When an IME Opinion Differs from a Treating Practitioners

When an IME (Independent Medical Examination) medical opinion differs from that of a treating practitioner, it may come as a surprise to someone with a legal or insurance claim relating to injury or illness. To understand your situation in the face of differing medical opinions, knowing how these two points of view interact and why opinions might differ is essential.

Let’s look at the reasons around differentiating opinions that can occur between an Independent Medical Examiner and treating doctor.

The Role of an IME in a Medico-Legal Process

An IME (Independent Medical Evaluation) is a vital part of the assessment requirement in the case of a lawsuit or insurance claim pertaining to injury or illness. These specialised evaluations are conducted by medical specialists who are accredited in training relating to the claim process. They are known as medical experts and their role is to provide their independent medical opinion based on the available information, and without bias.

The information reviewed by a medical expert is provided by the referring client (lawyer, insurance firm etc). This commonly consists of medical records from treating practitioners and other key documents which help to paint a picture of the circumstances relating to the claim. 

They will also perform a consultation with the individual and undertake any testing or research to help them determine their independent medical opinion. 

Understanding The Differing Perspectives

There are several ways a difference in conclusion can occur between a medical expert and a treating practitioner.

Treating practitioners form doctor-patient relationships with their patients and their main focus is to provide treatment that will help to cure or manage an injury or illness. Alternatively, the role of an Independent Medical Expert it to evaluate only, through a combination of the medical evidence available and the specific requirements of the claim (i.e., legislative rules, insurance policy criteria). The knowledge of these specific requirements comes from the specialised training undertaken by medical experts which treating practitioners generally will not have completed. 

Additionally:

  • Treating practitioners usually specialise in one field of medicine and may have less experience than the medical specialists conducting independent medical assessments. 
  • Doctors follow their patients’ illnesses and therapies over time. However, IME doctors only evaluate the patient at one specific time. This timing and context can affect opinions.
  • Different medical practitioners may interpret medical data, test results, and imaging examinations differently. They may also have different access to research and literature relating to emerging advancements in treatment or rehabilitation. 

Evaluating and Assessing Different Opinions

It is not uncommon for the opinions of a medical expert and treating practitioner to be different. Remember that the information and experience at hand by both doctors can vary significantly as does the role which each medical practitioner performs. 

Why the IME has been requested will also impact the language used (as a bridge between the legal and medical spheres) and forming of opinions.

Red Health Help to Guide You Every Step Of The IME Way

Here at Red Health, we believe that educating our clients and medical experts, along with the individual being assessed is the key to best outcomes when accessing an independent medical opinion. We’ll take the time to support each stakeholder through the medico-legal journey by answering any questions and giving them guidance.  

Need advice about finding the right expert or you are currently navigating a claim? Get in touch with the Red Health team.