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

September 15, 2016 11:40am

Leo J. Shea III, Ph.D.
Clinical Associate Professor of Rehabilitation at Rusk Institute
President, Neuropsychological Evaluation and Treatment Services, P.C.

Evan S. Schwartz

Schwartz Law PC / Quadrino Schwartz

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 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