Independent Medical Evaluations:

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Independent Medical Evaluations An Occupational
Medicine Physicians Perspective
Jane Sliwinski, M.D., M.P.H., C.I.M.E.,
C.M.R.O. [phone] janes_at_prevea.com April
30, 2008
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Independent Medical Exams (IME)

• Content
• 1. Diagnosis
• 2. Causation Assessment
• 3. Treatment Recommendations
• 4. End of Healing (EOH) date
• 5. Permanent Partial Disability (PPD) rating
• 6. Return To Work Recommendations

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Independent Medical Exams (IME) cont.

• When?
• Total incapacitation
• Inappropriate Return To Work Recommendations
• Diagnosis is unclear
• High PPD rating
• When patient has a prolonged recovery time (gt6
  weeks) Note Normal tissues heal in 6 weeks.

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Independent Medical Exams (IME) cont.

• When?
• Excessive Treatment - No EOH date
• Symptoms/condition greater than expected based on
  mechanism of injury
• Causation unclear.

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Independent Medical Exams (IME) cont.

• Why?
• To help patient by providing proper diagnosis and
  treatment recommendations
• To potentially end work comp claim and
  associated costs
• To obtain an appropriate PPD rating to reduce
  PPD related costs
• To reduce lost work time, light duty time
  associated costs.

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Record Reviews

• Why?
• To get MD opinion on specific questions
• To get claim reviewed early in claim, to
  hopefully shorten (or eliminate) duration of
  claim.
• Doesnt use up IME (1 IME per year allowed by
  Wisconsin Workers Compensation Law)
• Cheaper than an IME (no patient transportation
  costs, no lost work time, no patient/MD
  interaction time)

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Record Reviews (cont.)

• Can do a brief review or a full report
• Legally defensible
• Examples

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Fitness For Duty (FFD) Evaluation

• Why should employers send employees for FFD
  Evaluations?
• To see if employee can safely perform all of the
  essential functions of the jobif not, which ones
  can/cant they do are there any
  accommodations/restrictions advised?
• To determine if a medical condition could be
  aggravated by doing all essential functions of
  the job
• To determine if performing the job could lead to
  a high risk of substantial imminent harm
• When physician work restrictions are vague, seem
  inappropriate, or change dramatically overnight

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Fitness For Duty (FFD) Evaluation

• When physician says employee is totally
  incapacitated and its a non-surgical case
• Cost savings occur by preventing work injuries
  preventing legal challenges to ADA violations
  reducing lost work time costs reducing FMLA use,
  and Short Term/Long Term Disability claim use
• Examples

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Causation Consultations
What are they? Consults that assess the
work-relatedness of a condition

• Why should an employer have a causation
  consultation done?
• To potentially deny questionable W/C injury or
  illness claims
• To help patient if not W/C, recovery is faster
• To assess for pre-existing conditions, if job
  task caused a manifestation of symptoms from the
  pre-existing condition, rather than aggravating
  or accelerating the condition
• Saves company money by reducing w/c injury
  illness claims and associated costs.

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Causation Consults (cont.)

• When should an employer get a Causation Consult?
• With any claim with no specific injury
• With any claim with a syndrome diagnosis
• When the symptoms/condition are much worse than
  expected based on the mechanism of injury
• Content
• Medical Record Review
• Company Record Review (injury report, nursing /
  supervisor notes, job description)
• Optional
• Occupational Therapist Job Site
  Evaluation
• Physician Job Site Evaluation
• Job Video

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Causation Consults (cont.)

• Examples

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Independent Medical Evaluations An Occupational
Medicine Physicians Perspective
Jane Sliwinski, M.D., M.P.H., C.I.M.E.,
C.M.R.O. [phone] janes_at_prevea.com April
30, 2008