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 IME’s, what they’re for and what you can expect from them to clear up any misconceptions.
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.
IME’s 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 IME’s 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.
Other Independent Allied Health assessments
There are other assessments that are sometimes referred to as “IME’s”, they include:
Functional Abilities Evaluations (FAE): FAE’s 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)
The goals of an FAE, and its measurable results, can be utilized for such purposes as comparing a client’s pre-injury work status with their current functional tolerances in performing the duties of their job.
Additionally, FAE’s can be utilized to address issues with housekeeping/home maintenance tasks, as well as caregiving responsibilities.
A Cognitive Functional Abilities Evaluation is 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.
Occupational Therapy Assessments are 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 IME’s
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 in hospitals.
A Psychiatric IME report outlines:
- Source of referral.
- Date and Place of the Evaluation, and time spent for the preparation of 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 IME’s
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.
An Independent Psychological “IME” draws on various sources of information such as clinical interviews, and mental status examinations, along with objective and norm-referenced psychological tests, subjective surveys, interview information, school or medical records, medical evaluations, and observational data, in order to determine a person’s overall psychological functioning and their 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
- 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.
John Drudge, President
Rapid Interactive Disability Management (RIDM)
