Dr. Carol Walker and select Physical Medicine & Rehabilitation professionals are implementing a new evaluation procedure to cover all diagnostic needs for individuals with worker’s compensation injuries, long-term disability claimants, and those individuals involved in personal injury litigation.  We are offering a new approach to the evaluation process by viewing each case from a psychological/neuropsychological and medical perspective.  By working in collaboration we will pinpoint the exact needs of the individuals in the groups described above and will be able to ascertain and substantiate the presence of any psychological/neuropsychological or medical diagnosis and to determine specific restrictions or limitations that may result from the disorder or disorders. The IME will include and/or address the following:

Source of referral Date and Place of the Evaluation, and time spent for the preparation of the report Statement of non-confidentiality List of reference materials and of interviews utilized in the preparation of the report Detailed background information of the client Past psychiatric history Medical history Substance abuse history Present Mental Status Exam Any identifiable neuropsychological deficit Any identifiable mental disorder Description of the functioning of the client prior to becoming disabled Description of the functioning of the client after becoming disabled Review and summary of pertinent collateral information (medical and psychiatric records, accounts of acquaintances, co-workers, etc.) Diagnostic Impression/Severity of Impairment Reasoning as to how the diagnostic impression has been reached An individual’s ability to perform the substantial and material duties of his/her occupation from a neurocognitive, emotional, and medical perspective The extent to which neuropsychological deficits and/or mental disorders and/or medical conditions that are present cause sufficient impairment of function (restrictions, limitations and/or skill deficits) that would prevent the individual from performing the material and substantial duties of his/her occupation and other activities Client's historical interest in the specific occupation Personality, psycho-social, and other factors contributing to disability Issue of malingering (feigning signs and symptoms of cognitive and/or psychological conditions) Summary of previous treatment and an opinion as to whether or not adequate/optimal treatment was received by client The appropriateness of prior treatment Future treatment needs (impairment ratings, work restrictions)

The report will clearly document the individual’s strengths as well as their limitations.  The validity of the individual’s performance will be assessed to the greatest degree possible through the use of procedures designed to measure effort and motivation as well as the assessment of patterns of performance that have been shown to be associated with less than optimum effort.  Consideration will be given to accommodation or adaptations that might allow the individual to return to their occupation in spite of a decline from their prior level of functioning.

The components of the evaluation will include a review of pertinent medical records, a structured two-hour clinical interview with Dr. Walker with collateral interview where appropriate, as well as a comprehensive physical examination by a physician.

Neurocognitive assessment will be completed.  This will include a mental status examination as well as a history of the present condition and formal neuropsychological testing. Objective assessment of personality and behavior will also be completed.  Electro diagnostic testing (EMG/NCVs) will be performed if needed.  In the case of both the neuropsychologist and the physician, evaluation of the individual’s motivation and effort and symptom validity will be completed.  In the case of neuropsychology, standardized evaluation instruments as well as behavioral observations obtained during the course of the evaluation will be used.   

The report jointly created by all examiners will include a comprehensive description of the testing behaviors as well as diagnoses of the individual’s current condition.  The basis for the diagnosis will be clearly delineated. The effects of the condition on the individual’s ability to perform work and other activities will be listed.  If the individual appears to be appropriate for rehabilitation, medical or psychological services, these will be recommended, if requested, with specific guidelines regarding the treatment plan, duration and potential sources for provision of treatment. Dr. Walker will not provide any psychotherapy services for individuals referred for IMEs.  The PM & R physician will not provide ongoing treatment for individuals referred for IMEs.  If it appears that vocational rehabilitation intervention or ergonomic accommodations might facilitate the individual’s ability to return to work and other activities, these will be recommended on request.