How to get the best out of an IME referral.

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Independent Medical Examiners ('IMEs') are often briefed to answer multiple complex and important(for insurer,solicitor, court and examinee) issues relating to often remote and often poorly documented events.They are often in a difficult position as they practise in a most adversarial system at times. They are briefed with potential to become witnesses as experts of their specialty -not witnesses of fact.

Sometimes IMEs are briefed with no radiology films.I do NOT rely on radiologists' reports for a variety of reasons,including I like to see the images myself, radiologists use various nomenclature systems (se my other news article on this subject) and what someone refers to as 'mild' may be 'severe'! There is no reason why the IME should be withheld the films noting the expectations of them.

A helpful brief includes:

1. The examinee's written and signed statement of events,

2. The insurance certification,

3. The police/ambulance /ED department reports,

4. The treating doctors' actual contemporaneous notes-not just reports-actual notes-the best records are those closest in time to the injury i.e. contemporaneous,

5. All relevant previous medical notes to assess co-morbidites and any evidence of developing pathology that may not be readily apparent to all involved after the subject incident,

6. All specialist referral ,notes and reports,

7. All operation and hospital records.

8 List of current medications and allied health treatments.

9. Results of blood tests and other investigations.

10.Other IME /specialist reports to provide background on symptom/sign/clinical progression or regression.

The most accurate IME reports will be those based on and briefed with the above high quality data-best for ALL parties.

UCPR requires an IME /expert to declare information which he/she was not provided with but that the IME considered important in forming a concluded opinion.Please read UCPR to which IMEs advise to abide by in their reports as well as texts on IME reports.

An IME providing and signing off on a concluded IME report which may have significant consequences to the claimant, insurer or employer will do so at his/her peril unless the report either discloses the deficiencies in briefing or advises that he/she would be willing to provide a further  supplementary/supplemental report on being provided with the specific deficient material.

The interested reader will find all of these recommendations in :

(i) UCPR 2005 31.23 Code of Conduct and 31.27 Experts' reports

(ii) 'AMA Guides to the Evaluation of Disease and Injury Causation' , 2nd Edition, 2014, Ed. J Mark Melhorn et al Pages 146 to 153.

(iii)'Writing and Defending Your IME Report: The Comprehensive Guide', Ed Steven Babitsky ,esq et alPages 87 to 90 and 190-199 including 10.4 Conclusory  or "Net" report requirements.

A report not bearing logical and clinical evidence based reasoning commencing from evidence at time of injury may well be one for rejection(10.3 and 10.4 Babitsky et al.

This  standard applies equally to matters relating to :(i) PI , both for an insurer 'statutory' and  for a solicitor,litigated,(ii) medical negligence and(iii) evidence relating to charges against an individual. These matters relate to financial compensation, reputation and registration of a medical registrant and liberty of a citizen- a quick report neglecting important scientific evidence like the medical records in the first few weeks after the subject incident may well be unacceptable.

Providing a report for an insurer (statutory) in which a request for approval or rejection of surgery is NOT a minor matter.

 The medical and legal consequences which flow from a decision EITHER way MUST be appreciated by the briefer (and IME) and should not be made  without FULL briefing UNLESS there is a VALID reason why the IME must make this decision WITHOUT all of the above cited material: a 'quick' report is not necessarily a 'good ' report.Insisting that an IME give a concluded opinion 'one way or another' WITHOUT medical records, incident report, certificates, hospital records and at times not even the actual radiological films is unacceptable in my opinion.

 I have posted on the variations in radiology reports (bulges, prolapses, herniations ' protrusions, annular fissures, annular tears etc  are terms used often interchangeably in radiology reports -the term does NOT define causation ) and the need for the IME to actually view the films to determine CAUSATION as best he/she can is UNAVOIDABLE requirement in my opinion.

Dr Michael Coroneos is a senior Brisbane Neurosurgeon  with 6 Fellowships in Surgery and  was honoured to be  elevated to Master CIME by the American Board of Independent Medical Examiners (by examinations and training) in May 2017.

MCIME   FRACS  FACS)USA)  FRCS(Glasg)  FRCS(EDIN)SN   FRCS(IRE)  FRCS(ENG)   MB BS(1st Class Honours UQ 1980)  MAPS  MNSA  MNSQ

 Senior RACS Clinical Examiner. Honorary Adjunct Clinical  A/Professor.

All patients and brief preparers should obtain their own medical and legal advice. The opinions expressed in this article are solely those of Dr Micahel Coroneos.