One of my least favorite tasks is seeing what an Independent Medical Exam (IME) has said about any of my patients. IMEs are evaluations performed on a patient usually at the request of an insurance company or sometimes an attorney. Theoretically, these are to be used to determine the true nature of the medical problems and to provide recommendations for ongoing management of a patient. Usually they are performed in cases where there may be legal issues involved; mostly commonly the insurer is either workman’s compensation or auto insurer. These exams are performed by physicians who are often not actively in practice, and may not even have expertise in the area of treatment. Therefore the quality and purpose of such an exam is often questionable.
The Inherent Problems With Some IMEs
In my distant past, I also performed independent medical exams, most commonly for insurance carriers in workman’s compensation cases. The most common reason why insurers sent patients to my office is that they wanted to know what was really wrong with their clients and what may be the anticipated cost for future treatment. A good evaluation by a Physical Medicine and pain expert can at least tell them what is actually wrong with their client, and what are likely going to be necessary future treatments.
Instead of denying any injury ever occurred, several of the insurers took the proactive step to determine what was going to be the best way forward. Since they knew that I was going to tell the truth about the patient’s medical condition, it was valuable and a positive experience for both the patient and the insurance company. The last one I performed was a year ago and I had to ask if they knew the results may not be in the insurance company’s favor and if they would be okay with whatever I determined. Surprisingly, they really just wanted to know what was wrong with their client.
Most independent medical examinations I see are ordered by an insurance carrier and they only will hire physicians that they know will find any way deny that a medical problem exists. Often the physician will minimize an injury, and then report it as not feasible that the patient’s complaint can be present. The history taken is usually very short, and a physical exam is limited. The physician then develops “alternative facts” and delivers the “fake news” back to the insurer. Honesty and an understanding of pain, as well as most conditions that cause pain, is absent. The overall purpose is to minimize liability by the insurance carrier in a future legal setting. These exams are used to limit any ongoing medical care for a patient. The frustrating factor for the patient is that if these were done in a true independent manor and actually were done by professionals with real skill and understanding of the medical problems, then they could actually be useful.
Preparing For Your IME
The take home message for a patient who needs to undergo such an exam is that they need to be knowledgeable about the process. The patient should consider recording the exam for their own record, whether it is having a witness, taking notes or actually filming or recording the event such that one can counter incorrect information in any report. It is important for the patient to be fully cooperative and not combative and really participate in any exam such that any abnormalities will be evident. Lastly, insist that the report be made available to you or your legal representative so inaccuracies can be addressed later.
Rarely are independent medical examinations done to develop a full understanding by all parties involved in settling medical-legal issues. For a patient, the results of these exams should be taken with skepticism at best. For lawyers and insurance companies, honest and good exams would likely be more helpful. To develop future plans for a patient, currently the best source of information is usually the treating physicians. If the insurance company really wants to know what is wrong with a patient with a musculoskeletal problem, recruit the use of an experienced, board certified Physical Medicine physician. A good expert who can explain a range of management options is the needed expert to help settle questions in patient management.
Thomas Cohn, MD
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