Authority & Admissibility in Exams and Reviews

As we jump into 2026, we are excited to launch our 26 in '26 Blog Series. Each post will address a top-of-mind topic in the clinical evaluation services sector.  Let's start with the first in our series!

Authority and admissibility sit at the intersection of medicine, law, and process. In Independent Medical Examinations (IMEs), Peer Reviews, Fitness for Duty (FFD) exams, and Functional Capacity Exams (FCEs), the question is not only what opinion is rendered—but whether that opinion will carry weight when it matters most.

A clinically sound analysis can still fail if the examiner lacks the right authority. Credentials, licensure, specialty alignment, jurisdictional compliance, and documented independence are not technicalities; they are foundational to credibility. This is where URAC accreditation makes all the difference.

In practical terms, “authority” means the examiner is qualified and permitted to render an independent opinion for the purpose at hand, under the rules that apply to that claim. Authority goes beyond holding a license. It typically includes active licensure in the relevant jurisdiction (or compliance with any jurisdictional rules for out-of-state practice), appropriate specialty training for the condition in question, and clear alignment between the examiner’s scope and the questions being asked.

“Admissibility” is when authority gets tested. In litigation, administrative hearings, disputes, or appeals, the opposing side often attacks the foundation before addressing the substance. If authority is weak—wrong specialty, questionable eligibility, unclear independence—then the opinion may be discounted, excluded, or used only for limited purposes, regardless of how thoughtfully it was written.

Specialty alignment is one of the most common vulnerabilities. A licensed physician is not automatically the right authority for every question. Orthopedic issues reviewed by a non-orthopedic specialty, neurologic complaints evaluated without neurologic expertise, or psychological components addressed without behavioral health credentials create an opening to challenge foundation. Even when conclusions are reasonable, misalignment invites the argument: “This examiner is outside their lane.”

Jurisdictional nuance matters as well. Requirements for IMEs and record reviews vary across states and lines of coverage. Workers’ Compensation may impose eligibility requirements, scheduling and notice rules, disclosure obligations, or report content standards. Disability claims may be governed by policy language and evidentiary expectations. Auto and Liability matters may face heightened scrutiny on methodology and expertise in adversarial settings. A process that is compliant in one venue can be challenged in another if the authority elements are not mapped correctly.

Authority is also strengthened—or weakened—by process. High-quality programs reinforce authority through credential verification and monitoring, conflict-of-interest screening, specialty-appropriate matching, clear definition of scope, and quality assurance review. These controls do more than reduce operational risk; they demonstrate rigor and independence, which improves acceptance when an opinion is contested.

The takeaway: before focusing on the conclusion, confirm the foundation. The most defensible medical opinions start with the right examiner, properly vetted, operating within scope, under the correct jurisdictional and coverage requirements. 

Best Practice

Choose a clinical services partner that puts URAC accreditation to work for you. One with authority: confirming jurisdictional requirements, matching specialty to the clinical question, verifying credentials, and documenting independence. When authority is clear, admissibility and defensibility become much easier to sustain.

Next in the Series

Next Up in our 26 in '26 Series: B — Bias (Real vs. Perceived): how bias allegations arise and how neutral processes protect credibility.