1 / 17

Independent Psychiatric Evaluations

Independent Psychiatric Evaluations. C Donald Williams MD. Course Plan. Define psychiatric IME types and how they differ from other evaluations Worker’s compensation IMEs Emphasis because of greater opportunity Personal injury IMEs

arden-willis
Download Presentation

Independent Psychiatric Evaluations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Independent Psychiatric Evaluations C Donald Williams MD

  2. Course Plan • Define psychiatric IME types and how they differ from other evaluations • Worker’s compensation IMEs • Emphasis because of greater opportunity • Personal injury IMEs • Lesser opportunity—difficult entry—forensic certification helpful • How to conduct the exam • Review a sample exam

  3. Workers compensation IMEs • Purpose is to diagnose psychiatric conditions and determine causal relationship to workplace injury • Levels of causal relationship • >51% causal relationship • Pre-existing condition “lit up” • “2nd injury fund” compensable when Pre-existing condition from prior injury + present injury = permanent disability (other details)

  4. Differences from other IMEs • 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

  5. Benefits of IME work • 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

  6. Qualifications for entry • Board certification (relative-not absolute) • Experience treating injured workers • IME panel membership or reputation with contracting entities to perform solo IMEs • Attorneys • Claims management companies • Ability to author comprehensive reports quickly and efficiently • Willingness to testify at hearings (experience)

  7. Challenges of IMEs • Conflict with opposing parties • Can be intensely political • Boundary clarity essential • No treatment relationship • Never shade the findings • “Seeker of truth”—makes litigation more efficient • MAINTAIN TOTAL TRANSPARENCY • Anticipate occasional personal and professional attacks • Be prepared to mount aggressive legal defense • Clear documentation critical

  8. To start IME work • Begin with performing SSD evals • Be available to treat injured workers • 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

  9. The psychiatric evaluation • Review of medical records • 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

  10. Professional conduct • 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 • Harder than it seems on occasion--examples • Countertransference awareness helpful—e.g. fear of being like the claimant

  11. The place for templates • 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

  12. Confidentiality disclaimer • 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.

  13. Assignment letter questions • 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.

  14. Review a sample evaluation in detail-refer to packet now • Use standard format • Economy of language • Answer the questions posed in the assignment letter

  15. Summary • 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

  16. Where to get more information • www.aoop.org has links to AOOP Bulletin and prior meetings • www.cdonaldwilliamsmd.com links to prior courses, publications, and a list of references

  17. Your response and questions • Questions • Comments • Criticisms

More Related