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Writing
and Defending Your IME Report: The Comprehensive Guide
Steve Babitsky, Esquire, James J. Mangraviti, Jr., Esquire &
J. Mark Melhorn, MD
Detailed
Table of Contents
Chapter
1 Introduction and Executive Summary
Introduction
Answer Only the Questions Asked
Just Say “No”
Background Information and Transmittal Letters
The Examiner’s Qualifications
The Examiner’s True Area of Expertise
Medical Records and Other Documents Reviewed
Formatting
History
Physical Examination
Citing Authority
Opinions
The Powerful, Persuasive, and Understandable Report
Extraneous Language
Words to Avoid
The Influence of the Referring Client
Proofreading
Defending the IME Report
Model Reports
Chapter 2 Background Information and Transmittal
Letters
Executive Summary
Preliminary Identifying Information
Preliminary and Introductory Information
Transmittal/Cover Letters
Chapter 3 Stating the Examiner’s Qualifications Accurately
and Objectively
Executive Summary
Legal Requirements
Accuracy
Objectivity
Unearned Designations or Degrees
Knowledge of Literature
Chapter 4 The Importance of Staying within the Examiner’s
True Area of Expertise
Executive Summary
Legal Terms and Opinions
Costs, Value, Money
Different Medical Discipline, Specialty, or Sub-Specialty
Commenting on Non-medical Areas of Expertise
Chapter 5 Formatting
Executive Summary
Cover Page
Font
Topic Headings
Short, Concise Paragraphs
Spacing
Page Numbering
Chapter 6 Properly Disclosing Precise Medical Records
and Other Documents Reviewed
Executive Summary
Precisely Listing Medical Records and Other Documents Reviewed
“Including” and “Including, but not limited
to”
“Relevant portions of”
“Various”
Missing Medical Records and Documents Not Reviewed
Surveillance Material
Illegible Records
Records Supplied by the Referral Source
Chapter 7 The Examinee’s History
Executive Summary
Overview
Pre-existing Status/Past Medical History
Injury/Incident
Treatment History
Occupational History
Psychosocial History
Family Medical History
Chapter 8 Physical Examination
Executive Summary
Physical Examination
Pain Status Inventories
Current Status
Functional Status
Chapter 9 How to Use Citations to Texts, Journals,
Guidelines, and Other Authority to Bolster a Report’s Credibility
Executive Summary
Citing Authority Properly
Consequences of Failure to Cite Authority Specifically
Dated Authority
Quoting Authority
Authoritative
American Board of Independent Medical Examiners Guidelines
Documenting a Reliable Methodology
Diagnoses
Causation
Apportionment
Aggravation and Exacerbation
Prognosis
Maximum Medical Improvement
Permanent Impairment Rating
Work Capacity and Disability
Past and Future Care
Symptom Magnification, Fraud, Malingering and Objective Support
for Subjective Findings
Chapter 10 Stating Opinions and Conclusions in a Defensible
Manner
Executive Summary
State Opinions Clearly and with Confidence
State Reasons for Opinions
Conclusory or “Net” Opinions
State All Opinions to Which the Expert Will Testify
Documenting a Reliable Methodology
Diagnoses
Causation
Apportionment
Aggravation and Exacerbation
Prognosis
Maximum Medical Improvement
Permanent Impairment Rating
Work Capacity and Disability
Past and Future Care
Symptom Magnification, Fraud, Malingering and Objective Support
for Subjective Findings
Chapter 11 Making Your Report Powerful, Persuasive, and
Understandable
Executive Summary
State Things Clearly and Directly
Do Not Speculate or Guess
Guessing About Future Medical Costs
Avoid Boilerplate Language
Avoid Absolute Words
Avoid Vague, Equivocal, and Uncertain Reports
Do Not Use Emphasis When Expressing Findings or Conclusions
Use the Active Voice
Use Precise Language
Use First-person Singular
Use Confident Language and Avoid Hedge Words
Define Technical Medical Terms and Medical Jargon
Use Objective Language
Explain the Meanings of Medical Abbreviations
Avoid Argumentative Language
Beware of Commenting on the Credibility of the Examinee and Others
Maintain Consistency in and amongst Reports
Avoid Drafting Reports That Appear Biased or Partisan
Computer-assisted Report Templates and Standardized Language
Additional Recommendations
Chapter 12 Damaging Extraneous Language and Information
that Should Not Be Included in IME Reports
Executive Summary
“Friendly” Language
Directed at Counsel, Adjusters, or Other Referral Sources
Speeches
Letterhead
Cover Letters
Discussions with Retaining Counsel
Additional Examples of Extraneous
Language
Chapter 13 Red-flag Words to Avoid
Executive Summary
“Authoritative”
“Legal,” “Illegal,”
“Legally,” or “Illegally”
“Draft”
“Work Product,” “Confidential,” or “Privileged”
“Probable” and “Possible”
“Substantially”
“Obvious” and “Clearly”
“Appears”
“Presumably”
“Evidently”
“Supposedly”
“Is said”
“He,” “She,” “It,” “They,”
and Other Pronouns
Royal “We”
“It Seems,” “Could,” “Apparently,”
“I Believe,” and Other Hedge Words
“Complete,” “Thorough,” “Meticulous,”
“Exhaustive,” and Other Such Words
“Patient”
“Malingering”
“Alleged” and “Credible”
“Dictated But Not Read” and “Electronic Signature”
Chapter 14 Preparation of IME Reports and the Influence
of the Referral Source
Executive Summary
Draft Reports
Requests for “Corrections,” “Clarifications,”
and “Improvements”
Review and Finalization by the Referral Source
Cover Letter from Referral Source
Chapter 15 Catching Mistakes Before They Catch You
Executive Summary
Substantive Mistakes
Grammatical Mistakes
Typographical or Transcription Errors
Spelling
Run-on Sentences
Chapter 16 Defeating Counsel’s Tactics
Executive Summary
Tactics and Defenses
Chapter 17 Trick and Difficult Cross-Examination
Questions for Independent Medical Examiners
Executive Summary
Responses to 27 Trick and Difficult Cross-Examination Questions
for Independent Medical Examiners
Chapter 18 Model Reports
Report #1: Personal Injury-Upper Extremity Injuries
Report #2: Racial Discrimination-Emotional Distress
Report #3: Workers’ Compensation-Personal Injury
Report #4: Workers’ Compensation-Hearing Loss
Report #5: Workers’ Compensation (Claimant)-Chiropractic
Report #6: Motor Vehicle Accident-Neck, Upper Back, and
Anterior Knee
Report #7: Brain Injury
Report #8: Workers’ Compensation-Lower Back
Report #9: Personal Injury-Multiple Injuries
Report #10: Workers’ Compensation-Arm Injury
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