Evaluation and reporting requirements of the disability examiner.

Critics of the system within which IMEs occur might argue that there is in fact no such entity as a truly impartial evaluation because the practitioner always is aware of the source of payment for the visit and will color opinions in favor of that payor. Nonetheless, the ethical practitioner has no problem whatsoever refuting that rather cynical attitude. First, payment for any type of clinical visit must come from somewhere. Most importantly, always keep in mind what is in the best medical interest of the person you are examining, and you will avoid virtually all ethical dilemmas. To illustrate obvious examples, if a claimant has the objective impairments of herniated disc with associated radiculopathy, it makes no medical sense, and would certainly be unethical, to allow unrestricted RTW to a physical job. That clearly would not be in the best interest of a patient you were treating, nor should that be your opinion for an IME. Similarly, a person without any objective impairment documented after careful search is not well served by a continuing program of medications, time off work, useless modalities, and a growing "sickness" frame of mind. That would definitely not be in their best interest, and your opinion for a treatment case or for an IME should reflect that without hesitation. Once you make a consistent habit of always invoking what you truly believe to be in the best medical interest of the examinee, the long-term interests of the other involved parties will also be well served as a consequence. The insurance company will not be asked to either continue paying treatment and wage replacement costs for someone who could safely work, nor will it be forced to accumulate the unnecessary expenses of recurrent injuries to an injured worker returned to work prematurely. By faithfully adhering to the simple principle of not swaying from the best interest of the examinee, you might lose referral business from some sources. Certain employers, case managers, insurance carriers, attorneys, or others might want to rely on your opinion in all cases, perhaps to conclude that claimants are rarely if ever impaired (or at least not from work or auto accident-related events). Your practice and your reputation are much better off without that business. A well-planned and carefully performed IME, resulting in a detailed, understandable, and defensible report with the elements outlined in this article, will serve you and your referring sources well.