IMEs | Psychiatry | Psychology | Neuropsychology | Dr. Leonard Grossman

The Forest Hills IPA | Forensic | Peer Reviews | Psychiatric Fitness for Duty IMEs |

IMEs . . . What is an IME? The term " I M E " is an acronym for Independent Medical Evaluation, and refers to any psychiatric or medical evaluation performed by a "neutral" practitioner who has no treatment, financial, or professional relationship with the examinee or the examinee's care givers. Why are IMEs performed? IMEs are typically requested by insurance companies to independently evaluate disability status and/or appropriateness and need for treatment issues. Similarly, HMOs and PPOs will also sometimes request that an IME be performed on a member or receipient of benefits. Why are IMEs Necessary? Insurance companies must periodically perform IMEs in disability cases to corroborate disability status and make sure benefit receipients are under the care of a physician and are being appropriately treated. Without the IME process, it would be impossible for insurers to offer disability coverage. Can I arrange my own IME? Yes. Individuals receiving disability benefits (referred to as "claimants" in the insurance business) have the right to sponsor their own independent IME if and when the need arises. This typically happens when the claimant's care givers disagree with the insurance company's IME examiner on the issue of disability. Who pays for an IME? The party who requests it. If an IME is requested by the insurer, then it's the insurer who foots the bill. If an individual decides to sponsor their own IME, then it is he or she that must pay for it. Psychiatry . . . What is Psychiatry? Psychiatry is a branch of medicine which deals with the identification and treatment of mental illness. Clinical psychiatry is practiced by a licensed medical professional (M.D.) who is board certified in psychiatry. A licensed psychiatrist: may enter private practice and offer various forms of psychotherapy and medical treatments (i.e., psychotropic drugs, etc.) to individuals, families, and groups. can furnish legally-recognized clinical and diagnostic opinions and conduct diagnostic interviews regarding the presence, scope, and treatment of behavioral disorders, mental illness, and mental disease. can legally prescribe psychotropic drugs to treat mentally ill patients and admit them to a mental or medical hospital. is not usually trained to administer and interpret standardized psychological and neuropsychological tests. What's the difference between a psychiatrist and a psychologist? Psychologists and psychiatrists are equally qualified to give an opinion on an individual's psychiatric/mental status, treatment regimen, disability status, and back-to-work prognosis. The primary difference between them is not one of credentials but of function: The psychiatrist is licensed to treat mentally ill patients medically (i.e., prescribe psychotropic and other prescription drugs) and admit them to a mental health facility or hospital; the psychologist is licensed to treat mentally ill patients with psychotherapy and related therapeutic regimens, but may not in New York and some other states, admit the patient to a hospital. Psychology . . . What is Psychology? Psychology is the science of understanding, interpreting, and classifying the various aspects of human behavior. Clinical psychology is psychology practiced by a licensed professional with a Ph.D. or Psy.D. in psychology. The field of clinical psychology has developed and standardized a host of procedures and practices to detect, evaluate, and treat abnormal behavioral conditions and mental disorders. A licensed psychologist: may enter private practice and offer various forms of psychotherapy and counseling to individuals, families, or groups. can administer standardized psychological tests to patients in office and hospital settings, and interpret and report on their results. can furnish legally-recognized clinical and diagnostic opinions and conduct diagnostic interviews regarding the presence, scope, and treatment of behavioral disorders, mental illness, and mental disease. cannot prescribe medication and, in New York and some other states, may not admit patients to a mental or medical hospital. Neuropsychology . . . What is Neuropsychology? Neuropsychology is a highly specialized discipline within the field of psychology. The science of neuropsychology focuses on cognition, i.e., the ability of the mind and brain to think, reason, remember, learn, comprehend, etc. Clinical neuropsychology is practiced by a licensed psychologist specializing in neuropsychology. This specialty field has developed a variety of clinically standardized tests and procedures to evaluate the cognitive and functional effects of brain injury, brain damage, and organic brain disease. A clinical neuropsychologist: may enter private practice and offer various forms of psychotherapy and cognitive rehabilitation to individuals, families, or groups. can administer standardized psychological and neuropsychological tests to patients in office and hospital settings, and interpret and report on their results.  may furnish legally-recognized clinical and diagnostic opinions and conduct diagnostic interviews regarding the presence, scope, and treatment of cognitive/neuropsychological disorders, behavioral disorders, and mental illness. What's the difference between Neuropsychology and Neurology? Neurology is a field encompassing the science and study of the human brain and nervous system and its diseases. Clinical neurology is a specialty field of medicine; a clinical neurologist is an M.D. who is board certified in neurology. The function and practice of a clinical neurologist differs substantially from that of a neuropsychologist. Since there is great confusion between the two, it is important to carefully note the differences: The neurologist M.D. deals with the structural and physiological consequences of brain injury and organic brain disease, while the neuropsychologist Ph.D. investigates the cognitive and behavioral impact of such conditions. For example, an individual suffers serious brain damage in a car accident. The neurologist will run tests and make determinations as to the physical impact of injuries: Can the patient ambulate, move limbs and muscles, and maintain hand/eye coordination?; Is an EEG needed? How severe is soft tissue damage?; Is surgery in order?; etc. The neuropsychologist, on the other hand, will examine and test the patient's powers of cognition: Can the patient think and reason clearly?; Is long and short-term memory impaired?; Have reading, learning, and comprehension been compromised?; etc. It should further be noted that in disability determinations and related procedures, the neurologist is not "more important or qualified" in medical or legal terms than the neuropsychologist. The neurologist M.D. is qualified and licensed to make a clinical assessment regarding a patient's physical disability status as a result of brain damage; the neuropsychologist Ph.D. is qualified and licensed to make a clinical assessment of the patient's cognitive disability status. Both have important, but different, functions in examining and treating individuals suffering from head injuries and brain damage. What cognitive areas are assessed in a neuropsychological evaluation? Standardized neuropsychological tests used to assess cognitive functioning can detect and quantify impairments in: short and long-term memory functioning in all sensory modalities verbal and non-verbal problem-solving and reasoning abilities attention span and orientation to time, place, and space language recognition and speech competence visual-motor coordination and sensory abilities the ability to plan, abstract, and synthesize information FHIPA . . . What is The Forest Hills IPA? The Forest Hills IPA Inc. is an Individual Practice Association -- hence the "I P A" in "The Forest Hills IPA" and our initials -- of licensed mental health professionals and consultants. Established in 1987, FHIPA's nationwide provider network offers clients a wide variety of IME, peer review, and related consulting services, Member providers include psychiatrists, psychologists, and neuropsychologists. For additional information, see our page entitled About The Forest Hills IPA Inc.. What is an " I P A " ? " I P A " stands for Individual Practice Association. An IPA is a professionally owned business entity formed to make referrals to practicing professionals in a particular specialty area. Member providers act as independent contractors, and are free to negotiate their own fee for services with IPA management. IPAs can have as few as 2, or an unlimited number, of participating members. Forensic . . . What is a forensic IME evaluation? When most people hear the term "forensic," they think of a medical examiner performing an autopsy. While this is obviously not the case here, autopsies and forensic IMEs do share some common ground. Like an autopsy, the foresnic IME seeks to closely evaluate every salient aspect of a case and its causes and effects, including: a through review and documentation of the case history. an extended interview and evaluation of the subject and his or her medical history. a detailed investigation and description of past and present physical and/or psychiatric and psychological symptoms. an analysis of past and present treatment regimens and their efficacy and appropriateness. a close examination of potentially causitive and contributing factors. the administration and interpretation of appropriate diagnostic tests and procedures. the presentation of diagnostic findings, treatment recommendations, and a prognosis. In what situations are forensic IMEs typically employed? Forensic IMEs are often requested in hotly contested cases with potentially large monetary settlements and/or benefit packages attached to them. With millions of dollars at stake and every angle of a case subject to close scrutiny by competing attorneys, care givers, and IME examiners, both sides want to take their best shot at winning their case and "out credentialing" the other. For more information, see our special page on Forensic Psychiatric and Neuropsychological Evaluations. Peer Reviews . . . What is a Peer Review? In the insurance business, a peer review is written diagnostic and treatment related commentary and opinion on a case based on an examination of medical records in the case file. For example, an insurer might ask a psychiatrist to "peer review" the case of a disabled claimant under treatment by another psychiatrist. It's called a "peer" review because one professional is reviewing the work of another professional in the same specialty area. The reviewing professional made be asked to comment on treatment efficacy and appropriateness, present and future need for treatment, degree of disability, necessity of tests and procedures administered, test result interpretations, fee appropriateness, and other related issues. Fitness for Duty IMEs . . . What is a Psychiatric Fitness for Duty IME? The term "I M E" is an acronym for "Independent Medical Evaluation," and refers to any psychiatric or medical evaluation performed by a neutral (i.e., independent) practitioner who has no treatment, financial, or professional relationship with the examinee or the examinee's care givers. While IMEs are most frequently requested by insurance companies to assess disability status and need for treatment issues, employers may also request an IME to address employee fitness for duty concerns. For example, a trusted employee suddenly begins behaving erratically and uncharacteristically and without apparent provocation threatens a supervisor. It is imperative under such circumstances that an employer act quickly, responsibly, and fairly. This can be readily accomplished by promptly arranging an IME evaluation with an impartial psychiatric examiner. Such evaluations can help determine if there is a clinical psychiatric basis for such behavior, and if so, whether or not the employee is presently fit for duty and what medical steps may need to be taken to address the problem. For more information, see our page on Psychiatric Fitness for Duty Evaluations. Dr. Leonard Grossman . . . Who is Dr. Leonard Grossman? Leonard Grossman Ph.D. is the founder and President of The Forest Hills IPA Inc., a nationwide network of psychiatric, psychological, and neuropsychological IME and peer review providers and consultants. Dr. Grossman is a clinical psychologist with 30 years professional experience, and has been a practicing psychiatric disability consultant for insurers and businesses since 1987. He is also the Director of The Queens Center for Psychological Services and a member/diplomate of The American Board of Forensic Examiners. Dr. Grossman has authored position papers, articles, and publications on a wide variety of topics, including diet and depression, metabolic individuality and weight loss, documenting malingering, and chronic fatigue syndrome. More recently, Dr. Grossman has authored a bi-monthly series of newsletters available on this web site devoted to insurance-related psychiatric disability, IME, and peer review issues.   © Copyright 2006, The Forest Hills IPA Inc.,  Leonard Grossman, Ph.D. Site design by Michael CastellanoSend site comments to Michael Castellano