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Occupational Psychiatry--Independent Psychiatric Evaluations--Workers' Compensation Organizational Consultation--Second Injury Fund Evaluations C. Donald Williams MD CGP
Occupational Psychiatry--Independent Psychiatric Evaluations--Workers' Compensation
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Attention to Detail Is Crucial for Workers' Compensation Evaluations Robert Finn SAN DIEGO — Balanced presentations that avoid preconceived conclusions and pay careful attention to detail are key to conducting high-quality independent medical evaluations for workers' compensation, Dr. C. Donald Williams said at the annual conference of the Academy of Organizational and Occupational Psychiatry. Judges, attorneys, or the state labor offices that administer workers' compensation programs may be soliciting these independent medical evaluations (IMEs), Dr. Williams said at the meeting, which was cosponsored by the American College of Occupational and Environmental Medicine. Psychiatrists wishing to become involved in this area of practice must decide whether to do so as solo practitioners or as members of panels of consultants. These panels, which market their services to attorneys, corporations, and state funds, typically include a neurologist, an orthopedist, and other medical specialists in addition to a psychiatrist. The advantage of working for these panels is the administrative support that they provide. Some colleagues of Dr. Williams work with as many as five panels. But Dr. Williams, who has a private practice in Yakima, Wash., prefers conducting his IME business as a solo practitioner. He completed 85 IMEs in 2001. Although that level of effort requires that he employ support staff, including an office manager, a clerk, and a transcriptionist, he enjoys the freedom to establish mechanisms that work, to communicate with attorneys and insurance companies to define precisely what they need, and to tailor the depth, extent, and cost of the evaluation to the individual client. Psychiatric IMEs for workers' compensation typically include a detailed review of the patient's medical records, an in-person evaluation session including a mental status exam, and detailed responses to specific questions posed by the organization requesting the evaluation. Dr. Williams prefers to do the in-person evaluation first, and then to perform a microscopic evaluation of the patient's records. Other psychiatrists prefer to reverse the order. The resulting report typically runs 10-20 pages. Psychiatrists should not attempt to deliver what they expect will be the client's preferred conclusion. “Attorneys need a balanced, professional assessment of their client,” said Dr. Williams. “They don't need you to provide them with a shaded finding that you think they want to hear so you'll get more business. That's poor practice, and in the long term, it's going to backfire on you as well as everyone else because they're going to get slammed in court.” In fact, Dr. Williams estimates that one-half to two-thirds of the time, these cases go before a judge to whom he testifies about his conclusions. When meeting with the patient, it's important to disclose that the results of the evaluation will not be confidential but will be shared with a list of individuals and organizations involved in evaluating the submitted claim. Since many of these patients will be anxious and frightened, it's important to state explicitly that treatment is not the aim of the meeting and that no doctor-patient relationship will be established. Most clients are willing to pay $600-$1,500 for a psychiatric IME, although psychiatrists can sometimes bill as much as $3,000-$4,000 for more complex evaluations. Until a psychiatrist is highly practiced at performing IMEs, Dr. Williams recommends billing by the case rather than by the hour.
1. To be fully competent to conduct Workers' Compensation IMEs, you also must treat such patients in your practice. 2. Maintain neutrality, and avoid prejudice. 3. Refuse work in which there is an expected outcome. 4. When conducting evaluations, maintain comprehensive access to prior medical records. 5. Conduct only fact-based evaluations, drawing from the patient's medical records as well as your own evaluation. 6. Know the questions that will need to be addressed prior to the evaluation. 7. Don't venture opinions that are outside of your area of professional expertise. 8. Have the summary and conclusions tell a story, supported by data, that integrates plot line and character development. 9. Avoid clichés and boilerplate phraseology; remain alert for these in reviewing other IMEs.
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