Impairment evaluation in pain management: physician, or attorney in white coat?

Impairment and disability evaluations have become a growth industry in the United States. Impairment evaluation is sometimes termed independent medical evaluation, or IME. So-called independent medical experts are hired guns to provide opposite opinions, similar to attorneys in this case. IME is the practice of medicine on one hand. On the other hand, it is the practice of law in white coats. Impairment is defined as the loss of a physiologic function or of an anatomic structure. Disability, however, is defined as an inability or altered ability to successfully accomplish a given task. For successful implementation of various disability systems, the essential medical/legal interface can be successfully achieved only if the physician has at least a minimum level of understanding of the legal system, and the attorney has an adequate understanding of the medical facts and the limits of medical science. Many physicians approach impairment ratings and disability evaluations by extrapolating from the knowledge and experience gained in their specialties. However, there are numerous fundamental differences between the standard medical evaluation and impairment/disability evaluation. Important aspects of impairment evaluation include medical evaluation, analysis of findings, and comparison of the results. In impairment evaluation, it is crucial to establish causal relationship and decide on maximum medical improvement, apart from providing the impairment rating. This review will discuss various aspects of impairment evaluation.