What you need to know about an Independent Medical Examination (“IME“)

By Sanjay Adhia, M.D.

An IME is a face-to-face examination. A medico-legal IME is very different from a clinical exam. One is performed to treat a patient and establishes a doctor-patient confidentiality requirement. In a lawsuit, however, the IME is used to evaluate an examinee, usually a plaintiff or defendant, and provide a medico-legal opinion. There is no doctor-patient relationship and confidentiality is limited.

What is an IME?

It stands for Independent Medical Exam. An IME is a medical exam conducted by a third-party, unbiased physician. An IME is conducted for an attorney, employer, insurance company, government agency or other entity.

Why can’t the treating physician perform the IME?

A treating physician likely abides by the Hippocratic oath. The oath states Primum non nocere which is Latin for “First do no harm.” Thus, the treating physician is inherently biased, regardless of whether the person being examined is plaintiff or defense.

Can an attorney choose the examiner?

In many cases, both parties will retain their own examiner. In some cases, both sides will agree to use one examiner. Such an examination is known as NME (Neutral Medical Exam) or AME (Agreed Medical Exam).

What is the difference between an IME and a clinical exam?

The purpose of a clinical exam is to evaluate and treat a patient. Thus, there is a doctor-patient relationship. Confidentiality is required.

The purpose of an IME is to evaluate an examinee and provide a medicolegal opinion. There is no doctor-patient relationship and confidentiality is limited.

Generally, an IME entails a far more detailed evaluation and report than a clinical exam.

A good IME requires objective data. In a clinical setting, a patient’s description of their symptoms (sometimes called a self-report) may be sufficient to initiate a course of treatment. In a medico-legal setting, however, additional data is often required to render an opinion with reasonable medical certainty.

What is the procedure for an IME?

I will consult with the retaining party and determine what is being asked. It could vary between one question such as a diagnosis or dozens of detailed questions.

I will carefully review the records and identify any records that were omitted. I will also review other IMEs and psychological reports, if available.

A detailed psychiatric interview with the examinee or examinees will be conducted. Topics would include psychosocial history, family history, medical history, psychiatric history and psychiatric review of systems (comprehensive exam of mood, psychotic, anxiety, trauma-related and other symptoms utilizing the  DSM-5) and a Mental Status Exam.

If necessary, I will identify and interview collateral informants.

After thoroughly reviewing the data, I will formulate a provisional opinion. Often, I will discuss the findings with the retaining party. If requested, I will proceed with the report.

The report will include all the elements in the interview usually with a summary of the records and collateral interviews. I will discuss the DSM 5 basis for the diagnoses. I will also discuss why the examinee did not meet criteria for other relevant diagnoses.

Usually the attorney would like to know more than the diagnosis. I will then explain my opinion and answer any specific questions. Usually, the nexus between the opinion and the psychiatric aspects will be detailed.

As much as I enjoy testifying or being deposed, generally many attorneys would like to quickly resolve a case for their clients. I have found a well-written report will often eliminate the need for a lengthy trial.

Why should I retain a Board-Certified Forensic Psychiatrist to conduct an IME?

A forensic psychiatrist would have additional training and experience in conducting medicolegal evaluations. It would be advisable to retain an Independent Medical Examiner who is actively involved in a clinical practice. This will ensure the examiner has a better understanding of the Standard of Care, Maximal Medical Improvement and other nuances. It is often prudent to retain an expert who is Board-certified in Forensic Psychiatry. Board-certification in Forensic Psychiatry first requires Board-Certification in (general) Psychiatry. On occasion, a Forensic Psychiatrist will have other board-certifications such as Brain Injury Medicine or Sleep Medicine. Board-certification and an active clinical practice form the basis to overcome any challenges during a voire-dire that the disclosed Expert is not adequately qualified to render Expert testimony.

What is a QME and PQME?

These terms are used primarily in Worker’s Compensation cases. QME stands for “Qualified Medical Examiner.” Many states have panels of QMEs from which Worker’s Compensation claimants can choose. PQME is Panel Qualified Medical Examiner. Certain state Workmen’s Compensation programs utilize such examiners with state-by-state requirements, which may include a special examination and credentialing process. Psychiatrists and Psychologists may be QMEs but they are not equally appropriate for every case.

What is a DME?

A DME is Defense Medical Exam. It is a court-ordered exam of the plaintiff by the defense expert.

 

Posted 2019

Sanjay Adhia, M.D., Forensic Psychiatrist