Independent Psychiatric
Evaluations
C Donald Williams MD
Course Plan
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Define psychiatric IME types and how they
differ from other evaluations
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Worker’s compensation IMEs
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Personal injury IMEs
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Emphasis because of greater opportunity
Lesser opportunity—difficult entry—forensic
certification helpful
How to conduct the exam
Review a sample exam
Workers compensation IMEs
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Purpose is to diagnose psychiatric
conditions and determine causal
relationship to workplace injury
Levels of causal relationship
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>51% causal relationship
Pre-existing condition “lit up”
“2nd injury fund” compensable when Preexisting condition from prior injury + present
injury = permanent disability (other details)
Differences from other IMEs
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Worker’s compensation—impairment and
causal relationship to work injury
Personal injury—Determine the nature and
degree of impairment with specific tort
cause
Social Security—Impairment only
Fitness for duty—Impairment performing
the essential tasks of a specific occupation
Benefits of IME work
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Concentrated practice in detailed civil
forensic assessments
Intensive practice in conceptualization,
fact pattern analysis, and writing
Opportunity to introduce variety in
practice
Work performed outside the constraints of
health care insurance structure
Qualifications for entry
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Board certification (relative-not absolute)
Experience treating injured workers
IME panel membership or reputation with
contracting entities to perform solo IMEs
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Attorneys
Claims management companies
Ability to author comprehensive reports quickly
and efficiently
Willingness to testify at hearings (experience)
Challenges of IMEs
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Conflict with opposing parties
Can be intensely political
Boundary clarity essential
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No treatment relationship
Never shade the findings
“Seeker of truth”—makes litigation more efficient
MAINTAIN TOTAL TRANSPARENCY
Anticipate occasional personal and professional attacks
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Be prepared to mount aggressive legal defense
Clear documentation critical
To start IME work
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Begin with performing SSD evals
Be available to treat injured workers
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1-2 years experience desirable
Join IME panels in your state
Contact law firms that specialize in industrial
insurance work and provide work samples
Review “Examiner’s handbook” for your state
Practice development requires several years
The psychiatric evaluation
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Review of medical records
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Detailed recitation key to quality evaluations
“Needle in the haystack” common
Discover misstated facts—lack of foundation
and consistency in other evaluations
Face to face evaluation of applicant
requires between 45-120 minutes,
depending on the complexity of the case
Use DSM-IV multiaxial framework
Professional conduct
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Treat examinee how you would like your
relatives to be treated by a professional
Explain your role
Provide the evaluation requested by referral
source and answer their questions,
No value judgments
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Harder than it seems on occasion--examples
Countertransference awareness helpful—e.g. fear of being like the
claimant
The place for templates
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Create your own template using the SSA
format
Saves time--promotes efficiency
You or your transcriptionist fills in the
blanks
Ideal for voice recognition software
Confidentiality disclaimer
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Statement of Non-Confidentiality:
The limitations on confidentiality imposed by his/her
status as a Labor & Industries claimant were explained
and accepted. He/she was specifically advised that no
doctor-patient relationship was being established and
that a copy of this evaluation would be forwarded to
his/her attorney, who would utilize it as he saw fit in his
representation of him/her in the matter currently before
the Department of Labor & Industries. He/she agreed to
proceed with the evaluation with this understanding.
Assignment letter questions
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Your diagnoses for conditions causally related to this
industrial injury.
Any treatment recommendations made causally related
to this industrial injury.
Whether or not there is any permanent partial
impairment causally related to this industrial injury.
Whether one of the causes of this injured worker’s
inability to work between February 28, 2003 to
present, would be the industrial injury of March 1,
1990.
Review a sample evaluation in
detail-refer to packet now
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Use standard format
Economy of language
Answer the questions posed in the
assignment letter
Summary
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IMEs require discipline and commitment to
perform well
Foundation and consistency essential
Templates facilitate efficiency, consistency
Be readily accessible to your referral
sources—same day phone call return
Learn from your mistakes—be humble
Where to get more information
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www.aoop.org has links to AOOP Bulletin
and prior meetings
www.cdonaldwilliamsmd.com links to
prior courses, publications, and a list of
references
Your response and questions
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Questions
Comments
Criticisms