FAQS ON PERFORMING INDEPENDENT MEDICAL EXAMINATIONS
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Independent medical Evaluation Services
1. I HAVE BEEN HIRED AS AN INDEPENDENT MEDICAL EXPERT, HOW SHOULD I PREPARE FOR THE EXAM?
The first thing you should do before you ever see the patient for an IME is to review the medical records provided to you as well as any testing, studies and legal records which outline the patient's alleged injuries as a result of their accident. This review will provide the basis for your evaluation, highlighting the issues, and targeting your exmanintion.
2. HOW LONG SHOULD I SCHEDULE FOR EACH APPOINTMENT?
As this is not a comprehensive exam, but directed to the areas in question, there is no set time frame, which is considered appropriate for an Independent Medical Exam. It depends on which part of the body is allegedly injured and the patient's complaints. A questionnaire should be filled out by each patient that asks questions about the history of the accident, treatment, tests, medications, past history, employment history and complaints. This is also known as the subjective history portion of the IME. For JurisSolution's Patient Questionnaire, please visit our IME section. During the examination, you should go over the questionnaire to inform yourself of the nature and extent of the patient's injuries and ask any further questions that need clarification. A typical exam can take as little as 5 minutes or more than an hour depending on the injuries, your specialty, and the records provided to you.
3. WHAT FORMAT SHOULD I USE FOR MY REPORT?
Your report should be addressed to the referring law firm, insurance carrier, or IME Company. A cover letter will usually accompany the initial medical records indicating to whom the report should be addressed and any specific questions/issues that need to be addressed in your report. For a sample report, please visit our IME section. In your IME report, the subjective history section should always be put in the narrative form, for example: "The patient reports…" or "The patient alleges…" or "The patient states…" etc.
4. DOES A DOCTOR-PATIENT PRIVILEGE EXIST?
There is no doctor-patient privilege for IMEs. You are hired solely as a consultant to render a second-opinion. All of your findings should be contained in your IME Report. You should never discuss your findings or recommendations with the patient, family members, treating physicians or opposing counsel. If you need to discuss a certain aspect of the case, it should be done with the firm who hired you. You can also address your concerns in your report or in a separate confidential memo. Your role is as a consultant, thus no physician-patient privilege exists.
5. CAN I PERFORM DIAGNOSTIC TESTS DURING MY EXAM?
You are not automatically authorized to take x-rays or other testing that will cost more than your fee for the IME. You should call for approval for extra fees that were not previously agreed upon. Most companies will approve tests that are necessary to clarify your opinion, but in order to receive reimbursement; you should always call for pre-approval.
6. CAN THE PATIENT VIDEOTAPE OR RECORD MY EXAM?
It has been found to be within the patient's rights to videotape and record the IME. As the IME physician, you must allow a videotape or recorder into your examination room. Failure to do so could result in an aborted IME and could cost the defense the chance to have the claimant examined. If you feel intimidated by this action, you should not delay the exam, but remain professional and calm, and go about your exam, as you would do under normal circumstances. Any taping or form of intimidation can be noted in your report.
7. HOW LONG SHOULD MY REPORT BE?
Your report should follow this general format:
A typical report includes a Subjective History Section, which includes the circumstances of the injury, the areas initially injured, and initial hospitalization or emergency room care. It should include the names of any treating physicians, the type and frequency of the treatment received. Follow-up care should be documented as well as any other testing and/or surgery that may be related to the accident. Be sure to also include a past and subsequent medical history section including other accidents, injuries and surgeries.
There should also be an Employment History Section which states the patient's occupation at the time of the injury, whether the patient returned to work after the accident, and if the patient is currently working and in what capacity.
A Document Review is necessary to chronologically list each document provided for your review. Give a brief explanation including diagnosis and impression on same.
Following, your report should list the Patient's Chief Complaints that pertain to the accident. You should check them against the Bill of Particulars or cover sheet to the medical information so that you know what parts of the body are in contention.
Your Objective Examination should center on the parts of the body that are named in the case. In other words, should the patient have complaints regarding areas not mentioned as part of this case, there is no need to examine these areas and potentially open up other liability for the defense. Your Objective Examination should be limited to the areas of complaint and as alleged as part of the case. Range of motion testing and other objective tests in your area of specialty should be used so that you can support your conclusions later.
Your Conclusion Section should contain answers to the issues raised. Be honest and remain objective. If there is a causation section, it should be based on three things: the subjective complaints, review of documents and your objective examination. You can preface this section by saying, "Based on the history as reported to me by the patient, a review of medicals and my objective examination, I find the injuries causally related to the accident in question." Also, here you should mention any pre-existing conditions or injuries.
8. WHAT ARE THE DISTINCTIONS IN NEW YORK, NO-FAULT AND WORKERS COMPENSTAION AND TORTS CASES?
In No-Fault cases, the insurance carrier is primarily concerned with treatment. Specifically, they need to know whether the treatment is necessary and beneficial for the claimant or has the patient achieved all they can from their treatment plan. Pursuant to a recent change in New York State No-Fault law, if the independent medical examiner finds that no further treatment is necessary, the wording "No further treatment is necessary in my field of specialty, and any further treatment would be considered medically excessive" would be appropriate. The often-used term of "Maximum Medical Improvement has been reached" (MMI) is no longer appropriate.
Reports must be submitted in a timely fashion, so as soon as the IME takes place, a report should be generated, proofed and mailed, faxed or e-mailed immediately. Many times, the carrier may also ask you to fax or call in verbal information so that authorizations or denials can be expedited. If this is the case, testing or further treatment is pending your opinion.
Peer Reviews may be requested to determine whether medical treatment is indicated and should be authorized. A Peer Review should give a brief explanation of the history of the case, review of the treatment, document review, the proposed treatment plan including diagnostic testing, and finally, your opinion if the treatment is medically indicated. In other words, the insurance carrier is looking for your advice as to whether you agree with the treating physician's treatment plan. Answers to these questions are usually required within a week
In Workers Compensation cases the medical expert should pay particular attention the ANCR section of the cover sheet to the medical information. ANCR stands for Accident, Notice, and Causal Relationship, meaning, an accident occurred during the injured worker's employment, notice was given to the employer of the accident and causal relationship has been established to the body parts specified.
The most important aspects of your report should concern work abilities, need for treatment (frequency and duration), causal relationship (of injuries to accident) and degree of disability. If the issue is disability, use adjectives like: mild, moderate, marked and total, not percentages to determine the degree of disability, in accordance with the New York State Workers Compensation Guidelines.
Again, the reports must be submitted to the insurance carriers in a timely fashion, since benefits are contingent on your report. Physical capability forms and specific questions for authorizations for certain testing, percentages of impairment, or schedule loss of use evaluation, and section 15-8 issues such as possible apportionment and material and substantial issues may be asked and should be answered in an expedited manner.
In NY Workers Compensation cases, under your signature, you should give your WCB rating code and WCB authorization number. You should also give your availability for testimony.
A Liability case or Tort is a case that has been filed and is an actual lawsuit, not simply a claim against a carrier. There is almost always an attorney involved on both sides of the case, and the patient is also a plaintiff. The plaintiff's representative or attorney may accompany him/her to the exam and you should allow them to stay with the patient during the entire exam process if this is the case. If you feel intimidated or this causes any disruption to your objective exam, you should note this in your report.
In the cover sheet, there may be specific questions for you to address and you should pay close attention.
The referring firm may or may not want degree of disability addressed, need for further treatment or permanency addressed in the report. The best approach to doing a Liability IME is to remember that you are an impartial physician hired by the defense to give your opinion on the merits of the injuries alleged by the plaintiff.
9. WHAT IS AN ATTESTATION?
After you have concluded your report, and above your signature a perjury statement should appear. It states that you have read your report, understand the contents therein and swear to your conclusions. All IME reports should contain an attestation. Following
are several variations:
I state that I am a Board Certified Physician in the State of (state)and hereby affirm that the contents of this report are true to the best of my knowledge under the penalties of perjury.
I state that I am a physician authorized by law to practice in the State of (state), am not a party to this proceeding, am the physician who subscribed to the above report, have read the same and know the contents thereof; that the same is true to my knowledge, except as to the matters stated to be on information and belief, and as to those matters I believe to be true.
The undersigned, hereby affirms that the foregoing statements are true under the penalties of perjury.
Consideration should be given to local law, for instance, in NY No-Fault cases, use:
I, Doctor_________________________, being a physician duly licensed to practice in the State of New York, pursuant to New York CPLR Section 210.6, hereby affirm under the penalties of perjury that the statements contained herein are true and accurate.
10. IF THE INJURIES ARE OUT OF MY FIELD OF SPECIALTY, WHAT SHOULD I DO?
Stick to your area of expertise; in other words, do not comment outside your area of specialty. Similarly, you should not make referrals to specific doctors or other specialties, unless of course you are asked. Answer the questions that are being asked of you only.
The Legal Professionals of JurisSolutions