You May Not Know What You Don’t Know! Even When It Comes to IMEs—Until Now!

What Does an IME entail?

In our last OnPoint post, we outlined the basics of what an IME is. Let’s dig deeper to understand all the components.

Medical Records and Associated Diagnostic Studies

An IME physician should receive all relevant background, including the accident report, a complete medical record (including prior medical records), diagnostic test results, job descriptions, and claimant statements, all well in advance of the exam. From the medical records, they will review the chronology and medical history of the case, so they can determine what has occurred up to that point.

It should be clear what conditions, if any, have already been medically accepted by the workers’ comp insurer. For example, if there are four known injuries, but only two have been accepted by the insurer, that should be clearly indicated in the file or request.

It’s also important that the medical records arrive with any relevant diagnostic tests, such as MRI or CT reports, if available. Here are other examples of diagnostic information that might be included, depending on the intent of the IME:

• If the IME physician is evaluating a patient’s respiratory system, it’s important to include any pulmonary or lung function test results. If there are any diagnostic tests that were performed “prior” to the injury, it’s great to include those as well. That way, the IME physician can see a before-and-after assessment.
• If the IME physician is asked to determine whether hearing loss is job-related, it’s important to include a recent hearing test as well as the baseline test, which may have been conducted at the time the employee was hired. If the employee works in a noisy environment, a baseline hearing test is often performed.

Medical History

IME physicians will assess medical history through both a review of the medical records and information gathered directly from the patient during the physical exam. They will examine the mechanism of injury and identify clinical correlations with the type and severity of the injury. Any medical history collected during the exam would be documented and, when necessary, compared with what’s already in the medical records to determine whether there are correlations or discrepancies.

The IME physician will also inquire and look at:

• Preexisting or comorbid conditions. Past medical history can help to determine if any other conditions may be at play. For example, the patient may have a previous knee injury, diabetes, or high blood pressure.
• Medications. A list of previous and current medications will be obtained. Many IME requests ask to address medication management with a particular eye toward the opioid crisis. The IME physician may be asked to comment on the appropriateness of medications prescribed for the patient's injury and diagnosis.
• Psychosocial issues. An IME physician will want to know or assess psychosocial issues, as they can affect return-to-work efforts. In a later chapter of this eBook, we will take an in-depth look at the factors that can drive disability.
• Symptomology. The IME physician will also note any symptoms documented in the medical records and during the evaluation to help reach an accurate diagnosis.

Physical Examination

The examination begins when the IME physician sees the examinee. This could include watching the examinee walk in or out of the doctor’s office. The IME physician will have examinees engage in a variety of procedures to observe and evaluate how the affected body parts function. An IME physician may assess the affected area in different ways. For example, a physician evaluating lower back pain may ask the examinee to perform a heel-to-toe walk, assess lower-extremity muscle strength with squat-and-rise exercises, and evaluate the ability to get in and out of a chair.

During the examination, IME physicians may perform specific tests to determine whether the physiological response indicates any nerve, muscle, or soft-tissue injury. They will look, touch, and feel the affected areas. They may touch the muscles and the skin surface to see what kind of response the examinee has. Is there pain on palpation? Does the examinee report tenderness? Do they feel muscle guarding or splinting? What other responses do they observe in the examinee?

Does the examinee wince or pull away? Does the examinee seem to have an exaggerated response? The physician will check the range of motion of the muscles and joints. They’ll examine how much functionality the examinee has in the affected area.

The physician will observe and measure the examinee’s range of motion in the involved area. The measurement isn’t extrapolated. In other words, the physician won’t just look and guess at how far the examinee moved. Instead, he or she will take actual measurements, using an inclinometer or goniometer. The documented measurements should be as exact as possible and not be rounded to convenient values of zero or five.

Next up is All IME Partners are created equal, right? Not so fast! - Discover why impartiality is key — and how it shapes the future of claims.

If you are ready to explore further, download the entire IME eBook here: Emperion eBook.

If now is the time to request an exam, visit our online referral form.