An important part of most the Iowa workers’ comp cases that I handle is to get a good medical report from a neutral doctor to support my client’s case. When I send my clients to see the doctor that will write the report, that appointment is called an Independent Medical Exam or IME. The written analysis that the doctor eventually provides is usually referred to as the IME report.
I pick the physicians that I use for the IME process based on my past experience with the doctors that provide this type of service. I also read the decisions that are issued by the Workers’ Compensation Judges to stay up to date on what the Judges think of the opinions of the various experts that perform IMEs in Iowa.
Today I am going to talk about my strategy for the letters, records and other items that I send to the IME doctor. The IME doctor will read my letter and the enclosed documents before seeing my clients. After seeing the injured worker the IME doctor will answer my questions as part of the doctor’s report on my client.
I think these letters are very important. First, I need to write a good letter in order for the doctor to understand the case and provide their best analysis. Second, the letter to the IME doctor is actually going to be part of the evidence in the case. Therefore, I want to make sure that the letter is clear and accurate. I think that if I write a letter that is good enough in explaining the background of the injury that it can make a big positive difference in the case.
In talking about how I approach an IME I am going to use the example of a fact pattern that comes up fairly frequently. In this example my client is going to be a late middle age factory worker that has suffered a back injury that required surgery. After the surgery the worker was not able to return to his old job and was eventually fired by his employer.
The first step in getting ready for the IME is to obtain all the relevant medical records so that I can send them to the IME doctor to review. I personally analyze all the medical records so that I can identify any problems or issues that need to be addressed. Getting all the records on a timely basis is a lot more difficult than many people realize. Fortunately, my legal assistant Pam is excellent at handling all the details to make this happen.
In a lot of job injury cases involving factory work there is not a single event that injured a worker. Instead the injury developed through the cumulative trauma of doing repetitive work. If there is a dispute over whether cumulative work trauma caused the injury it is important to get good evidence of the job details to send to the IME doctor. In many cases I will get photographs and a video of the injured worker’s job duties so that I can share them with the IME physician.
I also work on getting the amount of weight that is involved in the job, any bending or twisting, and how often movements are made during a work day. I relay all this information to the IME doctor.
I usually start my letter to the IME doctor with a chronological overview of all the key events in the case. I think this helps the doctors to fit all the details of the medical records into the right place.
I then explain all the medical records that I am sending along for the doctor to review. I organize the records by all the different physicians and other medical providers that have seen the injured worker. For each set of records I explain how that specific provider fit into the care of my client.
I then shift to asking the IME doctor to answer specific questions. As an introduction to my questions I will review the Iowa work comp law relating to causation, burden of proof, and any other legal issue that is relevant in the specific case.
In most cases I will generally ask the doctor for his opinion on the following issues and his reasoning in support of his opinion:
1. A diagnosis of the injury the worker has suffered.
2. The doctor’s opinion on whether or not the injury was caused by work based on all the background information that I have provided, the doctor’s examination of the injured worker and the specific legal standard I have given to the doctor.
3. What degree of physical impairment has the worker suffered from the injury pursuant to the standards of the AMA Guides to the Evaluation of Permanent Impairment (5th Edition).
4. What future work restrictions the doctor thinks are appropriate for the injured worker.
5. Whether the doctor thinks any future medical care is appropriate, and if so, what specific care.
I will then ask the IME doctor for his opinion on any special issues in the case. These can vary quite a bit. For example, in a lot of job injuries involving cumulative trauma the employer and insurance carrier have denied the injury was caused by work. In these cases I will usually ask the IME doctor specific questions about flaws that I see in the strength or validity of the defense arguments.
The IME doctor’s report assessing the injury and answering my questions then becomes an important piece of evidence to help win the case and get my client the highest possible award or settlement.
Thanks for reading. I hope everyone has a happy and safe Thanksgiving holiday.