When can workcover send you to an Independent Psychiatric medical examinations (IME)
According to the Claims Manual, (under the ‘claims Management Segments) an s112 examination,aka an independent medical examination (IME) conducted by an IME psychiatrist may be appropriate only in the following circumstances:
- the case manager, in consultation with the technical manager is not confident that the advice (from the IMA or Medical Advisor provides sufficient evidence (from the treating practitioner, worker and employer) to establish the diagnosis and/or casual relationship or
- the information (from the treating practitioner, worker and employer) is conflicting or inconsistent.
Whilst the Act clearly states that workcover (your case manager) should seek answers to her/his questions first via discussion with your treating GP, psychologist or psychiatrist, they will inevitably try to send you to an IME psychiatry as often as possible (i.e. every 6 months) in the hope to find a loophole.
Before sending you to an IME Psychiatry,your case manager should provide you with a clear and valid reason for the need to be (re)assessed by an IME Psychiatry.
Your case manager will most often provide you with a bulls**t reason, such as “it has been 6 months since your last IME”; “the previous IME you saw states in his/her report that you should be reviewed in 6 months”; or they may occasionally provide you with a more reasonable reason such as ” we need to assess your ability to engage in rehabilitation/return to work, and assess whether your psychology services are of benefit and whether they should continue”.
Why does workcover send you to independent psychiatric examinations/assessments
- have you certified fit and/or
- cut off your benefits and entitlements (such as your psychology treatment)
Over the past 2 years I have been sent to 4 IME psychiatry (basically every 6 months). I have noted that when my case manager is unhappy with an IME report (which is my favour), she will send me to yet a different IME 6 months later.
For example IME Psychiatrist A stated in his report that I was unfit for all work and that I should be reviewed in 6 months. My case manager, clearly unhappy with the IME’s opinion, decided to send me to IME Psychiatrist B six months later. Whilst this report was reasonably in my favour (unfit for work), it also contained some nonsense comments about “other matters affecting my psychological recovery” detailing that “I was upset that my mother had not visited me since the accident” (hey my mom lives overseas and is too unwell to fly this distance!). The report also stated that I should be reviewed 6 months later.
Six month later my case manager sends me again to Psychiatrist B, explaining that Psychiatrist B had recommended in her report that I should be reviewed 6 months later as an explanation for the reason for the IME.
Note: here is the catch already: my case manager does obviously NOT send me to Psychiatrist A, who also requested I be reviewed in 6 months. See where this is going?
I obviously requested my solicitor to have me sent to another IME instead of IME Psychiatrist B, stating that I had a very traumatic experience with Psychiatrist B (which is true anyway) and that I refused to see that psychiatrist ever again.
We were successful and my case manager had no option but to sent me to IME Psychiatrist C for an assessment, instead of IME Psychiatrist B.
I had the assessment and a couple of weeks later I obtained a copy of IME Psychiatrist C’s report. Well, this was an eye-opener! The report by the way was in my favour stating (shall I say an honest report) that the IME agreed with Psychiatrist A and I was deemed unfit for all work for a long time. The report also stated that any “other matters affecting my psychological recovery were merely after-effects stemming from the injury and subsequent surgeries”, which is really true. For example, if I had not been injured and had not have to endure 10 major surgeries, I would not have been ‘upset’ that my mom could not visit me, right – cos I could have gone to visit her overseas.
Useful guide on how best to prepare yourself for a dreaded independent independent psychiatric examination
Questions workcover will ask the independent psychiatrist
The eye-opener of the IME report was that I had a look at the questions which were asked by my case manager.Please read through these real questions, so you know what workcover is after and how they will try to catch you.
- In your clinical opinion, is the worker’s current treatment appropriate? Please include your comment on the appropriateness of the type, frequency and duration of any treatment and in the case of medication, the dosage. >>Now, here you can already see what your case manager is after, namely an attempt to cease your psychology treatments (frequency/duration), and perhaps cease certain medications
- If ,in your clinical opinion, the worker’s current treatment is appropriate, how long should the currently precribed treatment continue? Please explain your opinion. >> Again, it’s about whether they can find a way to wind down your psychology sessions or cease them
- Would the worker be able to undertake the activities of daily living and/or return to work or stay at work or would the worker’s capacity to do so be reduced if the current treatment was ceased? >> this is an obvious question, again to try to cut off your psychology entitlements whilst of course keeping you at work.
- Do you recommend any changes in the worker’s current treatment? For example, should there be any change to the frequency of treatment. >> Needless to say how crafty workcover is in writing their questions to try and please cease either your psychology treatment or at the very least reduce your entitlements.
- What medical condition/injury does the worker have? >> this is also a tricky question, get not fooled! They want to see whether your employment injury is still a significant contributing factor to your current emotional state!
- In your pinion, what has caused the worker’s injury/medical condition? If there are multiple causes, please list all of these. Please give specific consideration whether the worker’s employment is still a cause. >> See what they’re doing and heading for? They are hoping to find OTHER causes (not your work injury) to your current emotional state of course!
- Can the worker return to work in their pre-injury duties and hours?
- If the worker cannot return to their pre-injury duties and hours, does the worker have a current work capacity?
- Can the worker return to work in modified pre-injury duties and/or hours; alternative duties
- If the worker can return to work in modified pre-injury duties what do you recommend? Modified pre-injury duties, modified pre injury hours, length of time for the modifications to remain in place, review time? >> O boy, now they are really getting desperate!
- If the worker can return to work in alternative duties, do you recommend alternative duties,alternative hours, length of time for the alternative duties, review time frame?
- When can the worker return to work whether is pre-injury duties, modified pre-injury duties or alternative duties?
- If the worker has no current work capacity, please provide your detailed opinion about why that is the case.>> WTF
- When should the worker’s capacity for work be reviewed?
- If there is ANYTHING other than the worker’s injury that is affecting their recovery including their return to work (i.e. DOMESTIC ISSUES, RELATIONSHIP PROBLEMS, RELATIONSHIP PROBLEMS AT WORK, SOCIAL FACTORS) >> This is where you need to be VERY careful on what you say!!!! In fact it is nobody’s business!!! How your sex life is, how your marriage is, who your friend are, etc HAS GOT NOTHING TO DO WITH YOUR INJURY. DON’T DISCUSS IT OR EMPHASIZE THAT YOUR INJURY IS AFFECTING YOUR SEX LIFE, YOUR MARRIAGE ETC.
- Does the worker have no work capacity for suitable employment arising from the secondary psychiatric condition related to “your injury” for this claim? Please don’t take into consideration any other injuries or conditions the worker suffers from. >> note the last bit!
- Is the worker fit to participate in a vocational assessment; vocational re-education assessment; retraining; a functional capacity evaluation; a work hardening program
- Does the worker’s psychiatric condition allow the worker to travel by public transport or car? >> Again, a very tricky question in my case because they were trying everything not to grant me taxi transport based on my physical injury and requested my specialist surgeon!!!!
- Any other comments?
In my case workcover was desperate to have me certified fit (although why remains a mystery as I am currently totally unfit from a physical perspective -however they would rely on an OLD physical IME by a general surgeon who stated in his report over 1 year ago that I MAY be able to work provided I was given no less than 22 ergonomic tools). That’s why they pursued the IME Psychiatry in the first place and REF– USED to send me to a physical IME after being notified of the catastrophic deterioration of my physical injury. They are pretty clever and DESPERATE.
Workcover was also threatening me repeatedly that my psychology entitlements would be ceased – they tried very hard but I successfully appealed it at the ACCS. Mind you after the conciliation, they tried to disregard the legal ruling by not paying my psychologist (and sending me a bill for $800)!!!
So, obviously workcover was also desperate to cease or cut off my psychology treatment by requesting the 4th IME psychiatry in 2 years (one very 6 months).
When you look back at question 15, this is where the IME psychiatrist twisted things to state that “I was upset that my mom did not visit” and that “this contributed to my recovery”. Yeah- nice try!). So, again, don’t talk about your PRIVATE life, or simply make it clear that your injury IS AFFECTING this and that. You should not have to discuss anything that is NOT RELATED to your injury because those workcover morons will try and make a case against you and, in my example, may have tried to say that “being upset about my mom not visiting” is the CA– USE of my depression/whatever and therefore they would NOT PAY for psychological treatment.
Good luck with your Psychiatric IME’s 😉