDENT MEDICAL EXAMINER?

Eligibility to become an independent medical examiner depends on who employs the provider. Each insurer establishes its own policies and criteria for IME providers. Each insurer must also follow state rules for IME providers. These rules vary a lot from state to state. Some states only permit physicians to give IMEs. Other states allow psychologists and similar professionals to give IMEs.

An IME provider must be qualified to diagnose the condition in question. So a psychologist would not be qualified to diagnose a person with heart failure. But in states such as California, which allow psychologists to act as IME providers, a psychologist could assess a person for schizophrenia or another mental health condition. 

In the context of litigation, there may be several examiners or other expert witnesses. They may present competing and contradictory theories. Either party can question the qualifications of the other party’s IME provider or expert witness. A party may also question the scientific basis for an examiner’s opinions—such as by alleging that the IME did not involve validated assessment tools. This is called a Daubert motion, named for Daubert v. Merrell Dow Pharmaceuticals, Inc., the Supreme Court case that established standards for expert witnesses. 

In general, the process to become an independent medical examiner requires: 

  1. Attending and graduating from college. 
  2. 2Attending either medical school or a graduate program. 
  3. Becoming licensed to practice in your state. 
  4. Becoming credentialed with an insurer or establishing a business as a contract IME provider. 

While a person does not have to become board-certified by The American Board of Independent Medical Examiners, pursuing this credential may help with finding work and establishing credibility. 

EVALUATION PROCESS FOR CLAIMS

A person might have to undergo an independent medical examination if: 

  • A doctor orders such an evaluation as part of litigation. 
  • Their attorney recommends an evaluation as part of litigation. 
  • A self-insured employer or insurer requests an evaluation because they disagree with the person’s doctor’s diagnosis or treatment recommendations. 

The rules about who can select an IME provider are complex and vary from state to state. Sometimes a person can select their own psychiatrist or physician, but in many cases, an insurance company gets to select the examiner. When an insurer selects the IME provider, the examiner may exhibit bias (conscious or unconscious) in favor of the insurer. So a person filing for workers’ compensation or disability may want to consult an attorney to help protect their rights. 

During the evaluation, an examiner may review a person’s previous medical records, including those that predate the injury or illness in question. They may also: 

  • Examine the person seeking benefits. This exam may include a physical exam, laboratory tests, and psychological testing. 
  • Gather information about the person’s background and history. For example, a person who seeks compensation for PTSD may need to answer questions about previous trauma that might have contributed to the development of PTSD. 
  • Compare current injury reports to previous reports. For example, if a patient complains of a new symptom that they never previously mentioned, the examiner may make a note of this. 
  • Conduct interviews of third parties regarding the person’s injury/trauma, physical and mental health history, and current level of functioning. 

Drawing upon this data, the examiner will draft a report with details about: 

  • The person’s current health. 
  • The cause or causes of any conditions. 
  • Whether any lifestyle factors contribute to the person’s current condition. 
  • The right course of treatment and the likelihood that treatment will work. 
  • The likelihood that the person is malingering, meaning that they are exaggerating any symptoms. 
  • The medical evidence for various symptoms. For example, if a person complains of chronic back pain, but the examiner cannot find medical evidence of a back injury, the report will likely note this. However, relying solely on visible evidence for symptoms can cause conditions such as fibromyalgia to be overlooked.

The ethical duties an IME provider must meet vary from state to state. They are also the subject of ongoing controversy. For example, there is not clear legal guidance about whether a provider must disclose an unrelated condition they discover during the IME. 

IME providers must meet their ethical duty to do no harm, and they can face disciplinary action if they injure a patient or lie to prevent a patient from getting care. Here again, however, there is little agreement. Courts, licensing boards, and insurers differ in their opinion of what constitutes harm, and there is no single rule that applies to all medical examinations. Independent medical examiners should consult state rules and their local licensing board for further guidance. Many licensing boards offer ethics hotlines that can answer questions about a provider’s ethical duty to patients. 

References: 

  1. Barreiro, S. (n. d.). What is an independent medical examination and how will it affect my workers’ compensation case? Retrieved from https://www.nolo.com/legal-encyclopedia/what-independent-medical-examination-how-will-it-affect-my-workers-compensation-case.html
  2. Certified Independent Medical Examiner [PDF]. (n.d.). American Board of Independent Medical Examiners. Retrieved from http://www.abime.org/documents/CIME.pdf
  3. Ebrahim, S., Sava, H., Kunz, R., & Busse, J. W. (2014). Ethics and legalities associated with independent medical evaluations. Canadian Medical Association Journal, 186(4), 248-249 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940566/
  4. Funk, C. (2018). Daubert motions: Challenging an opponent’s expert. Retrieved from https://www.theexpertinstitute.com/daubert-motions-challenging-opponents-expert/
  5. Goguen, D. (n.d.). Tips for the independent medical examination (IME) in an injury claim.  Retrieved from https://www.nolo.com/legal-encyclopedia/tips-the-independent-medical-examination-ime-injury-case.html
  6. Independent medical exams. (n.d.). Retrieved from https://psycholegalassessments.com/areas-of-expertise/independent-medical-examination-ime/
  7. National Directory of Independent Medical Examiners [PDF]. (2018). Retrieved from https://www.imenet.com/content/seak2018imedirectory.pdf
  8. Should you consider doing independent medical examinations for workers’ comp? (2009, Sepbember 29). APA Practice Update. Retrieved from https://www.apaservices.org/practice/update/2009/09-30/should-you-consider