Neuro IMEs- how to learn

[Westbound2019]

How did you learn to do IMEs or get started in this?

I want to learn more but did not have any exposure in my postdoc, so I’m not sure where to go for training or resources.

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[WisNeuro]

Really depends on what your prior training has been, among other things? For example, do you have fairly extensive brain injury experience, across a range of severity? That's helpful, as that'll generally be a bulk of what you see. Other then that, how well do you know the PVT literature? Can you relate biostats, think specificity and sensitivity, in a relatable way to triers of fact who are not in our field? Are you comfortable absolutely shredding apart colleagues in your geographic area for their mistakes? Couple quick initial questions.

Outside of that, I'd honestly see if you can find a mentor in your area who has been in the game and is respected. There are a lot of ways to misstep, and it helps to be able to consult with someone about various aspects as you learn the ropes.

 

[Therapist4Chnge]

Yeah...basically what Wis said.

I've learned to stick with what I know (dx-related), even though I get calls regularly for all sorts of stuff. You can find yourself in the deep end quickly if you get a messy case with diagnose(s) that are outside of your wheelhouse. There is usually plenty of work out there, but not all cases should be taken. I definitely recommend finding mentorship from a neuropsych and/or some ppl to talk through cases with in the beginning.

I'd also recommend talking with physicians who do IMEs regularly bc they can have some really helpful info too and from a different perspective. They know less about what we do (usually), but they can speak to how they do a chart review, what they look for, how they refer to areas adjacent to what they do, etc.

Phrasing can be unique to the work, so understanding what certain phrasing means (and doesn't) is helpful. There can also be case law (specific to your state) that you should know. This is mostly learned as you go. Reviewing other people's IMEs can be really helpful too.

The easiest place to start is probably straight document review. I always ask if there are questions they want answered because that can help structure your report. After the first half dozen you basically know what the typical lawyer wants, but I always prefer to have questions to answer because it helps ensure that you write a report that is useful to what is needed.

There are just a lot of little things that you can only really know and learn by doing, but being able to talk through a case and have someone look over your reports can help avoid major missteps.

 

[WisNeuro]

I'll chime in to support what T4C is saying about knowing what you don't know. In the IMEs I do, there are always a list of questions that they want me to answer. That's the first thing I look at. If there are questions I can't answer, I either refuse the case, or I send off an email saying that I can answer X and Y, but not Z. I also explain why I can't answer that, whether it be scope of practice, or they are simply asking you for mind-reading.

Always remember that you can and will eventually be on the stand having to explain how and why you came up with your conclusions, as well as your relevant training in those areas.

 

[PsyDr]

1) Learn how to do neuropsychological evaluations
2) Learn how to do forensic evaluations, paying specific attention to writing
3) Read the relevant laws for your state. Do NOT read about the laws. Read the actual laws.
4) Read the 3 relevant AMA textbooks
5) Obtain the specific training your state requires (e.g., QME cert in CA, organizational specific training in 26 states, etc).

 

[psyguru]

You could do a forensic psychology fellowship or ABIME

 

[WisNeuro]

You could do a forensic psychology fellowship or ABIME

If they're planning on neuro IME, ABPP would be the route they'd want to go in terms of certifications that are asked about.

 

[R. Matey]

1) Learn how to do neuropsychological evaluations

Is being a neuropsychologist a prerequisite to doing IME work or are there cases of psychiatric IMEs? I imagine the issue arises in cases of psychiatric disability.

 

[WisNeuro]

Is being a neuropsychologist a prerequisite to doing IME work or are there cases of psychiatric IMEs? I imagine the issue arises in cases of psychiatric disability.

You can also do psychiatric IMEs. In this area, we'll use them mostly for PTSD evals. That's going to be the bulk of personal injury claims on the psych side.

 

[PsyDr]

If they're planning on neuro IME, ABPP would be the route they'd want to go in terms of certifications that are asked about.

NO.

The legal requirements to perform IMEs are state specific. Some stares require specialized training through their worker's comp department, or through recognized educational organizations (e.g., CA’s QME training program). One MUST meet this legal requirement. ABPP doesn't meet any state's legal requirement for IME training, nor do they offer any training that covers this material.

Our professional recognition does not supersede the actual law.

Is being a neuropsychologist a prerequisite to doing IME work or are there cases of psychiatric IMEs? I imagine the issue arises in cases of psychiatric disability.

I would argue that pure psych IMEs are more common than neuropsych IMEs. Neuropsych requires an injury that is severe enough to cause problems, but not severe enough to make you dead.

 

[R. Matey]

I would argue that pure psych IMEs are more common than neuropsych IMEs. Neuropsych requires an injury that is severe enough to cause problems, but not severe enough to make you dead.

Lol, thanks. I was wondering b/c the few IMEs I've seen were from psychiatrists evaluating psychiatric conditions so I didn't know where that line was for psychologists.

 

[PsyDr]

Lol, thanks. I was wondering b/c the few IMEs I've seen were from psychiatrists evaluating psychiatric conditions so I didn't know where that line was for psychologists.

You're going to run into a lot of confusion. There are as many definitions of "IME" as there are jurisdictions (i.e., 50 states, and each little federal jurisdiction). Usually, the term refers to forensic exams related to injured workers (i.e., workers comp). But there are several other definitions. And some people use the term idiosyncratically to refer to any civil forensic case.

Who can perform IMEs is dictated by each jurisdiction. Many states have registries of people who are allowed to perform these exams. Some of those states require providers to undergo formal training through the state or state recognized training providers. In many states, only physicians are allowed to perform IMEs. However, some states allow chiropractors to perform IMEs. Some states allow psychologists to do them. It really depends. You have to look up your state's requirements, or you risk practicing illegally.

 

[WisNeuro]

NO.

The legal requirements to perform IMEs are state specific. Some stares require specialized training through their worker's comp department, or through recognized educational organizations (e.g., CA’s QME training program). One MUST meet this legal requirement. ABPP doesn't meet any state's legal requirement for IME training, nor do they offer any training that covers this material.

Our professional recognition does not supersede the actual law.



I would argue that pure psych IMEs are more common than neuropsych IMEs. Neuropsych requires an injury that is severe enough to cause problems, but not severe enough to make you dead.

Down boy Point taken. None of the states I practice in require anything of the sort, was not familiar with it. All I know is that all of the IME contact companies ask about ABPP before they'll even begin the credentialing process.

But, as always folks, make sure you have a good grasp of your state laws and relevant statutes.

 

[R. Matey]

You're going to run into a lot of confusion. There are as many definitions of "IME" as there are jurisdictions (i.e., 50 states, and each little federal jurisdiction). Usually, the term refers to forensic exams related to injured workers (i.e., workers comp). But there are several other definitions. And some people use the term idiosyncratically to refer to any civil forensic case.

Who can perform IMEs is dictated by each jurisdiction. Many states have registries of people who are allowed to perform these exams. Some of those states require providers to undergo formal training through the state or state recognized training providers. In many states, only physicians are allowed to perform IMEs. However, some states allow chiropractors to perform IMEs. Some states allow psychologists to do them. It really depends. You have to look up your state's requirements, or you risk practicing illegally.

It looks like psychologists can do them in my state, but so can OTs. I'm sure you guys love that.

 

[WisNeuro]

It looks like psychologists can do them in my state, but so can OTs. I'm sure you guys love that.

Haven't come across OTs doing IMEs here, but I routinely destroy their clinical reports in my IME reports.

 

[Therapist4Chnge]

Haven't come across OTs doing IMEs here, but I routinely destroy their clinical reports in my IME reports.

Same. They are mostly low hanging fruit if they try and talk about cog, mood, etc.