Medical Evaluation of Work-related Illness: Evaluations by a Treating Occupational Medicine Specialist and by Independent Medical Examiners Compared

Abstract

Treating physicians' and independent medical examiners' (IMEs') opinions were compared to identify differences of opinion and to develop a basis for understanding the differences. Twenty-three patients of an occupational health center (OHC) who had been examined by an IME were studied. OHC and IME opinions regarding diagnosis, work-relatedness, treatment recommendations, and disability assessment were categorized by degree of agreement. There was agreement on all four issues for only one patient. Opinions were most divergent with regard to disability assessment and least divergent with regard to diagnosis. Disagreement was unidirectional: the IMEs made fewer diagnoses, deemed fewer illnesses work-related, made fewer treatment recommendations, and assessed lower levels of disability than the OHC examiners. The results suggest that differences in opinion between the OHC and IMEs are due to differences in perspective, rather than skill or training.

The structure and process of workers’ compensation systems and the role of doctors: A comparison of Ontario and Québec

“…The literature on “gatekeeping” in WC and sickness insurance systems focuses on the role of doctors from various institutional and professional locations in the determination of access to benefits, and in RTW processes. Lax et al [] showed that doctors working for insurers, IMEs, provide more conservative opinions regarding work‐relatedness and level of disability than do TPs, differences the authors attribute to perspective rather than skill or training. A training manual for IMEs suggests that their role is similar to that of the police or private investigators [Forcier and Lacerte, ], an approach shared by some of the IMEs interviewed in our study.…”

Implementing a collaborative return-to-work program: Lessons from a qualitative study in a large Canadian healthcare organization

“…For example, Lax et al suggest that although the medical assessment is independent from the patients’ usual care, it is not independent from the organisation that contracts out the work i.e. the employer, as there is a financial commitment in place [33]. Following from this, previous research has discussed potential negative consequences of Independent Medical Assessments for workers and has questioned their fairness [34].…”

Saúde Ocupacional na região central do estado de Nova York: um ambulatório de doenças ocupacionais com financiamento público 25 anos depois

“…Grande parte tem sido baseada nos registros dos pacientes atendidos no serviço, na forma de relatos de casos clínicos ou de séries de casos. Por exemplo, o OHCC notificou a ocorrência de um grupo de casos de trabalhadores envenenados por chumbo empregados na indústria de cabos de telefone (LAX et al, 1996). Outro exemplo foi um estudo que avaliou as questões de saúde ambiental e respiratória devido à exposição a bioaerossóis e químicos em uma estação de tratamento de esgoto (LAX; SIWINSKI; MANETTI, 1999).…”

“…Outra pesquisa focou os aspectos da experiência do trabalhador lesionado, em particular, no sistema de compensação de trabalhadores. O trabalho feito pelo OHCC tem documentadas as dificuldades que trabalhadores lesionados enfrentam para ter acesso aos cuidados médicos, a natureza tendenciosa das "avaliações médicas independentes" (feitas por médicos contratados pelas companhias de seguro) em favor de empresas, e o grave trauma financeiro, social e psicológico sofrido por eles (LAX; MANETTI; KLEIN, 2004;LAX;KLEIN, 2008).…”