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IME Doctor Uses BMI Rating as a Diagnostic Tool Against Injured Workers of Color

by | Aug 15, 2023 | Workers' Compensation

The American Medical Association’s Council on Science and Public Health presented their report regarding issues with the body mass index (BMI) classification system to the Association’s annual meeting in Chicago this year. The report and resulting policy changes are summarized in an article published to the AMA’s website on June 14, 2023, titled “Use of BMI alone is an imperfect clinical measure.” One newly adopted AMA policy states that, among other things, “the use of BMI should not be used as a sole criterion to deny appropriate insurance reimbursement,” a particularly important remark for the field of worker’s compensation.

IME doctors often rely on BMI to argue that a person’s weight is why they are experiencing knee issues, not the work injury. This is especially harmful for injured workers of color. One IME doctor, whose job it is to examine injured workers from a neutral point of view, seems to have a predetermined answer to these injuries if the worker fits certain criteria. The IME doctor uses the BMI rating of workers with knee injuries as the causative factor for that injury if the worker is a POC. If the worker’s BMI rating is low enough, or if they are not a POC, the IME doctor is able to find other causative factors for the work injury.

In one instance, the IME doctor concluded that a white male patient with a BMI rating of 30 was “borderline” obese, and that his weight was a “contributing factor” for his progressing degenerative joint condition and knee injury. In a Black female patient with the exact same BMI rating, however, he found obesity to be the sole cause of her degenerative joint condition and knee injuries. The IME doctor officially ruled her work injury as a “minor and temporary” aggravation of her pre-existing condition. The white male patient, however, was given more leeway, as the IME doctor noted his work injury and subsequent knee surgery as a, “known causative factor for the development of degenerative joint disease of the knee.”

The IME doctor has been able to find alternative causes for the progression of degenerative joint disease and knee injuries in numerous other obese white patients. In one white male with a BMI rating of 36, he found, “patellar instability with recurrent dislocations” as a contributing causative factor to the development of progressive degenerative joint disease. In another white male with a BMI rating in the high 40s-to-50, he found his obesity to be a “contributing causative factor” to his knee injury, noting that his degenerative knee condition was caused by the work injury “in combination” with his obesity, not that his obesity was the sole cause as he concluded for a Black patient with a significantly lower BMI.

The IME doctor shows his implicit bias through the language he uses regarding different patients and their diagnoses. For injured workers of color, he often concludes that their obesity is the “causative” factor or sole cause of their degenerative condition and subsequent knee injury. For injured white workers he uses phrases opining that their “borderline” obesity is a “contributing factor to” or “reasonably consistent with” their condition and injury. Though these disparities may not seem significant, they can lead to inequality of care, treatment, and insurance coverage.

The American Medical Association has adopted new policies surrounding use of the BMI system, recognizing these issues including, “the historical harm of BMI,” “the use of BMI for racist exclusion,” and that BMI ratings “are based primarily on data collected from previous generations of non-Hispanic white populations and does not consider a person’s gender or ethnicity.” The IME doctor’s reliance on BMI ratings for injured workers of color promotes exactly the type of harm that these new policies seek to prevent. The use of BMI rating as a diagnostic tool to deny appropriate treatment or insurance coverage for injured workers of color is a racist, outdated, and harmful practice that has no place in the field of worker’s compensation.