From Setback to Comeback: IMEs That Drive Real RTW Results

Return to Work: IMEs Help Enhance RTW Results 

Early intervention is key in preventing a work-related injury from becoming a long-term disability. Research confirms that employees who don’t experience time away from work have better outcomes than those who do. When an employee is out for three months due to a work-related injury, the likelihood of that person returning to work drops to 50 percent, and after a year, the chance diminishes to nearly zero. 

A Sports Medicine Approach 

With these RTW statistics in mind, it’s important to utilize every available tool—including an IME—to adopt a treatment and RTW approach akin to sports medicine. In this approach, an injured employee is treated like a professional athlete. Treatment starts as soon as possible, with an emphasis on restoring function and quickly re-engaging the injured worker through modified duty or transitional assignments. 

Maximum Medical Improvement 

Oftentimes, adjusters order an IME to help make determinations related to RTW. For example, they may want to ask an IME physician to assess whether an injured employee has reached maximum medical improvement (MMI). Occupational guidelines define MMI as a state of medical stability in which the IME physician does not anticipate a significant change in functional ability in the future, for example, over the next 12 months. 

When an injured employee has reached MMI, the IME physician can assess whether this person is functionally recovered. The employee might not need further medical treatment, although there are times when an employee can return to work but still require some treatment to function. 

Impairment vs. Disability 

An impairment refers to a deviation, loss, or inability to use any body structure or function, whereas a disability involves activity limitations or restrictions in participation. This is an important distinction. 

Disability: A Matter of Perception 

Depending on an injured employee’s job or profession, it is possible for that person to be highly impaired but have limited disability; impairment is not the same as disability. These terms are often incorrectly interchanged. Injured employees might have permanent impairments, but with a can-do attitude, they can perceive themselves as having limited disability and, as such, recover and return to work. 

A Look at Illness Behavior 

It’s important to consider other factors that can affect disability. We’ve seen examples of individuals who sustained severe impairments but did not see themselves as exhibiting disabilities. Some of the many psychosocial factors that drive disability are age, level of education, job satisfaction, work status, legal representation, and socioeconomic class. 

In essence, it looks at whether psychosocial issues are impacting disability or recovery. If these issues are believed to be at play, IME physicians can complete this type of evaluation as part of their exam. For instance, they might want to perform such an assessment if the examinee exhibits poor effort or symptom exaggeration, which may lead to an underestimation of functional capabilities.

There are several ways to observe illness behavior. For example, one assessment tool is the Ransford Pain Drawing. It is given to an examinee with instructions to mark pain complaints on an anatomical drawing of the body. An examinee who was injured while shoveling snow might mark the drawing with back pain and pain radiating down the right leg. An IME physician would review that drawing and verify that the injury mechanism and pain pattern are consistent with physiology. 

Another examinee might take the same drawing and mark pain complaints across practically every body part on the diagram, which does not follow any logical anatomic pattern. There is no medical reason for that type of pain, so the IME physician might suspect the person of exhibiting symptom exaggeration. In an IME report, the physician would typically grade the level of exaggeration as mild, moderate, or severe. The physician could also perform a validity of effort assessment using hand grips and range-of-motion measurements. 

Certainly, other assessments and tools exist to help evaluate illness behavior, effort validity, and symptom exaggeration. These assessments are selected by the IME physician based on what they aim to evaluate. 

Assessing Physical Capabilities 

Following the Occupational Requirements Survey (ORS), an adjuster may also request an IME to assess the injured employee's physical capabilities. The ORS categorizes five strength levels: sedentary, light, medium, heavy, and very heavy, based on the physical demands and job requirements. 

A key factor in this decision involves the amount of weight that needs to be lifted and the length of time those demands last. For light work, for instance, a person is “seldom” required to lift more than 20 pounds. It also includes activities that don't involve material handling, such as squatting, bending, climbing, and similar actions. If a physical ability assessment is requested as part of the IME, a job description or job analysis should also be sent to the IME doctor. 

If an injured employee has a permanent impairment and cannot return to the pre-injury job, the IME physician may recommend offering vocational rehabilitation.  

Next on the OnPoint Case Resolution Series: Sound Medicine, Solid Opinions: The Power of Physician Insight.  A quality IME starts with a quality physician—thorough, prepared, and detail-driven from day one.  

 If you are ready to explore further, download the entire IME eBook here: Emperion eBook. 

If now is the time to request an exam, visit our online referral form.