The IME for Brain Injury: Anticipating Controversies in the Courtroom
While there are some advantages to retaining a forensic neuropsychologist who is very experienced with years of practice under his or her belt, standards of practice and research on assessment of concussion and malingering have evolved rapidly over the past several years. It is very important that the forensic neuropsychologist has remained up to date with the latest practices and research in these areas. Some of the questions and current controversies under current discussion that bear on the IME for brain injury include:
- Use of effort tests
- Use of multiple effort tests within the neuropsychological test battery
- Criteria for malingering and degree to which malingering is intentional vs. non-conscious
- What is the support for long-term sequelae and “chronic traumatic encephalopathy”?
- How should TBI be diagnosed?
- Should mild TBI be treated and what is being treated if so?
- Long term neuropsychological outcomes after TBI
- Disclosure of raw test data to attorneys and the court
- Third party observation
- Computerized testing
- Relationship between what is seen on neuropsychological testing and what is seen on brain imaging
- “Post-Concussion Syndrome”
- Blast exposure (military)
- Sub-concussive “blows”
- Repeated concussion and threshold for negative outcomes
Forensic neuropsychologists and attorneys should not be blind to these discussions. They will undoubtedly arise in the courtroom should the case go to trial. Forensic neuropsychologists who conduct an IME for brain injury should be prepared to defend their professional opinions in these areas. As an attorney, it is best to consider how these issues will arise with regard to your particular IME for brain injury case in advance of cross-examination, with the forensic neuropsychologist’s assistance.
About the author. Dr. Messler is a board certified clinical neuropsychologist and licensed psychologist who has provided thousands of evaluations where the question of traumatic brain injury was raised. She has also served as expert consultant and witness. She believes it is critical to provide an objective, scientifically defensible opinion, and to help the jury and court understand the implications of the neuropsychological aspects of cases before them.