Types of Independent Medical Examinations in Louisiana Workers Compensation

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Two Main 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 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 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.

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.

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