Medicolegal Experts Debate the Pros, Cons of Virtual Processes

Nancy Grover

Sarasota, FL (WorkersCompensation.com) – Exposure to COVID-19 at medical facilities where injured workers have been sent is prompting some of them in at least one state to file claims for additional benefits. “I’m already seeing claims come in … where the worker was forced to present to a medical facility where they believe they contracted COVID-19,” said Natalie Petit, Esq., a workers’ compensation defense attorney. “Also, Hawaii allows stress claims and I fully expect workers will file stress claims if they are forced to attend independent medical exams in person.”

Those are among the reasons Petit is in favor of virtual IMEs, at least during the COVID-19 pandemic. Petit was a panelist on a webinar yesterday hosted by Christopher Brigham, MD, of Brigham and Associates, on Virtual Medicolegal Practice: Achieving Success.

Virtual vs. In-Person

While many of the speakers felt that IMEs done via computer may not be as good as those done in person, they generally agreed that they can save costs and time and, for now at least, they are what we have.

“The real issue is not what is absolutely best, but what is going to be sufficient,” said David Langham, Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. “The primary focus is on processing these disputes because when a dispute is active an injured worker is likely not getting benefits or the employer is not getting that injured worker back to work. So the virtual is not the ideal IME, but it is much better than the case sitting and stagnating.”

Some medicolegal issues are easier to conduct virtually than others. Taking histories, for example, or inventories may lend themselves to computerized interactions. But what of the physical examinations?

“It’s a little more challenging,” Brigham said. “The big area of question is how do we go through and do the physical exam?”

Brigham, who has “thrived in a virtual environment for over two decades,” proceeded to conduct a simulated exam for a shoulder injury with one of the other panelists. With the camera pointed at the ‘patient,’ Brigham asked him to ‘stand up, take your arm out to the side and raise it up as high as you can. And back down. And cross your arm in front of you. Now let’s go back and raise it all the way up again.’ “We do this three times,” Brigham said. He then overlays the video content with a grid to help determine the person’s range of motion.

There are increasingly a variety of products available to aid the virtual physical exam. One involves using a strap on the worker’s arm; the sensors on the strap communicate to a box and reveals the range of motion. ‘Doctor in Your Pocket’ is another that allows the examiner to collect information from a distant patient.

“These are expanding our capabilities,” said Constantine (Dean) Gean, MD, from Liberty Mutual in California. “There is a convergence of technologies that will assist the IMEs.”

One of the issues surrounding virtual exams is whether they may be too limiting. “I’m not happy with the concept of telemedicine because there’s so much about being in the room with the person; not just the physical exam, but it’s just not the same thing … to get someone to open up and talk,” said Steven Feinberg, MD. “I don’t think we’ll be able to do high quality IMEs using this technique. But it may be all we have for a while. I just don’t see how we can do quality neurological or musculoskeletal exams.”

Benefits of Going Virtual

But some aspects of the virtual exams may actually improve the medicolegal process. One area is virtual document analysis.

“So many physicians doing IMEs get paper documents. It’s terribly inefficient and not goof for the environment. But clients have to print them out,” Brigham said. “It’s much more effective to have them come in electronically.”

Brigham pointed to a plethora of resources to electronically help analyze the documents, summarize the reports, and send them out. It can make it easier for everyone involved.

“I have challenges when I have to print out thousands and thousands of pages for an IME doctor,” said Katherine Nohr, Esq., a Hawaii based defense Attorney. “If I have the opportunity to do it electronically, that is much preferred.”

Depositions and testimony is another area where a virtual method may be as good or even better as having them done in person, in states where it is allowed. For one thing, it allows the judge, attorneys and many others to be included. It also can provide more insight into the person speaking.

“I’ve changed the toggle switch in Zoom so I can see you blinking your eyes and looking around as you respond and react. I see your facial expressions,” Langham said. “It’s head and shoulders above what we might get for a printed deposition. I’m bullish on that.”

Beyond Covid

For now, most if not all medicolegal aspects are being done virtually. It will require “everybody working together,” Feinberg said.

Going forrward, physicians and others involved in medicolegal issues are advised to start figuring out how to do it virtually and maybe develop best practices. “I would argue….we’ll see more and more virtual treating physician care, so this matches that in many ways and may possibly exceed it,” Nohr said.

“I think it’s coming. I think it introduces some uncertainty and it isn’t complete satisfying but it will be adopted in many states,” Gean said. “I’d just say learn as much as you can and potentially when things get back to normal regarding physical exams, it will find its niche.”

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