Fundamental Principles of Independent Medical Examination

An independent medical evaluation (IME) is a specialized examination or evaluation best performed by a physician who has special training and experience in assessing issues unique to an IME. IMEs must be independent, and opinions should be consistent and impartial and based on evidence-based medicine. An IME includes the essential elements of a medical assessment, including a history, a physical examination (usually), and review of records and studies, followed by clinical impressions or diagnoses, and then by recommendations. The medical assessment may include other practitioners, eg, psychologists and chiropractors. Depending on the referral request, the IME typically discusses disability (the definition depends on the local jurisdiction) based on deficits in the person's activities of daily living. In the IME, the evaluator may be asked to consider claims issues that include causation, apportionment, impairment, work ability, appropriateness, and costs of medical care and/or future needs. The physician who performs the examination does not provide care to the individual and provides medical opinions about issues associated with the case. Impartiality, objectivity, and an understanding of medicolegal issues are required of the evaluator. IME reports are not confidential and likely will be read by many stakeholders in a claim. Accordingly, nonmedical personnel should find it easy to read and understand the IME.

Independent medical evaluation for sick-listed workers in Norway: A focus group study of the experience of IME doctors

Background: Norwegian politicians have proposed the use of an independent medical evaluation (IME) as a possible solution for reducing long-term sick leave. The use of an IME implies that a new doctor interferes in the relationship between sick-listed workers and their general practitioner (GP). The aim of the current study was to explore experiences of IME doctors from an ongoing randomized controlled trial (the NIME trial evaluating the effect of IME in Norway). Methods: Two focus group interviews were conducted with eight of the nine IME doctors employed in the NIME trial. The discussions were audio-taped and transcribed. Systematic text condensation was used for analysis. Results: The participants reported that the IME provides important second opinions, which they felt empowered the sick-listed workers and provided new insights into their condition. Beneficial IME working conditions and enhanced insight into different sick leave measures were crucial to this perceived usefulness. Some of the participants expressed disappointment with GPs acting as passive conductors and struggled to provide feedback politely. Some adjustments were proposed as necessary for the IME to be implemented nationwide. Conclusions: The participants seemed to have gained a different stakeholder identity by sometimes seeing GPs, their peers, as obstacles to return to work and welcomed the use of IME on a regular basis.

Independent Medical Evaluation Best Practices

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, states that an independent medical evaluation (IME) usually is a “one-time evaluation performed by an independent medical examiner who is not treating the patient or claimant, to answer questions posed by the party requesting the IME.” Evaluators must adhere to best practice standards and must know that these standards may change over time and must meet the needs of the relevant jurisdiction. IMEs take place in several arenas, including automobile casualty, workers’ compensation, personal injury, medical malpractice, and long-term disability and differ from traditional clinical evaluations. The evaluating physician must be independent and has no (or only a limited) physician–patient relationship. The qualifications required of an IME examiner vary by arena, jurisdiction, and issues. Medical evaluators should be board certified and can obtain a special credential from, eg, the American Board of Independent Medical Examiners or the International Association of Independent Medical Evaluators. In addition, evaluators should have demonstrated abilities in report writing and court testimony, and a section of this article provides a general outline of the topics that should be covered in a thorough report. Quality IME reports are the result of thoughtful, thorough evaluations performed by physicians who have knowledge, skills, and experience in both clinical medicine and the assessment of medicolegal issues.