The Physician Perspective: Opinions Based on Reasonable Medical Certainty
A critical component of a quality IME is utilizing a quality physician. If claims staff and an IME company work together, the injured employee will be referred to the appropriate physician or specialist who is properly credentialed, qualified, and skilled in performing the required IME. Keep reading to find out what one of our IME experts considers key factors of a high-quality IME.
“For me, preparing for an IME starts three or four days before the actual exam,” said Amir Reza Moinfar, MD, of Elite Orthopedic & Musculoskeletal Center, Glen Burnie, MD. “I start by reviewing medical records. In some cases, these files can be on the order of up to several thousand pages. It’s a good opportunity to familiarize myself with the particular claim and to potentially catch items that may be missing from the file. For example, if I’m going to assess whether a claimant can return to full duty, I need the job description. If a claimant has had surgery, I need to most certainly have access to the operative note. There’s still time to request any missing information in advance of the exam. This helps to make the process, in my opinion, more seamless, thorough, and efficient.”
“When an IME physician gives an opinion, it needs to be based on medical evidence and based within a reasonable degree of medical certainty. There are legal ramifications that help hold an IME to a high standard,” explained Moinfar.
“There’s a certain skill set that’s required in performing these exams,” he added. “Much of it comes with experience, but a lot of it comes from proactively going out of your way to learn and become as proficient as possible in performing these exams. I chose not to perform IMEs straight out of training. First, I wanted to feel confident in my ability to treat patients and formulate decisions for their care. There are also legal terms an IME physician must become familiar with, such as causation, disability, impairment, and apportionment. These things aren’t taught in medical school, but a physician can take courses and study the practice of performing quality IMEs. Also, a lot of the skills associated with performing IMEs come with experience.”
Thank you to Dr. Moinfar for these insights!
Coming up next, Through the Examiner’s Eyes: Distinguishing Objective from Subjective in IMEs. IME physicians must ground their conclusions in objective medical evidence, facts they can see, measure, and validate, rather than emotion, opinion, or perception. But what happens when the data they need depends on the examinee’s own words or actions...?
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