Dr. Bill Gallagher 2015-03-03 02:20:47
The “Independent” Medical Evaluation If a case has any potential value the odds are your client will be asked to submit to an IME. Insurance companies know which doctors will write a favorable report and they usually find this to be a good investment that allows them to deny payment. So what is wrong with an IME? First, there is the name. “Independent” is a misnomer. You know that; the insurance industry knows that. This is so obvious that there is no need to discuss that word any further. “Medical” does belong in there as the person checking your client will most likely be a medical doctor and even if a chiropractor performs the exam they will be practicing chiropractic medicine. So already two-thirds of the title makes sense, but that is where it becomes more nonsensical. When I started in practice, IME stood for independent medical examination. Along the way that last part was changed to “evaluation,” which is actually more appropriate. An examination is a series of tests performed on a patient with the intention of determining a diagnosis. Today it is safer to call this an evaluation because there is less examination and more evaluation involved. A treating doctor will have a patient with a history and symptoms that will direct the doctor toward where to focus their examination. In an IME the doctor has a file, usually lacking proper documentation that will give them direction in doing their limited, problem-focused examination. This on the surface is a perfectly valid process and when done properly holds great weight in the legal process. The problem is that while it may be valid, on the surface most IMEs are superficial. Part of that is because the treating doctors’ notes that have been forwarded to the IME doctor do little to give that doctor much direction. The IME doctor is not looking for the problem; they are looking for the weakness in the treating doctor’s documentation. Without solid documentation the IME doctor will have a lot less to evaluate. The problem for you as a plaintiff ’s attorney is not so much that they are saying there is nothing wrong with your client, the problem is that your doctor has not done enough to demonstrate what is wrong. Bottom line the IMEs job is to evaluate what you are presenting, not to find the problem. So How Do You Avoid The Problems Presented When An IME Is Requested? Prevention is the first step. When your treating doctor has good documentation of a thorough examination, measurable and reproducible testing, and appropriate care the insurance company will not be so willing to go through the expense of finding the holes that are not there. If however, the doctors’ documentation looks more like Swiss cheese then it is easier to understand the value of an IME. While Colossus and the like place more value on medical doctors, their knowledge of musculoskeletal problems tends to be weak and their records are often not much better. Referring your cases to a chiropractor who knows what to look for and how to find the problems will make your job much easier. The other thing to do is have someone who knows how to perform a proper exam, in the room to observe the IME doctor. Having done this service for attorneys, and as someone who teaches doctors how to do a proper exam, I can tell you it is rare to find an IME doctor who would pass my class. Muscle testing is important to determine weaknesses often related to spinal nerve or disc involvement. The proper way to do this test is to hold pressure for three seconds or have the patient resist three times. Most doctors perform muscle testing incorrectly and ask the patient to resist only once. Such a test is invalid and as such so is the examination. A treating doctor who performs tests incorrectly will miss too many findings that could make your case for you. A treating doctor who has done their testing correctly and documented it properly, will have greater value than a costly IME doctor who does not. A second common problem is that any trained examiner can test half the cranial nerves simply by observation, but all too often the IME doctor report will state that cranial nerves were WNL without having tested all 12. Perhaps the biggest problem is that a treating doctor will do a series of orthopedic and neurological tests in order to establish a diagnosis. IME doctors typically will do one or two test and report that there are no problems found. Most jurors will agree that if it takes so many tests to prove there is a problem how can an IME doctor do so few to say there is no problem. Dr. Bill Gallagher, DC has been in practice for over 25 years and founded Phoenix Medical Legal Services to help provide doctors and lawyers with the training and support needed to succeed in personal injury. Their seminars on case management, concussion and physical examinations are approved for CE/CLEs for chiropractors and lawyers and provide them the skills and information to do their jobs better. To find out more about how their services can help to raise your case from the ashes go to www.phxmedlegserv.com or call (480) 664-6644.
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