From the KOHC Casebook of IMEs

• A 43-year-old male, press operator. Initially complained of pain in thumb and index finger, due to repetitive use.
• Job was changed to accommodate medical condition. Examinee had been treated by various health-care practitioners, including chiropractor and chronic pain specialist.
• Issues: ongoing right index and thumb swelling and pain - not resolving and conflicting medical opinions.
• Referred to KOHC for Independent Medical Examination. Interviewed, right hand function examined, measured and found normal.
• Medical condition found to be due, primarily, due to the results of violent attack on his person six months prior to IME.

IME opinion

• Repetitive Strain Injury (RSI) right hand - resolved.
• Biopsychosocial collapse (Post-Traumatic Stress Disorder).

Resolution

• Based on work-related issues, absence from work not justified.
• Case resolved.

• A 37-year-old unionized male worker.
• Issue: unreliable work attendance and habitual tardiness.
• Erratic behaviour.

Prior Diagnosis

• Alcoholism.

Plan of Action

• Dismissal. Employer felt they had discharged their duty to accommodate the employee's disability on several occasions.

IME opinion

• IME revealed Cocaine-binge addiction, which had not been revealed to a psychiatrist over four years of therapy treatment.
• Homosexuality not fully declared - especially to family.
• IME recommendations: Intensive in-patient and out-patient addiction - treatment therapy; homosexuality therapist to aid in addressing issues surrounding sexuality.

Resolution

• Full attendence at work.
• Currently three-and-counting years of sobriety.
• How won awards for outstanding acheivements at workplace.

• Union member diagnosed with renal cell carcinoma (RCC).
• Clinical diagnosis blamed cigarette smoking.

IME Evaluation

• Demonstrated negligible cigarette smoking history (4 pack/year).
• Negative family history for kidney cancer, but found extensive exposure to a heated solvent (trichloroethylene) in his work environment over a seventeen-year period. No protective personal equipment worn.
  
Resolution

• WSIB accepted trichloroethylene-induced renal cell carcinoma.

• Male, 49, presented with possible workplace-related shortness of breath.

Diagnosis

• Medical diagnosis: smoking-induced chronic obstructive lung disease (COPD)

Work History

• Worked with Beryllium products between 1982 and 1987 - braising beryllium pieces on a daily basis.

IME Evaluation

• Required special blood test (beLPT) to confirm Dx
• Chronic Beryllium Disease - maybe fatal if not treated with oral corticosteroids.
• Eight-pack year cigarette smoking history - considered to be minor.

Resolution

• Removed from exposure.
• Appropriate medical treatment instituted.
• WSIB accepted Chronic Beryllium Disease.

• Female, 31, government employee. Major automobile accident 12 years prior.
• Second automobile accident two years prior, with onset of debilitating low back pain one year ago.
• Magnetic Resonance Imaging (MRI) of lumbar spine essentially normal.
• All efforts to accommodate employee's restrictions exhausted by government department.

Contemplation

• Termination

IME Evaluation

• Diagnosis: Tarlov's Cyst (relatively rare tumour-like compression of the spinal cord in the sacral region of the spine).

Resolution

• Referred to neurosurgical expert in Tarlov's Cyst, saving the department the expense of a wrongful dismissal. Employee had a certifiable medical impairment, giving rise to a significant disabling condition.

• An employee denied Workplace Safety and Insurance Board (WSIB) compensation for low back injury.
• Reason - No specific injury date.

IME Evaluation

• Fifth Medical Evaluation.
• Found strong scientific literature evidence supportive of a cumulative trauma condition, lumbar spine.

• Male, 52, referred for IME assessment because of concern regarding prolonged asbestos exposure effects.

IME Findings

• Acute myocardial infarction (heart attack) at age 39
• Closer questioning uncovered several co-workers with premature cardio-vascular disease (employees worked in rubber manufacturing - a known cause of premature aging of cardiovascular system).

Resolution

• WSIB claim submitted for coronary artery disease - work-related.
• Ongoing monitoring for Asbestos related diseases planned.