FREQUENTLY ASKED QUESTIONS: (ASSESSMENT/ IME)
WHEN SHOULD AN IME BE REQUESTED?
ANSWER
An IME may be used to address/ clarify an individual’s medical condition, treatment program, and/or ability to return to work. In the event of a motor vehicle accident and/or other personal injury claim, IME’s are used in response to a request for a specialist assessment by one of the claimant’s representatives. This is often in response to a dispute as to the necessity for such a request.
An IME may be requested to determine level of recovery (Maximum Medical Recovery - MMR) and overall abilities/ limitations.
In cases where a treating physician is recommending restrictions that cannot be accommodated by an employer, an IME is helpful in clarifying any restrictions that may be medically necessary, and provide a rationale for their implementation.
IMEs may also be used to recommend early interventions/ treatment (preventively) as a means of assisting an employee to remain at work, and avoid transfer to STD or LTD.
Employers may choose to utilize an IME when there is a dispute with WSIB or an LTD insurer and they wish to appeal a decision on benefits.
HOW DO I DECIDE WHICH SPECIALTY TO REQUEST?
ANSWER
Orthopedic - typically requested when there is history/ evidence of fracture, dislocation, or other musculoskeletally relevant surgical intervention. It is valuable in addressing the reasonableness of any opinions and recommendations regarding functionality and/or rehabilitation.
Physiatry (Physical Medicine and Rehabilitation) – typically requested when there is history of soft tissue injury and/or rehabilitative interventions are being proposed, or are in place and are being questioned/ disputed/ revisited.
Rheumatology - These assessments are valuable when addressing unexplained/ or unusual arthritic and/or musculoskeletal disorders including rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, and autoimmune disease, as they pertain to a specific injury, disability, symptom group or unrelenting/ unresolved physical presentation.
Internal Medicine - Utilized when determining appropriateness of any interventions/ recommendations as they may relate to allergies and immunology, cardiology, endocrinology, hematology, infectious diseases, gastroenterology, nephrology, oncology, pulmonology, and/or rheumatology (arthritis and musculoskeletal disorders).
Psychiatry - requested when there are underlying medical/ psychiatric conditions creating or contributing to the disability in question. Psychiatrists are medical doctors with training in physical medicine and psychopharmacology, and are able to make psychiatric diagnoses and provide associated treatment and/or recommendations.
Psychology - requested when there is evidence of psychological disturbance/ disability as it related to personality development, behavioural issues, and social/ psychosocial impacts of a given disability. These assessments can also be used to address the reasonableness/ necessity of treatment recommendations/ therapies by other psychologists or related professionals.
Neuropsychological - as above, however with a focus on the neurological effects of an injury/ disability as they relate to psychological and cognitive function.
Psycho-Vocational - as above, however with a focus on the relationship between the psychological disability and employability and other pertinent vocational issues.
Allied Health Assessments - although not considered medical specialties and uncommon with LTD claims, allied health professional assessments (including chiropractic, physical therapy, occupational therapy, social work etc) may be requested in areas of personal injury and accident benefits to address the reasonableness and/or necessity of any recommended interventions.
WHAT DO YOU CONSIDER TO BE A NECESSARY RATIONALE FOR PERFORMING AN FCE?
ANSWER
Functional Assessments are required for any one or more of the following reasons:
>To obtain a baseline level of function in a healthy individual (to be used for comparison in the event the individual; subsequently becomes injured/ disabled).
>To obtain a baseline level of function in a disabled/ injured individual (to be used to evaluate improvement as a result of therapeutic interventions, or over time as a result of the healing process)
>To provide information regarding functional abilities and/or limitations on the date of testing.
>Assessment of claimant’s ability to return to sustainable levels of function at work.
>Measurement of claimant’s general function for either training/re-education purposes ; or to
>Assess a claimant’s ability to engage in alternative employment opportunities.
The basic functional capacity evaluation model is very flexible and can be tailored to the specific needs of the claimant or employee.
In addition to an objective measurement of function, the FCE also records metrics pertaining to reliability of effort and consistency of presentation. This, in conjunction with subjective complaints and other objective signs of effort/ reliability as observed by the assessor, also makes the FCE valuable in estimating sincerity of effort and issues surrounding evaluee motivation.
WHAT ARE THE DIFFERENCES BETWEEN PSYCHIATRIC ASSESSMENTS VERSUS PSYCHOLOGICAL ASSESSMENTS?
ANSWER
Psychiatric consultation is typically requested when there are underlying medical/ psychiatric conditions creating or contributing to the disability in question.
Psychiatrists are medical doctors with training in physical medicine and psychopharmacology, and are able to make psychiatric diagnoses and provide associated treatment and/or recommendations. Psychologists, on the other hand, are requested when there is evidence of psychological disturbance/ disability as it related to personality development, behavioural issues, and social/ psychosocial impacts of a given disability. These assessments can also be used to address the reasonableness/ necessity of treatment recommendations/ therapies by other psychologists or related professionals.
CAN FUNCTIONAL TESTING BE USED TO MEASURE INCONSISTENT BEHAVIOUR, DETERMINE PAIN LEVEL, OR COMMENT ON SINCERITY OF EFFORT?
ANSWER
Whether an individual’s behaviour is limited by actual or perceived pain, the motivation behind behaviour may be impossible to determine as there is no objective means with which to measure pain. However, if an individual is able to consistently perform all functional tasks requested through FCE testing, it is likely that performance on the date of testing is an accurate representation of their functional ability. However, if performance on the requested tasks was inconsistent then there is a possibility that the evaluee was self-limiting on the date of testing. A word of caution; apparent evidence of self-limiting should not immediately imply intent. Self-limiting may be due to any number of factors including the presence of actual pain, perceived disability, fear/ anxiety, social or cultural influences, concomitant illness/ injury, employment status, financial gain, and others. It is reasonable to presume that should those circumstances improve, then functional performance may also improve. As such, subsequent recommendations to address those concerns may be needed.
WHEN WOULD I REQUEST A WORKSITE ANALYSIS AS OPPOSED TO A PHYSICAL DEMANDS ANALYSIS? HOW DO ERGONOMIC ASSESSMENTS FIT IN?
ANSWER
A physical demands analysis does not typically require the presence of the employee as it is meant to address employment tasks for a specific category of work and quantifies job duties necessary to perform a given occupation. A worksite assessment on the other hand, more specifically addresses needs, stresses and environment particular to an employee and their immediate work environment. Often, it makes use of information gathered from a physical demands analysis and a review of pertinent file material and makes recommendations regarding return to work options. This type of assessment may incorporate medical/functional opinions as well. When an employee is planning a return to work with, or following a disability, the ergonomic assessment can address limitations of the workplace and suggest modifications to the work environment to accommodate the employee. In this manner, re-injury and failed return to work can be proactively addressed and avoided.
ANSWER
ANSWER
Psychiatric consultation is typically requested when there are underlying medical/ psychiatric conditions creating or contributing to the disability in question.
ANSWER
Whether an individual’s behaviour is limited by actual or perceived pain, the motivation behind behaviour may be impossible to determine as there is no objective means with which to measure pain. However, if an individual is able to consistently perform all functional tasks requested through FCE testing, it is likely that performance on the date of testing is an accurate representation of their functional ability. However, if performance on the requested tasks was inconsistent then there is a possibility that the evaluee was self-limiting on the date of testing. A word of caution; apparent evidence of self-limiting should not immediately imply intent. Self-limiting may be due to any number of factors including the presence of actual pain, perceived disability, fear/ anxiety, social or cultural influences, concomitant illness/ injury, employment status, financial gain, and others. It is reasonable to presume that should those circumstances improve, then functional performance may also improve. As such, subsequent recommendations to address those concerns may be needed.
A physical demands analysis does not typically require the presence of the employee as it is meant to address employment tasks for a specific category of work and quantifies job duties necessary to perform a given occupation. A worksite assessment on the other hand, more specifically addresses needs, stresses and environment particular to an employee and their immediate work environment. Often, it makes use of information gathered from a physical demands analysis and a review of pertinent file material and makes recommendations regarding return to work options. This type of assessment may incorporate medical/functional opinions as well. When an employee is planning a return to work with, or following a disability, the ergonomic assessment can address limitations of the workplace and suggest modifications to the work environment to accommodate the employee. In this manner, re-injury and failed return to work can be proactively addressed and avoided.