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 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

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