February 10, 2015
The medical profession significantly effects how the legal profession can help or hinder injured individuals seeking recompense. Though there is a multitude of ways the healing profession interfaces with the legal profession, I’d like to provide insight into common situations, relevant to injury cases, where the two professions intersect. My hope is that this series of posts will give you valuable insight for making the most of your interactions with medical professionals in the unfortunate case that you must pursue a legal course regarding an injury.
We’ve talked already about your relationship with your doctor and when to establish a new one. To truly understand that relationship, it’s helpful to know the roles that physicians play in workers’ compensation cases. Why? Because that knowledge is important to the outcome!
The law has clearly defined roles for physicians; roles that are relevant in workers’ compensation cases:
Attending Physicians
At the beginning of a case, the injured worker should select an attending physician who will agree to assist him/her throughout the treatment and recovery process. The attending physician can be almost any type of qualified health care provider; a chiropractor, a family physician, a psychologist, an orthopedic surgeon, a physiatrist or a neurosurgeon—to name a few.
The attending physician does not have to be the sole or even primary treating doctor; he/she can and should refer the patient to appropriate specialists. I have had several cases where the attending physician was a chiropractor and he made referrals to surgeons and physical therapists who were qualified to provide treatment outside the scope of his expertise.
Family physicians often make excellent attending physicians because they regularly make referrals to specialists, such as orthopedic surgeons, pain management professionals or psychologists.
In my opinion, injured workers often get better medical care with this arrangement in the workers compensation system than in the personal injury field, where no one physician is looking at all of the treatment provided.
An attending physician should be able to see the “big picture”, whereas specialists typically focus on a narrow scope of treatment. The specialist can lose track of what is the best overall treatment for the patient, because he/she isn’t looking at the big picture.
Treating Physicians
Treating physicians can be the attending physician or a specialist to whom the patient has been referred by the attending physician. Treating physicians are just that: they treat the patient.
Sometimes, the lines are blurred between the function of an attending physician and a treating physician and too often, physicians do not know what their role is in the workers’ compensation system. So, it is helpful if the injured worker has specifically designated a knowledgeable attending physician at the beginning of the case. This can help to avoid that confusion.
Employer Independent Medical Evaluation (EIME) Physicians
Employer Independent Medical Evaluation physicians are simply medical experts who are hired by the employer or the insurance company to conduct an evaluation of the medical records and the patient. Though these professionals are obligated to render “fair” medical opinions, it is believed that they seldom do. They are not truly “independent”, despite what they claim.
I believe it is generally accepted that an EIME physician’s role is to develop evidence that allows the employer/insurer to justify denial of benefits to injured workers. The moral justification (as opposed to medical justification) for this is that the employee has a treating doctor whose role is to provide medical care beneficial to the injured worker without regard to the cost being paid by the employer/insurer. The argument is that the treating doctor is not any more “objective” than the EIME physicians. That may be true under some circumstances, but often, this argument manages to dismiss the patient’s actual needs.
Second Independent Medical Evaluation (SIME) Physicians
Second Independent Medical Evaluation physicians are medical evaluators appointed by the Workers’ Compensation Board from a list of medical specialists who have agreed to serve as a SIME physician. SIME physicians provide no treatment or medical care, though sometimes they make recommendations to be followed by a treating physician.
A SIME is only conducted when there is a dispute between the treating physician and the EIME physician. Theoretically, a SIME physician is fair and objective, because they are reporting to the Workers’ Compensation Board. In reality, however, these physicians are often biased against either the employer or the employee, depending on the circumstances. Regardless, their report serves as “evidence” for use in workers’ compensation proceedings.
Conclusion
The role of each of these physicians is very different. Only the attending and treating physicians are providing medical care for the injured worker. The EIME and SIME physicians are professional witnesses, who have developed opinions that may be helpful to the Worker’s Compensation Board and the remaining parties in resolving a medical/legal dispute, which is being litigated.
In any case, as an injured worker, having an understanding of these roles can empower you to develop the appropriate relationship and dialogue with all physicians involved.