Predicating the Outcome of the IME Report Based on Mechanism of Injury

Although there is no cure-all that can make every IME report perfect, some things do make a difference.  For example, IME experts are more likely to give more weight to the history that is given closest in time to the injury.  Hence, it is vital to take recorded statements as soon as possible after an injury is reported.  IME experts are also more likely to be suspicious of an injury’s legitimacy if contradictory histories of injury are given.  In addition, evidence of prior problems involving the same body part increases the likelihood that the expert will conclude that the examinee experienced a mere manifestation of a preexisting condition or a temporary aggravation.  Diagnostic imaging studies often can be used to predict whether the expert will conclude that the condition is traumatic or preexisting and chronic. 

One underappreciated factor in predicting the outcome of a report is mechanism of injury.  Often how the examinee claims the injury happened is critically important.  We can reliably predict that an orthopedist will find a meniscus tear to be non-industrial if the examinee does not report a twisting mechanism of injury.  Also, in cases of significant acute injury and disability, a delay in treatment increases the likelihood that the expert will find that the injury did not occur as alleged and represents the mere manifestation of a preexisting degenerative condition.  For example, an expert is more likely to conclude a massive rotator cuff tear has a non-industrial origin if the examinee claims a traumatic episode cause the injury but he nonetheless waited a week to report it because the expert is likely to conclude that a massive acute tear would be so painful and disabling that the examinee could not continue working and would have reported the injury immediately. 

Mechanism of injury is important in occupational exposure claims as well.  An accurate job description, job video, and physical demands analysis tailored to the examinee can go a long way toward predicting whether the expert will find the work exposure to be a cause of the condition. Finally, the examinee’s personality will have some bearing on the expert’s opinion.  Experts tend to be less sympathetic toward hostile and unpleasant persons then friendly and straightforward persons. 

What is your technique to substantiate mechanism of injury?  Does it work and why?

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