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150 Independent medical evaluations: a systematic review
  1. J W B Busse1,
  2. Ebrahim1,
  3. Mahood2,
  4. Guyatt1,
  5. Kunz3
  1. 1McMaster University, Hamilton, Canada
  2. 2Institute for Work & Health, Toronto, Canada
  3. 3University Hospital Basel, Basel, Switzerland

Abstract

Objective Individuals suffering an injury or illness may be eligible to receive financial compensation based on their level of impairment and an independent medical evaluation (IME) often guides this determination. Our objectives are to determine the issues authors have addressed and their viewpoints, establish where evidence allows for recommendations regarding the best practices for IMEs, identify important gaps, and provide guidance on priorities for future research.

Methods We conducted a systematic review of all literature regarding IMEs conducted in a North American setting.

Results We identified 4667 potentially eligible studies; we retrieved 129 studies in full text and 88 proved eligible. We located another 22 eligible articles from bibliography searches. The chance-independent between-reviewer agreement (phi) on full text eligibility was 0.84. The majority of studies (81%; 89 of 110) were narrative reviews.

We found that authors of narrative reviews are much more likely to express favourable views if they perform IMEs, work for a company that arranges these assessments, or work in an area in which IMEs disputing patient’s reported level of impairment are likely to be helpful (Pearson correlation coefficient = 0.70, p < 0.001). The 8 reasons provided for which IMEs are arranged were establishing restrictions and limitations, adjudication, establishing causation, optimising treatment, determining maximum medical recovery, providing a diagnosis, establishing a prognosis, and delaying claim payment. A number of important limitations to the current approach to IMEs were identified, including lack of specific training or accreditation for clinicians performing these assessments, lack of standards for assessment reports, and the potential for considerable conflict of interest in that referral sources select clinicians that are well paid to provide reports, and sent more referrals if their reports are valued.

Conclusions Our review provides guidance on priorities for future research regarding the conduct, use, and interpretation of IMEs.

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