Whether you are dealing with personal injury or workers’ compensation, knowing the process of working with an expert witness for independent medical examinations can make or break your entire case. This article intends to explain some key points for how to work with an expert witness to obtain an independent medical exam (IME).
You want your IME doctor to be a specialist in the field of medicine connected to the injury sustained by the patient. The doctor should be actively practicing and seeing patients on a regular basis. An IME from a doctor who only gives opinions as an expert witness and is not treating patients outside of litigation can lack credibility. The IME doctor should be respected among his or her peers, because the IME doctor could be evaluated by an Expert Medical Advisor (EMA) which can have the final say with respect to two contradictory IME opinions.
In many personal injury and workers’ compensation cases, whether or not the patient is capable of working is a key issue. However, doctors are not vocational specialists. This means that the doctor needs to be clearly informed of the patient’s job and the duties that the patient has to perform on a daily basis. The doctor needs to base their opinion regarding the patient’s work status on objective medical findings and not the patient’s subjective complaints.
The best IMEs are thorough. The treating doctor will look at the intake forms for any ambulances or hospitals, the records of any other treating doctors, and examine the patient in person. Having the IME doctor evaluate the patient in person can be required by the rules of procedure and certainly makes the IME report more credible. This is why you should send out as many subpoenas as necessary and obtain all relevant medical records to provide to the IME doctor before an opinion is rendered. Some carriers may also obtain surveillance of a patient and want to show the surveillance to the doctor to convey that the patient is exaggerating their symptoms.
Working With Your Client
If you are a plaintiff’s or claimant’s attorney, you want to work with your client prior to being evaluated by the IME. It should be clear that the patient should be honest and not attempt to exaggerate their symptoms. However, it is also permissible for the patient to be proactive in the IME and direct the doctor to their areas of discomfort and provide the IME doctor a complete view of the state of their injury if the IME doctor does not ask questions in certain areas.
No doctor works for free. In workers’ compensation, there may be a fee structure that limits how much a doctor can be paid for an IME . If not, doctors may want a high hourly rate to perform an IME because of all the medical records they have to review to create the opinion.
After the IME doctor has performed the examination, he or she will prepare an IME report. Remember, depending on the state, if the patient requests a copy of an IME report it could potentially have an effect on their doctor-patient privilege for any other doctors or medical records related to the case or controversy. The report should outline all medical records the expert reviewed as well as the tests performed with the patient in person. The report should always be concluded with a reasonable degree of medical certainty and should not be speculative. The report should contain a finding of all relevant diagnosis and a determination if the diagnosis is related to the accident or if it is pre-existing. The doctor should also opine as to what ongoing medical treatment the patient needs as well as whether the patient has any permanent impairment ratings.
The rules of procedure may allow for an IME to be videotaped. If you decide to go that route, make it clear to the expert witness that it is for litigation purposes and not to invade the expert’s methods or privacy. A videotape can be used to show that the IME was conducted properly and show the extent of the patient’s injuries.
The rules of procedure for your particular state may allow any attorney and even a court reporter to be present during an IME. If so, any attorney can help guide the expert witness to specific areas or even question the legitimacy of any testing that is being performed. Attorney questions can help clarify what the doctor is basing their opinions off and if they are following objective medical standards like the AMA guidelines. Use your questions to your client’s advantage to help steer the opinion to your favor.
A doctor should always be prepared to be deposed based on any medical diagnosis and testing that they performed, especially if the treatment is related to a personal injury or workers’ compensation case. IME doctors may not like being dragged into the courtroom, because they like to be at the office or the hospital doing their jobs. To remedy this, try to get the other side to agree to admit the doctor’s deposition into evidence so that they do not have to appear live at the hearing.