From the KOHC Casebook of IMEs

Case 1: Medical-Legal

  • A 43-year-old male, press operator. Initially complained of pain in thumb and index finger, due to repetitive use.
  • Job was changed to accommodate medical condition. Examinee had been treated by various health-care practitioners, including chiropractor and chronic pain specialist.
  • Issues: ongoing right index and thumb swelling and pain - not resolving and conflicting medical opinions.
  • Referred to KOHC for Independent Medical Examination. Interviewed, right hand function examined, measured and found normal.
  • Medical condition found to be due, primarily, due to the results of violent attack on his person six months prior to IME.

  • IME opinion

  • Repetitive Strain Injury (RSI) right hand - resolved.
  • Biopsychosocial collapse (Post-Traumatic Stress Disorder).

  • Resolution

  • Based on work-related issues, absence from work not justified.
  • Case resolved.

Case 2: Union member

  • A 37-year-old unionized male worker.
  • Issue: unreliable work attendance and habitual tardiness.
  • Erratic behaviour.

  • Prior Diagnosis

  • Alcoholism.

  • Plan of Action

  • Dismissal. Employer felt they had discharged their duty to accommodate the employee's disability on several occasions.

  • IME opinion

  • IME revealed Cocaine-binge addiction, which had not been revealed to a psychiatrist over four years of therapy treatment.
  • Homosexuality not fully declared - especially to family.
  • IME recommendations: Intensive in-patient and out-patient addiction - treatment therapy; homosexuality therapist to aid in addressing issues surrounding sexuality.

  • Resolution

  • Full attendence at work.
  • Currently three-and-counting years of sobriety.
  • How won awards for outstanding acheivements at workplace.

Case 3: Union Member

  • Union member diagnosed with renal cell carcinoma (RCC).
  • Clinical diagnosis blamed cigarette smoking.

  • IME Evaluation

  • Demonstrated negligible cigarette smoking history (4 pack/year).
  • Negative family history for kidney cancer, but found extensive exposure to a heated solvent (trichloroethylene) in his work environment over a seventeen-year period. No protective personal equipment worn.
  • Resolution

  • WSIB accepted trichloroethylene-induced renal cell carcinoma.

Case 4: Union Member

  • Male, 49, presented with possible workplace-related shortness of breath.

  • Diagnosis

  • Medical diagnosis: smoking-induced chronic obstructive lung disease (COPD)

  • Work History

  • Worked with Beryllium products between 1982 and 1987 - braising beryllium pieces on a daily basis.

  • IME Evaluation

  • Required special blood test (beLPT) to confirm Dx
  • Chronic Beryllium Disease - maybe fatal if not treated with oral corticosteroids.
  • Eight-pack year cigarette smoking history - considered to be minor.

  • Resolution

  • Removed from exposure.
  • Appropriate medical treatment instituted.
  • WSIB accepted Chronic Beryllium Disease.

Case 5: Government

  • Female, 31, government employee. Major automobile accident 12 years prior.
  • Second automobile accident two years prior, with onset of debilitating low back pain one year ago.
  • Magnetic Resonance Imaging (MRI) of lumbar spine essentially normal.
  • All efforts to accommodate employee's restrictions exhausted by government department.

  • Contemplation

  • Termination

  • IME Evaluation

  • Diagnosis: Tarlov's Cyst (relatively rare tumour-like compression of the spinal cord in the sacral region of the spine).

  • Resolution

  • Referred to neurosurgical expert in Tarlov's Cyst, saving the department the expense of a wrongful dismissal. Employee had a certifiable medical impairment, giving rise to a significant disabling condition.

Case 6: WSIB

  • An employee denied Workplace Safety and Insurance Board (WSIB) compensation for low back injury.
  • Reason - No specific injury date.

  • IME Evaluation

  • Fifth Medical Evaluation.
  • Found strong scientific literature evidence supportive of a cumulative trauma condition, lumbar spine.


Resolution

 

  • WSIB claim accepted.

 


Case 7: Unions

  • Male, 52, referred for IME assessment because of concern regarding prolonged asbestos exposure effects.

  • IME Findings

  • Acute myocardial infarction (heart attack) at age 39
  • Closer questioning uncovered several co-workers with premature cardio-vascular disease (employees worked in rubber manufacturing - a known cause of premature aging of cardiovascular system).

  • Resolution

  • WSIB claim submitted for coronary artery disease - work-related.
  • Ongoing monitoring for Asbestos related diseases planned.