What is Workers’ Compensation IME and SMO?
Workers’ Compensation is a state-mandated insurance program that provides benefits to employees who suffer work-related injuries or illnesses. It is designed to provide medical care, wage replacement, and rehabilitation to injured workers. Independent medical exams (IME) and second medical opinions (SMO) are often part of the evaluation process for orthopedic worker’s compensation injuries.
Dr. Jeremy Burnham is a board-certified orthopedic surgeon with an active clinical practice and extensive expertise, reflected in over 50 peer-reviewed publications and book chapters. He provides orthopedic Independent Medical Evaluations (IME) and Second Medical Opinions (SMO) across Louisiana, serving the Baton Rouge, Lafayette, Hammond, New Orleans, and Alexandria regions.
Specializing in knee, shoulder, hip, ankle, and elbow workplace injuries, Dr. Burnham delivers thorough, unbiased, and comprehensive evaluations, complete with detailed, notated references to support his assessments.
To schedule an orthopaedic independent medical examination or second medical opinion with Dr. Burnham, call 504-826-3166 or contact us online.
Workers’ Compensation is typically funded by employers and is mandatory in the state of Louisiana for companies that have more than one employee and a payroll of $3,000 or more annually. Exceptions in Louisiana include:
Domestic employees
Undocumented aliens
Licensed real estate agents
Directors of Not for profits
Mining crews
Certain airline crews
Certain common carriers on the interstate or railroads
Workers Compensation aims to ensure that injured workers receive necessary medical treatment and support to return to work.
Types of Work-Related Orthopedic Injuries
Orthopedic injuries are common in workers’ compensation cases. These injuries can include sprains (muscle, ligament, tendon), strains, and fractures (bone injuries). Repetitive motion injuries, such as carpal tunnel syndrome and rotator cuff tendonitis, are also common. Some orthopedic work comp injuries are from work-related accidents, such as falls and motor vehicle accidents, can also result in orthopedic injuries. Various parts of the body can be affected, including the back, neck, shoulders, hip, muscles, ankle, knees, spine, and hands. A large number of knee and shoulder injuries are reported. The treatment for these injuries is variable, ranging from rest and physical therapy to surgery or other medical interventions.
Medical Evaluations in Workers’ Compensation
The Role of Orthopedic Surgeons
Considering that most work comp injuries are musculoskeletal in nature, orthopedists (specially trained in work place injuries and orthopedic surgery) play a crucial role in evaluating and treating work-related orthopedic injuries. They can provide medical guidance on the extent of a work related injury and the necessary treatment. An orthopedic surgeon can also provide guidance on return-to-work issues and any necessary accommodations. In some cases, an orthopedic surgeon may be required to provide second medical opinions (SMOs) or independent medical examinations (IMEs) to resolve disputes about workplace injuries.
The Independent Medical Examination (IME) and Second Medical Opinion (SMO) Process
An IME or SMO is an evaluation performed by a medical professional (usually a physician) who is not treating the injured worker. The treating physician cannon perform and IME or SMO. The purpose of an IME or SMO is to provide an objective opinion on the extent of an injury, degree of disability, and the necessary treatment. Often, SMOs or IMEs are used to resolve disputes between the injured worker and the insurance carrier. IMEs and SMOs can be ordered by nurse case managers, claims processors, attorneys, and others.
Filing a Workers’ Compensation Claim
If you are injured on the job, you should report the incident to your employer immediately. Your employer will provide you with a claim form to complete and submit to the workers’ compensation insurance carrier. You will then be directed to seek further medical attention from an authorized healthcare provider. The insurance carrier will review your claim and determine whether you are eligible for benefits. Approved claims can be eligible for benefits, including medical care and wage replacement.
What to Expect During an IME
The IME process typically involves a physical examination, review of medical records, and a written report. During an IME, you can expect to be asked questions about your medical history and the circumstances of your injury. The examining physician will also perform a physical examination to assess the extent of your injury, and this is usually focused on the musculoskeletal system. You may be asked to provide medical records and other documentation to support your claim. The IME or SMO process is typically brief, lasting around 30 minutes to an hour.
Records will be reviewed, including all relevant paperwork and previous treating physicians. A report will then be completed that includes the findings and comments on the diagnosis, if the diagnosis is a direct result of the work place injury, when did the injury occur, any previous related injury for the patient, and more. This applies for surgical and nonsurgical patients. The examining doctor may not actually treat the examinee, but can make recommendations for treatments or skilled services.
Challenging an IME Report
If you disagree with the findings of an IME report, you can challenge it in a timely manner. You should review the report carefully and identify any errors or inconsistencies. You can also request additional medical evaluations or seek a second opinion. In some cases, you may need to appeal the decision.
Returning to Work After an Injury
Returning to work after an injury can be challenging, but it is an important part of the recovery process. Your healthcare provider or physician can provide guidance on when it is safe to return to work and any necessary accommodations. You should also communicate with your employer to ensure a smooth transition back to work. In some cases, you may need to modify your job duties or take regular breaks to avoid exacerbating your injury, based on your ability, site of injury, and your comfort level performing those duties.
Workers’ Compensation Benefits for Orthopedic Injuries
Workers’ compensation benefits for orthopedic injuries can include medical care, wage replacement, and rehabilitation. Medical care may include surgery, physical therapy, and pain management. Wage replacement benefits can help you maintain your income while you are unable to work. Rehabilitation and physical therapy benefits can help you return to work and regain your functional abilities, for surgical or non surgical patients.
Common Mistakes to Avoid in Workers’ Compensation Claims
Failing to report the injury promptly (or did not contact the appropriate representative)
Not seeking medical attention from an authorized healthcare provider after the incident
Not completing the claim form accurately
Not communicating with the insurance carrier
Not following the treatment plan
Taking bad advice
Conclusion
Workers’ compensation claims can be complex and challenging, but understanding the process can help.
Effective communication regarding patient recommendations, challenges the patient may be dealing with, paperwork requirements, services needed, pain, and any recommended surgery by the doctor is key
Orthopedic injuries are common in workers’ compensation cases, and seeking medical attention from an authorized healthcare provider for evaluation is essential (diagnose accurately)
Independent medical examinations can provide an objective opinion on the extent of an injury and the necessary treatment.
Returning to work after an injury requires careful planning and communication with your employer.
By avoiding common mistakes and seeking guidance from a qualified healthcare provider, you can ensure a successful outcome in your workers’ compensation claim.