Presentation W O1

W O1 (Oral Presentation):
Ethical and Legal Issues Associated with Independent Medical Evaluations

Presented by: Shanil Ebrahim

Authors

Ebrahim S1,2,3,4, Sava H5, Kunz R6, Guyatt GH1,7, Busse JW1,2

  1. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
  2. Department of Anesthesia, McMaster University, Hamilton, Canada
  3. Department of Medicine, Stanford University, Stanford, USA
  4. Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Canada
  5. Sava & Associates, Toronto, Canada
  6. Swiss Academy of Insurance Medicine, University Hospital Basel, Basel, Switzerland
  7. Department of Medicine, McMaster University, Hamilton, Canada

Abstract

Background

Insurers, employers or lawyers often request Independent Medical Evaluations (IMEs) when faced with uncertainty about the cause or nature of a claimed disability, or the claimants’ functional status and/or rehabilitation potential. Because physicians’ primary responsibility is to the hiring third party and not the patient, different ethical and legal issues arise in the context of an IME versus the standard physician-patient relationship. To inform the current viewpoints on the conduct of IMEs, we conducted a systematic review of all narrative reviews and other viewpoint articles from a North American perspective.

Methods

We completed a systematic search of CINAHL, EMBASE, MEDLINE and PsycINFO, from inception of each database to September 2011 to identify articles discussing, from a North American perspective, independent clinical assessments related to judgments about disability made by a health care professional. Teams of reviewers screened titles and abstracts of identified citations and the full text of potentially eligible articles. We developed a coding system to categorize themes in eligible articles. We report here articles addressing issues of duty of care in the examiner/examinee relationship, disclosure of significant findings, and the examinee’s right to access the IME report.

Results

Of 89 eligible articles, 34 addressed ethical and legal issues, of which 20 (59%) discussed IME examiner’s duties towards patients and 19 (56%) discussed disclosure policies. Authors, courts and medical societies agree that physicians performing IMEs must maintain their responsibility to do no harm to examinees. Both authors and courts have expressed disparate views regarding whether examiners have responsibility to disclose to the examinee significant medical problems uncovered during their assessment. Authors disagree whether patients have the right to access their own IME reports; courts have ruled that physicians may be obligated to provide the IME report to the examinee upon request. The obligation is, however, contingent on the nature of the agreement with the hiring third party, and examinee’s consent.

Conclusions

Although our review provides guidance regarding the ethical and legal issues in the IME literature, contentious issues remain.

Schedule Details

Wednesday October 1
14:00 - 15:30 Afternoon Concurrent Sessions (W O1 - W O4 and Seminars 7 and 8)
Session: Ethical issues and vulnerable workers
Room B