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