1. The Essential IME and IRE
Jon B. Tucker, M.D.
Medical Director
Tucker IME, Inc. Pittsburgh, PA
The Essential IME and IRE

2. Specialties: Addiction Adolescent Medicine Cardiology Chiropractic
Dermatology
Electronic Medical/Health Records
Endocrinology
Geriatrics
Gynecologic-Oncology/Robotic Surgery
Internal Medicine
Neurology
Neurosurgery
Neuropsychology
Oncology

3. Specialties continued…
Ophthalmology
Oral and Maxillofacial Surgery
Orthopedic Surgery
Otolaryngology
Pain Management /Addiction Medicine
Pediatric and Maternal/Fetal Cardiology
Physical Medicine and Rehabilitation
Psychology
Psychiatry
Radiology, Neuroradiology
Thoracic Surgery
Traumatic Brain Injury/Concussion/Neuroradiology
Urology/Urological Surgery
And Many More

4. Tucker IME Locations Physicians serving various regions including:
Philadelphia/ Eastern PA
Central PA
Pittsburgh/Western PA
Ohio
West Virginia
Texas

5. Components of an IME Interview Diagnostics Physical Examination
Imaging studies
Objective testing
Laboratory
Physical Examination
Medical Records Review
Expert Opinion
Recommendations

6. Interview History – examinee’s perspective Q and A
History of the injury
Mechanism of injury
Relevant past medical and surgical history
Pre-existing disorder(s)
Examinee’s theory of injury
Treatment history, examinee’s perspective
Occupational disability history

7. Interview Current complaints Symptoms Ongoing or planned treatment
Medications
Work status

8. Diagnostics Imaging Studies Objective testing Provide the images
Forensic interpretation differs from radiological reports
Current imaging or new imaging can be helpful
Objective testing
Lab data
Electrodiagnostic studies
Specialty driven testing (non musculoskeletal)

9. Physical Examination More than 80% of IMEs are musculoskeletal
General condition may or may not be helpful to document
Body habitus
Gait pattern, body station
Hygiene
Overall health appearance
Substance abuse suspicion

10. Physical Examination Focus on injured body part(s) All areas Spine
General appearance and condition
Observational examination (very important)
Peripheral neurological examination
Range of motion
Symptom magnification/pain behavior mannerisms
Level of cooperation with examiner
Spine
Shoulder , upper extremity, hand
Stability/Instability
Specific functional examination tests

11. Physical Examination Hip and lower extremity Gait Alignment
Specific exam maneuvers for stability/instability/joint disorders

12. Records Review Chronological, by provider
Synopsis of the “high points”
Avoid any emphasis of prejudicial opinions made by others
Separate by category, expert v. non-expert
General medical
Occupational medicine
Specialist
Allied health
Testimony

13. Expert Opinion We divide into two sections “Impression”
“Recommendations”

14. Expert Opinion Impression Diagnosis (es) Causation Relatedness
Aggravation

15. Recommendations Prognosis MMI Disability Additional treatment
Relatedness of ongoing/additional treatment to the injury
MMI
Time to MMI
Full functional recovery?
Disability
Past, present, future
Ability to return to work

16. Physician’s Estimate of Physical Capabilities
General format is Dept. of Labor Guidelines
Sedentary, Light, Medium, Heavy
Body position and time limitations
Upper Extremity position/effort limitations
Lower Extremity position/effort limitations
Special considerations and limitations
TEMPORARY VS. PERMANENT
FCE NEEDED?

17. Impairment Rating Exam (IRE)
An IRE is an IME
PLUS
Determination that MMI has been attained
An AMA Guides to Permanent Impairment 6th ed.
rating is calculated
MINUS
No opinion of causation/aggravation rendered
No opinion of occupational disability rendered

18. MMI Maximum Medical Improvement
MMI is reached after sufficient time has passed for healing and recovery expected to occur from the treatment methodology chosen. 
All reasonable medical treatment has been offered and it has reached an effective clinical plateau beyond which significant improvement or decline is not anticipated
In practice, the condition is not expected to appreciably change in the next 12 months.

19. Repeat IMEs When to do MMI not attained at prior exam
Temporary PCE rendered at prior exam
Prior exam was difficult
Ongoing disability
Change in condition
Questionable treatment
Case management checkpoints
Termination/suspension/C&R

20. Utilization Reviews Essentials Pitfalls
Record Review
Medical necessity and reasonableness only
Pitfalls
Need to speak with treating physician, in practice this is very difficult
Lack of examination, must rely upon the diagnoses rendered by others
Practical use should be coordinated with IME

21. Option to Treat after IME
It happens!
Avoid in most cases
Must meet all three criteria
Examinee/IW, employer/TPA, and physician must all agree
IME physician, as a treating physician, has superior treatment skill/knowledge/expertise and the trust of the IW
Generally, the employer/TPA must be SURE that their IW will not receive appropriate care in their current setting

22. Questions/Comments
Contact us at Tucker IME anytime to help find the best expert or team of experts for your needs.
Jon B. Tucker, M.D., Chief Medical Director or
Eleanor P. McNulty, J.D., Chief Executive Officer
Phone:
Website:
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