Independent Psychiatric Evaluations C Donald Williams MD

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

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

Differences from other IMEs Worker’s compensation—impairment and causal relationship to work injury Worker’s compensation—impairment and causal relationship to work injury Personal injury—Determine the nature and degree of impairment with specific tort cause Personal injury—Determine the nature and degree of impairment with specific tort cause Social Security—Impairment only Social Security—Impairment only Fitness for duty—Impairment performing the essential tasks of a specific occupation Fitness for duty—Impairment performing the essential tasks of a specific occupation

Benefits of IME work Concentrated practice in detailed civil forensic assessments Concentrated practice in detailed civil forensic assessments Intensive practice in conceptualization, fact pattern analysis, and writing Intensive practice in conceptualization, fact pattern analysis, and writing Opportunity to introduce variety in practice Opportunity to introduce variety in practice Work performed outside the constraints of health care insurance structure Work performed outside the constraints of health care insurance structure

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

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

To start IME work Begin with performing SSD evals Begin with performing SSD evals Be available to treat injured workers Be available to treat injured workers 1-2 years experience desirable 1-2 years experience desirable Join IME panels in your state Join IME panels in your state Contact law firms that specialize in industrial insurance work and provide work samples Contact law firms that specialize in industrial insurance work and provide work samples Review “Examiner’s handbook” for your state Review “Examiner’s handbook” for your state Practice development requires several years Practice development requires several years

The psychiatric evaluation Review of medical records Review of medical records Detailed recitation key to quality evaluations Detailed recitation key to quality evaluations “Needle in the haystack” common “Needle in the haystack” common Discover misstated facts—lack of foundation and consistency in other evaluations Discover misstated facts—lack of foundation and consistency in other evaluations Face to face evaluation of applicant requires between minutes, depending on the complexity of the case Face to face evaluation of applicant requires between minutes, depending on the complexity of the case Use DSM-IV multiaxial framework Use DSM-IV multiaxial framework

Professional conduct Treat examinee how you would like your relatives to be treated by a professional Treat examinee how you would like your relatives to be treated by a professional Explain your role Explain your role Provide the evaluation requested by referral source and answer their questions, Provide the evaluation requested by referral source and answer their questions, No value judgments No value judgments Harder than it seems on occasion--examples Harder than it seems on occasion--examples Countertransference awareness helpful—e.g. fear of being like the claimant Countertransference awareness helpful—e.g. fear of being like the claimant

The place for templates Create your own template using the SSA format Create your own template using the SSA format Saves time--promotes efficiency Saves time--promotes efficiency You or your transcriptionist fills in the blanks You or your transcriptionist fills in the blanks Ideal for voice recognition software Ideal for voice recognition software

Confidentiality disclaimer Statement of Non-Confidentiality: 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 Your diagnoses for conditions causally related to this industrial injury. Your diagnoses for conditions causally related to this industrial injury. Any treatment recommendations made 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 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, 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 Use standard format Use standard format Economy of language Economy of language Answer the questions posed in the assignment letter Answer the questions posed in the assignment letter

Summary IMEs require discipline and commitment to perform well IMEs require discipline and commitment to perform well Foundation and consistency essential Foundation and consistency essential Templates facilitate efficiency, consistency Templates facilitate efficiency, consistency Be readily accessible to your referral sources—same day phone call return Be readily accessible to your referral sources—same day phone call return Learn from your mistakes—be humble Learn from your mistakes—be humble

Where to get more information has links to AOOP Bulletin and prior meetings has links to AOOP Bulletin and prior meetings links to prior courses, publications, and a list of references links to prior courses, publications, and a list of references

Your response and questions Questions Questions Comments Comments Criticisms Criticisms