Effectively Approaching and Utilizing the IME’s Evaluation, Treating Physician’s Opinion, the FCE, Neuropsych Evaluations, Medical Records and More

January 21, 2016 2:40pm

Daniel W. Srsic

Littler Mendelson P.C.

Alicia Paulino-Grisham

DI Law Group

Ronald Roberts Ph.D.
Forensic Neuropsychologist
Forensic Psychiatric Associates Medical Corporation

Henry G. Conroe MD
Clinical Assistant Professor, Rush Medical College Regional Medical Advisor, Social Security Administration
Region V

The Latest IME and FCE Issues and Considerations

  • The fundamental right to require IMEs or FCEs during each stage of the case: initial claim review, during litigation, during an appeal
  • What type of testing is required under the contract and what type of testing is most relevant to the claim
    • Disabling Physical Illness – is an FCE warranted? A neuropsychiatric exam?
    • Disabling Mental Illness – is the Neuropsychiatric exam warranted?
    • In a “pain case” what testing is relevant?
  • Has direct evaluation of claimants (e.g., field interviews, surveillance, IMEs) been being de-emphasized in favor of consults (e.g., in-house or contracted paper reviews by doctors and vocational analysts)? What are the implications of this?
  • When facing the IME – addressing the questions of:
    • Is the examiner qualified?
    • Under what circumstances will you allow the person to go?
    • What if they refuse to go? What are the implications?
    • Strategies for preparation

What Must Be Preserved and Produced Related to the Examinations

  • The exchanges between the examiner and insurance company?
  • The raw data from an IME, or Neuropsychiatric or Neuropsychological Exam?
  • Can the examination be videotaped, audiotaped or witnessed?
  • What data, if any is confidential?
  • What are the latest trends, issues and challenges being faced by both sides during this process?

How to Establish the Credibility of Examinations

  • Comparing and assessing the different approaches by physical therapists for the FCE
  • Comparing and assessing the different approaches to the Neuropsychiatric and Neuropsychological exams – examples of testing used and their purpose
  • Evaluating the Credentials of the examiners and potential bias
  • Taking action to establish unreliability and/or bias early on so that evidence of same can be included with appeal filing