Independent Medical Examinations

An independent medical examination is commissioned by a party to a case to answer specific medical questions. It is not treatment, it does not create a physician and patient relationship with the person examined, and its value rests entirely on the quality of the clinical reasoning behind it.

Dr. Ackland performs independent examinations for insurers, employers, and attorneys, and separately serves as a certified expert examiner on the Massachusetts Department of Industrial Accidents roster for impartial examinations ordered by an administrative judge.

What an examination can address

• Causation. Whether the diagnosed condition arises from the reported incident, from a pre-existing condition, or from some combination
• Extent of disability, total or partial, and whether temporary or permanent
• Medical end result, and whether further improvement can reasonably be expected
• Necessity of proposed treatment, including whether recommended surgery is indicated
• Reasonableness of treatment already provided
• Work capacity and restrictions, stated specifically enough to be applied

Why the subspecialty match matters

Orthopedic disputes are frequently more technical than the file suggests, and generalist opinions tend not to survive scrutiny in them.

A shoulder that remains painful after a rotator cuff repair is the clearest example. Was the repair adequate? Has it failed to heal, or re-torn? Is the residual problem attributable to the injury, to the surgery, or to degenerative change that predated both? Answering that reliably requires a surgeon who performs revision shoulder surgery and knows what a failed repair actually looks like on imaging and on examination.

Dr. Ackland has practiced orthopedic surgery since 1985, concentrates clinically on shoulder and knee reconstruction including revision surgery, and has treated Massachusetts workers’ compensation patients for over twenty years. He has seen these injuries from the treating side as well as the examining side, which is not true of every examiner.

What is included

Record review. Prior imaging, operative reports, treatment notes, and the reported mechanism.

Clinical examination. A full orthopedic examination of the region at issue and anything bearing on it, including the objective findings that either corroborate the reported symptoms or do not.

Primary imaging review. The actual studies wherever they can be obtained, not solely the radiology report. In shoulder and knee cases this regularly changes the conclusion.

Written report. Addressing the questions posed, with the reasoning behind each opinion set out rather than asserted. An opinion that cannot be traced back to a specific finding is of no use to a judge or an adjuster, and does not hold up when tested.

Arranging an examination

Contact the main office. It helps to provide at the outset:

• The specific questions to be addressed
• The body region involved
• Whether prior surgery has been performed, and by whom
• What imaging exists, and whether the primary studies can be supplied
• Any deadline the matter is working to

Languages. Dr. Ackland speaks English, French, Portuguese, and Spanish. Where an injured worker is more comfortable in a language other than English, please raise it when arranging the examination, since removing an interpreter from a process whose entire substance is the precise description of symptoms and function is worth planning for.

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