A recent decision from the Department of Industrial Accidents’ reviewing board illustrates the sort of circumstances under which an impartial medical examiner’s report can and should be found insufficient. The case involved Mae Roscoe, a sixty-two year old phlebotomist who was injured while working for Brigham and Women’s Hospital. At issue in this case was what credibility the impartial medical examination should be given.
Impartial Medical Examinations in Massachusetts
As part of the workers’ compensation reforms passed in 1991, Massachusetts legislators introduced the concept of an impartial medical examination (IME) procedure in an attempt to get rid of conflicting medical reports submitted by employees and employers (which, as one would expect, tended to favor the individual or entity who paid for them). The IME procedure, as conceived by the legislature, would require an independent and impartial physician to be employed to examine the injured employee, review his or her medical records, and then render an opinion as to:
· Whether a disability exists;
· Whether the disability is total or partial, permanent or temporary; and
· Whether the injury is related to an injury arising out of the course of the employee’s work.
The legislature gave such IME reports “prima facie” weight, meaning that the judge that reviews such reports accepts them at their face value and typically does not consider other medical evidence or reports on those issues.
The Facts of Ms. Roscoe’s Case
On July 11, 2011, while moving a heavy medical cart out of a patient’s room, Ms. Roscoe struck her right knee against a device attached to the patient’s bed. She experienced an immediate pain and reported the injury to her employer. She began receiving treatment for her injury in August 2011. She was found to have a torn medial meniscus in her knee and underwent a partial medial meniscectomy in November that same year. Following this surgery, she underwent three Synvisc injections and physical therapy. At the time of her workers’ compensation hearing before the reviewing board, she had not returned to work.
In disputing the amount of benefits payable to her, Ms. Roscoe claimed her benefits should have begun July 12, 2011 (the day after her injury). The insurer disputed the extent of Ms. Roscoe’s injury and incapacity, as well as the relationship between her injury and the scope of her employment. The administrative judge, adopting in part the findings of the impartial medical examiner, found that Ms. Roscoe was entitled to benefits only from July 11, 2011 until July 6, 2012 (the date of her IME). Ms. Roscoe as well as the insurer appealed this decision to the reviewing board. In particular, Ms. Roscoe wished to present medical evidence in addition to the IME report.
An Inconsistent IME is Inadequate
The reviewing board found the report of the impartial medical examiner to be unclear and contradictory. In this case, the examiner found that Ms. Roscoe had “a meniscal tear and contusion” related to her work injury. However, later in the examiner’s report he references a knee “strain,” despite never diagnosing Ms. Roscoe with a knee strain. Other inconsistencies were found in the examiner’s report, such as where, in one paragraph, the examiner notes that Ms. Roscoe did not have any preexisting conditions and then arguing that her July 11 injury exacerbated a preexisting condition. The reviewing board found that because of these inconsistencies the administrative judge should not have relied on this report (should not have given it “prima facie” weight). The reviewing board ordered that the case be sent back to the administrative judge who would need to admit and consider the additional medical evidence Ms. Roscoe wanted. This could lead to her receiving additional benefits.
Contact us today at (508) 755-7535 for a free consultation if you have been injured on the job and are filing for workers’ compensation benefits. Workers’ compensation law is complex, and you need an experienced attorney to protect your rights and make sure you get the benefits to which you are entitled.