Everyone who helps employers manage their workers’ compensation claims is aware of the importance of an independent medical examination (“IME”). Before I get to the 7 things you should make sure the examining physician addresses, let’s think about what you should be looking for from an IME. First and foremost, you should be looking for an honest opinion as to whether the issue (be it allowance of the claim, a treatment issue, or something else) should be contested or not. Obviously, you want the examiner to be sympathetic to the employer’s concerns. However, you should know early on whether or not what you are contesting is: a) likely to hold up at hearing or in court; and b) whether contesting something at this stage will end up costing the employer more down the road.
With that in mind, here are the 7 things that I always want an independent examiner to address:
- Why????? There’s nothing I like less than an IME that gives a one or two sentence answer to a question. Sure, I can make the arguments at the hearing; it’s what I do for a living. However, having been reminded by hearing officers enough times that I do not have an M.D.; I need the IME physician to explain the reasoning for his or her conclusions.
- You Didn’t Answer a Question I Didn’t Ask, Did You? If I’m writing the IME letter, I already have my theory of the case worked out. I want your honest opinion; I just only want it as to the questions I asked of you. If I need more clarification on something else related to the claim, I’ll ask.
- Did you Review the Radiology Images I Sent? I always want the examiner to look at the actual radiology images, not just the radiology report. It adds a tremendous amount of credibility to their opinion, particularly when the chiropractor or doctor who is requesting something hasn’t even bothered to review the images.
- Did you Review the Job Description I Sent? If the examiner is going to opine as to whether the injured worker can return to their former job, they need to know the exact physical requirements of the job in question.
- Did you Provide Work Restrictions IN DETAIL? If the injured worker has work restrictions, I need to have those in as much detail as possible. Hopefully, my client is going to be able to make an offer of light-duty work. If so, I need detailed work restrictions, so that I can make sure my client provides a job offer that describes, IN DETAIL, the specific job duties that fit within those physical restrictions. See 2 ways to make sure your light-duty job offer passes muster at the Industrial Commission for the reasons this is so important.
- Is This a Symptom or a Condition? In another post, I discussed how Ohio courts are split on the question of whether a symptom such as radiculopathy can be allowed in a claim. Regardless of how the decision maker is going to come down on that question, I want to know whether there is some underlying cause of the symptoms that is not related to the industrial injury.
- Are there Objective Diagnostic Findings, Clinical Findings, or Test Results to Support a Substantial Aggravation? More importantly, how are or are they not present? See question number one above. Please discuss in detail whether each of those criteria exist or do not exist. The new substantial aggravation standard is great for employers, but a one sentence statement doesn’t help me much. I especially want the physician to address the issue of clinical findings, whether they are present, and whether they are consistent with the diagnostic findings and test results.
On another note, for those of you who subscribe, I’ve decided to change the name of the blog to the even more long winded “Employers Workers’ Compensation Law Blog”. When it is available, I will post the new URL. If for some reason you stop receiving posts most Tuesdays, please e-mail me and I will make sure you continue to receive my witty commentary and insightful opinions.
Employers Workers' Compensation Law Blog 