Independent Medical Evaluation (IME)
Dr. Zunkeler performs independent medical evaluations (IMEs) for insurance companies and legal professionals. An IME combines a careful review of the available medical records and diagnostic imaging studies with a history and physical examination of the patient. Since IMEs are non-treatment encounters with a patient and since a patient-physician relationship does not exist, opinions regarding diagnoses and treatment options are usually not discussed with the patient during an IME visit. An IME report documents the history and physical examination of the patient, discusses the records and diagnostic images that were reviewed, and provides a list of probable diagnoses. In addition, a summary section provides a synopsis of the case and discusses important objective findings and diagnoses. Finally, specific questions of the party requesting the IME are answered. The completed report is then proofread for accuracy, signed, and sent back to the party that requested the IME, usually within 3-5 business days of the date of the IME visit.
What should you expect from an IME?
An IME provides a careful review of available medical records and diagnostic imaging studies and a detailed history and physical examination. Based on the information thus obtained, an experienced independent neurosurgical examiner is able to formulate valid insights about a patient's diagnosis, prognosis, and treatment options and whether or not an end point of treatment has been reached. In addition, the degree of probability to which a certain incident (e.g. a work injury, car accident, or fall) caused certain pathology (e.g. a disk herniation) and whether a treatment intervention (e.g. microdiscectomy surgery) is related to the reported incident or not can usually be addressed.
IME reports commonly address the following:
1. Diagnosis and prognosis.
2. Causal relationship of reported symptoms and physical exam findings to a claimed incident.
3. Appropriateness of medical or surgical care.
4. Presence or absence of pre-existing or subsequent medical conditions and the degree to which those conditions contribute to the patient's complaints.
5. Relatedness of medical or surgical care to an occurrence, i.e. a loss, an incident, or an injury.
6. Causation or lack of causation of reported signs and symptoms relative to a claimed injury, incident, or loss.
7. Whether an end point of treatment has or has not been reached.
8. Permanent impairment rating according to the American Medical Association's Guides to the Evaluation of Permanent Impairment.
What are the potential shortcomings of an IME?
An IME report can be an extremely valuable tool in assessing a patient's neurosurgical status, including spinal and musculoskeletal health issues. Unfortunately, the quality of an IME can be diminished by certain factors that are outside the control of the independent neurosurgical examiner. The quality of an IME depends on the completeness of medical records provided and the degree to which a patient is willing to cooperate with the IME process. Patients can greatly assist in the IME process and improve the quality of their IME report by bringing all of their diagnostic imaging studies to the IME appointment, by filling out the pre-visit questionnaire completely and truthfully, and by providing a factual history of their medical problem, including the problem that led to the IME.
The quality of the IME can be jeopardized by the following factors:
1. Patients showing up late or not at all for an IME appointment.
2. Patients not bringing relevant diagnostic imaging studies (x-rays, CTs, MRIs, etc., usually on CD) to the IME appointment.
3. Incomplete medical records.
4. Absence of an interpreter for patients with poor command of the English language.
At times (e.g. if a patient shows up late or if an interpreter is not available), an IME appointment will need to be rescheduled. Occasionally, information that was missing at the time of the IME appointment (i.e. diagnostic imaging studies, additional records, etc.) becomes available at a later date, and an addendum report taking into account the new information is provided.