We will be performing site maintenance on AAOS.org on August 16th from 8 - 10 PM CST which may cause sitewide downtime. We apologize for the inconvenience.

J. Mark Melhorn, MD

AAOS Now

Published 7/1/2017
|
J. Mark Melhorn, MD

Meeting the Unmet Need: Independent Medical Examinations

The Centers for Disease Control and Prevention reports 80.1 million visits per year to physician offices, hospital outpatient centers, and the emergency department for injuries. The nearly 3 million nonfatal workplace injuries and illnesses reported by private industry employers in 2014 occurred at a rate of 3.2 cases per 100 equivalent full-time workers.

Many of these workplace injuries result in a lawsuit or workers' compensation claim. Benefits paid under workers' compensation programs totaled $60.2 billion in 2011. Independent Medical Evaluation (IME) reports play an increasingly important role in workers' compensation cases, personal injury litigation, and long-term disability claims.

The workers' compensation system is continually challenged by a number of external forces, including the courts, the press, and even the Occupational Safety and Health Administration (OSHA). Orthopaedists are often asked to complete an Independent Medical Evaluation to assist the courts in understanding the cause, diagnosis, appropriate treatment, outcome, functional loss, and impairment resulting from injury. These reports are utilized by judges, hearing officers, and plaintiff and defense attorneys to settle claims. Physicians are frequently called upon at depositions, hearings, or trials to support, justify, and defend every word of their IME reports.

A Google search for "Independent Medical Examination" returns 3,670,000 results.  A review of the results finds most sites are created by attorneys and are designed to provide the examinee tips on how to prepare for his or her IME.

Learning how to conduct Independent Medical Examinations correctly is a skill seldom taught in residency programs.  Developing and defending your IME requires special training. There are a number of mistakes you need to learn to avoid when writing your IME reports.

Mistake #1: Not Answering the Questions Asked
Physicians frequently do not answer the questions asked by the referring source. The physician prepares a "standard" history, physical examination, and diagnosis without the requested specifics. Consider this question, for example: "Did the injury of May 15, 2016, result in the condition for which medical treatment is being requested?" What would be your justification for an answer of "yes" or "no"?

Mistake #2: Expressing Opinions on Issues Not Asked
Physicians sometimes opine in areas they were not requested to address. For example, although the patient does not complain of pain in her left wrist as a result of her fall, her radiographs demonstrate osteoarthritis that may have been aggravated by the fall. This results in unnecessary broadening of the claim.

Mistake #3: Expressing Opinions Outside of Their True Areas of Expertise
The requesting source may ask for opinions on topics that are not part of the physician's training.  For example: Was the delta V in the motor vehicle collision on July 1, 2016, sufficient to have caused the cervical strain that was diagnosed by Dr. Smith on November 15, 2016?

Learn more
The new half-day course "AAOS Improving Your IME Report" will be held Nov. 2 in Las Vegas, followed by the "19th Annual AAOS Workers' Compensation and Musculoskeletal Injuries" course, Nov. 3–5. For more information, visit www.aaos.org/courses

J. Mark Melhorn, MD, is the course director for the "19th Annual AAOS Workers' Compensation and Musculoskeletal Injuries: Improving Outcomes with Back-to-Work, Legal and Administrative Strategies" and the linked course "AAOS Improving your IME Report."