In medicolegal work, one of the most difficult questions is whether a later-diagnosed spinal condition was caused by an earlier traumatic event. This issue becomes especially complex when the claimant initially has no back pain, no neurologic deficit, and negative imaging, but later develops back pain, foot drop, bladder dysfunction, paralysis, or a vertebral compression fracture.
Physicians who transition away from direct clinical practice and into independent medical examinations, disability evaluations, peer review, malpractice review, licensing matters, workers’ compensation, and legal consulting often face a practical question: should they maintain hospital privileges?
Physician experts are sometimes asked to evaluate whether a claimant’s diagnoses should be expanded to include “segmental and somatic dysfunction” of the cervical, thoracic, lumbar, or sacral regions. This issue commonly arises in personal injury, workers’ compensation, motor vehicle collision, chiropractic treatment, osteopathic manipulation, and chronic spine pain claims.
Shoulder pain after a rear-end motor vehicle collision is common. The difficult medicolegal question is whether the shoulder pain represents a traumatic shoulder injury, such as a labral tear, or whether it is more consistent with cervical strain, referred pain, radiculopathy, myofascial pain, or an incidental MRI finding.
Independent medical examinations occupy a unique position in medicine. The physician performing an IME is not the treating physician. The examination is usually requested by a third party, such as an insurer, employer, attorney, court, or claims administrator. The purpose is typically to answer medical-legal questions about diagnosis, causation, impairment, work capacity, treatment necessity, prognosis, or disability.
