Medical Aspects of Disability and Case Management Flashcards

What is the primary purpose of an independent medical examination (IME) in a disability claim?

Answer: To obtain an objective medical opinion on causation, diagnosis, or functional capacity from a neutral physician

An IME provides an independent, objective medical evaluation to address specific clinical questions in a disputed or complex disability claim.

In disability case management, what does 'medical necessity' mean?

Answer: Treatment that is appropriate, necessary, and consistent with accepted clinical standards for the condition

Medical necessity means that treatment is clinically appropriate, required for the condition, and consistent with evidence-based standards of care.

Which medication class is associated with the highest risk of dependency and diversion in workers' compensation populations?

Answer: Opioid analgesics

Opioid analgesics carry the highest risk of dependency, misuse, and diversion, making their management a critical issue in occupational disability cases.

What is the purpose of utilization review (UR) in disability case management?

Answer: To evaluate the medical appropriateness and necessity of proposed or ongoing treatment

Utilization review assesses whether proposed medical treatment meets established clinical criteria for appropriateness and necessity.

Which occupational health tool stratifies injured workers into low, medium, and high risk for developing chronic disability?

Answer: STarT Back Screening Tool or similar psychosocial screening instruments

Psychosocial screening tools like the STarT Back identify workers at elevated risk for chronic disability so early targeted interventions can be applied.

What does 'chronic pain' generally mean in disability management contexts?

Answer: Pain lasting longer than 12 weeks beyond normal tissue healing time

Chronic pain is generally defined as pain persisting beyond the expected healing period, typically three to six months or 12 weeks.