What is a Medical Panel
Medical panels have been established under the Workers Rehabilitation and Compensation Act to answer medical questions that arise when there is a disagreement or uncertainty about aspects of an injured worker’s medical condition.
When a person is referred to a medical panel, they will meet with and be examined by a panel of doctors who will then make a decision about the question(s) that have been referred.
A decision of a medical panel is final and binding on all parties.
In my case I did not agree with the Notice of Assessment (the total body impairment assessment as given by the workcover agent which included a physical impairment rating as well as a psychiatric impairment rating) for both their physical assessment and their psychiatric assessment. Remember that workcover will base your impairment assessment on an Independent doctor/ impairment assessor of their choice, which just happens to be paid for by workcover.
The assessment was very unfair, they had omitted certain injuries, covered up others and rated my primary psychiatric impairment to 5%. To qualify for a lump sum compensation for a primary psychiatric impairment, you need a minimum of 10%. And we (my solicitor, my treating psychologist and psychiatrist) felt that the primary psychiatric impairment was extremely unfair.
We referred or appealed the Notice of Assessment (both physical and psychiatry) to the Medical Panel and I am going through the process as we speak.
Whilst the psychiatry medical panel is still fresh in my memory, I thought I’d share with you what the examination involves and what types of questions they will ask you, so you can ‘prepare’ yourself as best as possible.
It is very important that you read the post about “Impairment benefits for Psychiatric impairment: How to achieve the maximum” and have a good understanding about the differences between primary and secondary psychiatric injury. Only the primary psychiatric injuries count towards a lump sum compensation. Secondary psychiatric injuries do not count at all, however if you are “lucky” enough to be eligible for a common law damages claim, the secondary psychiatric injuries count under “pain and suffering”. (you can read more about the legislation here).
The Medical Panel Psychiatric Impairment Assessment
The psychiatric assessment may be requested in order to establish a link between the trauma and the victim’s psychological condition, or to determine the extent of psychological harm and the amount of compensation to be awarded to the victim.
You are not allowed to have a friend/support person present during the examination.
You will be examined by a panel, in my case there were two (2) psychiatrists in the room.
Questions the Medical Panel Psychiatrist(s) will ask you and what they are looking for
- What was the injured worker’s pre-morbid functioning level? This means that the psychiatrist will want to know how you functioned BEFORE the injury. This is determined by collecting relevant information about the injured person’s daily living activities prior to the accident. This will include a description from the injured worker of his/her premorbid functions. It may include information from the injured worker’s workplace and friend/ relatives, written reports (e.g., school reports) and any other relevant information. They will basically look for ANYTHING that can be held against you, anything that could be responsible for your current psychological injury other that the accident/injury itself. Questions they asked me were quite tricky, for example they asked what it was like at my workplace, was there anyone I did not like, was I bullied, treated unfairly, did I like my job. They are obviously looking for a reason that could explain your current metal state other than your injury/accident. For example they may believe that because you hated your job, you are depressed, or because someone bullied you you now have post traumatic stress. Be very careful what you say about your life before the accident.
- Does the injured worker have an impairment? The psychiatrist(s) will obtain information from many sources such as background information about you (and what you tell them), information from family, friends etc, and -most importantly- they will look at all PREVIOUS psychological, medical reports, including education and vocational reports. They will look at your treatment background and history, activities of daily living and look for all/any past (and present) accident/incidents. Again, they are doing this to see if they can blame another incident for your current mental state. For example, if you have a record of depression before the accident because for example you got divorced, they will use this against you. The background information from you would usually include information about your family, relationships, education and vocation, health / mental health and current problems; possibly interviews with other family members, work colleagues, and those who may be involved in your daily living activities. Previous reports may be those prepared about you by other assessors. Accident history information may include both your account of the present accident and details about any previous accidents you may have experienced. If there are independent reports about the accident, these may be of relevance.This may include past psychological, medical, education and vocation reports. If you have received any current or past treatment for injuries etc, these will be documented with supporting material from those engaged in treatment. Some measure of your responsiveness to treatment will be addressed. They will ask you about things you do in your days. They will look for things in your past, for example the death of a parent, a divorce, past relationships and how they ended, anything. Again be very careful what and how you say things because, if it’s true, you want to establish a clear link between your current psychological injury and your work accident.
- Is there a causal link between the “accident” and the “psychological impairment” ? The psychiatrist(s) will clearly state how, and to what degree , in his or her professional opinion, the accident contributed to the impairment. So, again they are looking for other factors that have or may have contributed to your condition. Again, be very careful what you say. For example if your marriage has or is breaking down, make sure you say that this is because of your accident and its after-effects. That is, if you had not been injured, chances are that there would not have been marital problems.
- Is the “impairment” stable , or as a consequence of time and/or treatment will the condition change ? If the assessment indicates that as a result of the accident the injured person sustained a mental impairment, the psychiatrist(s)’ next function is to determine whether the condition is stable. This question can usually be determined by examination of longitudinal data for a period of between 6 and 12 months. They will ask you how long you have been feeling like you do, also when it started or when you first became aware of it (symptoms). Again it is extremely important that you show them that the way you feel (i.e. depressed, post traumatic stress etc) is the direct consequence of your injury. For example, you may feel very depressed and say that you have been feeling like this since the 3d surgery… this will NOT count for primary psychiatric injury but will be a secondary injury. Try to relive your accident and, if true, emphasize that you first started having [nightmares, flashbacks, panic attacks, depression] within days or weeks of the accident and for example that consequent treatments/harassment/sacking have merely aggravated your condition. If true also emphasize that you became depressed very soon after the accident because you [had planned a trip, were studying for a degree, etc and it was taken away from you]. You can say, if true, that your depression /whatever worsened significantly after you were sacked or after you were bullied by workcover etc but make it clear that it started very soon after the accident (if true).
- Next they’ll measure the impact that the impairment has/had caused upon your daily functioning.The psychiatrist(s) will ask you questions about your activities of daily living, social functioning, your concentration level, and if your condition deteriorates in work or work-like settings. Questions about Activities of daily living include self-care and personal hygiene, sexual functioning, sleep, eating, preparing food, shopping, communication, speaking and writing, maintaining one’s posture standing and sitting, caring for the home and personal finances, walking, travelling and moving about (using public transport), recreational and social activities, and work activities. Questions about Social functioning relates to the following : ability to get along with family/ friends/ neighbours/ general public, ability to respond appropriately to people in authority, ability to co-operate with co-workers, ability to initiate social contact, and ability to participate in group activities.Concentration , persistence and pace relates to the person’s ability to complete tasks. This includes the ability to maintain focused attention long enough to complete everyday household/work tasks. Problems with concentration, persistence or pace may be seen to affect the person’s ability to complete the task. Deterioration or decompensation in work or work-like settings relates to the person’s failure to adapt to ‘normal’ stressful circumstances, show a negative response to stress, decompensate in work situations, fail to understand and follow instructions over extended periods, be unable to regularly attend work or maintain consistent standard of work, be unable to ask necessary questions, adapt to changes, be aware of hazards, or make plans independently. I think this last question about the impact the injury/psychological injury has on you daily living is very important and hence that is the reason why workcover will often resort to video surveillance/private investigators. For example, and because it is true, I told them that I have trouble concentrating because when I read a page in a book, I have to read it several times because I forget what I read; I told them that I am scared and that I feel jumpy when the phone rings (easily startled) because I am mortified that it will be my case manager; I told them that I don’t feel like socialising and that I had lost most of my friends; that I sleep a lot during the day, that I can’t be bothered showering/whatever; that I get very angry quickly for seemingly small reasons etc.
- You will also be rated on the following 6 criteria:1. intelligence (a person’s capacity for understanding); 2. thinking :the ability to form or conceive in the mind; 3. perception: the brain’s interpretation of internal and external stimuli; 4. judgment: the ability to assess a given situation and act appropriately; 5. mood: emotional tone underlying the behaviour; 6. behaviour: specifically examining behaviour that is disruptive, distressing or aggressive. For example, they will look at how you react when they make you relive the accident (i.e. anxious, hyperventilating; “not wanting to talk about it”, sweating, heart pounding; they will look at your eye contact, the tone of your voice (i.e. certain words you say could be emphasised or loud because of anger); whether you show symptoms of anxiety (i.e. like not sitting still, twitching etc); man, they even ask you -if you are suicidal- why you have not committed suicide!
It is a very serious interview, with many many ‘clever’ questions and at the end of it I was an emotional wreck, having had to relive multiple traumas. Needless to say that I came out of there crying and spend the rest of the day curled up in bed!
Now that I know what the Medical Panel is about, I wish I had seen an article or post about it (like this one) so that I could have prepared myself as best as possible.
Shortlink for this post: http://aworkcovervictimsdiary.com/?p=857