What to Expect

Medical Examinations

If you sustain a NEW INJURY at work, you should do the following:

1. Notify your supervisor and submit a written incident report as soon as possible. If your employer does not issue a report form, or has not provided one to you, write down a description of your injury, copy it, and provide it to your boss and doctor.
2. Obtain medical treatment as soon as possible, and provide an accurate description of the injury to your doctor.
3. Contact your lawyer if you have one.

Workers’ Compensation Law allows for the BWC (or the employer) to conduct Independent Medical Examinations on injured workers regarding various issues involving a claim. There are several examples of this. One of the most common examples would include whether the accident would actually cause the injuries as described, (which is the issue of the initial allowance of the claim itself). Quite commonly, an employer may have questions as to whether an incident as described in the claim application could give rise to the injuries that have been diagnosed by your doctor. Questions about the work activity giving rise to the injury are also common. For example, if a person is alleging carpal tunnel syndrome because of repetitive hand and wrist use on the line at a factory, the employer can question this, and whether the actual job itself would cause carpal tunnel syndrome to develop.

The medical exam process entails a doctor being hired to evaluate the injured worker, and review medical records on the injured worker that have been obtained in connection with the investigation of the claim.

Other issues include whether to amend the claim to include additional medical conditions. This is where a claim is initially allowed for a relatively minor injury such as a strain or sprain of a muscle, but medical information on hand indicates that there are other, more serious, or better descriptive conditions present in the claim. For example, one might have a low back sprain, but in reality suffers from a herniated disc at L5-S1, and this has not yet been allowed in the claim. Since Workers’ Compensation is a “condition sensitive” medical program, benefits are paid only for those conditions that are specifically allowed as approved medical conditions in the claim. In order for a medical condition to be allowed in the claim, it must be conclusively established that the condition does indeed exist, and it is directly and causally related to the work incident/injury as described. In a case such as this, a medical evaluation would provide insight and scientific information as to whether the claim should be amended for the condition requested.

An examination may also be conducted to determine whether treatment that has been requested is medically necessary, reasonable and appropriate for the allowed conditions in the claim. A medical exam may also address whether treatment is causally related to the allowed conditions in the claim, or cost- effective for the medical management of the worker’s medical situation. Thus if a doctor requests approval for surgery, or an expensive treatment regimen, the employer and/or the BWC has the right to have a medical examination by another doctor (second opinion) to determine whether the treatment is appropriate. When a doctor is not your own physician of record, or a consultation requested by them exams you, this is called an Independent Medical Evaluation (IME).

The BWC, and employer (both as legal parties to a Workers’ Compensation claim) have the right to have a worker examined on these issues. The costs of these evaluations are born by the party making the request. Thus if the BWC or employer requests an examination, they must pay for it, along with worker's lost wages incurred due to having taken off work because of the exam, and mileage and other travel expenses going to and from the evaluation (if it is over a certain distance).

If an examination is set up in your claim, the injured worker must be notified in writing of the date, time, and place of the evaluation, and this notification must be advanced reasonable notice. They can not give someone one day’s notice to attend the examination, and most of the time it ranges from over a week to several weeks in advance. Unfortunately, this does mean that activity in the claim can be put “on hold” at times due to this evaluation, This is the standard procedure in many Workers’ Compensation cases. The injured worker will receive written notification in the form of a letter, a copy of which is provided to the government’s claim file. The letter will provide instructions on where and when the examination is to take place, and what documents, or other information (if any) are to be brought to the evaluation. Some critics of this process suggest that it is simply (buying) evidence to be used later on at hearing or Court proceeding. These critics suggest that since the employer and/or BWC is “paying” for this evaluation, the doctor will be more inclined to provide an opinion that is consistent with the employer’s and/or the BWC’s interests. Of course, all employers, the BWC, and their legal representatives vehemently deny this, and so the battle of opinion rages on as to whether these medical examinations are truly unbiased and valid scientific evidence that can be used in a Workers’ Compensation claim setting, or Court proceeding.

On the day of the exam, you should try to arrive a few minutes early in order to complete any paperwork that the examiner may require of you. Be sure to bring your examination notice with you for confirmation of your attendance. With regard to an employer-sponsored examination, these will probably take place in a doctors office or clinic type setting at a location off-site from BWC property. In many cases the examining doctor may be from another city, who is “borrowing” another doctor’s office suite in order to perform the evaluation. Odds are you will be one of several people that are being evaluated by this individual doctor on that day. Please remember that this evaluation will be very brief, probably lasting only a few minutes. Critics of the process have consistently decried this, arguing that it indicates that the doctor’s mind has already been made up, and they are going to provide an opinion that is consistent with the employer’s interests. Others have suggested that the doctors that are hired for these type examinations are “true experts” in their field with many years of academic and clinical experience. As such they are “quite good at what they do”. Thus, they are so good, and so sharp, that they can get to the heart of a problem in a very brief period of time. Other defenders of the system argue that the examination is a mere culmination of a lengthy process wherein medical records are reviewed for hours, along with medical literature, and other research. Thus the evaluation itself would only compliment the previously-conducted process, and thus can be brief. Only the patient will be able to make that determination in assessing the quality and nature of the evaluation itself. But be prepared to undergo a very brief evaluation.

As to BWC evaluations, most of these are conducted in a medical examination room on the grounds of the Ohio Bureau of Workers’ Compensation. Each BWC service office is equipped with medical examination facilities that will allow for a doctor to come on-site and perform the evaluation. Usually a nurse or medical assistant will accompany the doctor and these evaluations are indeed as brief as the employer’s. There will be several other people waiting in line to have an evaluation like you, and the entire process will also take a matter of minutes. The same criticisms that have been lodged at the employer’s examination process have been directed at the BWC’s as well. Strangely enough, the employer and BWC appear to be using the same group of doctors in making evaluations. It is a rarity that the BWC’s medical examiner will be a practitioner with a active practice and huge case load. This too has drawn the ire of critics of the system, stating that this lack of clinical expertise results in unnecessary hearings, and unfair denials of Workers’ Compensation benefits.

The Industrial Commission of Ohio also conducts medical evaluations in certain situations as well. These are usually with regard to applications for Permanent and Total Disability Compensation, but can also be for other issues similar to the ones noted above. These type of examinations, however, are rare. With regard to Permanent Total evaluations, these are conducted at the Industrial Commission’s hearing facility. Each Industrial Commission hearing office also has facilities for medical evaluations like the BWC. If you receive notification from the Industrial Commission that you are required to attend an evaluation, please consult your attorney or Union Representative as soon as possible. These evaluations, like the others, are very brief and have been subject to the same criticisms as other exams noted above by various interest groups involved with Workers’ Compensation.

What you should do...