Orthopaedic Surgery IME & Workers’ Compensation Richard J. Friedman, MD Charleston Orthopaedic Associates

Disability Alteration of an individual’s ability to meet occupational, personal or social demands because of an impairment.

Impairment A deviation from normal in a body part or organ system and its functioning.

WC Evaluation Performed to assist in the evaluation of work-related injuries Evaluation of permanent physical impairment is the sole responsibility of the physician Need cooperation and input of nurses and case managers

WC Evaluation Orthopaedic surgeons very involved No training Conflict of interest Secondary gain Poor system with little incentive for the patient to get better

WC Physician must act without bias or preconceived views Must treat patient with respect, dignity and in a friendly manner.

Change in Physician’s Role PATIENT HISTORY PX EXAM TESTS PHYSICIAN

Change in Physician’s Role PATIENT LAWYER PHYSICIAN EMPLOYER ADMINISTRATOR/ADJUDICATOR DISABILITY RATING

Similarities Gather patient’s history Perform physical examination Order appropriate lab tests Assimilate the information Report the information obtained Act ethically

Differences Goals Treatment recommendations Work history Rating system requirements End results

Differences Peripheral issues Reliance on non-medical personnel Specific issues addressed Causation Legal responsibilities Referral sources

Understanding the Needs of the Referral Source What critical questions must the medical consultant ask of the referral source? What are the issues of this case? What is the purpose of the evaluation? What are you asking me to do? What questions do you want me to answer?

Contents of the Report Results of the clinical evaluation History of the medical condition Findings of physical examination Findings from laboratory tests and diagnostic procedures - x-rays, MRI Clinical impression

Contents of the Report Medical management plan Recommendations for further diagnostic tests Active treatment plan Rehabilitation Follow-up evaluation Return to work

Shoulder Injuries Muscle strain Tendinitis AC separation Dislocation Subluxation Impingement / rotator cuff SLAP tear Fracture

Knee Injuries Ligament sprain Muscle strain Tendinitis Torn meniscus Osteochondral injury Fracture Dislocation

Questions? Confusion? Thank You.