Are our Medical Panels biased?

bias-and-workcover

Speaking in general terms, it has been said by Victorian senior lawyers and many Victorian  injured workers that, when a matter (dispute) needs to be referred  to a Medical Panel,  the Medical Panel tends to provide fair and consistent outcomes; and that -unlike “independent” medical doctors (IMEs) – Medical Panel doctors generally display quite a high (or at least higher) level of independence….

Their medical examinations tend to be more careful, and more professional. Indeed many injured workers report a real difference between the often hasty and superficial examinations conducted on behalf of WorkCover earlier in a claim and the thorough Medical Panel examinations.

However, it has lately come to our injured attention, that more and more Victorian injured workers have been disappointed by unfavourable decisions made by a Medical Panel, and that unsympathetic and, yes, biased, Medical Panel doctors appear on the rise!

Through our interactions with many injured workers, it appears that Medical Panel assessments and examinations are currently conducted much more hastily, less thoroughly and that more and more “reports” and “opinions” appear to be lacking rigour, and even evidence-based medical substantiation. “Reports” frequently contain spelling and grammar mistakes, omitted submitted medical evidence (such as medical imaging reports) and are becoming more akin to our, often, grossly fudged IME “reports”.

Could it be that our Medical Panels are under-resourced and overworked, given that disputation is on the rise? Or are we really starting to see explicit bias?

Take the following story of injured worker “S”….”Since when do the medical panel get away with we don’t believe the MRI results.” (what!!!)

Are our Medical Panels biased?

Whilst there are benefits of referring a matter (dispute) to the Medical Panel (i.e instead of Court), the risks of undergoing a Medical Panel assessment should be clearly understood and explained to the injured worker, including that any  workcover “benefit”, such as approval for surgery, and any potential common law rights may also be affected by an unfavourable decision by an unsympathetic, hasty, or potentially biased Medical Panel.

Individual decision makers, whether at a Medical Panel or a Court, can have different views. This difference is, arguably,  only natural for human beings. This can affect the outcome of a determination. The outcome from a sympathetic Medical Panel will be better than from an “unsympathetic” Judge. Conversely, the outcome from a sympathetic Judge will always be better than from an unsympathetic, biased or fudged Medical Panel. It is not possible however, to know the composition of either forum in advance!

A medical Panel examination – Injured worker “S” ‘ story

“Went to the medical panel as there have been two requests for surgery, Long story short knocked back by [the workcover insurer]. Submitted all the usual cr*p doctors reports and MRI results etc.

Since when do the medical panel get away with we don’t believe the MRI results. (what!!!)

Great! Guess we have to open up our arms or limbs and show the problems inside.

Guess what this is getting appealed in a court what other proof can you give but MRIs showing the damage. Stupid people. This is what is stated on my rejection for surgery.”

We need to organize a mass rally against the medical panels that stuff up everything clear to see where there loyalty lies.

(Note: “S” is suffers from serious injury(ies) and horrific complications – which we have omitted for privacy reasons).

It is not the first time we have heard from injured workers (and seen reports) who have undergone a Medical Panel assessment, only to find out that critical evidence was omitted or twisted. This ranges from reports containing something the injured worker did not say (i.e. complains of pain in a certain body part, which was never raised), to having crucial medical evidence missing or fabricated.

In such another recent case a seriously injured worker (>40 % WPI), who has a destroyed joint and needs a special total prosthetic joint replacement, a Medical Panel wrote that “there is no bone destruction” (of/in the joint) – written black on white – whereas the injured worker submitted his/her MRIs, X-rays, CT scans etc, showing a massive bone fracture (2 x 2 cm) of the joint, as well as end stage osteoarthritis AND advanced stage of bone rot (aka: avascular necrosis). The injured worker was assessed as “stable and stationary”, only to have his/her joint fragment (splinter into pieces) about 8 weeks later. This was foreseeable as the medical images clearly showed imminent collapse of the joint surface.

This clearly shows that none of the Panel doctors actually looked at the images provided, or worse, that they were unable to read a medical image!

Whilst we may – at a push- accept a “spelling mistake” (maybe) or an omission of a fracture (if it would not have made much difference in the assessment or its purpose), we were gobsmacked to hear that a supposedly professional medical panel, consisting of 3-5 “specialists” would be capable to write that “they (simply) do not believe an MRI” and get away with it?

We also know that many of our IMEs (both the ‘good’, and the ‘bad’) rotate through Medical Panels –  so if you’re unlucky you can have a bunch of biased folks together, which may be the reason for the most bizarre opinion in “S”‘ case.

We also know that many Panels consist of doctors and specialists, not necessarily with expertise in the field of an injured worker’s injury. We often hear of injured workers who have been assessed by a “Rheumatologist” for example for a complex orthopedic injury? Or a “Neurologist”? If you are lucky you may have one general orthopedic surgeon on the panel, often one who has no experience in your type of injury (i.e a general orthopedic surgeon for a complex elbow or shoulder injury; or a shoulder surgeon for a complex knee injury)? Those unfortunates who suffer from pain syndromes such as CRPS never have a Pain Specialist on the Panel, yet their condition(s) are assessed by a “Rheumatologist” and/or a “Genereal Surgeon”.

In the case of injured worker “S”, s/he suffers – amongst other things- from an injury to the wrist/hand and submitted opinions from 5 doctors all saying s/he required further surgery to the wrist/hand area. They also stated s/he will lose all function on the hand, if the surgery is not undertaken within a certain time frame.

In this case, the Medical Panel was provided with all the reports and opinions (incl. imaging), and appear to have outright lied and also changed what the injured worker had said during the examination. On the Panel were two orthopedic surgeons and one Rheumatologist, who all “did the talking and writing”, says injured worker “S”.

Appealing Medical Panel Opionions

According to our legal sources, the decision of the Medical Panel (Vic) can only be appealed on very narrow grounds. It is only possible to appeal the decision if the Panel has made legal error.
It is not possible to appeal the decision of a Panel solely on the basis that it came to the wrong conclusion.
In order to appeal a decision of a Medical Panel, it is necessary to demonstrate that they have made procedural error. This type of appeal is very technical and must be made to the Supreme Court within strict time limits. If an appeal to the Supreme Court is upheld, the decision of the Medical Panel will be quashed and the matter sent back to the Medical Panel for a further decision. It is normal for the new decision to be made by different personnel at the Medical Panel.

Time limits

Appeals against the decision of a Medical Panel are only possible on extremely limited grounds. An appeal against the decision of a Medical Panel must be made to a judge of the Supreme Court of Victoria.
The time limits are extremely technical as an appeal can be launched either under the provisions of the Administrative Law Act or, alternatively, under the specific orders of the Supreme Court. Under the Administrative Law Act, the period can be as short as 28 days. (This period can be marginally extended more detailed reasons requested from the Panel and those reasons in fact supplied).
Under the orders of the Supreme Court the normal period for appeal is 60 days from the date of the decision. The Supreme Court, however, has a general discretion to extend this period where it is in the interests of justice.

We do also know that doctors from the Medical Panel(s) must now also provide detailed written reasons for their opinions/decisions. This is positive in the sense that the doctors really need to think hard so they can confidently explain in writing why they decided X or Y. : see the case: http://aworkcovervictimsdiary.com/2013/02/beware-that-medical-panel-opinions-decisions-are-legally-binding/

According to a paralegal, an appeal can be made when the Medical Panel have clearly “fudged” the report and added stuff that is not true as this matter and the documentation are relied on for the courts.

In “S”‘ case it appears the Medical Panel ” fudged”  his/her report and clearly stated “they do not believe the MRI’s”.

This (MRI/Medical imaging) is the only proof a worker has of injury besides describing the pain they are in.

It is believed an appeal can come from injured worker “S”‘s case, because the Medical Panel have “mucked up” his/her report.

According to injured worker “S”, the Panel also stated (in their report) s/he has pain in her/his elbows, and then( further down the report) stating s/he does not have pain in the elbows. The age of the injured worker the Panel wrote down is  also totally wrong and from reading the report they seem to have mixed up this injured worker’s report with somebody else’s.

When the “medical mummies” (retired has beens) have finished there examination and notes then the girls type up the reports and then they are supposed to be sent to the medical mummies lawyers for them to read and put their bit in.

How many people have come across numerous typing errors wrong information and total cr*p, and, according to a paralegal, on these grounds you can appeal because these are legally binding documents that are wrong.

Especially if it can be proven that they have ignored MRI’s, – as in “S”‘case – in other words, if you have hard evidence.

To convince the courts, our paralegal says, all you need is what they have written on your report – clearly a lack of regard for our (medical) science and also when a signed document is wrong they must take a look again, these documents are legally binding.

As said before, mistakes on these documents go towards discrediting the Medical Panels and therefore are biased and false documents.

If your GP gets things wrong and you suffer because of it you have grounds to sue for medical malpractice, same rule applies here – it is a loop hole that we need to exercise to be able to do anything about this cr*p we are enduring.

This injured worker is writing to both Canberra  and to the state of Victoria government to ask them how these Medical Panels can lie and get away with this – as this is a legally binding document.

We urge anyone that has problems with Medical Panels and the like, to share their stories on our site.

In turn we could then send a detailed and substantial letter to our State Government, including the Minister for workcover and hopefully can get something done, as we believe this is purely criminal and- as injured worker “S”, we intend to get things changed. According to our paralegal, the courts have also had enough of these Panels not doing the right thing.

 

Other articles you may find interesting:

[Posted on behalf of workcovervictim]

 

 



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9 Responses to “Are our Medical Panels biased?”

  1. The thing is that does not get told is more and more of these so called IME’s that we are sent to are now being put into rotations on these medical panels. From what my solicitor has to say though that this may be true but the doctors even biased reserve the Nast comments and tend to not be so nasty on judgement and do only what they think they can legally get away with in a court of law if it comes to that. Me personally I think that comes under a conflict of interest but no one is making these doctors accountable not is there a screening process to ensure that they are truly biased. Also guys on the forum my password has been reset and I don’t have a pc only have my phone and the password is to long and do not no how to copy an paste on a phone on the next few months I plan to get another computer and I will be set then until then I’m locked out

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    • @Statesman – we will reset your password later today and email it to you – and make it a short one, so you can access the forum from any device.

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      workcovervictim3 October 2, 2013 at 8:58 am
    • Biased IMEs are obviously bribed (guess who is behind??) and they do the unprofessional fraudulent activity because they can run away, they know what are the risks in the game, the system needs to be adjourned!

      Regarding copy and paste, if you have a smartphone, tap on the text and hold until the option to copy pops up, then you copy and paste in the same way.

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      Xchangingvictim October 4, 2013 at 9:06 am
    • Agreed. I think the has beens and dollar wanna-be’s that make up these Medical Panels look at your case, take 1 look at you and decide “nup” and then know the legal jingo to write that is enough to hold up in court.

      It might be the IME report submitted to the Medical Panel was written by an ole chum of theirs, so they are unlikley to go against their opinion regardless of other evidence.

      These Medical Panels decide on their conclusion (ie to deny your payments) then write just enough truth into their reports so you can’t appeal them to Court.

      Only stupid Medical Panels make stuff up or ignore evidence and actually say so in their report !

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  2. I totally agree that the medical fraternity that work with work cover report in favour of the insurer I just got my report for my shoulder from an upper limb specialist and he has told QBE that I am fit for full time duties and he’s got nothing to do with my back injury and my orthopaedic surgeon still wont give a time frame for me to return to full time hours and my physio is saying the same so I am now on the hunt for a second opinion but I just need to find one in Darwin.

    Cheers Tomsophie009

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    • A 2nd opinion is no good. The 1 opinion from the IME doctor will be used by your insurer to say your weekly payments and medical expenses will now be terminated. You will then need to lodge a request for conciliation which in turn will refer you to the Medical Panel for a determination of your medical status.

      You can go and get 10 independent medical reports all saying you are unfit for work but so long as the insurer has 1 IME report that says otherwise thats all they need to cancel your payments which will force you to go to the Medical Panel.

      And the Medical Panel is known as a “lottery” and its not about winning big, its known that because its outcome is unpredicable and at many times contrary to logic and/or the weight of the medical opinion.

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  3. I’ve been to probably 10+ IME’s over the years and about 6 Medical Panels. IME’s are completely biased and why wouldnt they be? If an IME writes not enough favourable reports for the insurer, do you think the insurer will be referring many more files to them? IME’s would become far more independent if WorkSafe allotted cases to them on a random basis rather than the individual doctor being handpicked by the insurers.

    As for the Medical Panel, they are more independent than the IME’s. However many doctors who sit on the Medical Panels also conduct IME’s for insurers! So it must be in the back of the doctors sitting on the Medical Panels that if they also find in favour of worker too often, this must “sully” their name in the opinion of the insurers when looking for IME files.

    Having been in the system for 10+ years, the last 2 years or so I believe the Medical Panels have become less independent and more toward IME’s. Not as bad as IME’s but certainly on that path.

    I’ve also noticed a disturbing trend that the Medical Panels are providing greater weight to IME reports (where you see those doctors for like 15 minute only 1 time) than your only treating GP or treating specialist. Surely your treating specialist who has the same if not greater qualifications and has been treating you for in many cases years is able to write a more thorough report than a 15 minute IME doctor? Unfortunately the Medical Panel trend seems to be to favour the IME reports.

    It would be very interesting to see the statistics (I bet the Medical Panels wont let anyone see them) of a year by year trend of how many Medical Panels have found in favour of the insurer Vs in favour of workers. I bet the trend has been favouring the insurers over the past couple of years.

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