Peer Expert Contributing Factors and Comments on Psychiatric IME Cases (n = 43)
| Contributing Factor | Peer Expert Comments |
|---|---|
| Professionalism and conduct concerns (n = 20) | Psychiatrist IME opinions were biased, not approached objectively |
| Information gathered for IME not done in collaboration with other healthcare providers (e.g. staff of group home) | |
| Clinical decision-making (n = 13) (less than thorough clinical assessment) | Failure to complete a mental status exam or include differential diagnoses |
| Inappropriate reliance on information from the employer's investigative report, which had not been independently verified | |
| Deficient medical history (e.g. current level of physical activities) and limited details regarding clinical observations | |
| Procedural violations (n < 10)a | Nonadherence to the legislative framework and regulatory body policies governing IMEs, including required notation of physician's qualifications and experience, and a list of the documents reviewed |
| Deficient documentation (n = 21) | Failure to explain or document thought processes or how the conclusions were reached |
| Sparse, sometimes illegible documentation, which lacked details | |
| Communication breakdowns with evaluees (n = 14) | Consent not obtained to disclose health information to a third party |
| Not alerting evaluee about diagnostic findings that would likely require further treatment (e.g., serious mental illness) | |
| Not ensuring communication is respectful regarding cultural sensitivity | |
| Not explaining the reasons for the IME and the physician’s role in the process | |
| Office problems (n <10)a | Delay in sending a report caused ineligibility for disability benefits |
↵a For confidentiality purposes, exact numbers are not reported when there are fewer than 10 cases.