Complex orthopedic injuries in Louisiana workers’ compensation, disability, and litigation systems need clear answers. Burnham Orthopedics & Sports Medicine, LLC provides independent medical examinations (IME), second medical opinions (SMO), and qualified medical evaluations backed by peer-reviewed research and clinical rigor. Every evaluation answers the specific medical questions the case demands, with reasoning that stands up to cross-examination and scrutiny.
Whether reviewing a knee injury claim, evaluating a proposed surgical approach, or assessing causation in a shoulder case, an orthopedic IME or SMO goes beyond routine procedure. It delivers a detailed clinical narrative built to withstand deposition, cross-examination, and trial.
In This Article
What Is an Orthopedic IME or SMO?
An independent medical examination (IME) is a clinical assessment by a physician with no prior treatment relationship to the patient. A second medical opinion (SMO) addresses a different need: it provides an independent clinical view when diagnosis, treatment recommendations, or prognosis are disputed. Both deliver objective third-party analysis on causation, treatment reasonableness, permanent impairment, and future medical needs.
In workers’ compensation, an orthopedic IME or SMO addresses specific questions: Did the work injury cause this condition? Was the recommended surgery appropriate? Has the patient reached maximum medical improvement? What permanent impairment, if any, resulted from the injury? For more on how these fit into Louisiana’s system, see the guide to the orthopedic IME and SMO process. In some states, a qualified medical examiner (QME) performs these evaluations and must meet specific credentialing requirements.
In disability and litigation cases, an IME or qualified medical opinion (QMO) evaluates functional capacity, prognosis, and whether future care is causally related to the incident. The common goal: a reasoned, defensible medical opinion that holds up to scrutiny.
Qualifications & Credentials
Dr. Burnham’s IME reports, second medical opinions, and qualified medical evaluations rest on a combination of clinical practice, peer-reviewed research, and regulatory knowledge. This depth ensures conclusions are not just clinically sound but also defensible under cross-examination.
Board Certification & Clinical Training: Dr. Jeremy Burnham is board-certified by the American Board of Orthopedic Surgery with fellowship training in sports medicine from a top-tier program. He maintains a full-time clinical practice treating both acute and chronic orthopedic conditions, with special focus on knee injuries (ACL reconstruction, meniscus treatment, complex multiligament injuries), shoulder injuries, and hip pathology. At Ochsner Health, he holds leadership roles including System Vice Chair of the Musculoskeletal Service Line and Regional Department Head of Orthopedic Surgery. He also holds faculty appointments and regularly consults on complex cases in sports medicine and general orthopedics. This active clinical and administrative role means his IME and SMO opinions come from a surgeon treating these injuries every day, not reviewing them from a distance.
Research & Publication Credibility: Dr. Burnham has authored or co-authored more than 50 peer-reviewed publications in journals including the American Journal of Sports Medicine, Arthroscopy, Journal of Bone and Joint Surgery, and Knee Surgery, Sports Traumatology, Arthroscopy. Most of this research centers on the knee: ACL biomechanics and reconstruction techniques, rotatory laxity assessment, meniscus pathology, multiligament injuries, patellar instability, knee arthritis, and return-to-sport outcomes. This means his IME and SMO opinions on knee injuries draw from research he personally conducted and published, not just review of others’ work. His publication record also covers shoulder and hip injuries, including massive rotator cuff tear management (Hughes, Burnham, et al., KSSTA, 2023), MRI evaluation of NFL shoulder injuries (Arthroscopy, 2018), and outcomes after hip arthroscopy (Shin, Burnham, et al., Journal of Hip Preservation Surgery, 2018). When evidence appears in an IME or SMO report, it reflects genuine scholarly engagement with that literature—a point attorneys, judges, and juries can verify through the published record.
Clinical Trial Leadership: Dr. Burnham serves as an investigator on multiple NIH and Department of Defense clinical trials examining outcomes in knee injuries and return-to-sport protocols. This regulatory involvement reflects deep understanding of how the medical community evaluates safety, efficacy, and long-term outcomes in ways that align with judicial and workers’ compensation standards.
IME, SMO & Work Comp Experience: Dr. Burnham has performed independent medical examinations and second medical opinions for attorneys, self-insured employers, and workers’ compensation insurance carriers. He understands the medical and legal issues in causation disputes, permanent impairment rating, and occupational rehabilitation. His experience as a qualified medical examiner spans a range of orthopedic conditions. He has presented at national forums on work-related orthopedic injuries and the medicolegal framework surrounding workers’ compensation claims.
What to Expect: The IME Process
Requesting an IME, second medical opinion, or qualified medical evaluation follows a structured approach built for thorough clinical assessment without unnecessary delay. Here’s what happens from start to report delivery.
Pre-Examination Preparation: Before the patient arrives, all medical records, imaging studies, treatment notes, diagnostic test results, and relevant legal or claims documents are reviewed. This step ensures the examination stays focused and efficient, and flags any gaps in the medical record that need to be addressed during the visit.
Patient History & Interview: The examination opens with a thorough history of the injury or condition, how it happened, what treatments were tried, and current functional limitations. Questions cover work demands, recovery expectations, and the patient’s perspective on cause and outlook. This narrative becomes the clinical foundation of the opinion.
Physical Examination: A full orthopedic examination includes range of motion, strength testing, special maneuvers specific to the body part involved, and assessment of functional limitations. For knee injuries, this includes ACL testing (Lachman, anterior drawer, pivot shift), meniscus testing (McMurray, Thessaly), and ligament stability assessment. Findings are recorded objectively and compared to published normative data.
Diagnostic Interpretation: All imaging (X-rays, MRI, CT) is reviewed alongside clinical findings. An MRI abnormality alone doesn’t determine causation or treatment necessity. The task is to align imaging with clinical presentation and mechanism of injury, then judge whether the findings fit the reported work injury or point to other factors.
Treatment Reasonableness Assessment: When surgery or advanced treatment was recommended or performed, the evaluation determines whether the approach is reasonable and supported by current evidence. This requires honest appraisal: sometimes recommended surgery fits the clinical picture, sometimes conservative care would have been equally reasonable or better. The opinion follows the evidence.
Report Delivery: Reports are typically completed and delivered within 2 to 4 weeks of the examination, based on case complexity and volume of records to review.
Case Types We Handle
The IME and SMO practice addresses the full range of acute and chronic orthopedic conditions in workers’ compensation, occupational health, and personal injury litigation. Whether the need is an independent medical examination, second medical opinion, additional medical opinion (AMO), or qualified medical evaluation, specific areas include:
Knee Injuries: ACL tears, meniscus tears and repairs, PCL and collateral ligament injuries, multiligament injuries, knee osteoarthritis (causation and progression), and post-surgical complications. The research and clinical background in ACL outcomes allows detailed analysis of operative versus conservative approaches and prognosis for functional recovery.
Shoulder Injuries: Rotator cuff tears, labral injuries, acromioclavicular (AC) joint injuries, instability, and post-operative outcomes. Causation assessment in overhead workers and evaluation of surgical necessity are examined with clinical rigor.
Other Orthopedic Injuries: Ankle sprains and fractures, wrist and hand injuries, hip injuries, spine-adjacent musculoskeletal conditions (when orthopedic input is appropriate), and complex polytrauma affecting multiple joints.
Functional Capacity Evaluation: When a formal functional capacity evaluation (FCE) is needed, the practice partners with trusted community rehabilitation specialists who conduct objective, standardized FCE testing. These findings integrate with clinical examination and imaging review to provide a complete picture of work capacity relative to the injury.
Causation Disputes: When a pre-existing condition is claimed to have been aggravated by a work injury, or when the connection between the incident and symptoms is contested, a detailed clinical analysis links mechanism, injury pattern, and recovery trajectory to the alleged cause. These cases often benefit from a second medical opinion (SMO) or qualified medical opinion (QMO) to clarify competing accounts.
Examination & Report Methodology
Every IME report, second medical opinion, and qualified medical evaluation follows a structured, defensible methodology aligned with accepted medical and legal standards. For more on what makes an evaluation hold up in court, see the overview of key factors in orthopedic IME evaluations.
Evidence-Based Analysis: Opinions rest on peer-reviewed literature, clinical guidelines (AAOS, AOSSM), and published research where relevant. Treatment reasonableness assessments cite Louisiana Title 40 workers’ compensation medical treatment guidelines and the Official Disability Guidelines (ODG). When studies are referenced, their relevance to the specific case is explained and limitations of the evidence are acknowledged. Vague appeals to “common sense” or unsupported claims are excluded.
Disability and Impairment Ratings: Permanent impairment ratings use the AMA Guides to the Evaluation of Permanent Impairment, 5th and 6th Editions, as required by the applicable jurisdiction. Objective functional deficits (range of motion loss, strength deficits, imaging findings, special test results) are documented and the correct rating methodology is applied. Reports include a clear explanation of how clinical findings translate to the impairment percentage, so attorneys, judges, and adjusters can follow the logic without medical training.
Objective Findings Over Subjective Impression: Reports emphasize measurable clinical findings (strength, range of motion, special test results, imaging correlation) rather than subjective impression. When subjective elements matter to the clinical picture, they are noted and tied to objective findings.
Consideration of Confounding Factors: A complete IME acknowledges potential confounders: pre-existing conditions, prior injuries, psychological factors, litigation incentives, and recovery patterns that may differ from typical cases. Addressing these openly strengthens rather than weakens credibility.
Clear Reasoning Chain: The report takes the reader through the logic: here is the mechanism, here is what the examination showed, here is what the medical literature says about this pattern, therefore here is the conclusion. A judge or jury should follow the reasoning without medical training.
Specific Rather Than Vague Conclusions: Instead of “likely permanent impairment,” the report names the specific functional limitation and supporting evidence. Instead of “probably not related,” the report explains why the clinical pattern doesn’t fit the alleged mechanism.
Report Turnaround & Peer Review
Standard Turnaround Time: Most IME and SMO reports are completed and delivered within 2 to 4 weeks of the examination. Complex cases with extensive imaging, multiple prior surgeries, or large medical record volumes may need more time. Expedited turnaround is available for urgent matters when the schedule allows.
Report Length & Detail: Reports typically run 8-15 pages depending on complexity. A simple meniscus tear takes fewer pages than a multiligament injury or a causation dispute with multiple prior injuries. Length reflects clinical need, not padding.
Peer Review Standards: All reports are peer-reviewed for clarity, accuracy, and defensibility before delivery. Conclusions are verified as well-supported, clinical reasoning is transparent, and potential cross-examination challenges are anticipated and addressed.
Deposition & Trial Availability: Deposition and trial testimony are available. Board certification, extensive published research, and clinical trial involvement provide strong credentialing for expert witness work. Opinions are formed independently and presented as stated, never tailored to match retaining counsel’s preferences.
Frequently Asked Questions
How long does an IME or SMO examination typically take?
A standard orthopedic IME or second medical opinion examination typically lasts 45 minutes to 90 minutes depending on complexity. Simple acute injuries may take 45 minutes. Complex cases with multiple prior surgeries, imaging to review, or functional capacity assessment components may need the full 90 minutes. Time depends on clinical thoroughness, not arbitrary limits.
Can I request an IME or second medical opinion on a case where I disagree with the treating physician?
Yes. That’s a main reason for requesting an IME or SMO. If a treating physician recommends surgery that seems excessive, or denies work-relatedness when it appears valid, an independent evaluation can clarify the medical issues. The opinion is formed objectively based on clinical presentation and evidence, not swayed by the treating provider’s position. Support for the treating physician is given when evidence warrants it, and disagreement follows when the clinical picture doesn’t align.
What if the IME concludes the patient should have undergone surgery, but the treating physician did not recommend it?
This is exactly why IMEs matter. The clinical presentation is assessed against current evidence and professional standards. If the patient has a structural injury that conservative care has failed to resolve, and peer-reviewed literature supports surgical intervention, the report will state that assessment. Conversely, if surgery was recommended but clinical findings don’t support it, or if conservative care remains a reasonable first step, that conclusion is documented. The IME’s role is to provide an objective assessment, not to align with either the treating provider or the retaining party’s preferred conclusion.
How do you assess permanent impairment and functional limitations?
Permanent impairment ratings use the AMA Guides to the Evaluation of Permanent Impairment, 5th and 6th Editions, based on jurisdiction and state regulations. Objective functional deficits (range of motion loss, strength deficits, special test abnormalities, imaging findings) are documented and the correct rating methodology is applied. Treatment reasonableness assessments reference Louisiana Title 40 workers’ compensation medical treatment guidelines and the Official Disability Guidelines (ODG). Reports explain how clinical findings translate to impairment ratings and how limitations affect work and activity capacity in practical terms.
What guidelines do you use for impairment ratings and treatment recommendations?
Impairment ratings use the AMA Guides to the Evaluation of Permanent Impairment, 5th and 6th Editions, as required by the applicable jurisdiction. Treatment reasonableness and medical necessity assessments reference Louisiana Title 40 workers’ compensation medical treatment guidelines and the Official Disability Guidelines (ODG) where applicable. Using recognized, standardized guidelines ensures consistent, reproducible, defensible opinions across legal and administrative settings.
The Bottom Line: An orthopedic independent medical examination or second medical opinion is not a formality. It is a detailed clinical analysis that answers the specific medical questions the case demands. When conducted by a board-certified, fellowship-trained orthopedic surgeon with extensive published research and clinical trial experience, the resulting qualified medical opinion carries both clinical weight and legal credibility. Whether challenging an inflated claim, seeking a second opinion on a treatment plan, or building a strong causation narrative, a rigorous, evidence-based evaluation provides the foundation needed.
Request an IME or Second Medical Opinion
To schedule an independent medical examination, second medical opinion (SMO), peer review, or expert consultation, contact Burnham Orthopedics & Sports Medicine, LLC directly.
About Dr. Jeremy Burnham
Dr. Jeremy Burnham is a board-certified orthopedic surgeon and sports medicine specialist at Ochsner-Andrews Sports Medicine Institute in Baton Rouge, Louisiana. He earned his medical degree from Louisiana State University Health Sciences Center in Shreveport, completed his orthopaedic surgery residency at the University of Kentucky, and his sports medicine fellowship at the University of Pittsburgh Medical Center. He has authored over 50 peer-reviewed publications in journals including the American Journal of Sports Medicine, Arthroscopy, and the Journal of Bone and Joint Surgery. Dr. Burnham founded Burnham Orthopedics & Sports Medicine, LLC to provide independent medical examinations (IME), second medical opinions (SMO), qualified medical evaluations (QME), and expert consulting services to attorneys, self-insured employers, and workers’ compensation carriers. He serves as Clinical Faculty at the University of Queensland-Ochsner Medical School and lectures nationally on orthopedic surgery and sports medicine topics. His IME and SMO reports are grounded in peer-reviewed evidence, clinical rigor, and transparent reasoning built to withstand expert scrutiny.
References
- American Medical Association. Guides to the Evaluation of Permanent Impairment, 5th Edition (2000) and 6th Edition (2008). AMA Press.
- Louisiana Revised Statutes, Title 40: Public Health and Safety. Workers’ Compensation Medical Treatment Guidelines.
- Official Disability Guidelines (ODG). Work Loss Data Institute. Evidence-based treatment and return-to-work guidelines.
- Hughes JD, Burnham JM, et al. Nonarthroplasty options for massive rotator cuff tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2023.
- Burnham JM. Editorial commentary: MRI evaluation of shoulder injuries in NFL athletes. Arthroscopy. 2018.
- Shin JJ, Burnham JM, et al. Refractory pain after hip arthroscopy. Journal of Hip Preservation Surgery. 2018.
- Burnham JM, et al. Anatomic tunnel placement and rotatory laxity in anterior cruciate ligament reconstruction. Annals of Joint. 2017.