December 21, 2012

The Importance of Obtaining High Quality Expert Medical Opinions


GENERAL IMPORTANCE OF EXPERT MEDICAL OPINIONS.
In Iowa Workers' Compensation cases the issues of whether an injury arose out of work and the extent of the injury are frequently in dispute. The Iowa Supreme Court has pointed out that the side with the best expert opinions will frequently win the case. See for example St. Luke's Hospital v. Gray, 604 N.W.2d 646 (Iowa 2000). Therefore, it is important in every workers' compensation case to make sure you get persuasive supporting medical opinions.

The opinions of the treating physicians are frequently very important. In some cases the opinions of the treating physicians can be sufficient, and it is not necessary to obtain a second medical opinion. However, in many cases the treating physicians understandably are not interested in getting involved in the litigation process. In those cases it is definitely necessary to obtain an independent opinion from another physician.

PROCEDURE TO OBTAIN AN INDEPENDENT MEDICAL EXAM. In cases where the Defendants have admitted that the injury is work related the employer has a duty to reimburse the claimant for getting his own expert medical opinion concerning the extent of the injury. The medical testing in which the employee gets to pick the doctor is called an independent medical exam or IME. The second paragraph of Iowa Code Section 85.39 sets out the procedures for how a claimant obtains this IME reimbursement.

However, in cases where the employer is denying that the injury arose out of the job it is frequently even more important to obtain an IME.

CHOOSING AN IME DOCTOR.
In choosing a physician to perform an independent medical exam and provide expert opinions you want to pick a doctor that has the confidence of the Deputy Commissioners and the Workers' Compensation Commissioner that will be deciding the cases. The Commissioner's office gives weight to the board certification of the doctors and the quality of their past opinions. However, I think the most important factors in each case are whether the doctor provides a good report that shows that the doctor understands the case; and whether the doctor provides logical causation and damage opinions that are reasonable and supported by the evidence and the medical standards on diagnosing and rating injuries.

In determining the extent of impairment most doctors generally follow the AMA Guides to the Evaluation of Permanent Impairment. The Iowa Workers' Compensation Commissioner prefers the 5th Edition of the AMA Guides. (See Iowa Administrative Code Section 876-2.4.). However, the Commissioner does permit and consider impairment ratings based on the individual opinions of the physicians, or other medical standards. However, medical opinions that are based on widely recognized standards are generally found more persuasive.

TIMING. There are a number of factors that go into picking the right time to have the independent medical exam performed. First, you want to make sure that the worker has reached maximum medical improvement, and therefore you do not want to set up the exam too soon. At the same time you have to make sure that the exam is done soon enough to comply with the Commissioner's rules concerning the exchange of expert reports before the workers' compensation hearing.

MATERIALS AND QUESTIONS FOR THE IME DOCTOR.
It is very important that you give the doctor everything that is necessary to allow the doctor to give an informed opinion about the injury. In every case you want to provide complete copies of all the relevant medical records. Many of the doctors also find it helpful to have copies of x-rays and MRIs, CAT scans, and other tests. A good job description and a video of the work in question can also be helpful for the doctor.

Every case has special issues and you need to ask the IME doctor for his opinions on these areas. Additionally, in most cases you will want to ask the doctor for his diagnosis of the injury, whether he thinks any further treatment is necessary, whether he thinks the injury was caused or substantially aggravated by work, his opinion on the extent of impairment, and whether he thinks future work restrictions are appropriate.

By giving the IME doctor the necessary background material and asking the right questions you can help the doctor provide the best possible opinions for the case.