SCOPE
WHAT IS A DISABILITY EVALUATION SPECIALIST
PURPOSE: To create an understanding of what a Disability
Evaluation Specialist and Independent
Medical Examiner is and how to facilitate the utilization of such skills in
conjunction with all other parties including, but not limited to attorneys,
insurance companies and government agencies, for the effective
and expedient resolution of legal, governmental and insurance issues dealing
with personal injury, environmental exposure, Workers' Compensation and Social
Security.
I. DEFINITIONS:
Disability Evaluation Specialist - a healthcare professional using a standardized approach to the identification, evaluation and rating of impairment and disability (AADEP).
Independent Medical Examiner - uniform standards of competency for licensed physicians who conduct independent medical examinations (ABIME).
Impairment
- AMA Guides to the Evaluation of Permanent Impairment, 1997 Florida
Impairment Rating Schedule.
Disability
- Americans For Disability Act, job descriptions.
Future vocational and/or medical
rehabilitation requirements.
Exacerbation.
Aggravation.
Maximum
medical improvement (MMI).
Functional capacity evaluation (FCE).
Patient/examinee.
Patient
(examinee), doctor, attorney, insurance company relationship.
II. MEDICAL EXAMINATION:
Initial
Interim
Final
Independent medical evaluation
Update to final evaluation (medical evaluation)
Amended final evaluation (medical evaluation)
Point of clarification
III.
SCOPE, i.e., Vendors:
Personal injury - independent
medical evaluations, attorneys, insurance companies.
Workers' compensation - MMI,
managed care, required IME.
Social Security
- (Patient's attorney) Facilitate and/or eliminate the appeals process; (Social Security
Administration, Florida Department of Labor and
Security) review and/or establish impairment, restrictions.
Insurance Companies
1.
Review reasonable, necessary and appropriate
2.
Maximum medical improvement
3. Treatment course, prognosis, improvement
Pension, disability programs -
Review disability status regarding maintenance of a disability program.
IV.
TYPE OF EFFORT:
Simple
- often soft tissue - clear
causality without preexisting conditions - treated appropriately within an
anticipated treatment period.
Moderate - involves several
variables i.e., preexisting, patient hasn't followed treatment plan, many
Complex - history of several
injuries, abundance of medical records,
patient victimization, somatatization, psychiatric
manifestations, questionable liability
(slip and fall, environmental, development post
traumatic myofascial or fibromyalgia syndrome, apportionment, causality, possible elements of malpractice or poor treatment outcome, old case (over 18 months), significant
physical injury.
V.
TYPES OF CASES:
Mental
Cosmetic
Soft tissue
Head
Psychiatric
Organic
Somatoform
Post traumatic myofascial pain/fibromyalgia pain syndromes
Temporomandibular joint syndrome
Environmental exposure (respiratory, skin)
Toxicology
Adverse reactions to medications, inappropriate labeling of medications
VI. DISTINGUISHING FEATURES OF A MEDICAL EVALUATION BY A DES, IME:
Attention
to preexisting conditions with
quantification with regard to improvement, physical limitations and present
therapy predating the injury in question.
Attention to physical restrictions
and limitations before and after the alleged injury.
Detailed
analyses of diagnoses with special
attention to objective findings and
specialist's evaluations.
Complete review of all consultants'
reports with logical marginalization.
Clear
report (anatomy of a report);
Appropriate
header and footer with specific
identifying information and number of pages with total number of pages.
Chief complaints.
Age and summary of injury.
Treatment course.
Past medical history.
Social history (work, hobbies, history SSI, habits, marital status,
education).
Family history.
Review of systems.
Physical
examination (objective clinical findings... pinprick, range of motion, Tinel, Phalen's, Adson's, observation, palpation).
Diagnostic studies
(chronological, identification of medical specialty, diagnoses, salient professional
opinions, "media is the message."
Assessment - Diagnoses with
documentation of appropriate objective diagnostic studies
and date (towards the top) followed by all additional diagnoses including status post, history of and additional objective findings.
Permanent functional impairment
rating.
Overall discussion with regard to
causality,
preexisting, apportionment, medical certainty, objective and clinical criteria.
Physical limitations
and/or restrictions, recommendations regarding vocational rehabilitation, functional capacity evaluation.
Additional recommendations
with regard to diagnostic studies and review
of injury with effect on establishing
and/or modifying the permanent functional impairment rating.
Does not have -
1.
Editorializing.
2.
Opinion of treatment of other professionals.
VII.
HOW SUCH A REPORT MAY DIFFER FROM PREVAILING REPORTS FROM
CHIROPRACTORS, NEUROLOGISTS, ORTHOPAEDISTS, PHYSICAL REHABILITATION SPECIALISTS
AND OTHERS:
Essentially nothing
new under the sun though patients are seeing more physicians and medical information is often skewed to the
consultant's specialty.
Family practitioner relies on experts.
Familiarity with impairment and disability guidelines as per the AMA
Guides to the Evaluation of Permanent Impairment, 4th Edition.
VIII.
ADDITIONAL SERVICES TO OBJECTIFY A TREATMENT END POINT AND COORDINATE
THE PROJECTION
OF FUTURE VOCATIONAL AND MEDICAL REHABILITATION NEEDS, INCLUDING COST: (helps to eliminate
work within the attorneys' offices)
Functional capacity evaluation
Vocational rehabilitation evaluation
IX. RANGE OF COST FOR THE MEDICAL EVALUATION:
Simple
Moderate
Complex
Functional capacity evaluation
Vocational rehabilitation evaluation
X. GENERAL COMMENTS:
Malingerer
pet peeve (reports not properly labeled
merry-go-round report)
range of treatment within two years (MMI varies from state to state)
work - no work
everything written
decision analysis
formats
readability
presentation in court
discussion of various reports.
XI. SUMMARY:
Essentially attempt to
extract,
develop and/or frame the entire medical/legal context with regard to the medical
perspective based on consistent history, physical examination, objective
findings and consensus of medical specialists with an opinion of causality,
impairment, apportionment, physical restrictions and additional diagnostic
recommendations,
the purpose of which facilitates a just and appropriate decision
with regard to the resolution of the patient's medical/legal claim.
Definition / Scope / Affiliated Clinics / THE HEALTHPLACE JOURNAL OF DISABILITY & INDEPENDENT MEDICAL EVALUATION/Cases / Medical/Legal Resources / IME & Insurance Co / Attorneys / Home