When complex orthopedic injuries land in the workers’ compensation, disability, or litigation system, clarity matters. With expertise spanning clinical practice, peer-reviewed research, and regulatory knowledge, Burnham Orthopedics & Sports Medicine, LLC provides independent medical examinations (IME), second medical opinions (SMO), and qualified medical evaluations grounded in peer-reviewed evidence and clinical rigor. This foundation ensures that every evaluation answers the specific medical questions at stake in the case, with defensible reasoning that can withstand cross-examination and scrutiny.
Whether evaluating a knee injury claim, requesting a second medical opinion on a recommended surgical approach, or needing a qualified medical examiner (QME) to assess causation in a shoulder case, an orthopedic IME or SMO is more than a procedural examination. It is a detailed clinical narrative designed to stand up to cross-examination, deposition, and trial.
In This Article
What Is an Orthopedic IME or SMO?
An independent medical examination (IME) is a clinical assessment performed by a physician with no prior treatment relationship to the patient. A second medical opinion (SMO) serves a related but distinct purpose: it provides an independent clinical perspective when there is disagreement about diagnosis, treatment recommendations, or prognosis. Both IMEs and SMOs deliver objective, third-party analysis of causation, reasonableness of treatment, permanent impairment, and future medical needs.
In the workers’ compensation system, an orthopedic IME or SMO answers specific questions: Did the work injury cause this condition? Was the recommended surgery reasonable? Has the patient reached maximum medical improvement? What permanent impairment, if any, results from the injury? For a deeper look at how these evaluations fit into Louisiana’s workers’ compensation framework, see our guide to the orthopedic IME and SMO process. In some jurisdictions, these evaluations are performed by a qualified medical examiner (QME) who meets specific state credentialing requirements.
In disability and litigation contexts, an IME or qualified medical opinion (QMO) evaluates functional capacity, prognosis, and whether future care is causally related to the incident in question. The goal is always the same: a well-reasoned, defensible medical opinion that survives scrutiny.
Qualifications & Credentials
Experience in orthopedic medicine spanning clinical practice, peer-reviewed research, and regulatory expertise forms the foundation for every IME report, second medical opinion, and qualified medical evaluation delivered. This depth ensures that conclusions are not only 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 and fellowship-trained in sports medicine at a top-tier program. He maintains a full-time clinical practice encompassing both acute and chronic orthopedic conditions, with particular expertise in knee injuries (ACL reconstruction, meniscus treatment, complex multiligament injuries), shoulder injuries, and hip pathology. Within Ochsner Health, he holds leadership positions across the musculoskeletal and orthopedic service lines, 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 across sports medicine and general orthopedics. This active clinical and administrative role means IME and SMO opinions reflect the perspective of a surgeon treating these injuries every day, not someone reviewing them from a distance.
Research & Publication Credibility: Dr. Burnham has authored or co-authored over 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. The majority of this research focuses 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 depth means IME and SMO opinions on knee injuries are informed by research personally conducted and published, not solely by reviewing other authors’ work. The publication record also extends to shoulder and hip injuries, including work on 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 is cited in an IME or SMO report, it reflects firsthand scholarly engagement with that literature, and attorneys, judges, and juries can verify that engagement through the published record.
Clinical Trial Leadership: Dr. Burnham serves as an investigator on multiple clinical trials sponsored by the NIH and Department of Defense, examining outcomes in knee injuries and return-to-sport protocols. This regulatory involvement means a 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 specific medical and legal issues that arise in causation disputes, permanent impairment rating, and occupational rehabilitation. Experience as a qualified medical examiner includes delivering qualified medical opinions across a range of orthopedic conditions. He has presented extensively on work-related orthopedic injuries and the medicolegal framework surrounding workers’ compensation claims.
What to Expect: The IME Process
Whether requesting an IME, a second medical opinion (SMO), or a qualified medical evaluation, the process follows a structured, standardized approach designed to provide a comprehensive clinical assessment in a time-efficient manner. Here is what the process looks like from intake to report delivery.
Pre-Examination Preparation: Before the patient arrives, all available medical records, imaging studies, prior treatment notes, diagnostic test results, and any relevant legal or claims documentation are reviewed. This preparation ensures the examination is focused and efficient, and allows identification of any gaps in the medical record that should be addressed during the encounter.
Patient History & Interview: The examination begins with a detailed history of the injury or condition, mechanism, treatment timeline, and current functional status. Questions address work demands, recovery expectations, and the patient’s own assessment of causation and prognosis. This narrative forms the clinical foundation of the opinion.
Physical Examination: A comprehensive orthopedic examination includes range of motion, strength testing, special provocative maneuvers specific to the body region 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 documented objectively and compared to published normative data.
Diagnostic Interpretation: All imaging (X-rays, MRI, CT) is reviewed in the context of clinical findings. An MRI abnormality alone does not determine causation or treatment necessity. The role is to correlate imaging with clinical presentation and mechanism of injury, then assess whether the findings are consistent with the alleged work injury or other contributing factors.
Treatment Reasonableness Assessment: If surgery or advanced treatment was recommended or performed, the evaluation assesses whether the approach is reasonable and supported by current clinical evidence. This requires honest assessment: sometimes recommended surgery is appropriate, sometimes conservative care would have been equally reasonable or superior. The opinion follows the evidence, not the treating physician’s choice.
Turnaround & Report Delivery: Reports are typically completed and delivered within 2 to 4 weeks of the examination date, depending on case complexity and volume of records to review.
Case Types We Handle
The IME and SMO practice focuses on the full spectrum of acute and chronic orthopedic conditions encountered in workers’ compensation, occupational health, and personal injury litigation. Whether the request is for an independent medical examination, a second medical opinion, an additional medical opinion (AMO), or a qualified medical evaluation (QME), specific areas of expertise include:
Knee Injuries: ACL tears, meniscus tears/repairs, PCL and collateral ligament injuries, multiligament injuries, knee osteoarthritis (causation and progression), and post-surgical complications. Given the research and clinical focus on ACL outcomes, evaluations bring particular depth to knee cases, including assessment of operative versus conservative management and prognosis for return to function.
Shoulder Injuries: Rotator cuff tears, labral injuries, acromioclavicular (AC) joint injuries, instability, and post-operative outcomes. Causation assessment in overhead workers and reasonableness of surgical intervention are evaluated with clinical precision.
Other Orthopedic Injuries: Ankle sprains and fractures, wrist and hand injuries, hip injuries, spine-adjacent musculoskeletal conditions (when orthopedic consultation is indicated), and complex polytrauma involving multiple joint systems.
Functional Capacity Evaluation: When a formal functional capacity evaluation (FCE) is needed, the practice partners with trusted community rehabilitation providers who specialize in objective, standardized FCE testing. These findings are integrated with clinical examination and imaging review to provide a comprehensive assessment of work capacity relative to the injury.
Causation Disputes: When a pre-existing condition is claimed to be aggravated by a work injury, or when the relationship between the incident and symptoms is contested, a detailed clinical analysis links mechanism, injury pattern, and functional recovery to the alleged causative event. These cases often benefit from a second medical opinion (SMO) or qualified medical opinion (QMO) to clarify the competing narratives.
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 detail on what makes an evaluation defensible, see our overview of the key factors in orthopedic IME evaluations.
Evidence-Based Analysis: Opinions are grounded in peer-reviewed literature, clinical guidelines (AAOS, AOSSM), and published research where applicable. Treatment reasonableness assessments reference Louisiana Title 40 workers’ compensation medical treatment guidelines and the Official Disability Guidelines (ODG). When citing studies, the relevance to the specific case is explained and limitations of the evidence base are acknowledged. Vague appeals to “common knowledge” or unsupported assertions are avoided.
Disability and Impairment Ratings: Permanent impairment ratings are performed using 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 appropriate rating methodology is applied to assign an impairment percentage. Reports include a clear narrative explaining how clinical findings translate to the impairment rating, so attorneys, judges, and adjusters can follow the reasoning without medical expertise.
Objective Findings Over Subjective Impression: Reports prioritize measurable clinical findings (strength, range of motion, special test results, imaging correlation) over subjective impression. When subjective elements are part of the clinical picture, they are identified as such and correlated with objective findings.
Consideration of Confounding Factors: A comprehensive IME acknowledges potential confounders: pre-existing conditions, non-occupational injury history, psychological factors, litigation incentives, and recovery patterns that may diverge from typical cases. This credibility enhances rather than detracts from the opinion.
Clear Reasoning Chain: The report walks the reader through the logic: here is the mechanism, here is what was observed, here is what the medical literature says about this presentation, therefore this is the conclusion. A judge or jury should be able to follow the reasoning without medical expertise.
Specific Rather Than Vague Conclusions: Instead of “likely permanent impairment,” the report states the specific functional limitation and the evidence supporting it. Instead of “probably not related,” the report explains why the clinical pattern does not 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 date. Complex cases with extensive imaging, multiple prior surgeries, or large volumes of medical records may require additional time. Expedited turnaround is available for urgent matters when scheduling permits.
Report Length & Detail: Reports typically range from 8-15 pages, depending on case complexity. A straightforward meniscus tear may require fewer pages than a multiligament injury or a causation dispute involving multiple prior injuries. Length is determined by clinical necessity, not padding.
Peer Review Standards: All reports are peer-reviewed for clarity, accuracy, and defensibility before delivery. Conclusions are verified to be well-supported, clinical reasoning is transparent, and potential cross-examination challenges are anticipated and addressed proactively.
Deposition & Trial Availability: Availability for deposition and trial testimony is provided. An extensive publication record, board certification, and clinical trial involvement provide strong credentialing for expert witness proceedings. Opinions are formed independently and stand as stated, never fabricated for retaining counsel preference.
Frequently Asked Questions
How long does an IME or SMO examination typically take?
A standard orthopedic IME or second medical opinion (SMO) examination typically takes 45 minutes to 90 minutes, depending on case complexity. Simple acute injuries may be assessed in 45 minutes. Complex cases with multiple prior surgeries, imaging to review, or functional capacity assessment components may require the full 90 minutes. The length is driven by clinical thoroughness, not arbitrary time constraints.
Can I request an IME or second medical opinion on a case where I disagree with the treating physician?
Yes, that is a primary reason for requesting an IME or SMO. If a treating physician recommends surgery that appears excessive, or denies a work-relatedness claim that seems valid, an independent evaluation or second medical opinion can clarify the medical issues. The opinion is formed objectively based on the clinical presentation and evidence, not influenced by the treating provider’s stance. Support for the treating physician’s opinion is provided when the evidence warrants it, and disagreement follows when the clinical picture does not align.
What if the IME concludes the patient should have undergone surgery, but the treating physician did not recommend it?
This situation highlights why IMEs are valuable. The clinical presentation is evaluated against current evidence and professional standards. If the patient has a structural injury that conservative care has failed to address, and peer-reviewed literature supports surgical intervention, the report will reflect that assessment. Conversely, if surgery was recommended but the clinical findings do not support it, or if conservative care remains a reasonable first-line approach, that conclusion is stated. The role of the IME is to provide an objective assessment, not to rubber-stamp either the treating provider or the retaining party’s preferred narrative.
How do you assess permanent impairment and functional limitations?
Permanent impairment ratings are performed using the AMA Guides to the Evaluation of Permanent Impairment, both the 5th and 6th Editions, depending on the jurisdiction and applicable state regulations. Objective functional deficits (range of motion loss, strength deficits, special test abnormalities, imaging findings) are documented and the appropriate rating methodology is applied. Treatment reasonableness assessments reference Louisiana Title 40 workers’ compensation medical treatment guidelines and the Official Disability Guidelines (ODG). Reports include a clear narrative explaining how clinical findings translate to the impairment rating and how limitations affect work and activity capacity in practical terms.
What guidelines do you use for impairment ratings and treatment recommendations?
Impairment ratings are performed using the AMA Guides to the Evaluation of Permanent Impairment, both the 5th and 6th Editions, depending on the jurisdiction and applicable state regulations. 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 that opinions are consistent, reproducible, and defensible across legal and administrative settings.
The Bottom Line: An orthopedic independent medical examination or second medical opinion is not a box to check. It is a detailed clinical analysis that answers the specific medical questions a case requires. When that IME or SMO is conducted by a board-certified, fellowship-trained orthopedic surgeon with extensive published research and clinical trial experience, the resulting qualified medical opinion has both clinical depth and legal credibility. Whether defending against an exaggerated claim, seeking a second medical 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 designed 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.