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The Independent Medical Evaluation
by Scott R. Masterson, M.D., CIME
Division of Physical Medicine and Rehabilitation
In the course of a day, a physician may see a number of patients who have sustained muscular, skeletal, or neurological injuries secondary to trauma. Many of these injuries will have occurred at work or in an automobile accident. In these situations a physician will not only address the medical issues, but also social, vocational, and legal issues that may impede the patient's recovery. The physician also will be called upon to communicate with a number of non-medical third parties that have a strong interest in the patient's progress. Many physicians, including those specializing in muscular, skeletal, and neurological problems, are ill-equipped to handle these potentially volatile situations.
Recently, there has been a growing trend to educate physicians in the field of forensic medicine. The ultimate goal is for physicians to become comfortable in the application of scientific knowledge to legal problems. One of the cornerstones of forensic medicine is the Independent Medical Evaluation (IME).
IME Defined
The Independent Medical Evaluation (IME) is an examination performed by a physician or other health care provider in order to clarify medico-legal issues. By definition, the physician performing the evaluation is not otherwise involved in the care of the injured person. The purpose of the IME is to generate a report for a third party, not to supply care to the person. In fact, there is no physician-patient relationship established during an IME.
The arenas of utilization for these evaluations are worker's compensation, personal injury, and disability determination. The request for an IME will come from attorneys, claims adjusters, judges, employers, and state and Federal agencies (e.g. Social Security Administration). The main purpose of the IME is to answer medical questions for non-medical personnel and to expedite case management. A number of characteristics are necessary for a good report. An IME report needs to be: (1) responsive to questions posed, (2) informative, (3) supportable, (4) understandable, and (5) usable in the legal arena.
Although the physician may be asked to address many issues, the most important are diagnosis, causation, maximal medical improvement, impairment and/or disability, work capacity, appropriateness of care, and recommendations for future treatment. It would be too daunting a task to define all of these terms in this article, but I will address each one in detail in future articles.
Past Context and Present Value
Historically, the quality and veracity of many IME reports have been questioned. This is bound to happen when a medical report is converted into a legal document without benefit of "translation." Although a physician may have the needed training and aptitude to provide quality medical care (and produce a comprehensive report) this does not necessarily make him or her a medico-legal expert. Unfortunately, many a physician has wandered blindly into the adversarial minefield of jurisprudence and returned humbler for the experience. This problem has been minimized by the development of medical organizations such as the American Board of Independent Medical Examiners and the American Academy of Disability Evaluating Physicians. These groups have taken on the job of improving the quality and uniformity of these reports by providing educational courses and certification exams for physicians interested in performing IMEs.
If performed by a qualified physician, an IME can generate an impartial and concise medical report that assists in directing a medical case to a timely, safe, and cost-effective closure.
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