INDEPENDENT MEDICAL EXAMINATION Dr. Jeffery Luther
What is an Independent Medical Exam? Objective and impartial medical exam Requested by workers compensation insurer or self insured provider Conducted by health care provider (MD or DO) who is not part of the worker s medical treatment team.
Who can perform an IME? MD or DO with unrestricted license Medical knowledge in a specific area pertinent to the case Experience, training, or credentials in the area of IMEs
Features of Report Worker s Compensation Motor Vehicle Injury or Personal Long Term Disability IME Types IME of Medical Injury IME Exams Conventional Medical Exam Level of History Detail Directed toward objective documentation, usually utilizes protocol for IR Directed toward objective documentation, sometimes utilizes protocol for IR Directed toward objective documentation, sometimes utilizes protocol for IR Directed toward diagnosis, rarely utilized protocol for IR Physical Exam Always Always Always Always Diagnosis Usually Often Often Rarely Causation Usually Sometimes No No Prognosis Often Often Often Often MMI Usually Often Often Rarely Impairment Rating Usually Sometimes No No Functional Often Often Often Rarely
Features of the IME Introduction History Record review Physical examination Other objective data (laboratory results, imaging) Opinions Impressions Discussion of diagnoses Comments on past medical treatment
Features of IME continues Comments on future treatment Prognosis As appropriate: MMI, Causation, Impairment Rating, Apportion Addressing specific questions
What happens during the exam? Provider identifies him/herself as an independent examining physician Verify the worker s identity Discuss the following: Remind the worker of the party who requested the exam Explain that the physician-patient relationship will not be established
What happens during the exam? Discuss the following: Tell the worker that information provided during the exam will be included in a report Review procedures that will be used during the examination Advise the worker that they may stop the procedure if it is beyond their abilities or becomes painful Allow the worker to ask questions
Who is present during the exam? The exam is limited to the examinee and the examiner. A chaperone of the appropriate gender may be present A translator may be required
History Chief complaint(s): symptoms and chronology. Pain: location, frequency, radiation, duration, and factors that aggravate or alleviate symptoms. Standardized pain or behavioral inventories Associated symptoms: weakness or neurologic complaints. Mechanism of injury Initial symptoms and their course. Response to treatment. Describe the symptoms before and after the subject incident.
History Continued Symptoms from before incident Subsequent injuries or episodes that have occurred since then incident. Current functional status: activities of daily living, work activities, sports, hobbies and social functioning. Occupational history: time off work, job duties relevant to current injury, with comparison of prior and subsequent job activities. Relevant past medical history: previous relevant injuries or conditions, other conditions or injuries requiring medical treatment. Personal, family, and social history when relevant. Review of Systems
References AIMEHI (2005). Standards for Independent Medical Examinations. Retrieved March 20 th, 2015 from www.aimehi.com
Physical Examination General appearance, behavior. Formal and informal observations : relationship or lack of relationship with other physical findings. Who was present: chaperone, translator, other participants. Affect, attitude, cooperation, and mental status. Pain behavior Use of assistive devices Vital signs as appropriate. Detailed clinical examination findings: pertinent positive and negative findings