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            Neuropsyche IME's should not be used for all impairments, but because of the possible subjective nature of the interpretation, disability insurers frequently request these exams indiscriminately to achieve results favorable to the company. Neuropsyche exams should not be used in cases where the diagnosis is depression or other mental and nervous disease without the review of a Psychiatrist or Psychologist.  Some tests may be applied in a psychological IME, but using a Neuropsyche exam alone to determine DSM-IV diagnosis may not be appropriate.   

            In the case of CVA (cardiovascular accident or stroke) Neuropsyche tests are usually done by the neurologist shortly after, perhaps within six weeks and then again one year later. Permanent cognitive impairment may not be evident for long periods of time. If the one year Neuropsyche exam is not completed, the insurance company may request an IME and review the two exams to determine if there has been any improvement. This is a normal part of the process for those with CVA, but it is preferable to obtain the Neuropsyche exam by your own Neurologist rather than submit to an insurance company IME at a later date.

            Test raw data, the actual tests themselves, should never be placed in disability files, nor should it be requested or provided to anyone who is not qualified to interpret such results. On many occasions, claims handlers request the raw data and place it in the claims file only to be reviewed by an RN or another unqualified medical resource. This practice is inappropriate. Only the medical directors should request the actual raw data and once received it should be kept in a special file with access to only those with medical credentials to interpret results. The results of Neuropsyche exams range 95% in favor of the insurance company.

            Disability insurers manipulate the entire process of the neuropsyche exam from beginning to end. If the disability insurer is made aware your physician ordered you to have a Neuropsyche exam, it will request a copy of the "raw data" and have one of their internal physicians evaluate the results in favor of the insurance company. Very rarely, will the insurance physicians agree with any Neuropsyche report you have obtained on your own. In fact, there is evidence to suggest disability insurers often disagree with their own IME physicians and request the raw data to interpret it in such as way as it supports a claim denial.

            Please don't read over the fact that disability insurers rarely, if ever accept the results of the original  written evaluative report, even their own, if it doesn't support a claim denial. Since the opportunity exists to "interpret and evaluate" the raw data, it can be "manipulated" to say just about anything you want, within reason. 

Functional Capacities Examinations

            Functional Capacities Evaluations (FCE) are often the most requested IME even though FCEs were are not intended to evaluate disabilities for private insurers. In my experience, the results of FCE's range 60% to 90% against the insured. From an insurance point of view, for structural injuries of the hands, bones, feet, back, the FCE administered by a qualified occupational physician produces the most objective, verifiable, and accurate results. Or, so the story goes.

            Originally, the intended purpose of a Functional Capacities Evaluation is to provide Worker's Compensation with impairment body ratings expressed as a % percentage of full-body disability. The FCE is specifically designed to rate work related back and neck injuries, not those disabilities resulting from impairments such as those common for fibromyalgia, chronic pain, MS, SLE, or RSD.

            The tests used in an FCE are limited to objective body ratings resulting in  conclusive statements as to whether an individual can lift, climb, walk, kneel. These types of exams are useless in evaluating a claimant's ability to "sustain work" for an 8-hour day, for example. Unless the claimant is asked to do an FCE for more than one day, the results are nothing more than a quick photo shot of someone's ability to perform physical work for a few  hours.

            For the insured, however, the FCE produces mixed results, and there are many indicators in the test which can be interpreted and manipulated in favor of the disability insurer. For most individuals with private disability insurance an FCE is a disaster waiting to happen.

            Functional Capacities Evaluations include physical tests to determine how much weight you can lift or carry; your ability to use hands and feet i.e. pinch strength, grip, fine manipulation; ability to climb stairs, lift overhead, crawl, bend, stoop; physical endurance, i.e. ability to work consistently and give full physical effort; and of course determine your functional capacity by defining your physical ability as either: sedentary, light, medium or heavy capacity.

            The FCE may result in a rating of full body disability usually expressed as a percentage. The insurance company will ask the FCE physician to give you restrictions and limitations (things you may not do at all, and activates you may only perform at a certain level or duration). The IME physician will state whether he/she believes you made a full effort on the exam.  

            Individuals should never consent to a Functional Capacities Evaluation without the permission of their primary care physician. It may be your impairment is such that a physical capacities evaluation will cause you physical harm. This is why most disability insurers are required to obtain a prescription from your doctor in order to require you to submit to an FCE.

            You should always check with your doctor to make sure he has signed a prescription allowing you to have the examination. This is significant for those with back and/or muscle injuries as well as those who have limited stamina to perform the completed test. Prescriptions written for a FCE by anyone other than your primary care physician, such as a prior insurance IME physician are inappropriately obtained. You should object strenuously to this prescription, and refuse to submit to the evaluation until a prescription is written by your primary care physician.       

Psychiatric and Psychological Tests

            Although some of the tests used in the battery of Neuropsyche tests can be used in a psych IME, some tests are unique. The conclusion or outcome of these tests is to give you a rating in each of the Axis diagnosis scales of the DSM-IV, and a GAF, a global assessment of functioning rating.  GAF Ratings are expressed as 45/70 which means you now have a GAF of 45 but within the last six months, it was 70.

            Here is a copy of the Global Assessment of Functioning Scale used by mental health providers to evaluate your functioning and report to the insurance company: