C. Donald Williams, MD CGP
January
18, 2002
Basic Skills Workshop, 2002 Annual Meeting, San Diego
Workers’ Compensation IME’s
Author's Note--Although names and locations have been changed to preserve confidentiality, this material is for professional use only and is Copyright, 2002, C. Donald Williams MD
Plan for this presentation
Academic: To teach by utilizing real Workers’ Compensation IME’s, and analyzing them in detail
Practical: To present strategies for managing the entire process efficiently
Critical Concepts:
We will first review two psychiatric opinions regarding the same patient, and then examine the court decision that was resulted from completed litigation, giving attention to why one opinion was given weight and the other wasn’t. It will be easier to understand the points made in this course having reviewed these examples by means of blunt dissection. Later, we will examine some additional IME’s, giving closer scrutiny to different elements of a quality IME.
Introduction:
Performing Independent Psychiatric
Evaluations in Worker’s Compensation Cases provides an opportunity for you to
increase the economic base of your practice while developing new skills that
will be of value in the rest of your practice.
Writing reports of superior quality is an intellectual
challenge—requiring preservation of neutrality with no investment in
“outcome”, the efficient integration of considerable amounts of clinical
material, framing a hypothesis regarding the subject’s psychiatric
diagnosis(es), and depending on the assignment presented by the client, offering
opinions regarding causality, prognosis, and treatment.
You should be familiar with the Workers' Compensation Statutes in your state, as the rules that govern administration of claims vary from state to state.
Resources
A good resource is the United States Department of Labor website-- http://www.dol.gov/dol/esa/public/regs/statutes/owcp/stwclaw/stwclaw.htm. Using this web resource and your browser's search engine you can locate the relevant information for your state.
http://www.dol.gov/dol/esa/public/regs/compliance/owcp/wc.htm is another useful Department of Labor listing that contains the names, addresses and phone numbers of State Workers Compensation officials for all 50 states, from whose offices additional information may be obtained.
Create a new market or expand the existing market in your community
Panels of consultants typically
market their services to corporations, and often perform psychiatric evaluations
in concert with orthopedic, neurology, and other specialty evaluations.
As an independent professional, the solo psychiatrist has an opportunity
to provide a level of service that is not generally available through panels.
Your goal is to provide added value--to meet a professional and business need that has not been addressed by other professionals in your community. Your goal should be to provide evaluations of higher quality, more quickly, for approximately the same cost as your competitors, and through efficiency achieve a greater return per hour. Although the principles governing the production of quality IME’s apply in any context, it is easier to achieve these goals working independently, as you are free of organizational bottlenecks not of your own making.
This is accomplished by
identifying the needs of the marketplace through observation and experience.
Be a part of the solution, not part of the problem
Slow report production and
failure to respond to phone calls from attorneys, government agencies, and other
clients are often problems for psychiatric and other medical professionals. We
must be cognizant of the pressures and challenges facing our clients, which
typically involves integrating data from a variety of sources, and then meeting
court or other administrative deadlines. Practically
speaking, this means answering phone calls promptly, having on site
transcription services, quick editing and review, and troubleshooting with the
client to remedy shortcomings in report data presentation and formulation.
Never be an arrogant doctor.
You are part of a professional team.
You should always learn from your clients.
Be friendly in a professional manner.
Know your client's needs and objectives
Insurance companies will often
request second opinions regarding diagnosis and treatment of insured's.
As a practical matter some companies appear to be more interested in
objectivity than others. You have no control over the process or ethics of an
independent organization. Your
professional integrity always comes first.
The better companies and professionals will request your services again.
Attorneys need to know the facts
so they can make effective decisions regarding litigation and settlement
negotiations. Claims managers need competent evaluations to manage claims.
Successful and experienced attorneys are usually very adept at case analysis.
They always know the laws better than you do as they apply to workers’
compensation; your job is to answer their questions, employing your expert
medical knowledge.
Judges and commissions sometimes
order independent evaluations to assist them in making decisions about
individuals over whom they have jurisdiction.
They should specify the issues that need to be addressed.
The Social Security Administration contracts for a large number of Independent Psychiatric Evaluations. These are special purpose evaluations, and are addressed in a separate presentation.
Integrity
Avoid allowing your real or imagined perception of your client's outcome objectives to influence your findings--shaded findings usually damage all parties by making legal proceedings less efficient, longer, and therefore more costly. There is also a human cost—in terms of the emotional strain experienced by the stakeholders. The format of your report should be adjusted to communicate the findings in the most effective manner. An assignment letter that outlines the data to be gathered and the issues to be addressed is typically provided, and should be requested if it is not.
Quality
The presentation format and style
should be that which is most useful to your client. You must always answer the
questions posed in the assignment letter, or else explain clearly why you
cannot. Always check the spelling
and grammar of your reports.
If you make a mistake, fix it for free--immediately, with grace, elegance, and aplomb
Performance Objectives
Always exceed the expectations of your client. In other words, promise your report by Friday, but deliver it the preceding Wednesday.
By your performance, educate your clients to expect a professional product your competition is unable or unwilling to provide.
Charge accordingly, as clients
learn the value of your work.
Requirements
Professional Commitment--You must
maintain a personal and professional commitment to provide professional services
of exceptional quality on a 24/7 basis. If
you think of this work as a sideline activity used to fill in schedule gaps, and
assign it a lower priority than the rest of your practice, you are unlikely to
achieve the success that would otherwise be possible. If a client requires
special services, provide them, and charge reasonably but accordingly.
Adequate support staff and equipment—Daily on-site transcriptionist support is essential if your practice is busy, as is an office manager to negotiate and schedule client referrals. Someone must organize the disorganized files that clients typically provide. Unless you can command $300 per hour to perform those tasks yourself, it is preferable to pay someone to do it for you at a lower hourly rate. The point to consider here is how to provide a cost-effective report to your clients. Many clients are prepared to spend $600-1200 for an independent psychiatric evaluation; fewer clients are willing to repeatedly spend $3000-4000. One should not allow either procedural or mechanical obstacles to stand in the way. Have enough telephone lines so that callers don't get busy signals or an answering machine/service; a fax machine with a dedicated phone line; and computer fax sending capability direct from your word processor.
Accomplishing the above will allow you to achieve the following:
· To have the medical and other records organized for efficient review when you dictate your report.
· To provide immediate on-site transcription and review, with same day faxing of the report to your client.
· Realize a 2-3 day turnaround from completion of patient interview to the provision of final report to your client.
Continuous improvement
Always solicit feedback from your clients, asking how the report could have been more useful. It is always possible to do a better job, and your clients will provide you with invaluable training. Your reports in 2001 should be better than your 2000 reports, and so forth.
Organization of the report
An outline for a formal disability evaluation can be reviewed here.
Your evaluation--utilizing a standard format. The value of using templates.
Case examples
As time allows, we will review several IME's that demonstrate several strengths and weaknesses, both with regard to record review, clinical data presentation, and synthesis. We will employ the guidelines discussed earlier, with attention to the reference evaluations and court opinion. The fact that ambiguity is often present will be illustrated. These IMEs will be provided at the course.
Summary and audience questions