Determining Disability Claims through Independent Medical Examinations

Often the primary question raised by the referral source for the IME physician is to determine disability. Disability is the alteration of a person’s capacity to meet personal, social,or occupational demands or statutory requirements because of impairment. Disability is a relational outcome, contingent on the environmental conditions in which activities are performed. Whereas impairment is a loss, loss of use, or derangement of any body part or organ system, it’s affect on the inability to perform functionally is disability.

Diagnosis is once again instrumental in determining disability. Is the diagnosis treatable or is the condition quiescent or at maximal medical improvement. Does the condition limit the patient functionally due to weakness, loss of motion, imbalance, fatigue, pain or a host of other problems associated with their diagnosis. The more specific the diagnosis and objective the exam, the greater the arguments for or against disability.

Disability can also be determined for a specific job or partial or as a total inability to work in any capacity. Also the question of duration or permanency of the disability may be raised. When considering a patient’s ability to function one must weigh the significance of his condition, whether they have rehabilitation potential or if accommodations will allow the patient to function in the workplace.

When evaluating individuals with neurologic or musculoskeletal conditions we need to perform a thorough exam. Oftentimes additional information can be gained by having the patient undergo a Functional Capacity Evaluation (FCE) performed by a qualified and experienced therapist. It is also important to consider any behavioral or motivational factors that may be present. Ultimately the recommendation regarding a patient’s ability to work should be consistent with their diagnosis and associated physical findings and symptoms.