Ethics of File Reviews & IME's

Psychologists: This 4 credit ethics course is the most expensive one on our website, but it is also the best deal. You'll get 4 Ethics CE PLUS the names of over 70 referral sources who send out referrals for medical records file review and/or independent medical examination (IME) work. The only comparable course that exists that does this is the once-a-year SEAK workshop (and they aren't APA approved, don't offer ethics credits and cost over $1,000).

By including the referral source list for you, this course not only gives you 4 ethics credits-- it pays for itself by giving you the tools to generate great referrals for file review and/or IME work.

Medical File Review and IME's are a great way to supplement your income. You can make more money and spend more time at home through file reviews and/or IME's. You can find a more independent lifestyle or supplement your retirement income with interesting work. You can learn more about this type of work at

In this course, psychologist Dr. Todd Finnerty will provide commentary for you related to the APA Ethics Code and the APA Specialty Guidelines for Forensic Psychology. The course is based on reading two PDFs and answering 41 True/False questions. The quiz questions appear in the text alongside the content they are based on and also include page number references. Dr. Finnerty has performed file reviews on disability claims since 2004.

Course Objectives:
• Participants will be able to list ethical issues involved in medical records file reviews and independent medical examinations
• Participants will be able to recognize common logical fallacies
• Participants will be able to apply the APA ethics code to reviews and IME’s
• Participants will be able to describe the Specialty Guidelines for Forensic Psychology

Who butters your bread? There is an idiom “know which side your bread is buttered on.” It essentially boils down to knowing who to be nice to in order to benefit yourself. However, leading with “what will butter my bread?” has rarely been a successful ethical decision-making strategy. I’d also like to think that most of us are able to manage those impulses and maintain an ethical framework for decision-making.

However, the judge in the case Maiden v. Aetna (N.D Indiana) 2016 WL 81489 essentially accused the psychologist consulting for the disability insurance company of knowing what side his bread was buttered on. In Maiden v. Aetna there was an allegation that the reviewing doctors were biased in favor of Aetna because Aetna paid them. The judge wrote in relation to these independent consultants that “one might reasonably wonder just how independent the reviewers [the judge named them specifically] really are. Their bread has been buttered by Aetna before; each of them has been hired by Aetna multiple times to conduct these kinds of disability reviews.” There was concerns that the reviewers cherry-picked evidence in favor of Aetna. The judge noted that a consultant “may have financial incentive to be hard-nosed in his claims evaluation…”

Taking an approach like the judge suggests would be contrary to our ethical principles, standards and guidelines. For example, in the Specialty Guidelines for Forensic Psychology Guideline 1.02 it notes forensic practitioners “strive for accuracy, impartiality, fairness, and independence.” It notes “forensic practitioners recognize the adversarial nature of the legal system and strive to treat all participants and weigh all data, opinions, and rival hypotheses impartially. When conducting forensic examinations, forensic practitioners strive to be unbiased and impartial, and avoid partisan presentation of unrepresentative, incomplete, or inaccurate evidence that might mislead finders of fact.”

The potential ethical concerns of knowing which side your bread is buttered on doesn’t only impact the consultant. The treating provider also has factors working on them. They may perceive an advocacy duty to the patient. They are also, of course, being paid by the patient. More compellingly, they may fear a negative impact on the treatment relationship and a potential reprisal from their patient such as a board complaint or malpractice lawsuit. Their resulting risk-management approach may be to keep their patient happy and offer favorable opinions for their patient centered primarily on their self-report. This risk management/advocacy perspective from a treating provider can potentially impact the opinions a treatment provider offers. However, this also can put a treatment provider at ethical risk. Treating providers should be careful of situations where multiple relationships may arise. They may begin to perform the dual role of forensic expert offering opinions while also trying to maintain a treatment relationship and advocate for their patient. This can lead to ethics problems. The Specialty Guidelines for Forensic Psychology Guideline 4.02.01: Therapeutic-Forensic Role Conflicts notes “providing forensic and therapeutic psychological services to the same individual or closely related individuals involves multiple relationships that may impair objectivity and/or cause exploitation or other harm.” Psychologists are to “make reasonable efforts to refer the request to another qualified provider.” Treating providers should be very cautious in relation to how they respond to requests from their patients to offer forensic-oriented opinions.