Dealing with workers compensation request for an independent medical examination

When you make a claim for workers compensation insurance benefits such as taxi transport, surgery, physiotherapy etc, the insurer will often request that you undergo (yet again) what it calls an “Independent Medical Examination”, but which I prefer to call an “WorkCover insurer’s Medical Exam”, because the doctor is far from independent.

A word about insurance companies. I am stating the obvious, but this is so often forgotten, it just amazes me. Insurance companies make a profit by not paying claims and medical bills.

Disabuse yourself of any idea that the examiner (doctor) is there to help you. He is hired to destroy your case, for example:

  • find some cause of your problem the workcover insurer won’t have to pay for,
  • deny the existence of your problem,
  • find that your problem falls within some policy exclusion,
  • show that you’re malingering, or disobeying medical advice,
  • deny the severity of your complaints,
  • list all the activities you’re capable of,
  • smear you by showing you lied or concealed other accidents, etc.,
  • challenge the prognosis,
  • show that no further treatment is needed,
  • minimise the disability and inability to work,
  • criticise the treating doctor’s care,
  • find inconsistencies in your medical history.

Some more tips on how to deal with (yet another)  independent medical examination under workers compensation

Only state-registered doctors can conduct a physical examination. Check out the examiner (doctor) on the internet for licensing or disciplinary problems. For example use the Australian Medical Association to see if they are registered. Or the Australian Society of Orthopaedic Surgeons, etc. Another useful site is the Australian Health and Medical Law Website. Another useful site is ratemd where you can find doctors that have been rated by others – this notorious Dr Terace, the psychiatrist IME is rated on this site – have a peek

Check this out -a criminal IME (click to enlarge)

Many of these IME doctors are rejects who can’t hold a real job, or can’t get one because of prior discipline. Object if you find any problems!

You must carefully prepare for this exam!  (Please refer to our previous post “More about WorkCover Independent Medical Examination (IME)” on how to prepare and protect yourself for the IME)

Get ALL and carefully review all the records from your treating doctor(s). Or obtain copies of all relevant reports from the workcover insurance company under the Freedom of Information Act.
Make sure that no important material is omitted. Even rehearse your entire medical history is needed, so you are fully prepared.

The WorkCover insurer must also give you adequate notice and discuss with you a suitable time to attend the examination. They must also provide you with an explanation for the reason for the IME, and this, together with the details of the date and name of the IME and location must be in formal writing (post) and not via email or phone.

Take a witness to the IME with you  and have him/her audiotape the proceedings (conceal it if necessary).

Sign nothing except the sign-in sheet when you arrive. Don’t fill out any forms, or sign any waivers. Written statements or answers to written interrogatories are not part of the IME. In particular, refuse to fill out any “history forms” the office staff may say are “routine”.

Don’t allow anyone but the agreed-upon doctor to conduct the exam. Allow no one else in the room except a nurse, your witness, and, if needed, an interpreter.

The questions and physical examination must be limited to the area which is “in controversy”. If you’re complaining of a knee injury, there is no need to do a pelvic exam.  And you may refuse to discuss parts of your medical history which are irrelevant.

IME doctors are trained to observe patients even when the formal exam is not taking place, as getting on and off the examining table. They have been known to leave a dollar bill on the floor to try to catch a patient bending over to pick it up, but perhaps not mentioning the accompanying grimace of pain. Some will even observe the way you get in and out of your car and walk across the parking lot. Be aware.

Always be friendly and polite. Never express anger, but be firm. Don’t tolerate any abuse.

Make sure the oral medical history you give the doctor is complete. If he cuts you off, tell him “Doctor, I have not finished my answer to your question. May I please complete my answer? Don’t you want to know the truth?”. You should answer only those questions that are directed to medical issues. Remember: THIS IS NOT YOUR DOCTOR. Anything you tell this doctor will not be confidential and can be used by the insurer against you.

There is another school of thought which holds that you should give NO oral or written medical history to the examining doctor, since this amounts to a deposition without statutory safeguards.

If something the doctor does causes pain, be sure to say so. Don’t be afraid to say “Ouch!”. The witness should record what was being done and the results. If he observes your gait, have the witness mark the number of steps and the condition of the floor. If he measured grip, did he just have you squeeze his fingers, or did he use a dynamometer? If he measured symmetric muscle circumferences, did he measure up from the floor or a finger-tip to assure symmetric locations? Did he measure bending angles with a goniometer, or did he estimate them?

After the exam, revert to helpless patient mode, and ask the doctor for his prognosis, recommendations for future treatment, etc.

After the exam, pick up all the cards, brochures, etc. available in the doctors office. If other patients appear to be waiting for IMEs, talk to them, and get their names and phone numbers. They may well be useful witnesses later on!

It may be useful to schedule an appointment with your own doctor later that day, in case a rebuttal of any adverse findings is needed. Have him send for a copy of the IME’s report as well, to check for errors and problems.

Note: These IME doctors are paid far beyond their normal charges, to see the patient for a few minutes and find some reason, that the workers compensation insurance “adjuster” can pay less than he/she should. Not all doctors will tailor their opinions to what the insurance adjuster wants to hear. But remember this: This is one of the most profitable types of work for doctors to do, especially in this era of managed care. There are doctors who will slant their opinions towards the insurance company. If you were an “adjuster”, which would you hire?

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3 Responses to “Dealing with workers compensation request for an independent medical examination”

  1. Some comments:

    1. Remember that the people in the waiting room may not be quite so useful. In my case the people were in fact the case manager and her supervisor. They had made an appointment with the IME after me so that they could immediately discuss my case. At the time I did not know who they were though I should have clicked from the writing pads in their hands. They were in fact observing me while I waited.

    2. As has been discussed previously, often on the days surrounding an IME appointment the insurer (Allianz, Xchanging or whoever) will arrange for surveillance to be conducted. At anytime the insurer knows where you’ll be (any prearranged thing, or regular routine) can and will be used for surveillance on you and your family.

    3. I’ve also previusly suggested that you contact the medical board in your state to request all of the registration info for the IME. This usually includes (name, date of birth, home address, educational information, restrictions and so on). This information may also reveal if the doctor is a fly-in from interstate.

    Good luck all. Fight the power!

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    • That’s a shocker to have actually your case manager and her supervisor sitting in the IME’s waiting room – wouldn’t have crossed my mind! Thanks for the tip!

      The other day though I attended the medical panel with my partner and it was blatantly obvious that we were followed from the moment we got out of the car, into the coffee shop (at the Panel’s office at the bottom, main entrance), then up to the Panel’s waiting room. The guy looked like a PI as well, hiding behind a news paper and every time I went somewhere (i.e. toilet), my partner saw him looking/watching…

      In fact you got to assume that you are being watched every day and act accordingly – that is: follow your doctor’s restrictions at all times.

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      workcovervictim October 13, 2011 at 2:23 pm
      • I believe that you should have taken pictures. Nothing irritates a surveillance operative more than having his cover blown.

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