Yesterday we received a “share your story” from a Victorian injured worker, whose claim is managed by CGU, and who was sent to an all-too-common- despicable, geriatric independent medical
examinator exterminator (IME). This most unethical “doctor”, a disgrace to the profession really, dared to state that there was nothing wrong with the injured worker, despite clear MRI evidence of a lumbar disc protrusion with nerve compression. He had the guts to state that the injured worker is”fit for 40 hour per week” normal duties, and in doing so is just about to destroy a person’s life and livelihood! Disgusting!
Injured worker sent to geriatric lying independent medical examinator (IME)
The injured worker’s story: in his own words
” fark cgu and fark [Dr name] of [place] this geriatic old bastard says i no longer have an injury and it didn’t happen at work. So what did happen and where did it happen.
All my doctors and specialists disagree and believe I have a mechanical lumbosacral spine dysfunction
Independent medical examinations
Unfortunately, attending medical examinations is a necessary part of a WorkCover claim. Failure to attend examinations at reasonable intervals may result in the suspension of a claim. However beware that the workcover insurer does not go on a “doctor shopping” spree, one of their favourite pastimes! Most lawyers would agree that one (to two if unstable) examinations per year is “reasonable”.
The major issue of the poor quality of – and often highly biased medico legal assessment is well described by a lawyer, who herself was injured at work, and consequently experienced major issues injured workers face with the so-called medico-legal consultants (doctors). She really wonders if these are doctors who are struck off, too old to practice, where their Hippocratic oath is and, most importantly, believes that an urgent review is needed into the medico-legal consultant industry.
Don’t be disillusioned as many of these examiners are well-known to the courts (and some are literally laughed out of court) and lawyers practising in the WorkCover jurisdiction.
Little weight is placed on the results of these examinations by courts.
Attending medical examinations can be stressful, but some simple steps will make an examination less stressful. You can find them under the keyword “IME”, for example more about IME and how to protect yourself; the dreaded independent medical examinations: a good video tutorial etc.
In other words: once you get notification (= a rejection letter) from CGU (you insurer) that your weekly payments and/or medical treatment and like services /whatever are to be ceased based on this biased IME’s opinion, you can appeal the decision at Conciliation.
Dealing with disputes with workcover (Vic)
[Note: similar procedures are in place in all states]
With the proper guidance most disputes with WorkCover should be resolved without a court hearing. Most disputes are initially referred to the Accident Compensation Conciliation Service, which will attempt to resolve a dispute in an informal manner.
How to lodge a conciliation request
Referring a dispute to the Accident Compensation Conciliation Service merely requires the completion of a simple form and sending that form to the service. The postal address of the service is:
GPO Box 251
Melbourne Vic 3001
A conciliation form can be obtained from the following;
- the Accident Compensation Conciliation Service – telephone 1800 635 960 or (03) 9940 1111
- download a form now here
- your WorkCover claims agent
The form should be completed by filling in all relevant particulars. The form asks you to specify whether anyone is assisting you with your conciliation. Generally, lawyers are not permitted to attend conciliation on your behalf but assistance is available, at no cost, from two excellent advocacy services:
- Union Assist can assist members of unions who have a referral arrangement with Union Assist. If you are a union member you should contact your union and they may be able to represent you themselves or may refer you to Union Assist.
- WorkCover Assist is also an excellent advocacy service which is independently funded by government. WorkCover Assist advocates for persons who are not union members or persons who do not wish to use a union-based service.
Both services employ skilled and committed advocates who will attend conciliation to assist you and to argue your case.
If you insert the name of the organisation assisting you with conciliation on the form this will mean that they will automatically be copied in on correspondence and also ensures that your matter will be scheduled at a time that is suitable to the advocacy service. This can be inserted as follows:
‘to be advised’
‘WorkCover Assist/Union Assist’
When completing the form you will be asked to specify the decision of the WorkCover agent that you are disputing. Normally, the decision will be contained in a written notice but sometimes it may be conveyed to you verbally by your WorkCover agent. In other cases, you may want to refer a matter to conciliation because the WorkCover agent has failed to make a decision about a particular aspect of your case- e.g. pay travelling expenses, approving surgery etc. This type of dispute should only be referred to conciliation after a reasonable period has expired for WorkCover to respond to your request. It is also useful to try and contact the WorkCover agent and request a response before referring the matter to conciliation. If these efforts are unsuccessful, you should refer the matter to conciliation.
You should insert the details of your dispute in the large box at the bottom of the form. If you have received a written decision from WorkCover that you dispute, you should include a copy of that decision.
These are a number of typical examples that could be inserted;
- ‘I dispute the decision to terminate my entitlements’
- ‘I dispute the decision to reject my claim’,
- ‘The WorkCover agent has incorrectly calculated my pre-injury average weekly earnings’,
- ‘The WorkCover agent has failed to pay travelling expenses forwarded to them on.’
- ‘The WorkCover agent has failed to approve my request for surgery which was submitted on..’
When you have lodged your conciliation form by posting it to the Conciliation Service, you will receive an acknowledgement. The Conciliation Service may also provide you with DVD which shows how a typical conciliation is conducted.
If your dispute involves medical issues, the Conciliation Service will provide you with some forms for you to sign and give to your doctors. This form requests the doctors to prepare a report on your condition and to send that report to the Conciliation Service. If the conciliation has not sent enough copies of the form you can contact conciliation and request more or, alternatively, you can photocopy the form. The bill for the preparation the report should be sent to the WorkCover Agent.
The Conciliation Service will contact you again and advise you that a date has been allotted for your conciliation. At this point, you should contact your conciliation advocate to advise them of the date and to make arrangements to meet with them. As they have been specified as your agent in the form that you lodged, they will have been copied in on all correspondence related to your matter. The Conciliation Service will also have provided to them any copies of medical reports that they have received about your matter.
The conciliator who will be handling your matter will then contact you to provide you with more information about the conciliation process.
Lawyers are generally not permitted to appear at most conciliation hearings, but two excellent and free advocacy services are available to assist you. Union Assist is an advocacy service for union members and WorkCover Assist is able to help other employees. [We HIGHLY recommend WorkCover Assist]
If you are unhappy with the outcome of conciliation, you are able to pursue your claim by court action.
Some disputes can also be resolved by referral of the dispute to the Medical Panel. Whether or not you should have your dispute referred to the Medical Panel is a complex issue, and depends on the circumstances of your particular case. A determination by the Medical Panel is final and conclusive and cannot be appealed against except in the rarest of cases. The Medical Panel can make binding determinations on issues such as whether you are incapacitated for work, whether incapacity is permanent and/or work related.
You should contact your lawyer for advice, preferably before you are referred to the Medical Panel. In some instances detailed written submissions should be made to the Medical Panel prior to a consultation with them to ensure relevant considerations are taken into account.
Also see blog articles for more information (there are heaps more under search term “ACCS”, “conciliation”, “medical panel” for example)
- Going to a Conciliation conference for your work injury
- Resolving workcover disputes with the Accident Compsensation Conciliation Service (ACCS)
- WorkCover terminates payments – conciliation or medical panel?
- What if a claim is rejected or notice is given that weekly payments will stop?
- Medical Panel or a judge
Hope this helps, mate and thank you for sharing your story. We will be adding the name of this evil IME to our list of “Hired Guns”, which you can find in our Forum.Kick Butt!