The American Board of Independent Medical Examiners

Peterson, Kent W.; Babitsky, Steven; Beller, Thomas A.; Brigham, Christopher R.; Lea, Randall D.; Reed, Presley O.; Mueller, Kathryn; Talmage, James B.; Hoops, Donald L.; Coyne, K.; Knapp, D P; Whitfield, Regina R.

doi:10.1097/00043764-199706000-00004

Cited by 7 publications

(3 citation statements)

References 1 publication

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“…Equality before the law requires that claimants with similar health impairments and exposed to similar work demands should receive similar judgments of medical restrictions and limitations. Concerns have been raised, however, regarding low quality evaluations 6 7 8 and poor reliability between medical experts. 9 10 11 12 13 14 Evaluation of disability is a complex process that is affected by the skillset, attitudes, and beliefs of the expert, and few countries enforce standards of practice, 3 5 which presents considerable challenges to reliability (box 1).…”

Section: Introductionmentioning

confidence: 99%

Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies

Barth

Boer

Busse

et al. 2017

BMJ

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Objectives To explore agreement among healthcare professionals assessing eligibility for work disability benefits.Design Systematic review and narrative synthesis of reproducibility studies.Data sources Medline, Embase, and PsycINFO searched up to 16 March 2016, without language restrictions, and review of bibliographies of included studies.Eligibility criteria Observational studies investigating reproducibility among healthcare professionals performing disability evaluations using a global rating of working capacity and reporting inter-rater reliability by a statistical measure or descriptively. Studies could be conducted in insurance settings, where decisions on ability to work include normative judgments based on legal considerations, or in research settings, where decisions on ability to work disregard normative considerations.Teams of paired reviewers identified eligible studies, appraised their methodological quality and generalisability, and abstracted results with pretested forms. As heterogeneity of research designs and findings impeded a quantitative analysis, a descriptive synthesis stratified by setting (insurance or research) was performed.Results From 4562 references, 101 full text articles were reviewed. Of these, 16 studies conducted in an insurance setting and seven in a research setting, performed in 12 countries, met the inclusion criteria. Studies in the insurance setting were conducted with medical experts assessing claimants who were actual disability claimants or played by actors, hypothetical cases, or short written scenarios. Conditions were mental (n=6, 38%), musculoskeletal (n=4, 25%), or mixed (n=6, 38%). Applicability of findings from studies conducted in an insurance setting to real life evaluations ranged from generalisable (n=7, 44%) and probably generalisable (n=3, 19%) to probably not generalisable (n=6, 37%). Median inter-rater reliability among experts was 0.45 (range intraclass correlation coefficient 0.86 to κ−0.10). Inter-rater reliability was poor in six studies (37%) and excellent in only two (13%). This contrasts with studies conducted in the research setting, where the median inter-rater reliability was 0.76 (range 0.91-0.53), and 71% (5/7) studies achieved excellent inter-rater reliability. Reliability between assessing professionals was higher when the evaluation was guided by a standardised instrument (23 studies, P=0.006). No such association was detected for subjective or chronic health conditions or the studies’ generalisability to real world evaluation of disability (P=0.46, 0.45, and 0.65, respectively).Conclusions Despite their common use and far reaching consequences for workers claiming disabling injury or illness, research on the reliability of medical evaluations of disability for work is limited and indicates high variation in judgments among assessing professionals. Standardising the evaluation process could improve reliability. Development and testing of instruments and structured approaches to improve reliability in evaluation of disability are urgently ...

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Section: Introductionmentioning

confidence: 99%

Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies

Barth

Boer

Busse

et al. 2017

BMJ

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“…It is into this context that IME advocates are stepping, offering services to corporations. IME advocates are quite open about the fact that their clients are corporations and managers, and that their task is to counter the prevalent overdiagnosis of occupational injuries and illnesses and exaggeration of disability [5,12]. As one Disability Case Manager put it: "One reason employers and disability carriers dig in their heels is because we know a large portion of physicians exaggerate .…”

Section: Context: a Brief Descriptionmentioning

confidence: 99%

“…When this relationship is established, according to this perspective, the physician tends to become an advocate for his/her patient, rather than a dispassionate observer. Because no doctor/patient relationship is established between the IME and the worker/patient, IME advocates assert the IME's opinion can be unbiased [4,5].…”

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confidence: 99%

Independent of What? The Independent Medical Examination Business

Lax

2004

New Solut

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Workers suffering from a work-related health condition frequently are required to undergo examination by a physician chosen by the employer or a Workers' Compensation Insurance Carrier. While the opinions of physicians performing these "Independent Medical Examinations" (IMEs) have been criticized as biased by a conflict of interest, IME advocates assert that the methods used by the IME result in an objective and superior opinion. This article explores this claim to objectivity and superiority. It argues that pro-employer/carrier bias is embedded in the methodology IMEs advocate, and that the practical impact of the IME approach is to reduce the recognition of occupationally related health conditions and to minimize the disability associated with such conditions. The IME approach is more accurately characterized as a tool to standardize a product that can be marketed to corporate clients, rather than a way to precisely assess work-related health conditions.

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Erroneous Impairment Ratings

Brigham¹

2006

AMA Guides® Newsletter

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This article continues a discussion of the results of a nationwide study that reviewed 2100 impairment ratings and found a large number of errors (see the May/June issue of The Guides Newsletter). Spinal impairment ratings, for example, often are erroneous. Although the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) clearly specifies use of the Diagnosis related estimates (DRE) method, evaluators sometimes incorrectly use the range-of-motion (ROM) method, which is fraught with potential error and typically results in higher impairment ratings. The most common problem associated with rating the lower extremities is combining multiple duplicative impairments. Multiple impairments typically are combined rather than added because the latter usually results in overrating impairments. A sidebar highlights red flags to erroneous AMA Guides ratings, and evaluators can take a number of steps to ensure accurate ratings. The first of these is to ensure an unbiased rating, preferably by a board-certified physician who, ideally, also has certification in the performance of independent medical and impairment examinations. The client requesting the evaluation should provide a cover letter describing the specifics of the evaluation, and the evaluator's report should comply with standards defined in the AMA Guides. All submitted reports should be reviewed by a physician experienced in the use of the AMA Guides; this cannot be accomplished by a nonphysician reviewer.

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The American Board of Independent Medical Examiners

Cited by 7 publications

References 1 publication

Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies

Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies

Independent of What? The Independent Medical Examination Business

Erroneous Impairment Ratings

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