Should you consider doing independent medical examinations for workers' comp?
by Legal & Regulatory Affairs Staff
The APA Practice Directorate has received an increasing number of inquiries from psychologists who provide, or would like to provide, professional services in workers' compensation cases. For some psychologists, this practice area may offer an opportunity to help diversify their professional services and revenue streams.
Many psychologists already deliver mental health treatment services for job-related illness or injury covered by workers' comp. In addition, some psychologists provide independent evaluations of employees who have filed workers' compensation claims.
These examinations, often referred to as "Independent Medical Examinations" (IMEs), generally involve an assessment of the employee's condition by an impartial licensed health care provider. IMEs are often required when a dispute arises regarding the nature of the alleged illness or injury or upon request of one of the involved parties. For example, depending on state law, an IME may be requested by the employer, employee, administrative law judge or workers' compensation board.
Although IMEs are most frequently performed by physicians, in many cases they are appropriately conducted by psychologists. For example, psychologists may be selected to provide evaluations in cases involving mental illness or head injury.
Some psychologists who have the skills needed to perform IMEs, however, are prohibited from doing so by state law. With the exception of federal employees and a few other specific groups, such as coal miners covered by the Federal Black Lung Program, workers' compensation claims are governed by state law, which can vary considerably among jurisdictions.
In response to members' interest in this issue, the APA Practice staff conducted a review of workers' comp laws, regulations and related policies. To summarize the results for the 50 states, plus Washington, D.C. and the federal government:
- 17 allow psychologists to do IMEs
- 14 may permit psychologists to do IMEs
- 21 do not allow psychologists to do IMEs
Montana is a good example of a state that specifically designates psychologists as independent medical examiners and clearly defines the conditions under which such examinations may take place. According to Montana's labor law: "In the event of a dispute concerning the physical condition of a claimant or the cause or causes of the injury or disability, if any, the department or the workers' compensation judge, at the request of the claimant or insurer, as the case may be, shall require the claimant to submit to an examination as it considers desirable by a physician, psychologist, or panel within the state or elsewhere that has had adequate and substantial experience in the particular field of medicine concerned with the matters presented by the dispute." (Montana Code Annotated, 2009, section 39-71-605).
Among the other states that allow psychologists to perform IMEs, several specifically recognize psychologists as independent medical examiners by statute or regulation. Others allow designated "health care providers," including licensed psychologists, to provide IMEs.
Of particular interest in light of the APA Practice Organization's continued advocacy for including psychologists in Medicare's definition of "physician," several states' workers' comp laws and the Federal Employees' Compensation Act already include psychologists in their physician definition, resulting in a clear authorization for psychologists to perform IMEs.
States categorized above as "may permit" psychologists to do IMEs do not specify in their statutes or regulations who can conduct medical evaluations. For each of these states, APA contacted the workers' compensation agencies directly and was told that psychologists may be able to conduct IMEs - for example, if selected by an insurance company or the workers' compensation board.
To find out if your state allows psychologists to provide IMEs, please consult the chart attached at the end of this article. The references listed at the bottom of the chart provide links to each state's workers' comp website.
These state government websites offer a wealth of resources regarding workers' compensation, often including a section for health care providers as well as the full text of state law, rules and regulations. These sites typically are a good place for psychologists to start educating themselves if they are interested in expanding their practice by providing workers' comp treatment or evaluation services.
For more information, contact the Legal and Regulatory Affairs Department at (800) 374-2723, ext. 5886.
PLEASE NOTE: Legal issues are complex and highly fact-specific and require legal expertise that cannot be provided by any single article. In addition, laws change over time and vary by jurisdiction. The information in this article should not be used as a substitute for obtaining personal legal advice and consultation prior to making decisions regarding individual circumstances.