INDEPENDENT MEDICAL EXAMINATION

Independent medical evaluations (IMEs) are examinations performed by a healthcare provider (examiner) who is not otherwise involved in the person's (examinee) care, in order to clarify legally significant medical and other case issues.

Independent medical examinations/evaluations vary in complexity, dependent upon the specifics of the case and the issues involved. The process may require hours of examiner time, dependent upon the case and the effectiveness of the examiner. Most evaluations are based on a single visit with the examiner.

Evaluations are to be independent, impartial and without bias. The IMEs involve the essential elements of a medical assessment including history, examination and review of applicable diagnostic studies.

The examiner performing the IME does not assume the role of the treating provider and does not provide any treatment recommendations directly to the examinee. The IME report is sent to the requesting entity party and the examiner is reimbursed by the same party.

The most important product of an IME is the examiner's report to the client. It should be a thorough, clear, easy-to-read report that is unbiased; the product of a thorough evaluation that addresses the issues requested by the client.

IMEs are performed by examiners, who are not involved with the examinee's (person's) care, in order to establish current clinical status and to clarify non-medical issues. The IME report must reflect specific IME training (knowledge, skills and abilities), quality of the evaluation and address in a clear and defensible manner the questions posed.

Issues which may be addressed in an IME include:

1. Causation
2. Relatedness
3. Assessing apportionment;
4. Correct diagnosis;
5. Clinical status of the patient
6. Appropriate medical treatment
7. Recommending additional diagnostic tests and medical evaluation which need to be accomplished;
8. Whether the patient has reached maximum medical improvement
9. Patient's ability to return to work (fitness for duty; work capacity); and
10. Rating permanent impairments.

NEUROPSYCHOLOGICAL ASSESSMENT

Neuropsychology is the study of brain-behavior relationships. Clinical neuropsychology combines the knowledge base, developed through classical, localizationalist neurology with the modern methods of psychometric psychology.

The objectives of neuropsychological assessment in clinical practice are to assess and diagnose disturbances of mentation and behaviour and to relate these findings to their neurological implications and to the issues of clinical treatment and prognosis.
A variety of behavioural measures ("tests") are administered in a standardized, controlled fashion, and the results are used to infer an individual's underlying ability and current functioning in a number of broad cognitive domains. The major cognitive domains typically assessed in a neuropsychological examination include: attention, memory, intelligence, language, visuoperception, visual-spatial thinking, psychosensory and motor abilities, "frontal lobe" or executive functions, academic achievement, and personality or emotional functions.

Performance on tests of cognitive abilities are compared with normative performance levels of the general population. Negative deviation from these normal population levels may suggest impairment, either constitutional or acquired, in a given cognitive domain. Cognitive strengths resulting from training, as well as natural ability are reflected by performances that exceed those of the general population.

Insult to various regions of the brain due to either injury or disease may result in characteristic patterns of deficit. These patterns may be used to develop hypotheses about the neurological processes involved as well as to generate descriptions of cognitive, emotional, and functional competence.
Neuropsychological assessments involve:

1. Medical History
2. Clinical Interview
3. Behavioural observations
4. Psychometric Tests

The neuropsychologist will integrate test data, history, clinical interview, behavioral observations, and available laboratory and radiological evidence into one cohesive summary report that arrives at a neurobehavioral diagnosis and discusses the neurological implications.

NEUROLOGY ASSESSMENT

A thorough assessment of the integrity of the nervous system and the impact of any neurological condition on the ability to function. A Neurology assessment may include a variety of tools including a physical assessment of the nervous system and EMG nerve conduction testing. EEG's, brain scans, and MRIs may be recommended to provide objective confirmation of subjective complaints.

Issues which may be addressed:

• Level of consciousness, orientation
• Motor ability, strength, range of motion of each extremity
• Sensory ability in each extremity
• Speech, clarity & appropriateness
• Papillary reaction to light, equal, accommodation
• Sclerae, color/ presence of edema
• Breathing pattern
• Pain (character, location, intensity, precipitating/aggravating factors)
• Vision/ hearing deficits
• Paresthesias
• Reflexes (grade 0 - 4+)

PSYCHOLOGICAL ASSESSMENT

The purpose of a psychological evaluation is to determine what is happening in the client’s psychological life and personality factors that may be affecting their ability to move forward in their healing process. The evaluation is performed by licensed practitioners who have a Ph.D. in Psychology. They have an expertise in the diagnosis and treatment of behavioural, emotional and psychological disorders however do not prescribe medications. Typically the psychological assessment consists of a client interview and psychological testing. When used judiciously, psychological tests have high levels of diagnostic accuracy which can assist the psychologist in their assessment of the individual.

PSYCHIATRIC ASSESSMENT

Clients with psychiatric illnesses such as depression, bipolar affective disorders, and schizophrenia as well as those being treated with psychiatric drugs should initially be referred for a psychiatric assessment. In the role of an assessor the psychiatrist is there to provide an impartial opinion however does not to treat the individual.