What to Expect From An Independent Medical Examination 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 Independent Medical Examinations in Louisiana Workers Compensation

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 a question regarding the Foot and Ankle Disability Index (FADI).

The Independent Medical Examiner may send the questionnaire to the 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 in Independent Medical Examinations in Louisiana Workers Compensation

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 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 Independent Medical Examination Itself in Louisiana Workers Compensation

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 in Louisiana Workers Compensation

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

In fact, depending on the number 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

The Louisiana Statutes 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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