INDEPENDENT MEDICAL EXAMINATIONS IN THE FPDR SYSTEM

In FPDR by rapsheet

The most frequently asked question with regard to FPDR claims is about so-called “independent medical examinations.”  These are also known as “IMEs” and a variety of less-savory titles.  Police officers and firefighters usually ask a variant of the question, “Do I have to go to this?”  The answer is “yes,” if a member wants to pursue a claim or maintain benefits, but there is a bit of explaining I need to do to show why I give that answer.

Among the powers the City Charter vests in the FPDR Board is the power to write administrative rules requiring independent medical examinations.  In Section 5-202, the Charter states:  “The rules may require applicants for benefits from the Fund and persons receiving benefits from the Fund to submit to and undergo mental and physical examinations by one or more licensed physicians and psychologists designated by the Fund Administrator for that purpose.”  The FPDR Board has applied this power and written rules that require the following:

  1. The Fund may require an examination as a condition of receiving benefits or continuing to receive benefits.
  2. The Fund must provide notice to the member and his or her attorney at least ten (10) days prior to the examination.
  3. The notice must identify the particular examiner or facility, the purpose of the examination, the specialty area of the examiner, and the date, time, and place of the examination.
  4. The notice must confirm that the Fund has notified the member’s attending physician about the examination.

The rules also require reimbursement for mileage and transportation expenses and the “reasonable cost of child care, meals, lodging and other related services” incurred because of the examination.

The rules do not address what happens when a member cannot attend an examination because of a conflict with the appointment date.  Neither do the rules address what happens when a member or his or her attorney identifies a particular examiner as biased against members in general or the particular member.  In practice, the Fund and its adjusters have exhibited flexibility in changing examiners or appointment dates when the member contacts them well in advance of the scheduled IME date.  In this, as in all matters related to FPDR matters, I advise members to act as soon as possible.

Another frequently asked question is, “what should I say and do at the examination?”  The “rules of engagement,” so to speak, are pretty simple and straightforward when it comes to independent medical examinations.  The basic rule is to tell the truth.  The second basic rule is to answer the question that is asked.  These rules apply, not only to independent medical examinations, but also to telephonic interviews the Fund conducts with applicants for benefits.  The Fund is entitled to honest answers to its questions regardless of whether those questions come through an adjuster, an IME doctor, or a telephonic interviewer.

Having said that, however, members should recognize that independent medical examiners work for and are paid by the Fund.  IME doctors do not establish physician-patient relationships with members, they are not member advocates, and everything said to the IME doctor can and almost certainly will be related back to the Fund.  Prior to an examination, therefore, it is a good idea to check in with an attorney handling FPDR matters.  There may be areas in which a member may need advice, not only with regard to questions the IME doctor may ask, but also with regard to the scope of the examination.  In other words, a member may have a question about tests or diagnostic tools that may be used in an examination.  This last issue often comes up in mental examinations, where the IME doctor may wish to use a broad-based personality inventory or similar diagnostic tool.  The member or member’s attorney may want to contact the FPDR adjuster to object to the administration of a particular test.

In short, the IME examination is a staple of the system.  Members should be aware of their obligations, but should also be aware of the limitations on IMEs and their rights with regard to IMEs.