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

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

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

5. 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

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

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

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

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

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

12. Differences Goals Treatment recommendations Work history
Rating system requirements
End results

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

14. 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?

15. 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

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

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

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

20. Questions?
Confusion?
Thank You.