Independent Medical Examinations in Louisiana Workers Compensation

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What Is An Independent Medical Examination in Louisiana Workers Compensation?

If there are opposing doctors' opinions regarding an injured employee's condition or capacity to work, the Office of Workers' Compensation Administration or the workers compensation Judge can appoint an Independent Medical Examiner to examine the employee, or simply to review the employee's medical records.

This examination is called an Independent Medical Examination, or simply an IME.

For a technical definition, the AMA (American Medical Association) defines an Independent Medical Examination (IME) as a unique and specialized examination and report, ideally performed by a medical physician with special training and experience in the field of Independent Medical Examinations.

So basically, an Independent Medical Examination (IME) is when a neutral third doctor is chosen to "break the tie" between the employee's doctor and the insurance company's doctor when they disagree.

Basic Information on Independent Medical Examinations

Either the workers compensation insurance company or the employee can file a Form LWC-WC 1015: Request for Independent Medical Examination, with the Medical Services Section of the Office of Workers' Compensation Administration (OWCA). 

A copy of the actual LWC-WC Form 1015 is available here.

The Director of the Office of Workers' Compensation Administration (OWCA) will select the doctor to handle the Independent Medical Examination (IME), and will also set the cost of the Independent Medical Examination (IME).

The workers compensation insurance company will pay for the Independent Medical Examination (IME).

The independent medical examiner has 30 days from the date of the examination to issue a report, and any objections to this IME report shall be made by filing a Form LWC-WC 1008: Dispute for Compensation, which will take the matter to Court in front of the workers compensation Judge.

A copy of the actual LWC-WC Form 1008 is available here.

The injured employee can bring a family member, friend or attorney to the Independent Medical Examination (IME), but if the employee refuses this Independent Medical Examination (IME), then the employee's lost wage payments may be temporarily suspended.

It is typically improper to obtain an Independent Medical Examination for the purpose of addressing questions of causation, as the current position of the Office of Workers' Compensation is to deny IME requests based on causation questions.

It is also typically improper to obtain an Independent Medical Examination for the purpose of addressing questions of medical necessity (ie does the employee need this treatment, or should it be approved), since these questions of medical necessity should be instead handled through the Utilization Review process. 

A Second Medical Opinion is NOT an Independent Medical Examination

It is fairly typical for an injured employee to be asked to undergo an Independent Medical Examination, especially if the employee requires surgery or another expensive procedure, or suffers from long-term disability.

And most injured employees will be required to undergo a Second Medical Opinion (SMO).

But all injured employees need to know that an Independent Medical Examination is NOT Second Medical Opinion (SMO).

Why is this important?

It is important because Independent Medical Examination physicians are appointed by the state, while Second Medical Opinion (SMO) physicians are chosen by the workers compensation insurance company.

So in that sense, an Independent Medical Examination may actually help support the employee's case or position, though it could also undermine the employee's claim as well.

Nevertheless, the workers compensation insurance company representatives often tell injured employees that they have set up an Independent Medical Examination, when in reality, they have set up a Second Medical Opinion.

Written notice of a real Independent Medical Examination will be sent directly from the Louisiana Office of Workers Compensation Medical Services Division or from the Louisiana Workers Compensation Court, not from the workers compensation insurance company.

Also, an Independent Medical Examiner is not actually the employee's doctor, which means that the Independent Medical Examiner will not actually treat the employee.

But more importantly, this means that there is no doctor-patient privilege between an employee and an Independent Medical Examiner, so nothing that the employee says will be confidential, and anything the employee says will likely become part of the Independent Medical Examiner's report and possibly used against the employee. 

Independent Medical Examinations are NOT Entirely Conclusive

Louisiana courts have ruled that while an Independent Medical Examination report should be given "significant weight" because the IME doctor is an objective party, the IME report is not conclusive and the judge must evaluate all of the medical evidence.

In other words, just because an Independent Medical Examination report goes against an employee, does not mean that the Judge will decide against that employee.

And just because an Independent Medical Examination report goes in favor of an employee, does not mean that the Judge will decide in favor of that employee.

Again, the workers compensation Judge will evaluate all of the medical evidence, and make an impartial decision.

But, nevertheless, the opinion of the Independent Medical Examination report will be strongly considered, and usually the workers compensation Judge will make a decision that is in agreement with the Independent Medical Examination report.

Procedures for an Independent Medical Examination in Louisiana Workers Compensation

How to Order an Independent Medical Examination

Louisiana law allows for either party - the workers compensation insurance company or the employee - to request an Independent Medical Examination (IME) from the Office of Workers' Compensation.

There are two ways in which the Independent Medical Examination can be ordered:

    1. An Independent Medical Examination where the IME physician is selected by the Office of Workers Compensation Medical Services Division; and
    2. An Independent Medical Examination where the IME physician is selected by the workers compensation Judge.

If a claim is already in workers compensation court, then the parties can request an Independent Medical Examination through the Office of Workers' Compensation Medical Services Division, or through the presiding workers compensation Judge.

If a claim is not already in workers compensation court, then the parties are limited to requesting an Independent Medical Examination through the Office of Workers' Compensation Medical Services Division. 

Also, any party requesting an Independent Medical Examination must make its request at or prior to the court's pre-trial conference; requests for Independent Medical Examinations made after that time will be denied except for good cause or if it is found to be in the best interest of justice to order such examination.

The employee and the workers compensation insurance company should provide the doctor who will perform the Independent Medical Examination with copies of all of the employee's medical records.

But the employee cannot contact the doctor who will perform the Independent Medical Examination, except to schedule the appointment and go to the exam.

Independent Medical Examiners Selected by the Office of Workers Compensation Medical Services Division

The more common method of obtaining an Independent Medical Examination is by having the Independent Medical Examiner selected by the Office of Workers Compensation Medical Services Division.

Under this method, the Office of Workers' Compensation Medical Services Division can appoint an independent medical practitioner to examine the employee to address a “dispute” as to his “condition” or “capacity to work.”

And the Independent Medical Examiner will report his or her conclusions from the examination to the Office of Workers' Compensation Medical Services Division and to the parties, and the report shall be submitted as evidence on the facts to be used for any related disputes.

But if both the employee's treating physician and the Second Medical Opinion (SMO) doctor (selected by the workers compensation insurance company) agree as to the employee's medical condition or work status, then the workers compensation insurance company cannot request that an Independent Medical Examination be performed.

Independent Medical Examiners Selected by the Workers Compensation Judge

Under this method of obtaining an Independent Medical Examination, the workers compensation Judge may order the employee to be examined by a physician selected by the workers' compensation court.

This method is generally accomplished by one party filing a Motion to Order an Independent Medical Examination within the district court where the claim is already pending.

However, it is entirely at the workers compensation Judge's discretion as to whether to order the Independent Medical Examination, based upon whether the requesting party has shown good grounds for a court-appointed Independent Medical Examination.

So just because the workers compensation insurance company requests an Independent Medical Examination from the workers compensation Judge, does not mean that the Judge will in fact order the workers compensation Judge will order the Independent Medical Examination.

Procedures Following an Independent Medical Examination

Following the Independent Medical Examination, the Independent Medical Examiner will draft a report on the examination, and will send a certified report directly to the Louisiana Office of Workers Compensation Medical Services Division or to the Louisiana Workers Compensation Judge who requested the IME.

And the opinion of the Independent Medical Examination report will be strongly considered by the workers compensation Judge, and usually the workers compensation Judge will make a decision that is in agreement with the Independent Medical Examination report.

But just because an Independent Medical Examination report goes in favor of an employee, does not mean that the Judge will decide in favor of that employee.

Again, the workers compensation Judge will evaluate all of the evidence to the appropriate legal standards, and make an impartial decision.

Also, either party can appeal the decision of the workers compensation Judge to the appellate circuit court.  

Last, the employee cannot contact the physician who is performing the Independent Medical Examination, except to schedule the appointment and go to the exam.

If there even appears to be any improper contact with the Independent Medical Examiner, the workers compensation Judge will most likely throw out the Independent Medical Examination report, and not consider it as evidence.

An Independent Medical Examiner is One of Three Typical Types of Doctors in Louisiana Workers Compensation

Generally speaking, there are three main different types of doctors that an injured employee might see during the course of the employee's workers compensation claim.

These three types of doctors are:

    1. The doctor that the employee chooses to be his or her treating physician for the employee's work-related injury;
    2. The doctor that the workers compensation insurance company chooses to provide it with a Second Medical Opinion (SMO); and
    3. The doctor that the workers compensation Judge or the Louisiana Office of Workers Compensation Medical Services Division selects to perform an Independent Medical Evaluation (IME).

These three different categories of doctors will perform different roles during the course of an injured employee's workers compensation claim.

#1: The Employee's Treating Physician

Under Louisiana law, an injured employee has the right to select one treating physician in any field or specialty.

The injured employee's treating physician is the doctor that the employee chooses to be his or her treating physician for the employee's work-related injury.

Importantly, this treating physician is the doctor who actually provides the treatment, unlike the doctors who provide infrequent Second Medical Opinions (SMOs) and one-time Independent Medical Evaluations (IMEs).

So for example, the injured employee's treating physician is the doctor who would actually perform a procedure, such as a surgery.

Also, the injured employee may have several treating physicians, if the employee needs treatments with different types of specialized doctors.

#2: The Insurance Company's Second Medical Opinion (SMO) Physician

Under Louisiana law, an injured employee has the right to select one treating physician in any field or specialty.

But at the same time, an injured employee is required to submit to an examination by a physician provided and paid for by the employer or the workers compensation insurance company, as soon after the accident as demanded.

In other words, the employer and the workers compensation insurance company have the right to have the injured employee examined by a doctor which they choose.

This examination by the the insurance company's doctor is called a Second Medical Opinion (SMO).

If the employee refuses this examination, the employee's lost wage payments may be temporarily suspended.

A major difference between the insurance company's Second Medical Opinion (SMO) doctor and the injured employee's treating physician is that the insurance company's Second Medical Opinion (SMO) doctor would never actually treat the employee - such as actually perform a procedure, such as a surgery.

Instead, the purpose of the insurance company's Second Medical Opinion (SMO) doctor is to dispute the opinion and treatment plan of the injured employee's treating physician.

In other words, the purpose of the insurance company's Second Medical Opinion (SMO) doctor is to provide a basis on which the insurance company can deny workers compensation benefits due the employee. 

In fact, the injured employee should be aware that the employee's Second Medical Opinion appointment is a time in which the workers compensation insurance company is most likely to employ video surveillance by a private investigator on the employee.

This is because the insurance company know where the employee is and where the employee is going on the day of the employee's Second Medical Opinion appointment.

#3: The Office of Workers Compensation's Independent Medical Examination (IME) Physician

Typically, if the injured employee's treating physician and the insurance company's Second Medical Opinion (SMO) doctor disagree on the employee's condition, disability, or proper course of treatment, the parties will have an Independent Medical Examination (IME) performed by a third doctor.

Either the employee or the workers compensation insurance company can request this Independent Medical Examination (IME) by completing an OWC Form 1015 and forwarding it to the Medical Services Section of the Office of Workers' Compensation Administration.

However, this Independent Medical Examination (IME) physician will be chosen by either the workers compensation Judge or the Louisiana Office of Workers Compensation Medical Services Division.

Like a Second Medical Opinion (SMO) doctor, a major difference between the Independent Medical Examination (IME) doctor and the injured employee's treating physician is that the Independent Medical Examination (IME) doctor would never actually treat the employee - such as actually perform a procedure, such as a surgery.

Instead, the Independent Medical Examination (IME) would only perform a one-time examination, and then write a report based on this examination and all the other evidence and medical records available to him or her, including the opinions of the injured employee's treating physician and the insurance company's Second Medical Opinion (SMO) doctor.

Typically, Independent Medical Examination (IME) doctor will agree with either the employee's treating physician or the insurance company's Second Medical Opinion (SMO) doctor, and in most cases the Judge will rule in favor of whatever the Independent Medical Examination (IME) doctor decides.

Also, like a Second Medical Opinion (SMO) examination, if the employee refuses this Independent Medical Examination (IME), then the employee's lost wage payments may be temporarily suspended.

Independent Medical Examinations versus the Utilization Review Process in Louisiana Workers Compensation

Under Louisiana law, an injured employee has the right to select one treating physician in any field or specialty.

But at the same time, an injured employee is required to submit to an examination by a physician provided and paid for by the employer or the workers compensation insurance company, as soon after the accident as demanded.

Typically, if the injured employee's treating physician and the insurance company's Second Medical Opinion (SMO) doctor disagree on the employee's condition or disability, the parties will have an Independent Medical Examination (IME) performed by a third doctor.

Either the employee or the workers compensation insurance company can request this Independent Medical Examination (IME) by completing an OWC Form 1015 and forwarding it to the Medical Services Section of the Office of Workers' Compensation Administration.

However, this Independent Medical Examination (IME) physician will be chosen by either workers compensation Judge or the Louisiana Office of Workers Compensation Medical Services Division.

Like Utilization Review, the Purpose of the Independent Medical Examination is for the Insurance Company to Dispute the Claim

Instead of treatment, the purpose of the Independent Medical Examination (IME) is for the workers compensation insurance company to dispute the opinion and treatment plan of the injured employee's treating physician.

In other words, the purpose of the insurance company's Second Medical Opinion (SMO) doctor is to provide another basis on which the insurance company can deny workers compensation benefits due the employee. 

Then again, the purpose of the Utilization Review process is also for the workers compensation insurance company to dispute - and ultimately deny - the employee's claim.

So when is each one used?

Utilization Review or Independent Medical Examination (IME)?

So, an Independent Medical Examination (IME) can be extremely helpful to the workers compensation insurance company, because they are used to deny medical treatment to an injured employee.

However, disputes over whether medical treatment is necessary are decided through the Utilization Review process (beginning with the OWC Medical Services Division), and not by a doctor performing an Independent Medical Examination (IME).

The purpose of an Independent Medical Examination (IME) is instead to address questions of medical causation, the employee's physical condition, and the extent of the employee's work capabilities.

In other words, if the workers compensation insurance company and the injured employee dispute whether a particular type of treatment recommended by the treating physician is medically necessary, the Utilization Review process is the appropriate forum to resolve this dispute.

But if the workers compensation insurance company claims that the employee's complaints are not related to the work accident, or if it disputes the employee's inability to work, then the workers compensation insurance company should have the employee examined by an Independent Medical Examination (IME) doctor. 

Of course, an Independent Medical Examination (IME) doctor could give an opinion on what he or she thinks is reasonable and necessary medical care, in order for the workers compensation Judge to consider.

But Louisiana law requires that a decision first be made by the Medical Director in the Utilization Review process, before the OWC Judge determines whether the Medical Director's decision was correct (and potentially at that point considers the opinion of the Independent Medical Examination doctor).

Two Types of Independent Medical Examinations in Louisiana Workers Compensation

Two typical types of Independent Medical Examinations in Louisiana workers compensation are:

    1. Impairment Rating Independent Medical Examinations; and
    2. Return to Work Duty Independent Medical Examinations.

Impairment Rating in Independent Medical Examinations

Impairment is not necessarily the same as disability.

Specifically, "impairment" is a medical condition meaning an anatomical or functional abnormality or loss following maximum rehabilitation, while "disability" is a legal term describing when an individual is unable to have gainful activity because of an impairment.

Impairment ratings in Louisiana are based on the 6th AMA Guides to the Evaluation of Permanent Impairment.

Impairment ratings can only be determined if the examinee is at maximum medical Improvement (MMI), which means the completion of all contemplated treatment, or that all the treatment that has been offered that has been declined.

Concerning the impairment rating:

    • The IME will indicate which reference is being used to determine the rating;
    • The IME will reference specific pages, tables, figures used in determining the rating;
    • Impairment ratings are different for each body part;
    • Impairment ratings are converted to "whole person" impairment ratings; and
    • When different body parts are affected then the impairment ratings are "combined" as defined by the reference.

Return to Work Duty in Independent Medical Examinations

When an Independent Medical Examination gives an opinion on the employee's ability to return to full work duty, or to return to light duty work, the Independent Medical Examination report will:

    • Provide a job description for an evaluation of a specific job; and
    • Provide the examiner's opinion of the employee's ability to perform certain tasks.

A functional capacity evaluation (FCE) is typically obtained to give the examiner some objective evidence, since the FCE can:

    • Test for validity;
    • Measure the employee's abilities; and
    • Be performed by a physical therapist with experience in performing this evaluation.

A Return to Duty Independent Medical Examination can:

    • Be done before maximum medical Improvement (MMI) is reached;
    • Release the examinee to regular or modified duty despite the need for further treatment;
    • Analyze a job description that is available for review and determination; and
    • Give modifications or restrictions as appropriate for the employee's condition, if a job description is not available.

What to Expect From an Independent Medical Examinations in Louisiana Workers Compensation

For Independent Medical Examinations, the injured employee can expect:

    • Prepared questionnaires in advance of the examination;
    • Pain scales and drawings during the examination;
    • Detailed questions during the examination; and
    • A detailed Independent Medical Examination Report following the examination.

Prepared Questionnaires

In advance of an Independent Medical Examination, the examiner may give a prepared questionnaire to the injured employee that asks about:

    • Medical history of the employee;
    • Medications of the employee;
    • Surgical history of the employee;
    • Allergies of the employee;
    • Social history of the employee; and
    • Work history of the employee.

Some questionnaires may be specific for certain types of injuries, and ask specific questions on particular body parts in reference to related disability scales.  For example:

    • For back injuries, the examiner might ask question regarding the Oswestry Disability Index;
    • For neck injuries, the examiner might ask question regarding the Neck Disability Index (NDI); and
    • For foot and ankle injuries, the examiner might ask question regarding the Foot and Ankle Disability Index (FADI).

The Independent Medical Examiner may send the questionnaire to employee ahead of time to save time, or may simply ask the employee to complete the questionnaire right before the examination.

It is crucial that the employee's answers to all questionnaire questions are extremely thorough, complete and truthful.

Pain Drawings and Scales

For Independent Medical Examinations, the injured employee can expect pain drawings and scales for the employee to complete.

Pain drawings are drawings or sketches of the human body (usually one front and one back), where the injured employee is asked to circle or mark areas of the body in which the employee is feeling pain.

Pain scales are scales in which the injured employee is present with 11 numbers (0-1-2-3-4-5-6-7-8-9-10), and asked to "circle the number that best describes your pain."

It is absolutely critical that the employee's answers to all these pain drawing questions and pain scale questions are extremely thorough, complete and truthful.

When completing these these pain drawing questions and pain scale questions, it is no time to be a hero (by downplaying at all the level of pain) or to be forgetful or minimizing of the true intensity or locations of the employee's pain.

The Examination Itself

During an Independent Medical Examination, the Independent Medical Examiner will ask questions about the employee's:

    • Detailed medical history
    • Incident
    • Current symptoms
    • Treatment including therapy, surgery, etc.
    • Medications
    • Past history (chronic medical conditions)
    • Activities of daily living
    • Past surgery
    • Past hospitalizations
    • Military history
    • Social history
    • Work history
    • Education
    • Hobbies
    • Vice habits (smoking, drinking, illicit drugs)
    • Review of systems
    • Psychiatric symptoms

The detailed physical examination will also be:

    • Focused on body part(s) that are affected;
    • Many times consisting of a head to toe exam;
    • Often including a neurological exam; 
    • Often including a mental status exam; and
    • Often involving measurements of joints.

However, the Independent Medical Examination usually does not include measurements of abilities for specific tasks (such as lifting, climbing, etc).

The Independent Medical Examination Report

Regarding an Independent Medical Examination, the Independent Medical Examiner will provide a report within 30 days.

In fact, depending on the amount of records to review, the report may only take a week or two to complete.

The Independent Medical Examination Report will include identifying information, such as

    • Claimant name
    • Requesting party
    • Demographics
    • Claim number
    • Date and time of exam

The Independent Medical Examination Report will thoroughly report on:

    • Detailed medical history
    • Incident
    • Current Symptoms
    • Treatment including therapy, surgery, etc.
    • Medications
    • Past history (chronic medical conditions)
    • Activities of daily living
    • Past surgery
    • Past hospitalizations
    • Military history
    • Social history
    • Work history
    • Education
    • Hobbies
    • Vice habits (Smoking, drinking, illicit drugs)
    • Review of systems
    • Psychiatric symptoms

The report will likely include behavioral observations of the injured employee, including descriptions such as:

    • Attentive
    • Pleasant
    • Cooperative
    • Dressed
    • Symptom magnification
    • Examiner's observation of pain
    • Any other behavioral observations (such as walking in the parking lot before and after the exam)

The report will likely include the employee's vital signs and measurements, such as:

    • Blood pressure
    • Pulse
    • Temperature
    • Weight
    • Height

The report will likely include details from a physical exam of the employee, including:

    • General observations
      • Nourishment
      • Development
      • Age appearance
    • Head
    • Eyes
    • Ears
    • Nose/Throat
    • Heart
    • Lungs
    • Abdomen
    • Musculoskeletal
      • Extremities
      • Back
      • Measurement of range of motion for specific joints
    • Skin
      • Temperature for certain conditions (CRPS)
    • Genitalia/Rectum

The report may also likely include details from a neurological exam of the employee, including:

    • Cranial nerves
    • Pathological reflexes
      • Babinski
      • Clonus
      • Hoffman
    • Cerebellar function
      • Heel to shin
      • Tremors
      • Gait
    • Muscle strength
      • With 3 repetitions
    • Muscle tone
    • Proprioception
    • Nystagmus
    • Sensory testing
      • Neurotip
      • Monofilament
    • Vibratory sensation
    • Romberg
    • Two point discrimination

The report will also likely include the following:

    • Diagnoses
    • Questions and answers asked by the referring agency
      • Impairment rating
      • Fitness for duty
    • Listing of all records reviewed
      • Medical records
      • Radiographs
      • MRI's
    • Photos or video - digital

The report may also likely include a Disclaimer, stating that the examiner:

    • Did not provide care
    • Examined once (or more)
    • Focused on allowed conditions
    • Reviewed the records listed
    • The findings are accepted

The Disclaimer will also likely state that:

    • The opinions are only the examiner's opinions
      • Based upon review of the records
      • Based upon the medical examination
    • There was an expectation that the materials are true and correct
    • More information may or may not change the opinion rendered
    • No recommendation for claims administration or administrative functions to be made or enforced

How to Prepare for An Independent Medical Examination in Louisiana Workers Compensation

It is extremely important for any injured employee in Louisiana to throughly prepare for a workers compensation Independent Medical Examination, ideally with the help of the employee's attorney.

First, an experienced Louisiana workers compensation attorney will want to determine if the employee should even be having an Independent Medical Examination, by asking:

    • Is there a valid basis for an Independent Medical Examination?
    • Should the dispute be handled in the Utilization Review process instead?
    • Are there actually conflicting medical opinions (which are required for an Independent Medical Examination)?
    • Is there a valid basis under which to file an objection to the Independent Medical Examination?
    • What are the repercussions if the workers compensation Judge agrees that an Independent Medical Examination is improper or unnecessary?

If the employee is going to submit to an Independent Medical Examination, the employee should take the following steps to prepare for the examination: 

    • The employee should make sure that all medical records and diagnostic films have been submitted to the Independent Medical Examiner well in advance of the examination.
    • The employee should make sure that he or she is extremely familiar with his or her complete medical history. The Independent Medical Examination doctor will likely be well aware of the employee's complete medical history, and will likely ask the employee about all of this medical history, including even minor injuries. So the injured employee needs to be prepared to discuss the entire medical history - including injuries and illnesses big and small, recent and from long ago - and especially any medical history related to the body part injured in the workers compensation accident. Ideally, the employee would have an experienced workers compensation attorney to assist with this.
    • The employee should make sure that he or she is extremely familiar with the employee's complete course of treatment. Again, the Independent Medical Examination doctor will likely be well aware of the employee's complete medical history, and will likely ask the employee about all of this medical history, including even minor injuries. So the injured employee needs to be prepared to discuss the employee's complete course of treatment. So the employee should review the employee's complete medical records and notes, including all tests, surgeries, procedures and other treatment that the employee has received. 
    • The employee should review his or her current symptoms. The injured employee needs to be prepared to inform the Independent Medical Examiner of all the employee's current symptoms in detail. The employee should try not to forget any symptoms or limitations, even if that means the employee should bring in personal notes to the examination to refresh the employee's memory.
    • The employee should review exactly how the accident happened. The injured employee needs to be prepared to inform the Independent Medical Examiner in detail about exactly how the injury happened. The employee should try not to forget any details, and make sure there are no inconsistencies in the events, again even if that means the employee should bring in personal notes to the examination to refresh the employee's memory. The employee should also discuss these events with his or her attorney ahead of the Independent Medical Examination.
    • The employee should find out what else has been submitted to the doctor. The injured employee should make sure that he or she is fully aware of all the medical records and information that the Independent Medical Examination doctor has received in advance of the examination.
    • The employee should find out exactly what the workers compensation insurance company has told and asked the Independent Medical Examination doctor. The injured employee should make sure that he or she is fully aware of any information that the workers compensation insurance company has submitted to the Independent Medical Examination doctor, especially any information besides the medical records. Ideally, the employee would have an experienced workers compensation attorney to handle this. But often the insurance company will send a letter to the Independent Medical Examination doctor that unfairly describes the employee's injury or medical situation in a light that is unfair to the employee.  The employee needs to know what that letter says, so that the employee can refute any unfair or prejudicial information in that letter. 
    • The employee should review exactly what the employee is going to tell the Independent Medical Examiner about the employee's medical history, medical conditions, and accident history. The injured employee should make sure that he or she is fully prepared and knows exactly what he or she will say when the Independent Medical Examination doctor asks "what is your medical history" or "tell me about the accident" or "how are you feeling today." Ideally, the employee would have an experienced workers compensation attorney to assist with this.
    • The employee should possibly ask the employee's primary treating physician for a supplemental and updated medical report explaining the employee's current updated condition, as well as why the treatment that the treating physician has recommended is exactly the type of treatment that the employee needs. The injured employee should make sure that his or her medical records are up-to-date and thorough. If they are not, the employee should return to the treating physician in advance of the Independent Medical Examination, in order to make the medical records up-to-date and complete. Ideally, the employee would have an experienced workers compensation attorney to handle this. 
    • The employee should dress appropriately for the Independent Medical Examination. The injured employee should act in a manner that is consistent with the employee's injury. That means that the employee should wear or bring any devices needed because of the employee's injury, such as a brace, crutches, or a sling.
    • The employee should plan to arrive early for the Independent Medical Examination. It is never a good idea to be late for an Independent Medical Examination, and missing an appointment time can result in a suspension of workers compensation benefits.
    • The employee should plan to bring a friend or relative to the Independent Medical Examination. A trusted friend or relative can act as an observer in the Independent Medical Examination, by taking notes, providing emotional support, and acting as a witness.
    • The employee should discuss with the employee's attorney the possibility of the employee's attorney actually attending the Independent Medical Examination. The employee's attorney can also act as an observer in the Independent Medical Examination, by taking notes, providing emotional support, and acting as a witness. The employee's attorney can also assist the employee should improper or irregular events occur. 
    • The employee should refrain from taking pain medication or anti-inflammatory medication prior to the examination, if allowed by the employee's treating physician. Refraining from taking pain medication or anti-inflammatory medication prior to the examination will allow the Independent Medical Examination doctor to objectively view the employee's symptoms and medical issues. 

How to Handle an Independent Medical Examination in Louisiana Workers Compensation

Again, if there are opposing doctors' opinions regarding an injured employee's condition or capacity to work, the Office of Workers' Compensation Administration or the workers compensation Judge may appoint an Independent Medical Examiner to examine the employee, or simply to review the employee's medical records.

This one-time examination is called an Independent Medical Examination (IME).

At the examination, the Independent Medical Examination doctor will take the employee's medical and accident histories, ask about current symptoms, and perform a physical examination.  

This IME doctor will have reviewed the medical records in advance.

Some Independent Medical Examination doctors will actually watch an injured employee from the minute the employee leaves his or her car until the moment that the employee returns and drives away.

Independent Medical Examination doctors have regularly issued reports which say things like “the patient ran from his car into the building, but then began to limp when he entered the examination room.” 

An injured employee at an Independent Medical Examination (IME) should:

    • Be honest in all aspects;
    • Be polite and respectful;
    • Be specific and detailed in describing injuries and symptoms;
    • Include all injuries and symptoms that are related to the accident;
    • Be truthful about the employee's physical limitations;
    • Explain why the employee's previous injuries are different from the employee's work-accident injuries;
    • Stay calm, and let the IME physician know right away if the physician actually hurts the employee;
    • Be aware of the fact that the IME physician is neither the employee's advocate nor the employee's medical doctor;
    • Be mindful that the employee may be surveilled by an insurance investigator, by wearing braces and using canes; and
    • Limit activities on the day before, the day of and the day after the IME, due to possible surveillance.

As for a list of things that an injured employee at an Independent Medical Examination (IME) should NOT do:

    • Do not exaggerate or fake injuries, because many IME doctors will note exaggeration in the IME report;
    • Do not downplay pain or symptoms;
    • Do not attempt to over-react when touched or prodded;
    • Do not be offended by the doctor's questions;
    • Do not ask medical questions about your treatment;
    • Do not answer questions that are not asked;
    • Do not contribute information beyond the scope of the examination;
    • Do not make small talk;
    • Do not overly compliment the IME doctor;
    • Do not discuss the specifics of the legal case; 
    • Do not discuss any conversations with the employee's lawyer. 

Overall, the most important point for the injured employee in an Independent Medical Examination is for the employee to be detailed and thorough, but not to exaggerate any injuries.

 

The Louisiana Statute for Independent Medical Examinations in Louisiana Workers Compensation

The primary Louisiana statutes on Independent Medical Examinations are La. R.S. 23:1123, La. R.S. 23:1124, La. R.S. 23:1124.1, La. R.S. 23:1125 and La. R.S. 23:1317.1. These statutes read as follows:

§1123. Disputes as to condition or capacity to work; additional medical opinion regarding an examination under supervision of the secretary

If any dispute arises as to the condition of the employee, or the employee's capacity to work, the secretary, upon application of any party, shall order an additional medical opinion regarding an examination of the employee to be made by a medical practitioner selected and appointed by the secretary. The medical examiner shall report his conclusions from the examination to the secretary and to the parties and such report shall be prima facie evidence of the facts therein stated in any subsequent proceedings under this Chapter.

Amended by Acts 1983, 1st Ex. Sess., No. 1, §1, eff. July 1, 1983; Acts 1988, No. 938, §1, eff. July 1, 1989; Acts 2010, No. 3, §1, eff. May 11, 2010; Acts 2012, No. 235, §1; Acts 2017, No. 381, §2, eff. June 23, 2017.

§1124. Refusal to submit to an additional medical opinion regarding an examination; effect on right to compensation

If the employee refuses to submit himself to an additional medical opinion regarding a medical examination at the behest of the employer or an examination conducted pursuant to R.S. 23:1123, or in anywise obstructs the same, his right to compensation and to take or prosecute any further proceedings under this Chapter may be suspended by the employer or payor until the examination takes place. Such suspension of benefits by the employer or payor shall be made in accordance with the provisions of R.S. 23:1201.1(A)(4) and (5). When the employee has filed a disputed claim, the employer or payor may move for an order to compel the employee to appear for an additional medical opinion regarding an examination. The employee shall receive at least fourteen days written notice prior to the additional medical opinion regarding an examination. When a right to compensation is suspended no compensation shall be payable in respect to the period of suspension.

Acts 1997, No. 393, §1; Acts 2013, No. 337, §1; Acts 2017, No. 381, §2, eff. June 23, 2017.

§1124.1.  Cumulative medical testimony; medical examination

Neither the claimant nor the respondent in hearing before the hearing officer shall be permitted to introduce the testimony of more than two physicians where the evidence of any additional physician would be cumulative testimony.  However, the hearing officer, on his own motion, may order that any claimant appearing before it be examined by other physicians.

Acts 1988, No. 938, §2, eff. Jan. 1, 1989.  Acts 1989, No. 260, §1, eff. Jan. 1, 1990.

§1125.  Right of employee to written report of medical examination; penalty for failure to furnish

A.  Whenever an employee who is being treated by his choice of medical provider shall, at the request of the employer, the employer's insurer, or the representative of the employer or its insurer, submit to any type of medical examination and a medical report is received by said requester, such employee or his representative shall be entitled to a copy of the written report of the results of said examination within thirty days from the date the requester receives the report.

B.  Whenever an employee has accepted medical treatment by a health care provider referred by the employer, the employer's insurer, or the representative of the employer or its insurer, he shall be entitled to receive a copy of any medical records of the medical provider that are in the possession of the employer or its insurer within thirty days from the date of the written demand upon the employer, the employer's insurer, or the representative of the employer or its insurer.

C.  Such written report or records shall be furnished to said employee or his representative at no cost to the employee.  Any employer who without just cause fails to furnish such report or records to an employee so requesting same within the thirty-day period provided for above shall be liable to the employee for a civil penalty in the amount of two hundred fifty dollars, plus reasonable attorney fees for the collection of such penalty.

Added by Acts 1976, No. 243, §1; Acts 1999, No. 134, §1, eff. June 9, 1999.

§1317.1. Additional medical opinion regarding medical examinations

A. Any party wishing to request an additional medical opinion regarding a medical examination of the claimant pursuant to R.S. 23:1123 and 1124.1 shall be required to make its request at or prior to the pretrial conference. Requests for additional medical opinions regarding medical examinations made after that time shall be denied except for good cause or if it is found to be in the best interest of justice to order such examination.

B. An examiner performing additional medical opinion exams pursuant to R.S. 23:1123 shall be required to prepare and send to the office a certified report of the examination within thirty days after its occurrence.

C. The report of the examination shall contain the following, when applicable:

(1) A statement of the medical and legal issues the examiner was asked to address.

(2) A detailed summary of the basis of the examiner's opinion, including but not limited to a listing of reports or documents reviewed in formulating that opinion.

(3) The medical treatment and physical rehabilitative procedures which have already been rendered and the treatment, if any, which the examiner recommends for the future, together with reasons for the recommendation.

(4) Any other conclusions required by the scope of the additional medical opinion regarding a medical examination, together with reasons for the conclusion reached.

(5) A curriculum vitae of the examiner.

(6) A written certification personally signed by the examiner that the report is true. The substance of the certification shall be: "I certify that I have caused this report to be prepared, I have examined it, and to the best of my knowledge and belief, all statements contained herein are true, accurate, and complete."

D. If a physical examination of the claimant was conducted, the certified report shall contain all of the following additional information:

(1) A complete history of the claimant, including all previous relevant or contributory injuries with a detailed description of the present injury.

(2) The complaints of the claimant.

(3) A complete listing of tests and diagnostic procedures conducted during the course of the examination.

(4) The examiner's findings on examination, including but not limited to a description of the examination and any diagnostic tests and X-rays.

E. When the additional medical opinion medical examiner's report is presented within thirty days as provided in this Section:

(1) The examiner shall be protected from subpoena except for a single trial deposition. However, upon a proper motion for cause, the workers' compensation judge may order further discovery of the additional medical opinion by a medical examiner as deemed appropriate.

(2) Except to schedule the deposition or further discovery as described above, the office of the additional medical opinion medical examiner shall not be contacted regarding the claimant by any party, attorney, or agent.

F. Objections to the additional medical opinion regarding a medical examination shall be made on form LDOL-WC-1008, and shall be set for hearing before a workers' compensation judge within thirty days of receipt. No mediation shall be scheduled on disputes arising under this Section.

Acts 1995, No. 328, §1, eff. June 16, 1995; Acts 1997, No. 88, §1, eff. June 11, 1997; Acts 2012, No. 235, §1; Acts 2017, No. 381, §2, eff. June 23, 2017. 

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