Evaluating Psychiatric Care in Independent Medical Examination

Not all workers’ compensation cases focus on physical injuries or illnesses. Sometimes, an employee’s ability to perform his or her job is hindered by a psychological condition. For example, he or she might be experiencing post-traumatic stress disorder (PTSD) from a workplace event. The psychological condition could even be precipitated due to an employee’s on-the-job injury.

In these cases, a psychiatric independent medical examination (IME) might be requested. Though not as common as conventional IMEs, they’re equally essential to helping parties reach an unbiased determination based on objective data. A physical IME process occurs when a licensed physician conducts an examination of an individual (patient) to review that person’s condition. After the examination, the doctor develops a report on it and submits it to the parties who requested it.

The Impetus for an IME

Psychiatric IMEs can be requested by an employer, insurance company, attorney or court official. They’re utilized to procure an independent assessment of a patient’s condition based on evidence-based guidelines. The findings can confirm or deny the need for further psychiatric treatment, how long it’s necessary and how it affects the person’s ability to safely and efficiently perform his or her job.

In addition to PTSD, which is one of the more common psychological conditions in workers’ compensation cases, depression, addiction, schizophrenia and generalized anxiety, panic, somatic symptom and bipolar disorder frequently fall into the category of mental health issues included in psychiatric IMEs. 

A Role for Recommendations

Psychiatric IMEs are conducted by board-certified psychiatrists who have never met or treated the person who is the focus of the case. It’s a more detailed and thorough type of exam than one used to determine a physical injury or illness and includes an interview on topics including family, medical and mental health history, substance use and employment background. The psychiatrist performs a review of the person’s psychiatric symptoms and typically uses the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to do so. Data such as records on the person’s medical and psychiatric history and any treatment completed also are part of the psychiatric IME.

Once the initial examination is concluded, the psychiatrist handling the case compiles and documents a report stating his or her opinion on the case as well as a prognosis and options for additional treatment. The report encompasses a decision based on a review of records, examination responses and test results, stating the person’s ability to return to his or her job and any specific limitations.

Qualifications for IME

To obtain an unbiased determination in a psychiatric IME case, the doctor overseeing it must be free of any conflict of interest and have experience in the specialty at the focus of the case. He or she cannot be employed by either the party requesting the IME or the person for whom it’s being executed.

For the independent review organization facilitating the IME, best practices are for accreditation by an industry-leading organization such as URAC, as well as robust cybersecurity practices certified by HITRUST. Those with a proven quality assurance program run with state-of-the-art technology provide another level of security and satisfaction for psychiatric IME cases.

MLS – Meeting Your IME Needs

MLS employs a nationwide network of licensed psychiatrists to ensure our clients possess every tool necessary to confidently process a workers’ compensation claim review. Plus, we’re URAC-accredited and offer a host of other services including utilization and peer reviews, functional capacity evaluations and impairment ratings.

To combat any possible security issues in IMEs, our workflow processes, policy, procedures and culture revolve around safeguarding confidential information. Our portal technology and integrated web system are continually updated to ensure our secure PHI repository is in observance of federal privacy guidelines like HIPAA.

Read more about our nationwide physician network, and contact us to find out how we can serve you with our unparalleled customer service.

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