<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Avoiding the Risks of Indendant Medical Exams (IME)
 
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                Independent Medical Exams (IME), Avoiding and Correcting Problems
 
 
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Whether they are done at the request of an insurance company, an attorney in a legal case, or a court in some dispute, they usually are not the same as a second opinion. The quality can vary widely, depending on the physician doing the exam, and to a lesser extent the rules of the state.

What problems can I have?
An IME may have a strong influence on your disablity rating, which determines if you can work and what your work restritions are. Usually there is a rating regarding regular work, medium duty work, light duty work, sedentary work, or no work ablity. Specific restrictions about how much can be lifted, and how much bending can be done are also common, as are the number of hours if it is less than full duty.
Also this will likely affect any disablity benefits you get which are usually based on this.
IME exams can sometimes worsen symptoms, particularly if they are vigorous.
There can be considerable time and travel to get to the IME physician.
They can start new needed treatments, delay treatments, or block treatments depending on the results. Delays can go on for weeks, months and years.

This is why you have to prepare for the IME, and don't leave it completely to the system. Usually even a lawyer or nurse going to the exam with you will not guarantee the best results. For that, you need to study this course and take all the advice that applies to you.

There are several keys to getting the most out of these, and some dangerous traps. Some of the same rules that we have listed for treatment apply, but we want to pull them together for you here. But most basically be sure to read all your records.

My IME report doesn't consider my doctors recommendation, because the IME doctor didn't have his notes.
First , be sure you have complete medical records. This is not easily accomplished for the reasons discussed elsewhere. Many of the frustrations in IMEs result from incomplete records. Even if the insurance company has them, it does not mean the IME doctor will. This leads the the doctor and insurance company to take information with missing pieces, because it's been provided to them that way. To make the point, when you see a commercial of someone providing a doctor with all of a patient's medical records from some computer bank, this rarely happens in real life. Only if you have had all your health care and tests in one facilty which is well ahead of its time will that occur. In truth records are usually scattered among different offices, not infrequently misplaced, and made hard to get by many regulations.
This problem allows confusion to arise, and facts to be missed, seen out of proportion or inaccurately. It is very important ot understand that it is much harder to straighten out later the problems this causes than to get it right at first. Be sure you have your records, know if they are accurate and complete. Some patient are wholly unaware tests they are supposed to have are not done, or incorrect statements about them are blocking their benefits because they done read the medical record.
And while we're talking about records, films and imaging studies are a special problem. Be sure you understand that an MRI scan, an x-ray, or any other test done with imaging is not the same as the typed report. The physician needs both. The radiologist report may be scanty or even be inaccurate. The person doing the report may not have been a specialist in the area of your problem, for example. As the old saying goes, the picture is worth 1000 words. So both the films and the report are essential. It's usually easier to bring them than rely on them being sent, because often they are really shipped or some films may be left out. The easiest way of all is usually to have a film copy made for you each time the study is done, then bring them. This protects you against loss, and saves a lot of time and effort trying to get them.

I didn't know I contradicted my own records.

Read your records and be careful not to contradict them without good reason plus an explanation. If you forget or omit some key point which is opposite to what you're saying, that changes the impact. You'll confuse the doctor or lose credibility. The result may be a worse report or even one contradictory to your real problem. Common mistakes are to leave out a past injury or symptom that is in a similar location. Then if some reference is found to it, the old problem, which you said did not exist, creates confusion and is harder to get in perspective. On the other hand if you explain it up front, it can be kept in proportion.
Another common mistake is not have the more recent notes from your physician. This can create potential delays, because the IME doctor may not be able to even comment on a proposal for a medication or an operation without a note from you physician explaining what was requested and why. While some offices are prompt in typing notes, others can take days or months before they are completed. Furthermore, those notes then have to move from the doctors office to the insurance company, then to the company that set up your IME and finally to your IME doctor. Plenty of chances present for them to be lost or delayed along the way. The same is true for recent films. Your best course is to have a copy, particularly any recent records.. Then you can supply them at the meeting.

Why doesn't he have all my symptoms in the report?

Be sure to take the exam seriously, and be sure to describe your own symptoms and problems accurately and precisely.
If you don't tell it, or you confuse it, it will be missed because you are the only source. If you generalize too much, for example "my whole body hurts", the physician is left with no clues. It's very difficult to hone in on the real problem. This can lead to a less effective analysis and treatment. Or, your problem may not even be understood. Such a situation makes it harder to make a recommendation, or even to justify the support which you need in terms of work restrictions or money. On the other hand don't say too little. Most patients try not complaining to their family and friends, and they will be very limited when describing their problem. Sometimes the only clue is the facial expression. Remember that you are the only one in the world who can give insight into what you feel. Feelings like pain will not show up on any imaging study or blood test, no matter how sophisticated. The physician is depending on you to provide that information. State it well.Tell exactly where pain is, how far it runs, and when it occurs. These are invaluable clues that no one else can provide. This makes you the key partner in the care, and keeps the exam on track.

Avoid being examined in a way that worsens your symptoms. Sometimes you can find it to be unpleasant, or make your symptoms worse. If this happens, be sure to tell the physician right away. Most physicians will not want you to experience extra discomfort during and after the exam, but when the patient doesn't indicate worsening quickly enough this is more likely. If the style of physician is such that strong maneuvers are made,be sure you let them know when you start feeling pain. Hopefully that will end the maneuver.

Will the physician discuss his findings with me?
Usually the physician cannot discuss your case at the end of the IME, but you often can learn something. This restriction is partly because the full record should be reviewed so that an incomplete conclusion is avoided. And that is usually done later. Also, the rules of the Independent Medical Examination usually prevent discussion of your specific case. However , you can get valuable information from many examiners by asking general questions which are not about you specifically, but rather are about the type of problem you have. So the trade-offs between two types of treatments or operations may well be discussed. Issues of what type of conservative therapy to use can often be discussed. And there are other examples. If the examiner feels that wholly different treatments or directions of treatment may be appropriate to your kind of problem, you can often get a sense of this in such discussions. If you are looking for another formal second opinion that does involve a doctor-patient relationship, some general recommendations may be made.
Usually the reports of the doctor are sent to the company and by them to you, your doctor and insurance company as well as other involved parties. This often takes a couple of weeks and the time may be mandated by regulations, and can vary. When you get the report, be sure to read it.

What if the IME report has errors?
If you feel points from the exam were misunderstood or records were not seen, it's worthwhile to point this out at once. Usually the best way is to write a careful, well thought out letter to both the company doing the exam and the insurance company. You usually do not get to communicate directly with the physician examiner, but the IME Company will send it on. It's likely this will produce corrections, or at least an explanation. Plus you registered your disagreement and concern.
If you find that something was inaccurate, or problematic, you may request another IME. The way this is received varies with insurance companies. If you think wrong conclusions occurred it is a good idea to get a second opinion from a physician who is established and respected in the community or profession. Should that doctor make different recommendations, it will temper the effect of the IME in other evaluations and decisions.

Does the IME determine if my treatment will be approved?
The IME influences but does not always determines the insurance company decisions. The decision process varies wtih a number of factors that include state laws, the type of injury (e.g. workmans complensation versus no fault), and who is managing your case. While the IME opinion is important, it may be followed or ignored in an individual case. The insurance company is a key factor, but your personal physician's opinion is also very effective. If your physican makes a good argument for your care and is persistent about it, your odds of getting approval imrpove substantailly. Depending on the details, a court process may be involved and a judge may reconcile differing recommendations. The key is to learn how your process works, then take this into account.

In summary, the keys to making the IME work for you are to have accurate records which are complete, to know what is in them. Then explain your history and your symptoms in a clear and accurate manner, without making them too broad or too limited. If there is a disagreement with the IME, requests corrections. If that's not effective, look for another opinion that helps to provide insight on the real nature of your problem.

For more on IME dangers, on understanding how disablity ratings conflict, geting the doctor to be careful with you, checking that you are fully prepared, and other vital matters. Take the steps below.

 


IME Intro

These below require a regular membership level.

Power Patient Approach To IMEs
Disablity
Seven IME Snares
Quiz Yourself to Optimize the Odds
Finally, Use Our Checklist Before Your IME


Need More IME Help? Call For a Consult.

Schedule a phone consultation
after the course at 1 561 282 6576
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