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Best Practices in Conducting an IME for BWC

Tuesday, October 30, 2018   (0 Comments)
Posted by: OPA BWC Task Force
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The Bureau of Worker’s Compensation maintains a panel of psychologists who have demonstrated the training, experience, and interest to conduct "independent medical examinations" of Ohio’s injured workers. OPA, through its BWC Task Force (David Schwartz, Ph.D., Chairman) recently reviewed a document that sets down "best practices" in conducting these exams.

There are three types of exams that BWC may request. In an “additional allowance” exam the psychologist first considers whether the injured worker meets diagnostic criteria for a proposed condition. If he does find evidence of the condition, he considers whether it was primarily caused by the work injury. For example, a worker injures his back on the job. He consults a psychologist, psychiatrist, or counselor who offers a diagnosis of major depressive disorder. BWC refers the injured worker for an IME. The psychologist may concur or disagree with the proposed diagnosis. If present, he may find that the condition is attributable to the effects of the work injury, including persistent pain and loss of valued activities. Or, he may conclude that the condition is primarily attributable to other factors, such as a divorce or a different medical problem.

In an "extent of disability" exam the psychologist considers the treatment the injured worker has received to date. Factors she considers include the amount of time in treatment, the extent of the cooperation of the injured worker, and whether observable behavioral improvements have resulted. She offers an opinion as to whether the injured worker has reached "maximum medical improvement."  If so, treatment may continue for maintenance purposes. “Temporary total disability” payments may cease, although the injured worker may qualify for other forms of compensation.

In a "percentage of permanent impairment" exam the task of the psychologist is to provide an estimate of the degree of impairment--to daily activities, socialization, mental processes, and adaptive flexibility--the injured worker experiences. The challenge is to rule-out the influence of extraneous factors such as other medical problems, other psychological difficulties, and family discord.

BWC requires an exam that is truly independent. The psychologist accepts the assignment with no biases for or against injured workers or employers. His report will have consequences in the lives of all parties. He provides not only an opinion but the reasoning behind it.

The foundation of a quality report is a quality interview. The psychologist asks a full range of questions. His job is similar to that of a journalist. Success requires engagement and a healthy curiosity. It is not the injured worker's job to know what to report. It is the job of the psychologist to know what to ask.

In forming her conclusions the psychologist uses information she gains in her review of records and in her interview. Psychological instruments also yield valuable information. The document discusses how to select an instrument that is appropriate to the type of exam.

Special circumstances can arise. Some are not uncommon:  the need for a translator, a request for the presence of a third party. Others fortunately are rare:  a plan for suicide, behavior that is threatening to the examiner. The document offers guidelines for managing these challenging situations.

The psychologist fulfills her duties within the ethical framework established by the codes of her profession. One that applies to the examination of injured workers is APA's Specialty Guidelines for Forensic Psychology.

Perhaps the most challenging aspect of conducting a BWC exam is drawing conclusions about causality. BWC does not seek a study of all aspects of an individual's functioning. They want a report on psychological functioning as it affects employment. But injured workers are not simply participants in the workforce. Before they were injured, and after, they marry, divorce, lose loved ones to death, become ill, recover, get in trouble with the law, win money in the lottery.

For example, a depressed man may have divorced five years prior to his injury, and had a break-up with his lady friend three months prior to the exam. If the psychologist decides to impute his depression primarily to these factors, rather than to pain and other effects of his work injury, she provides an explanation of her reasoning.

A psychologist cannot promise all parties to a BWC exam a report with which they will agree. She can promise them a fair and thorough assessment.