DIA Impartial Medical Examinations

When a Massachusetts workers’ compensation claim is disputed, the medical question at the centre of it does not get resolved by argument. It gets resolved by an examination.

Under M.G.L. c.152 §11A, an administrative judge may refer a disputed claim to an impartial physician drawn from the Department of Industrial Accidents roster of certified expert examiners. That physician is retained by neither party. They examine the injured worker, review the record, and submit a written report to the judge.

Dr. Michael Ackland is on that roster.

What the impartial examination decides

The impartial report addresses the medical questions the case turns on. Depending on what is in dispute, that can include:

• Whether the diagnosed condition is causally related to the reported workplace injury
• The extent of disability, and whether it is total or partial
• Whether the disability is temporary or permanent
• Whether the worker has reached a medical end result
• What restrictions apply, and what work the person can realistically perform
• Whether proposed treatment is reasonable and necessary

The report carries statutory weight. That is precisely why the examination needs to be done properly, by someone whose clinical judgment holds up under examination from both directions.

Why the specialty match matters

An impartial examination is only as good as the clinical expertise behind it, and orthopedic disputes are frequently more technical than they first appear.

A shoulder that still hurts after a rotator cuff repair raises a different question from a shoulder that has never been operated on. Was the original repair adequate? Has it re-torn? Is the residual problem the injury, the surgery, or something that was present beforehand? Answering that requires a surgeon who performs revision shoulder surgery, not a general assessment.

Dr. Ackland’s clinical practice is concentrated in exactly the area where these disputes cluster: shoulder and knee injuries, and reconstruction after a previous operation has failed. He has practiced orthopedic surgery since 1985 and has treated Massachusetts workers’ compensation patients for more than twenty years, which means he has seen the same injuries from the treating side as well as the examining side.

Independent medical examinations

Separately from impartial work, Dr. Ackland performs independent medical examinations for insurers, employers, and attorneys.

An IME is arranged by a party to the case rather than ordered by the judge. It is used to evaluate causation, the necessity of proposed treatment, the extent of disability, or the reasonableness of a treatment course already underway. The distinction between the two matters, and is set out in more detail in our guide to independent and impartial examinations.

Where Dr. Ackland is serving as the impartial examiner in a case, he does not also act for a party in that case.

What an examination involves

A complete examination includes:

1. Record review. Prior imaging, operative reports, treatment notes, and the reported mechanism of injury.
2. Clinical examination. A full orthopedic examination of the affected region, and of anything relevant to it.
3. Imaging review. The actual images where they are available, not solely the radiology report. This routinely matters in shoulder and knee cases.
4. A written report addressing the specific questions posed, with the clinical reasoning stated rather than asserted.

Reports state the basis for each conclusion. An opinion that cannot be traced back to a finding is not useful to a judge, and does not survive cross-examination.

For attorneys, insurers and employers

To arrange an examination or discuss whether a case fits Dr. Ackland’s subspecialty, contact the main office. It is helpful to know at the outset:

• The specific medical questions at issue
• Which body region is involved
• Whether prior surgery has been performed, and by whom
• What imaging exists and whether the actual studies can be provided
• Any deadline the case is working to

Coverage. Examinations are conducted at the Dedham office, with the other Massachusetts offices available where travel distance is a genuine obstacle for the examinee.

Languages. Dr. Ackland speaks English, French, Portuguese, and Spanish. In a state where a significant share of injured workers are more comfortable in Portuguese or Spanish, that is worth raising when the examination is arranged.

For injured workers sent for an examination

If you have been notified that you must attend an impartial or independent examination, it is a normal part of a disputed claim and not a sign that something has gone wrong.

Bring your imaging if you have it, and be straightforward about what you can and cannot do. Overstating symptoms and understating them both damage a claim, because the examination includes objective findings that either fit the account or do not. What helps you is an accurate account.

We have written a fuller explanation of what happens at these examinations.