Managing Psychiatric and Psychological Disability and Workers Compensation Claims With an Independent Medical Examination Facilitator

By: David Fisher, Ph.D., ABPP, LP
Linda Beckman, RN, BS, CCM, CLNC
And 
Stacey Marchese 

© PsyBar LLC, 2005 - 2008

Introduction

PsyBar LLC developed these training materials to offer disability and workers compensation insurance professionals a common core of knowledge about psychological and psychiatric Independent Medical Examinations (IMEs). It is necessary to know the concepts described in this material in order to manage psychological/psychiatric claims effectively. 

Training Goals

To help disability and workers compensation insurance professionals:

• Recognize the appropriate roles of the insurance professional, the IME Facilitator and the Independent Medical Examiner.
• Understand how to work with an IME Facilitator. 
• Learn common reasons necessitating psychological/psychiatric IMEs.
• Understand how to prepare for IMEs.
• Skillfully evaluate the quality of psychological/psychiatric IME reports.
• Appreciate important psychological issues related to the assessment of fibromyalgia, chronic pain, and chronic fatigue syndrome. 
• Understand the most important neuropsychological concepts. 

Table of Contents

Part 1: History of IMEs 

• A brief history
• Roles of parties involved in IMEs 

Part 2: Concepts to consider before requesting a psychological/psychiatric IME 

• Policy Language 
• Functionality and Functional Capability

Part 3: Obtaining a helpful psychological/psychiatric IME 

• Developing appropriate, file specific referral questions 
• Clarification of the Insurance Professional's goal 
• How to ask questions 
• Development of a standard set of referral questions 
• Sample referral questions for workers compensation claims
• Sample referral questions for disability claims

Part 4: IME Facilitator's role 

Selection of the proper professional to perform the IME
Evaluation of the Independent Examiner's expertise
Providing formal protocols for the IMEs 

Part 5: Making referrals to the IME Facilitator

Part 6: Assessing claimant effort and truthfulness 

• Tests to assess validity and effort

Part 7: Understanding Neuropsychology

• Reasons to request neuropsychological evaluations
• "Cognitive Impairment" 
• Types of psychological tests
• Tests of personality, adaptive behavior, and mood
• Tests of intellectual functioning and memory
• Tests of the ability to perceive the world accurately, and to move one's body
• Other considerations when selecting psychological tests, including foreign language requirements
• How to request specific psychological tests
• Examples of how psychologists interpret test scores in neuropsychological examinations 

Part 8: Impairment in claimants with subjective illness

• Problems diagnosing subjective illness
• Independent Examiners' views on subjective illness
• The Insurance Stance on Subjective Illness
• Using the biopsychosocial model can assist case/claim managers in resolving subjective illness claims
• Signs that there might be a significant psychological cause of limitations in functioning in claimants with subjective illness
• How Independent Examiners determine if there are significant psychological and environmental causes for limitations in functioning in claimants with subjective illness 

Part 9: Examination