THE ROLE OF THE INDEPENDENT MEDICAL EXAMINATION (IME) NURSE OBSERVER
In this blog, I’ll be reviewing Independent Medical Examinations (IME’s): What they are, the role of the IME examiner, and IME nurse observer.
What is an IME: Independent Medical Examinations (IME’s) are medical examinations performed by a qualified physician or other examiner who has not previously treated the injured client. The IME examiner’s goal is to evaluate the injured client’s prior treatment, and the current condition of the injuries reported by the plaintiff. The IME serves as ammunition, a means to challenge claims, lawsuits, and evaluations of injured workers’ treating physicians. IMEs are also referred to as Defense Medical Examinations (DME’s) as the provider examining the client was hired by the defendant’s attorney, or insurance company to defend their side of the case.
IME Examiner: The role of the IME examiner is restricted to examining only what pertains to the event in question, questioning about the nature of the accident, or how the injury occurred. The IME examiner is not permitted to ask questions that would raise liability issues/concerns. E.g., inquiring about cell phone use while driving.
IME Nurse Observer: Legal Nurse Consultants are well qualified to serve as IME observers. LNC’s have the dual nursing, and legal nurse consulting educational background (LNC educational background should be verified by the hiring attorney client), hands-on clinical experiences to support application of knowledge, and skill sets, strong leadership acumen, and effective communication skills. These qualities leverage IME nurse observers favorably to professionally, and diplomatically hold the IME examiner accountable.
Roles of the IME nurse observer:
- Educate the client on the IME process, procedures, limitations per the state’s regulations, and case specific court paperwork, as well as office procedures (E.g., evolving Covid-19 safety protocols)
- Observe the examination, and take detailed notes during the examination specific to tests performed, client’s response to tests, type of focused assessment performed, completion of comprehensive head to toe assessment, omissions in examination, or tests.
- Compile time stamped authoritative reports of all that was said and done during the examination to be compared with the IME examiner’s reports
- Be aware of what screening and diagnostic tests are permitted within the IME examiner’s scope of practice, and based on the alleged injury
- Object to inappropriate history taking, screening processes, and tests not relevant to the alleged injury
- Serve as a client advocate
- Testify regarding the examination (E.g., in the event the IME examiner’s report differs from the IME nurse observers report)
- Paralegals are at time sent to attend IMEs to act as legal representatives as they are knowledgeable about what is and is not permitted during an IME. However, paralegals cannot testify in the event a discrepancy is identified.
- Paralegals do not have the medical training to support a critical IME observation.
- The profession of nursing is viewed as the most honest and ethical profession. When nurses serve as testifying experts, they are often viewed honorably by jury members.
Know Your State Codes and Regulations: Review your states Code of Civil Procedure, and regulations. In New York State, for example, the plaintiff is “entitled to be examined in the presence of his or her attorney or other legal, or non-legal representative, as well as interpreter.” Additionally, in NYS, women have the right to have a female IME examiner, or a woman of their choosing present when the IME is performed by a male IME examiner. This section of the NYS Labor Law (Section 206A) is often violated.
Importance of Knowing Basic IME Rules: Failure to comply with the rules and regulations of IMEs can influence the outcome for the client, and the lawsuit.
Know your state’s Code of Civil Procedure as each state has different regulations.
- Identify yourself upon entry into the examination room
- Observe examination without interference
- Refrain from bringing surveillance materials (applicable to NYS) (Know your state’s Code of Civil Procedure as each state has different regulations)
- If the IME examiner refuses to allow the IME nurse observer into the examination room, encourage the client to leave the examination location. The IME nurse observer should then follow up with the client’s attorney
- Prevent the client from completing unnecessary intake forms that could be misinterpreted. Support the opportunity for relevant intake questions to be asked in the presence of the IME nurse observer to allow for recording
- Ensure that the client does not sign documents unless the legal team permits
- No member from the defense team should be permitted to attend the IME examination
References:
New York Committee for Occupational Safety and Health https://www.nycourts.gov/reporter/webdocs/NYCOSH_Independent_Medical_Examinations.htm
Official Compilation of Codes, Rules, and Regulations of the State of New York, Department of Labor, Workers’ Compensation
P.S. Comment and Share: What has been your experience with IMEs? Historically, who have you retained as IME observers? What worked well? What didn’t work well?
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