MEDICAL EXAMINATION

[Pages:116]Industrial Commission

MEDICAL EXAMINATION

MANUAL

Effective 09/10/19

MEDICAL EXAMINATION

MANUAL

Our mission is to serve the injured workers and the Ohio employers through expeditious and impartial resolution of issues arising from workers' compensation claims and through establishment of adjudication policy.

Mike DeWine

GOVERNOR

Industrial Commission

Jim Hughes

CHAIRMAN

MEMBER

Daniel J. Massey

MEMBER

Table of Contents

GENERAL CONSIDERATIONS Legal Considerations....................................................................................................... 4

Injury Allowed Condition(s) Impairment Disability Independent Medical Examination Addenda Interrogatories Depositions File Reviews Medical Examinations

Independent Medical Examination Considerations......................................................... 7 Specialists Administrative Agents Acceptance of Allowed Condition(s) Causation Review of Pertinent Medical Records Clinical Findings Maximum Medical Improvement AMA Guides Whole Person Impairment Functional Limitations

Ethical Considerations.................................................................................................... 9 Confidentiality Disclosure Maintenance of Medical Records

Administrative Policies.................................................................................................. 10 Legal Status Examination Observers Recording Examinations Interpreter Chaperone Impartiality Ex Parte Communication Examination Requirements Timeliness Reporting

Examination Scheduling................................................................................................ 12

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Billing Procedures......................................................................................................... 13 Independent Medical Examination & File Review Fees Out-of-State Cancel & No Show Fees Fees for Addenda, Interrogatories, & Depostions Allowed Diagnostic Testing Submitting a Fee Bill

Directory of Commission Offices................................................................................... 16

EXAMINATIONS BY BODY SYSTEMS

Musculoskeletal, Cardiovascular, Respiratory, Central and Peripheral Nervous System Multiple Claim Musculoskeletal/Neurological System

Examination Reporting Format Instructions..................................................... 18 Report Example................................................................................................ 22 One Claim Cardiovascular System Report Example................................................................................................ 27

Oral and Maxillofacial Examination Reporting Format Instructions..................................................... 36 Report Example................................................................................................ 39 Guidelines to the Evaluation of Impairment of the Oral and Maxillofacial Region, published by the American Association of Oral and Maxillofacial Surgeons, 2002.................................................................... 43

Mental and Behavioral Examination Reporting Format Instructions..................................................... 58 Methodology.................................................................................................... 62 Report Example................................................................................................ 63

The Visual System Examination Reporting Format Instructions..................................................... 72 Methodology.................................................................................................... 75 Report Example................................................................................................ 76

Ear, Nose, and Throat Examination Reporting Format Instructions..................................................... 82 Methodology.................................................................................................... 85 Report Example................................................................................................ 86

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APPENDIX Medical Examination Referral Letter............................................................................. 92 Medical Exam Worksheet.............................................................................................. 94 Statement of Facts........................................................................................................ 95 Appropriate Assessment Forms..................................................................................... 98 IC Provider Fee Bill...................................................................................................... 101 Permanent Total Disability Application........................................................................ 102

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