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What is an Independent Medical Examination (IME)?

This is not as straightforward a question as one might suspect.

IME’s are many things.

Generally speaking, an independent medical evaluation is an objective, third-party medical (or allied health) examination that may be requested by insurance companies, HR departments, lawyers, benefit providers, or employers, in order to obtain an independent opinion of the clinical status of an individual following an automobile accident, workplace incident, or the development of an illness that significantly interferes with typical functioning.

The term IME is also used interchangeably between Independent Medical Examination and Evaluation.

We are going to take a deep dive into IMEs, what they’re for and what you can expect from them to clear up any misconceptions.

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Key Takeaways From the Article

1. Independent Medical Examinations (IMEs) serve as objective assessments by third-party professionals to evaluate an individual’s medical condition following incidents like automobile accidents or workplace injuries, often requested by insurance companies or employers.
2. IMEs encompass a wide range of evaluations, including physical, psychiatric, psychological, and neuropsychological assessments, to provide comprehensive insights into the examinee’s health status and functional abilities.
3. The outcomes of IMEs can significantly influence decisions related to insurance claims, legal cases, and employment matters, highlighting their importance in determining accommodation needs, benefits entitlement, and return-to-work readiness.

Who Conducts an IME?

A key difference between an IME and treatment from one’s attending physician is that when a physician is providing an independent medical exam, they are not treating the individual as their patient (i.e. there is no therapeutic relationship).

This means that the physician’s role is to provide an unbiased medical opinion to the organization that is requesting the exam, and not to provide treatment or advocate on behalf of the examinee.

IMEs are conducted either in person or in some cases virtually depending on the circumstances and specialty type.

There are also other types of independent medical exams, such as when a physician reviews an individual’s medical record (Record Reviews/File Reviews). During a medical record review, the physician’s role is the same as when conducting in-person IMEs insofar as the reports must be objective and unbiased.

Doctors performing an Independent Medical Examination follow a fairly standard process that addresses issues related to the injury/illness and its severity.

Depending on the type of specialty, the parameters of the examination may differ, such as the type of physical examination and testing conducted.

What Happens During an IME?

Evaluations usually take between 1-2 hours but can be less depending on the extent of the injuries being assessed and the skill level of the assessor.

IME physicians carefully review all documents they consider relevant to their report. The duty of the IME Assessors is to provide opinion evidence that is fair, objective and non-partisan, and to provide opinion evidence that is related only to matters that are within the expert’s area of expertise.

During an independent medical exam, one can expect the physician to:

  • Explain the purpose and scope of the exam, including how it differs from a usual physician visit, what will be examined, and why.
  • Allow discussion of any concerns the person may have about the exam and how these concerns may impact the exam.
  • Have a chaperone present when appropriate.
    • The chaperone is normally provided by the physician at their discretion or arranged by the referral source.
  • Use an interpreter where required.
    • In such circumstances, an independent interpreter will be utilized.
  • Obtain signed and witnessed consent prior to proceeding with the exam. This includes consent to having an interpreter or chaperone present.
  • Refer the examinee back to their regular family physician for further care if another medical condition is discovered during the exam.
  • Provide necessary care if an emergency situation arises and no other physician is available.
  • Document all findings of the exam.
  • Protect the privacy and confidentiality of the examinee’s personal health information.
  • Explain that the report will go to the organization requesting the exam, a copy of which may be provided to the individual’s treating physician where requested.
    • Before sharing the report, the physician may first consult with the organization that requested the exam.

The specialty selected for an IME is determined by the nature of the individual’s injury, illness, medical treatment, and/or return to work (RTW) circumstances or issues to be resolved.

At the time of the IME appointment, it is important to note that IME physicians are not “required” to provide independent medical exams.

Did You Know?

The concept of Independent Medical Examinations (IMEs) has roots in the early 20th century, particularly with the establishment of workers’ compensation laws in the United States. The first comprehensive workers’ compensation law was passed in Wisconsin in 1911, creating a system where workers were entitled to compensation for workplace injuries, irrespective of fault.

This system necessitated objective medical evaluations to determine the extent of injuries and the appropriate compensation, laying the groundwork for what would evolve into modern IMEs. These evaluations were designed to provide an unbiased assessment of an injured worker’s condition to facilitate fair compensation and support return-to-work decisions.

A recent example of IME usage involves the pandemic and its impact on workplace health claims. With the surge in long-term health issues associated with the pandemic, insurance companies and employers have increasingly turned to IMEs to assess the ongoing health implications for affected employees.

In 2021, a large insurance provider in Canada began utilizing specialized IMEs to evaluate the functional abilities of individuals claiming disability benefits.. These examinations aimed to understand the complex symptoms associated with the condition, such as chronic fatigue and cognitive impairments, to make informed decisions on benefit claims and support for workplace accommodations.

Other Independent Allied Health Assessments

There are other assessments that are sometimes referred to as “IMEs”, they include:

Functional Abilities Evaluations (FAE)

FAEs are designed to objectively determine a client’s ability to function.

Objective assessment measures include:

  • testing for positional tolerances (sitting, standing, and walking)
  • strength tolerances (lifting, carrying, pushing/pulling)
  • dexterity (fingering, handling, feeling)
  • endurance (aerobic capacity)

Les évaluations des capacités fonctionnelles, et ses résultats mesurables, peuvent être utilisés à des fins de comparaison entre la situation professionnelle d’un client avant sa blessure et ses tolérances fonctionnelles actuelles dans l’exécution des tâches de son poste.

Additionally, FAEs can be utilized to address issues with housekeeping/home maintenance tasks, as well as caregiving responsibilities.

Cognitive Functional Abilities Evaluation

An objective assessment of work-related executive function (i.e. memory, attention, ability to plan and organize, emotional control, etc.) that uses standardized assessment and observation of functional/work simulation activities in order to determine an individual’s work capacity and to determine strengths and limitations with regard to cognitive functioning in conjunction with the cognitive demands of the individual’s job.

Évaluations d’ergothérapie

Utilized to assist persons whose ability to function in everyday living is disrupted by injury or illness and to assess entitlement to ongoing benefits.

The clinical measurement and observations/task demonstrations of pre- and post-accident related tasks take place within the individual’s home.

The goal of assessment is to assist the injured or ill individual in achieving independence (as well as a feeling of productivity and satisfaction) in such areas as personal needs (bathing, dressing), as well as in the performance of housekeeping and home maintenance tasks (food preparation, grocery shopping, laundry, vacuuming, lawn care).

Specific physical tolerances are tested and compared with normal/functional limits.

Vocational Rehabilitation Assessments

Provide a comprehensive, objective review of an individual’s employability before and after the development of a disability.

Psychometric and vocational testing is included as part of the evaluation process and suitable job targets for each individual are provided.

When finished with their assessment, the IME doctor will complete a report that includes information about:

  • The current physical and functional status of the individual, including observations on appearance, behavior, range of motion, etc.
  • Whether the injury/illness is typical of injuries or illnesses of a similar nature.
  • Whether the treatment for the injury/illness is appropriate and or effective.
  • Whether the examinee’s complaints/symptoms are consistent with the circumstances of the event.
  • Observation of symptom levels such as pain for example.
  • Determination of the severity of impairment or disability, if any is present.
  • Limitations the individual has because of injury/illness.
  • Evaluation of impairment and disability.
  • Whether the examinee has reached Maximum Medical Improvement.

Upon consent, Non-Medical Summaries can also be provided to employers and other stakeholders in instances where personal medical information cannot be shared.

Multiple IME examinations or “Multi-Disciplinary” assessments with different specialties may be required where the individual has multiple or complex injuries or a complex medical condition.

In these cases, a file review is conducted by the medical coordinator or lead physician on the team prior to evaluation in order to determine both the types and optimal sequencing of the assessments to be conducted.

Psychiatric IMEs

An independent psychiatric evaluation is a medical assessment conducted by a psychiatrist to assess for mental and behavioral diseases and impairments.

A key difference between psychiatrists and psychologists is that psychiatrists are board-certified medical doctors and psychologists are not.

A psychiatric assessment involves gathering information from the individual and others (often through a review of medical records), conducting a mental status examination and then formulating diagnostic and treatment suggestions.

Psychiatrists have the benefit of many years of medical training and seeing many patients in emergency rooms, outpatient clinics and hospitals.

A Psychiatric IME report outlines:

  • Source of referral.
  • Date and Place of the Evaluation and time spent preparing the report.
  • Statement of non-confidentiality.
  • List of reference materials and of interviews utilized in the preparation of the report.
  • Detailed background information of the client.
  • Past psychiatric history.
  • Medical history.
  • Substance abuse history.
  • Present Mental Status Exam.
  • Description of the functioning of the client prior to becoming disabled.
  • Description of the functioning of the client after becoming disabled.
  • Review and summary of pertinent collateral information (medical and psychiatric records, accounts of acquaintances, co-workers, etc.).
  • Diagnostic Impression/Severity of Impairment.
  • Reasoning as to how the diagnostic impression has been reached.
  • Relationship of present impairment to client’s ability to work (in a specific occupation and general or related fields).
  • Client’s historical interest in the specific occupation.
  • Personality, psycho-social, and other factors contributing to disability.
  • Issue of malingering (feigning signs and symptoms of mental illness).
  • Summary of previous treatment and an opinion as to whether or not adequate/optimal treatment was received by the client.
  • Prognosis/Need for additional treatment.

A Psychiatric IME provides pertinent information that is conveyed in a report to the referral source and provides a professional, comprehensive psychiatric opinion.

This opinion addresses the questions asked by the referral source in comprehensible terms to help in the process of making legal or administrative decisions concerning the individual.

The report communicates the information and opinions in a comprehensive, understandable manner.

It enables the referral source to engage in informed decision-making regarding the evaluee.

The end report is an independent, comprehensive, comprehensible, and defensible psychiatric opinion based on the available data.

Psychology IMEs

An Independent Psychological “IME” is when a psychologist who has not previously been involved in a person’s care is asked by a third party to examine an individual.

A psychologist is not a medical doctor and cannot prescribe medication. As above, there is no doctor-patient relationship. Psychology IMEs are conducted in order to determine the cause, extent and treatment of work-related or other psychological injuries such as those stemming from auto accidents or other life circumstances.

The psychologist will provide diagnoses based on psychometric testing and a clinical interview and will assess whether an individual has reached maximum benefit from treatment; and whether any permanent psychological impairment remains after treatment.

Independent Psychological IME

An Independent Psychological “IME” draws on various sources of information, such as:

  • clinical interviews
  • mental status examinations
  • objective and norm-referenced psychological tests
  • subjective surveys
  • interview information
  • school or medical records
  • medical evaluations
  • observational data

…in order to determine a person’s overall psychological functioning and capacity for productive work and/or return to pre-incident functioning.

An Independent Psychological “IME” is requested for several reasons.

Primarily, the IME objectively determines the extent of the mental impairment involved either as a primary condition or as the result of secondary trauma and difficulty adjusting following the accident, illness, or injury in question.

The individual may have also been in treatment for an extended period of time and there is concern regarding whether the treatment continues to be warranted, whether treatment will be required for an extended period into the future, whether continued treatment is related to a specific event, or whether there are any permanent impairments/disabilities as a result of the initiating trauma.

An Independent Psychological “IME” is usually requested in connection with traumatic injury or an ongoing psychological condition.

Individuals are examined for signs of the symptoms reported and symptom validity testing is conducted.

Psychological assessments include some or all of the following components:

  • Review of file documentation provided by the client or referring agency.
  • Semi-structured clinical interview.
  • Psychometric testing involving the evaluation of general psychopathology, personality factors, intellectual functioning and trauma.
  • Symptom validity assessment and the psychological assessment of exaggeration, malingering and deception.
  • Collateral information from other health care providers or significant others.
  • DSM diagnosis.
  • Formulation of relevant causal or contributing factors.
  • Prognosis and (treatment) recommendations.
  • Written assessment report.

Neuropsychologist Independent Medical Examinations

A neuropsychological assessment is conducted by a specialist psychologist trained in neuropsychology.

Neuropsychological assessments are designed to measure brain functions, including:

  • memory
  • concentration
  • behavior
  • planning ability
  • ability to conduct tasks

The assessment involves a discussion/interview where the individual is asked questions about their injury and other background information.

The assessment includes psychometric tests and tasks, including puzzles, questions and problem-solving activities.

A Neuropsychological evaluation involves extensive testing and the potential duration of the assessment is generally between 4-8 hours.

Regardless of the type of IME conducted, the purpose of the evaluation is for the physician or allied health practitioner to objectively and impartially assess the individual’s medical and/or psychological symptoms related to their accident, injury, or illness.

The examiner involved systematically evaluates an individual’s ability to function and respond physically and/or mentally to various life tasks as well as any short and long-term implications resulting from the injury.

They may make recommendations as to treatment, accommodations, or restrictions on a person’s ability to perform daily activities at home, work, or recreational activities as requested.

Bottom Line

In wrapping up our exploration of Independent Medical Examinations (IMEs), it’s clear that they play a pivotal role in bridging the gap between medical evaluations and legal, insurance, or employment decisions.

Whether you’re an individual facing an IME, a healthcare provider, or a stakeholder in the legal or insurance sectors, staying informed about the process, rights, and responsibilities involved is crucial.

If you’re in need of Independent Medical Examination (IME) services in Canada, reach out to RIDM. Our extensive national network of multidisciplinary physicians is eager to assist.

Remember to communicate openly with your legal advisor, ensure your rights are respected, and approach the examination with a clear understanding of its purpose and potential impact.

IMEs can be a complex process, but with the right preparation and knowledge, they can be navigated successfully to achieve fair and objective outcomes.

Further Considerations

Origins of Formal IMEs: The formalization of Independent Medical Examinations (IMEs) can be traced back to the early 20th century, but the practice gained significant momentum in the 1940s and 1950s as insurance companies and legal systems sought more standardized methods to resolve disputes over medical claims.

Global Variations: While IMEs are commonly used in countries like the United States, Canada, and Australia, the specific regulations, standards, and practices surrounding them can vary significantly. For example, the criteria for selecting medical examiners and the rights of the examinee during the process differ from one jurisdiction to another.

Multi-disciplinary Approach: Modern IMEs often involve a multi-disciplinary approach, especially for complex cases. Teams may include specialists from various fields such as orthopedics, neurology, psychology, and occupational therapy, providing a holistic assessment of the individual’s condition.

Technological Integration: The integration of technology in IMEs has been growing, with the use of telemedicine for remote evaluations and digital platforms for the secure exchange of medical records and reports. This has increased during the COVID-19 pandemic, highlighting the adaptability of the IME process to public health needs.

Ethical Considerations: There is an ongoing debate within the medical and legal communities about the ethical considerations of IMEs, particularly concerning the potential for bias towards the party requesting the examination. This has led to the development of ethical guidelines and standards of practice to ensure that IMEs are conducted fairly and impartially.

FAQs from Canadian Employers, Insurance Companies and Legal Firms

What are the implications for employers who request an IME in Canada?

A: Employers may request an IME to determine the extent of an employee’s injury or illness and their ability to return to work. However, employers must be mindful of respecting employee privacy and human rights legislation. The information gathered from an IME must be used solely for determining accommodation needs and fitness to return to work.

As an insurance company in Canada, when can we request an IME?

A: Insurance companies can request an IME when there is a need to clarify a policyholder’s health condition, particularly when there’s a discrepancy in the medical information provided, or when deciding on a claim. It’s crucial to ensure that the IME request is reasonable and necessary, as unwarranted requests may infringe on the insured’s privacy rights.

How should legal firms in Canada handle information from IMEs in personal injury cases?

A: Legal firms should handle IME information as confidential medical data. If the IME was requested by the opposition, the law firm has a right to access the report. It can be used to understand the claimant’s condition better and formulate legal strategies. But it’s important to ensure that the use of the IME adheres to the rules of confidentiality and privilege in the legal process.

What is the role of a Medical Consultant in IMEs from a Canadian legal perspective?

A: A Medical Consultant’s role in an IME is to provide an unbiased medical opinion on the individual’s medical condition, treatment, and prognosis. This information can be crucial in legal proceedings, for instance, in personal injury or workers’ compensation cases. The Consultant’s opinion needs to be objective and based on their medical expertise.

In Canada, can an insurance company stop benefits based on an IME?

A: If the IME concludes that the insured individual is no longer disabled or that their treatment is not necessary, the insurance company may decide to terminate benefits. However, the insured has the right to challenge this decision. The insurer should consider all available medical evidence and not solely rely on the IME. Disputes over termination of benefits often end up in litigation, and insurers must be prepared to defend their decisions in court.

FAQs relevant to Independent Medical Evaluations (IMEs) in BC and Ontario:

How does the Workers’ Compensation Board (WCB) in British Columbia use IMEs?

A: The WCB in British Columbia, known as WorkSafeBC, may request an IME to help make decisions about a worker’s claim, particularly if there are medical issues that are complex or disputed. The purpose of the IME is to provide an impartial, third-party medical opinion on the worker’s condition, and the findings can influence decisions about disability benefits, treatment plans, and return-to-work plans.

Are there any specific guidelines for IMEs in Ontario under the Workplace Safety and Insurance Board (WSIB)?

A: Yes, the WSIB in Ontario has specific guidelines for IMEs. The WSIB can arrange an IME to clarify an injured worker’s functional abilities, medical restrictions, or prognosis. It’s important to note that the doctor performing the IME does not provide treatment but instead gives an objective opinion based on the examination and review of medical records.

How does the Insurance Act in British Columbia influence the use of IMEs for motor vehicle accident claims?

A: The Insurance Corporation of British Columbia (ICBC) often requires IMEs to verify the severity of injuries sustained in motor vehicle accidents and to determine appropriate compensation. However, under the Insurance Act, claimants have certain rights, including the right to have a medical professional present during the examination and the right to receive a copy of the IME report.

In Ontario, can an IME be used to dispute a claim for accident benefits under the Statutory Accident Benefits Schedule (SABS)?

A: Yes, an insurer can request an IME to dispute a claim under the SABS. If there’s disagreement over the necessity of a benefit or treatment plan, or about the degree of the claimant’s impairment, the insurer can use an IME to provide an independent medical opinion. If the claimant disagrees with the IME’s findings, they can challenge the report through mediation, arbitration, or court.

What is the role of an IME in long-term disability (LTD) cases in British Columbia and Ontario?

A: In both BC and Ontario, insurers can request an IME to validate a claimant’s LTD claim. The results of the IME can influence whether the insurer approves or denies the claim, or continues or terminates the payment of benefits. The claimant has the right to challenge the findings of the IME, especially if they feel that the report inaccurately represents their condition or disability.

General FAQs About IMEs

What qualifies a physician to conduct an IME?

Answer: A physician qualified to conduct an IME typically has specialized training in the relevant field of medicine, extensive clinical experience, and knowledge of legal and insurance guidelines related to medical evaluations. They must also be impartial and not previously involved in the patient’s care.

Can an examinee refuse to undergo an IME?

Answer: Yes, an examinee can refuse to undergo an IME; however, refusal may have implications for their case, such as affecting insurance claims or legal proceedings. It’s advisable to consult with a legal professional before refusing an IME.

How is the privacy of my health information protected during an IME?

Answer: The privacy of health information during an IME is protected under laws such as HIPAA in the United States and PIPEDA in Canada. Examiners are required to handle medical records and reports with confidentiality and share them only with authorized parties.

What happens if the IME report disagrees with my treating physician’s findings?

Answer: If the IME report disagrees with your treating physician’s findings, it may lead to disputes in your claim or case. It’s often necessary to resolve these discrepancies through further medical evaluations, legal negotiations, or mediation.

Can an IME be conducted virtually?

Answer: Yes, virtual IMEs have become more common, especially due to the COVID-19 pandemic. These remote evaluations use telehealth technology to assess the examinee, though they may not be suitable for all types of assessments.

Are IMEs only for workers’ compensation cases?

Answer: No, IMEs are used in various contexts, including personal injury lawsuits, disability insurance claims, and workers’ compensation cases. They can assess a wide range of medical issues related to the eligibility for benefits or compensation.

How long does it take to receive the results of an IME?

Answer: The timeframe for receiving IME results can vary depending on the complexity of the examination and the report’s thoroughness. Typically, reports are completed and sent to the requesting party within a few weeks of the examination.

Can I bring someone with me to the IME?

Answer: Yes, examinees are often allowed to bring a companion, such as a family member or legal representative, to the IME for support. However, the companion’s presence during the actual examination may be subject to the examiner’s discretion and specific guidelines.

What if I disagree with the IME findings?

Answer: If you disagree with the IME findings, you may seek a second opinion from another specialist or challenge the findings through legal or administrative processes. Documentation and support from your treating physicians can be crucial in these situations.

Do IME physicians provide treatment recommendations?

Answer: While IME physicians assess the examinee’s condition and provide an independent medical opinion, they do not engage in a treating relationship with the examinee or offer direct treatment recommendations. Their role is to evaluate the condition in the context of the claim or case.

Glossary of Terms Used in this Article About IMEs

Independent Medical Examination (IME): A comprehensive assessment conducted by a third-party physician or medical specialist to provide an unbiased opinion on an individual’s medical condition, often in the context of legal or insurance claims.

Third-party medical examination: An evaluation performed by a medical professional who is not previously involved in the individual’s care, intended to offer an impartial perspective on the individual’s health status.

Insurance companies: Organizations that provide coverage for risks in exchange for premium payments, often involved in requesting IMEs to assess claims related to health, accidents, or disability.

Functional Abilities Evaluations (FAE): Assessments focused on determining an individual’s capacity to perform various physical tasks, helping to understand their ability to work or complete daily activities following an injury or illness.

Cognitive Functional Abilities Evaluation: A detailed assessment aimed at evaluating an individual’s cognitive capabilities, such as memory, attention, and executive functions, particularly in relation to their work or daily activities.

Occupational Therapy Assessments: Evaluations conducted by occupational therapists to determine an individual’s ability to perform everyday tasks and activities, often used to guide rehabilitation and return-to-work plans.

Vocational Rehabilitation Assessments: Comprehensive evaluations that aim to assess an individual’s employability and potential for re-entering the workforce, considering their skills, capabilities, and limitations following an injury or illness.

Psychiatric IMEs: Specialized medical examinations conducted by psychiatrists to assess mental and behavioral conditions, offering insights into the psychological impact of an injury or illness.

Psychology IMEs: Assessments carried out by psychologists (non-medical doctors) to evaluate the psychological and emotional aspects of an individual’s condition, focusing on issues such as stress, anxiety, and coping mechanisms.

Neuropsychologist Independent Medical Examinations: In-depth evaluations by neuropsychologists to assess cognitive and behavioral functions, aiming to understand the brain-behavior relationship after an injury or in the presence of neurological conditions.

Medical Consultant role: A professional who provides expert medical opinions in IMEs, aiding in the interpretation of medical findings and their implications for legal, insurance, or workplace matters.

Workers’ Compensation Board (WCB) British Columbia: The regulatory authority in British Columbia responsible for workplace safety, insurance, and compensation, including the use of IMEs in decision-making processes.

Workplace Safety and Insurance Board (WSIB) Ontario: The organization in Ontario that provides insurance and support to workers injured on the job, including the coordination and use of IMEs.

Insurance Act British Columbia: Legislation governing insurance practices in British Columbia, including provisions related to the use of IMEs in the assessment of claims.

Statutory Accident Benefits Schedule (SABS) Ontario: A regulation that outlines the benefits and compensation available to individuals involved in motor vehicle accidents in Ontario, including the role of IMEs in determining eligibility.

Long-term disability (LTD) cases: Situations involving individuals who are unable to work for an extended period due to injury or illness, often involving IMEs to assess the extent of disability and entitlement to benefits.

Virtual IMEs: Assessments conducted remotely using digital communication technologies, allowing for the evaluation of individuals when in-person examinations are not feasible.

Record Reviews/File Reviews: The process of examining an individual’s medical records by a medical professional to provide an opinion in the absence of a physical examination, often part of the IME process.

Maximum Medical Improvement (MMI): A state where an individual’s condition has stabilized to the point that no significant improvement is expected, even with further medical treatment, often determined through an IME.

Independent Psychological IME: A specific type of psychological evaluation conducted to assess the mental and emotional impact of an injury or illness, aiming to provide an objective understanding of the individual’s psychological state.

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