Here at BarnesCare, we frequently get questions from clients about the different types of work-related physical exams we offer. In this first article in our “Ask the Doctor” series, Tom Kibby, MD, MPH, CIME, FACOEM, BarnesCare chief medical officer, provides detailed descriptions of three of our most commonly requested exams.
Return-to-Work Exam (RTW)
A return-to-work exam is requested when an employee is returning from medical leave of typically less than six months, with a note from the treating physician stating the date of expected return and whether any work restrictions are recommended. No prior medical records are requested, and this exam can often be scheduled on a walk-in basis during normal hours. Typically the employer will have all employees of a job category go through the RTW process, and most of the time there are not employer concerns about the particular employee.
After registration the employee fills out the health history and review of systems form. Then the medical assistant obtains vital signs and fills out a brief history on the RTW form. The provider interviews the employee and if necessary performs a focused exam. If enough information is present to satisfy the provider, the provider completes the form and indicates whether the employee may return to work full duty, return to work with restrictions, or not return to work. The provider has the option of requesting more information or medical records based on the circumstances, which may delay the final opinion.
A simple statement without diagnoses or medical information is completed. A copy is given to the employee and an additional copy is sent to the company contact. A phone call or further memos to the employer are usually not required. This process is streamlined to require minimal provider time and documentation.
Fit for Duty (FFD)
A fit-for-duty exam is more case dependent. Often the employer contacts BarnesCare staff with questions about an employee’s ability to carry out their routine duties. This may be either in a currently working employee or an employee who is returning from medical leave but in some altered medical state.
The employer will be asked to outline the concerns in a memo and provide a job description including the physical functions required. These are reviewed with the physician, who will determine if further medical records are needed. An evaluation is scheduled with the physician and employee, which requires about an hour. After registration, the examinee fills out the health history and review of systems form. The medical assistant will obtain biometrics. The physician ensures the employee understands that medical information will be released to the employer only with the consent of the employee.
The physician will prepare a report and assessment, including an opinion whether the employee is suitable to continue working with or without restrictions. The physician will call the employer following the evaluation.
Independent Medical Evaluation (IME)
Independent medical exams are more formal evaluations. They are scheduled usually by attorneys, insurance case managers or through a third-party scheduler. The concerns are formally outlined in a cover memo and usually address issues such as causation, final rating, treatment second opinion or disability. These exams are scheduled with a physician who is preferably certified as an independent medical examiner.
Medical records and the cover letter should be received at least one week prior to the appointment. After registration the examinee fills out the health history and review of systems form. The medical assistant will obtain biometrics. During the visit, the physician notifies the examinee that medical information will be released to outside parties. The physician will interview and examine the individual. The examinee is not informed of the final opinion.
A full typed report is prepared outlining the medical history, review of medical records, exam and discussion of questions to be addressed.
Detailed information about physical exams is always available on the BarnesCare website. Contact us to request an appointment.