All rogue IME doctors ought to be purged from the workcover system

corrupt-ime

workcovervictimsdiary.com believes that our government can and should do a far better job within workcover system to at least ensure that all workcover victims are treated fairly so that they have the best possible chance of reaching optimal recovery after a work injury. One way to ensure a fairer system would be to purge all poor quality -and frankly- biased insurer-chosen  IME doctors, which are a massive ongoing problem for injured victims.

All rogue IME doctors ought to be purged from the workcover system

corrupt-ime

Work injury victims are repeatedly forced to attend (unnecessary) “Independent” Medical Examinations (IME) when they make a workcover claim. Unlike any other visit to a doctor, injured workers have no choice in who their “independent” medical assessor will be, as this decision is made by their workcover insurer (and medically uneducated case manager).

During such an IME, vulnerable and injured workcover victims are no longer ‘patients’ but are now ‘clients’ to whom the assessing IME doctor basically owes no ‘duty of care’. Far too often the IME doctor will provide an unqualified, biased or trashy assessment that becomes part of a injured worker’s medical file. Workcover benefits, such as medical and like treatment (incl. surgery), weekly payments and rehabilitation are often wrongly discontinued based on a shoddy IME doctor’s report and it can take months to even years to have these treatments and benefits reinstated.

Worse yet, our government also allows the workcover insurer to terminate or suspend an injured worker’s benefits for simply failing to appear at an IME assessment when ordered to do so.

Workcover victims should be very concerned when attending these IME assessments when there is no real and reliable oversight, no way of knowing whether that IME doctor  has a multitude of complaints about the quality of their work that have been kept “secret”or out of sight, i.e the IME doctor has been found guilty of an offence or has been subject to disciplinary action or an adverse finding in relation to his / her duties as a medical practitioner by a court, board, tribunal, organisation, body or entity including the Medical Practitioners Board  or an interstate or overseas body; the IME doctor has his/her workcover authority approval previously revoked

Several of our searches related to Legal/Court Decisions found that some Judges/ Arbitrators etc have described what they are asked to accept as ‘IME doctor/expert witness evidence’ as “inaccurate, misleading, defective, incomplete, deficient, not correct, beyond their field of expertise and flawed” .

How is the vulnerable injured worker supposed to discover the information on such –at times censored– matters that have kept the public in the dark about the quality of the medical services provided by these shoddy doctors?

Are injured workers supposed to read all legal cases so that they can inform themselves of such adverse IME legal decisions?

Fact is adverse comments about IME doctors / expert witnesses are deeply buried in Decisions few workcover victims ever read! So the injured worker is kept in the dark about the “qualifications” and reputation of the IME doctors and must attend at his/her own risk. For this reason alone, workcover victims should never attend IME  assessments without a family member or friend to accompany them to keep records.

Needless to say that all this has worked out well for the workcover insurance industry and for those for-hire IME doctors who provide insurers with the medical reports used to decide whether or not an injured worker is entitled to treatment and benefits.

The lack of accountability has allowed a small group of pro-workcover insurer  and anti-injured workers doctors to operate without fear of consequences while providing workcover insurers and our courts with unsound and substandard IME reports. Reports that are then used to disqualify and discrediting legitimately injured workers.

Seriously injured workers will never get fair treatment unless/until the quality of insurer assessments -IME doctors- denying them workcover benefits (including medical treatment benefits) improves.

Shoddy insurer-chosen IME doctors have been a continuous problem for countless injured victims, particularly the most seriously injureds.

Many of the IME doctors and workcover authorities and their insurer agents who have been the key architects of our insurance compensation system have the opinion that many injured workers exaggerate their impairments for opportunistic gain…

Some of these ‘experts’ have been sketchy characters indeed.

For example: Dr Lawrence Terace – psychiatrist: See: as mentioned in WA Parliament ; See: hired guns in workers compensation.

“The prominent feature at this interview was what I consider to be overacting. The appearance of great anguish was so excessive that I can only regard it as histrionic. It is my impression that [his complaints] are manufactured for the purposes of elaborating upon what may have been a genuine disorder in the past………….In my opinion the state of the patient no longer meets the criteria of PTSD, but rather impresses me more as malingering hysteria……

The injured person’s account of the examination:

“I found Dr X’s attitude from the start to be provocative and intimidating. He frequently smirked when I replied to his questions, and the whole interview with him was more in the nature of an interrogation. At a later stage of the interview Dr X sat me in a chair and asked me to hunch up my shoulders. [Dr X has no orthopaedic qualifications or expertise.] I indicated to him that I was in pain and that pushing down caused me pain. He asked me to hunch up my shoulders again and I refused. He pushed down on my shoulders hard..”

This IME has obviously helped set a standard of injured worker bashing and abuse that became acceptable and it continues to this day.

Many such IME doctors whose sole source of income is through insurer sponsored IMEs have, through their reports, disqualified many thousands of legitimate and vulnerable workcover victims.

The problem of bias

Judges have been complaining about the lack of objectivity in expert evidence for a long time. The following lament was made by a judge over a hundred years ago:

“Undoubtedly there is a natural bias to do something serviceable for those who employ you and adequately remunerate you. It is very natural, and it is so effectual that we constantly see persons, instead of considering themselves witnesses, rather consider themselves as the paid agents of the person who employs them.”

See Lord Arbinger v Ashton (1873) 17 LR Eq 358 at 374.

A number of judges have stated that in their opinion adversarial bias on the part of expert witnesses remains a problem, despite the code of conduct.

Sure, there are some good and (many) bad IME doctors, but that is the problem! Shouldn’t ALL IME reports be accurate when the quality of life for our most vulnerable injured or ill workers lies in the balance?

We believes all ‘rogue’ IME doctors ought to be purged from the workcover system – whether providing (on a hefty fee for service basis) substandard, shoddy, unqualified or flawed assessments to workcover insurers – or to injured worker’s lawyers – or to both.

workcovervictimsdiary believes that any IME doctor who has been the subject of repeated adverse judicial commentary due to unqualified, incomplete, or shoddy assessments – that IME doctor should be barred from participating in the system.

If our judges or arbitrators have made critical or adverse comments concerning an IME doctor, we believe they should make the comments public rather than leave them deeply buried in decisions that very few read.

Adverse comments made about a rogue IME should be allowed to be used against the IME  in subsequent cases and disallow the use of any IME who has been the subject of , lets say, 3 negative comments. This would be the only way we could get rid of ALL shoddy, biased IME doctors.

In order to attempt an ending to the practice of  substandard, biased IMEs we should all add links to interesting stories and legal cases with quotes from the judges (where applicable) of fact that speak volumes about the inferior quality of these IMEs.

Some examples:

Complaints against IMEs – WorkSafe Victoria (Online Claims Manual)

If a worker is concerned about the conduct of a s112 examination, they may make a complaint.

Complaints may include allegations of any of the following:

  • causing unnecessary pain in an examination
  • complaints of an examiner’s manner
  • incorrect reporting
  • inappropriate behaviour.

WorkSafe’s role

All complaints about IMEs should be referred to the IME Services Branch of WorkSafe (contact 03 9641 1757).

The nature of the IME complaint determines how the complaint will be handled. WorkSafe will only investigate administrative complaints. Other complaints in relation to the professional and ethical conduct of IMEs may be referred to either the:

  • Medical Practitioners Board of Victoria or relevant Allied Health Board or
  • Health Services Commissioner.

Types of complaints

Verbal complaint

If a verbal complaint is received, the agent must:

  • register a complaint
  • advise the complainant that WorkSafe assesses all complaints about IMEs and that the complaint will be referred to WorkSafe
  • Notify WorkSafe immediately about the complaint by contacting the Health Services Group on 03 9641 1757. The details to include are:
    complainants name (if not worker, please specify)
    claim number
    name of examiner
    outline of complaint.

Agents must not contact the medical examiner regarding the complaint or any matter related to the complaint.

Written complaint

If a written complaint is received, the agent must:

  • date stamp the day of receipt
  • forward complaints within 24 hours of receipt to:

IME Services Branch
WorkSafe Victoria
GPO Box 4306
MELBOURNE  VIC  3001

  • or fax immediately to 03 9641 1767
  • Include any relevant additional information in regard to the complainant or medical examiner, for example medical reports, IME referral letter correspondence previously received etc
  • place a copy of documentation on the worker’s claim file
  • notify the complainant that WorkSafe assesses all complaints about IMEs and that the complaint will be referred to WorkSafe.

Agents must not contact the medical examiner regarding the complaint or any matter related to the complaint.

Keep a register of complaints

Agents are encouraged to keep a central register to record the details of medical complaints against a s112 medical examiner, whether verbal or in writing. The details that may be recorded include:

  • date complaint received
  • medical examiner’s name and address
  • details of appointment
  • name of worker
  • claim number
  • name of employer
  • name of person or organisation making complaint, if different from worker
  • details of complaint
  • type of complaint:
    verbal or written
    administrative or medical
  • date complaint referred to WorkSafe
  • details of any action taken.

Referrals to s112 medical examiner who was the subject of a complaint

If the worker has lodged a complaint and specifically requested not to be referred to the IME again, agents should seek an alternative IME for future examinations.

Note: Only WorkSafe can remove a medical examiner from the approved list but agents can determine which medical examiners from the list are to be used.

We can get rid of rogue IME doctors, but in order to do so all injured workers who have undergone a substandard IME assessment and/or received an adverse, biased and flawed IME report should make a formal complaint!

Further reading

Guide for Independent Medical Examination Reports – WorkSafe Victoria

 related article

 

[Post dictated by WCV and manually transcribed on behalf of WCV]

 



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37 Responses to “All rogue IME doctors ought to be purged from the workcover system”

  1. When I asked Worksafe to provide me with a list of IME’s closer to my Home so I didn’t have to travel 2 hours each way to see the insurers local IME they told me Worksafe don’t have lists and it is handled by the insurer and I needed to ask them?
    When I queried the insurer about a closer IME they told me there were no IME’s in my area, they only have IME’s in Melbourne.

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    • Hi Jo, I have just been told I have to fly to Sydney because there’s no IME in the Central West NSW, which may be correct. But I bet they do come out this way to examine people. I was told at first to catch a 6.25am flight which meant leaving home at 5.30am!!…so I got onto the REX website and found there was flights at 10.25am.
      So I made sure the case manager and her understudies knew of this. Eventually I received a call back and they had changed the flight to the later time.
      I had emailed my lawyer of these proceedings and when I get the official letter of my appointment, I will forward it promptly. Maybe they can pressure the IC to use an IME closer to where I live.

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      • Go onto the WorkCover website and search the assessors to find one in your area. The WorkCover guidelines state they must be in an area geographically close to where you live. Ring WorkCover and tell them the insurer is not following the WorkCover IME Guidelines. The insurer is only allowed to send you to an IME if they can’t get the medical evidence from your treating doctor or specialist so ask the case manager what attempts they have made to do this.

        Have a good read of the following to see if the insurer is complying with the guidelines and make an objection via email to your case manager if they are not. Just read a good court case recently where the insurer breached the guidelines and the injured worker did not attend their preferred IME and the arbitrator found the guidelines were mandatory and the insurer failed their legal obligation. If they are sending you to Sydney they are wasting money so you can be pretty sure they are using a preferred assessor for a reason.
        All NSW injured workers need to read these guidelines and object to the insurer and complain to WorkCover if the insurer is not complying.
        http://www.workcover.nsw.gov.au/formspublications/publications/pages/independent-medical-examinations-reports-march-2012.aspx

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        Bashed and bullied April 25, 2014 at 11:57 pm
        • Thanks, for that. I’ve managed to get the flight changed to 10.25am so I’m not hanging around Sydney for hours on end. I’ll see what the letter says when it comes next week.
          I have already contacted a lawyer about this, so we’ll see what pans out.

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  2. I cannot believe the number of crooked assessors both my husband and I have experienced. My husband was subjected to three AMSs of whom lied about the information provided, misrepresented other medical information and provided biased reports that had false and misleading information. he was subjected to at east four other IMEs who did the same, plus an Independent Physiotherapist Consultant who misrepresented facts and diagnosed outside his area of expertise. I saw a physiotherapist consultant who did the same and I was assessed by an IME who wrote a most fraudulent report. We have the proof of all these as their own reports, notes and replies make clear they have provided false and misleading evidence but even though this is so obvious those taking our complaints have showed nothing but reluctance to even provide a reply. They verbally acknowledge, remove the reports but there is no action and the same people just carry on doing the same old thing regardless. There is no accountability and this goes on and on and I have had enough. We know we must keep pushing for more to be done but at times it gets so overwhelming.
    Just having a vent but wish someone would listen and be prepared to take action against these bastards!!! The trouble is when these assessors are found to be corrupt it demonstrates the whole system is out of control and no one wants that out!!!

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    Bashed and Bullied April 3, 2014 at 1:55 pm
    • Yes all the IMEs are just in it for themselves they love the money,so they will lie so they can keep thE $$$$$$$ coming in.They have stopped paying for some of my treatment because one of their doctors say I don’t need it,but my doctor just says I do.So im paying for it myself,yet they have a f pi sitting outside my house and I can see him,so work that out.All I do is go to my treatments and come home that’s it,so good luck to this f shit head of a pi in his car im watching him watching me what a joke,hope he needs to go number 2s really bad.

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      • @tony

        only a suggestion.

        get a camera and film him or get someone you know to film his car, plate number etc. someone you know or yourself ( depending on you injury/s ).

        walk up to his car with a camera knock on his window and greet him saying something like:

        hello, im just here today monitoring suspicious activity within the neighborhood, have you noticed any suspicious cars hanging around the area.

        (make sure whoever films the private investigator gets his or her face on camera + plate number of the car)

        – after report it to the police immediately, give them the details of…. (the suspected drug dealers/burglary/pedofile watching ‘your kids’ or ‘neighbours kids’).

        no harm reporting it to the police. you are concerned and you should be!

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        HuntingWorkcover April 3, 2014 at 4:11 pm
        • Hunting Workcover,thanks for the tip I love it and im going to get my neighbour to do it he is an islander and built like a brick shit house,he also has young kids and he too is sick of him.He watches him watching me.Wasting all that money on a stupid pi who is so obvious a blind man could see him sitting there and im left to pay for my treatment its just all bullshit

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          • are these clowns protected by stalking laws….if not I would have them charged for stalking

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  3. I live in Darwin and was sent to an IME in Brisbane !! The flight alone cost them $2000.

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    • the transport provided for me to see specialist in brisbane was minimum $70 a ride and $350-450/night hotel plus airfares….could have spent on fixing my leg

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  4. It took 5 months to get an appointment with a specialist who would actually agree to see some one on WorkCover.

    This is the statement workers need to divulge on canberra with!!

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  5. Went to IME appointment was a dick head say it was 5 minutes physical exam the rest interigation wouldn’t let me answer the questions fully spoke to me like I was shit.KARMA is all I can say.Please tell me these arseholes must and I mean must get threats they have too,does anyone know of this just someone must have a story just to make me feel better.

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  6. they will spend money like it really does get printed there, 5 years in my claim and we estimate a minimum $250k spent on legal and WC proceedings (NSW) and they lose everytime.
    Remember IME’s and any opinion costs anywhere from $2-$4k I have seen invoices from legal for reports $3500 for a report that had mostly inaccurate details in it and could not even get my name right/employer and past was way off and where I lived Ihad never even been there.
    they will spend spend,spend, accept it as it is easier to understand as I use to get so angry but I am sure there stock holders wouldn’t be happy with how they throw money away, well not really they are paying for lies, I have had 12 reports done and not one was correct and the bullshit in it just makes you laugh at how a person can deliberately accept money to story tell. They should all be forensic tested- lie detector when giving evidence- if it is good enough for the police.

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  7. The whole system is rotten to the core with entrenched corrupt, criminal behaviour by both the insurance companies and the ‘IME’s. Bias is a huge conflict of interest. In NSW we’ve just had our Premier Barry O’Farrell fall off his throne after a ‘slam dunk’ piece of evidence in relation to the very generous $3000 wine gift. I know that I would never forget a gift like that, especially when he acknowledged even that it was bottled in the year of his birth. I find it hard to accept Barry’s sudden memory loss. I am sure he remembers other things just fine. But hey, he’s not going to admit lying because that’s a criminal offence. ‘Forgetting’ isn’t.
    IMEs may not get gifts (maybe they do?) but they get to stay on the list kept by the insurers – as long as their bias is towards the insurers. This of course means there is a huge financial interest that is an obvious conflict of interest – but the NSW, VIC, etc. State Governments turn a huge blind eye to it because it all relates back to the State Treasury.
    NSW Workers Comp have ‘Approved Medical Specialists’ employed for Workers Comp (i.e. State Government) who are supposed to be unbiased but overwhelmingly their WPI% and other findings reflect a huge differentiation to any figures provided by external examiners. And the actual inventor of the now legislated WPI% scale in NSW – Dr. Julian Parmegiani is quoted in the ‘Sydney Morning Herald’ on Nov 21, 2001 in article “Rising din of ‘head noises’ on front line” (article about NSW Police yet again being accused of rorting the NSW Workers Comp system – despite no evidence of this) that ‘there are people who exploit the system’ and ‘there are a minority who are “stuck in frontline duty and see the generous compensation scheme as ‘a way out’.” He also is quoted as saying “The prospect of compensation, and the examples of colleagues who leave with generous payouts, foster a ‘sense of entitlement and a sense of injustice’. He is also quoted as saying “Some psychiatrists have built their career on this.”
    I must have been spending all of my time around a very different ‘circle of friends’ because I have never come across police who are doing this. If I ever found out anyone was trying to make a fraudulent claim I would immediately report it to the police. So how can Dr. Parmegiani who is an Approved Medical Specialist for NSW Workers Comp, be allowed to continue with an obvious pre-determined bias which I argue is without evidence (this sense of entitlement and injustice). I want to see evidence that supports his claims. Especially since he is on the panel for AMS and this is the last port of call for WPI% claim appeals. Very disturbing. The only injustice police (and others in the system) would express is the terribly biased workers compensation system that is unjust. Let’s hope that Workers Comp cannot hijack your website again to try and shut you down and destroy all of your ‘evidence’. I hope that those responsible are criminally prosecuted and sent to gaol. There needs to be a Royal Commission looking at all States.

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    • Joe, the sad reality is that some people who put in compo claims are not genuine, and they ruin it for the rest. All you need to do is to watch A Current Affair or Today Tonight, and you’ll see videos of supposedly wheel-chair bound people building brick walls and jet-skiing. If you don’t believe there are any crooked cops, just watch the cops who starred in Blue Murder. Most injured workers, including cops, are fair-dinkum and need to be compensated, but I agree, the system set up to assess them could be a lot better.

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      • @Jessie,

        You have hit a raw nerve!

        Either you are naive, only very recently injured or work in the insurance industry.

        Are you for real?

        Of course there are fraudulent workcover claims made by ingenuine workers. However, the percentage of fraudulent claims is minute (more knowledgeable WorkCover researchers on this blog would have accurate figures) I think it is a fraction of 1%. I do remember reading in a WorkCover Annual Report (Victoria, I think) that when the total cost of investigating possible WorkCover fraud is divided by the number of successful prosecutions, it amounts to several hundred thousand dollars per conviction!

        If WorkCover investigated the fraudulent activities of employers under-reporting on their annual returns, or over-charging by IMEs and other hangers on in the workers compensation industry, I am sure they would get better bang for their legal and investigative buck!

        Ever heard of Medicare fraud? Should every treating doctor be assigned a team of private investigators, just because a small percentage of doctors are fraudulent? Should Medicare reject every payment request to all doctors and force them to commence legal proceedings to justify their position? Of course not – that would be illogical, irrational, ineffective and extremely costly.

        Because that is exactly what WorkCover does to all seriously injured workers.that are unable to return to work within 3 months (the time of despair for case managers who miss out on juicy bonuses).

        Jessie, you would be better, joining hands with your likeminded flock, singing Kumbaya and offering sacrifices to the great benefactors of the modern world – Insurance Companies!

        No genuine, seriously injured worker, will ever survive this corrupt system with your “bend over and take it up the arse” attitude.

        Yep, let’s get rid of corruption and fraud – but let’s start with the politicians (like NSW’s Greg Pearce, Barry O’Farrell and the 2012 legislation), the insurance companies and their lobbyists, the corruptible bonus system across the whole WorkCover System, IMEs, Rehab Consultants etc etc

        Here endeth the lesson 🙂

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      • Excellent comments Joe and FU_CGU, they are what main stream media should be reporting. Jessie, I do not know your circumstances but you need to know some facts. The rate of fraudulent prosecutions for injured workers is 0.05%, so is demonizing the 95.5% of genuine injured workers fair? We have all been part of the anecdotal observations which are so prevalent in this society. You know the ones – My Uncle knows the father of a man who was not injured but managed to get millions from the taxpayer. The problems with this are that the facts do not line up with the reality. A Current Affair is notorious for lumping all ‘crooks’ together, such as the personal injury woman with the sore neck, the ‘dole bludgers on the Gold Coast’ and the surveillance of the fake injured worker. We are supposed to be outraged at all this because they are stealing from us. What is never mentioned is the fact that the taxpayer pays NOTHING towards Workers Compensation and NOTHING towards personal injury claims (and don’t give me the increase in premiums for the insurance company as a reason to be annoyed with the victims as those increases happen anyway). Lip service is paid to the genuine victims and the emphasis is always upon the assumption that someone is rorting the system. I am NOT a doctor, I cannot assess another person’s injuries and most people do not have the expertise to do this (even doctors who are watching tv and not assessing the victim in real life). Have you ever asked yourself why A Current Affair never does any segments on James Packer rorting the system or Twiggy Forrest not paying any taxes for over 16 years? The attacks on injured workers is an easy sell and even injured workers fall into the trap. I will get upset about fraudulent injured workers when everyone gets upset about insurance companies paying money to politicians to change legislation to their benefit (I have never seen a tv show on that one). FU_CGU gave you a really great lesson, mine is just a follow up, I hope we have enlightened you a bit, cheers.

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      • Before you guys start shooting, please realize I’m not defending the system. I know someone who had a good result. By that I mean that it took years to get the claim accepted, they got a paltry amount and they didn’t jump off a cliff . That was before they changed the laws. Now he would have ended up on the street, living in a cardboard box. You can blame everybody, but ultimately it’s the politicians who decide how the system works.

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      • This debate here reminds me of the dog whistling debates over the level of “welfare cheats”. Those on the Left say welfare fraud is so low as to be non-existent and benefits should be paid out no questions ask because they fundamentally believe that they are entitled to be provided for by the government. Those on the Right say welfare fraud is rampant, should be tightly means tested because they fundamentally believe that people should be responsible for providing for themselves.

        None of these arguments have anything to do with the level of actual fraud, how and why fraud occurs and how it is deterred and are simply advanced by people to support their underlying political ideologies on welfare.

        The fact is workers compensation fraud by workers is not rare; nor is it rampant.

        The 1% of claims figure that gets bandied around might make everyone feel all warm and fuzzy but it has no basis in reality and seems to have taken on the status of urban myth amongst injured workers.

        Fraud is never measured as a number or percentage of total claims – it is measured as a $ of premiums.

        Prosecutions and conviction rates is NOT a measure of the level of workers compensation fraud anymore than we measure the rate of murder by the level of prosecutions and convictions for murder; it measured by the number of dead bodies. The same applies to any type of crime.

        Fraud is particular difficult crime to detect let alone prosecute or obtain convictions – no matter the type of fraud and whom it is committed against; it is rarely prosecuted and even more rarely reported to authorities. When it comes to fraud against government agencies or Workcover schemes and alike more often than not it is far simpler for them to just terminate the claim or cut the particular benefit, seek repayment etc. to minimise the loss rather than try and prosecute. Businesses that catch employees defrauding them do the exact same thing – easier and simpler to just terminate the person, wear the loss and move them on and let them become someone else’s problem. As a result fraud is very much a hidden and buried crime.

        Also government agencies, unlike police forces, have very strict prosecution guidelines and can only prosecute as an absolute last resort and only for the most egregious and repeat conduct. Stopping the continuation of the fraud by a particular individual or recovery of the money is the primary focus; not prosecution.

        The arguments that yeah it might happen but some other group engages in it more or worse is in effect condoning it by “your group” and only denouncing it when it committed by the “other group”. This is neither helpful or productive. Fraud is fraud no matter who commits it and in what numbers. It is never justifiable or reasoned away.

        All fraud whether it’s against WorkCover schemes, Centrelink, the government, financial institutions, businesses, or against private individuals is illegal and is a crime and should be denounced and called out for what it is – criminal behaviour.

        Fraud is fundamentally crime of the frailty human nature; more people than not will do it if they can get away with it. That is just a fact of human nature. The right to apply for workers compensation and the availability of money creates intrinsic temptations for people to attempt to obtain benefits fraudulently. Fraud is nothing more than a crime of opportunity. Opportunity creates the motivation in people. If the opportunity exists and the detection chance is low, this creates the motivation in people, which in turn causes the fraud to occur. The only effective way to deal with fraud is before the fact – to stop it from occurring to begin with by removing the opportunity by having strict controls. It does not matter whether that is in Workcover, employee theft or a family member passing off fraudulent cheques to empty out their Great Aunt Dot’s bank account. The controls are there to deter the fraud to begin with; not detect it after it occurs.

        If there are no controls, the opportunity is created and fraud becomes rampant. Humans that would otherwise be honest become dishonest. Make things harder by having controls and scrutiny, whether it be making a centrelink claim, insurance claim or whatever and the level of fraud reduces significantly. Which is why we are subjected to the level of scrutiny when making workcover claims, or centrelink or applying for a bank loan. This is simply a reflection on the of the scheme’s underlying susceptibility and vulnerability to fraud if no controls were in existence. The high level of scrutiny is intended as a fraud deterrence measure not as a fraud detection measure.

        The level of scrutiny imposed on workcover claimants in general is not designed to infer criminality on you and your claim (though you can perceive it that way if you wish), its intent is to send a message to deter the fraudster from ever making a claim and entering the system in the first place. Unfortunately scrutiny is the price we all have to pay to keep other people honest.

        A low level of fraud is NOT a reflection of peoples honesty or the honesty of a particular group but rather it is ONLY a reflection of the tightness and effectiveness of controls which acts as the deterrent by decreasing the opportunity and hence the motivation to commit fraud. Injured workers do not possess some saintlike honesty and ethics and are no more or less honest than the rest of society. If all controls and scrutiny were removed from the Workcover schemes within no time fraud by workers would be rampant. This is the reality of what is intrinsic human behaviour.

        This is Auditing 101 and Criminology 101.

        Which bring me back to Jessie’s original point:

        the sad reality is that some people who put in compo claims are not genuine, and they ruin it for the rest

        Exactly! It’s not James Packer’s “rorting” or Twiggy Forrest’s tax bill or even Workcover fraud committed by service providers or employers that subjects genuine injured workers to increasing scrutiny, but rather other workers who continue to exploit vulnerabilities in the system that subject genuine injured workers to ever increasing scrutiny. It’s the fraud committed by our own kind aka workers that make our lives more difficult. To condone WorkCover fraud by workers or turn a blind eye to the reality of its existence ultimately will only serve to make our own journey in through the system and those that come after us that much more difficult because of ever increasing controls and scrutiny placed upon claimants.

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        • @Madame Zena,

          Thank you for your well considered post. I agree with the fundamentals of your post that

          fraud is a crime of opportunity

          enabled by

          the frailty human nature;

          I do not accept that the blatant and blanket use of fraudulent practices by one group is justified to prevent possible or potential fraud of an individual.

          The original post

          All rogue IME doctors ought to be purged from the workcover system

          highlights IME fraud. Rogue IMEs characterise the

          the frailty human nature

          : there is opportunity, there is minimal chance of ever getting caught and they get rich off the system- all under the guise of the Hippocratic Oath.

          Call me an idealist, but I believe in justice, a fair go and equality. I am not a saint, we all bend the rules to some degree, but I despise anyone, or any group, that systemically allows fraud and injustice to prosper.

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        • You can own your opinion, but not the facts

          “WorkCover received 354 referrals of alleged fraudulent activity of the workers compensation system in 2009/2010. Ten prosecutions resulted in convictions, 18 matters resulted in cautions in lieu of prosecution and 18 warnings were issued. 0.05% of injured workers.”

          I would also like to point out the fact that I said “Have you ever asked yourself why A Current Affair never does any segments on James Packer rorting the system or Twiggy Forrest not paying any taxes for over 16 years? ” was referring to A Current Affair. I enjoy the opinion of others as long as they refer to the facts stated and not manipulated to promote a position which was not implied. Fraudulent injured workers should be prosecuted as should tax avoiders, but when you have a media which is continually pushing one side and NOT the other, then it should be pointed out, unless you basically agree with that position yourself. Please refrain from taking statements out of context.

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        • There do need to be controls and checks performed, but not to the current level. If there is an injury and it can be proven to be work related then that injury should be accepted, treatment given and if permanent impairment is as legislated then a payout given.. All this to-ing and fro-ing from IME to IME to panels and conciliation is unnecessary… We all know the stress it places on one. Even the court room makes me feel anxious, to the point where I cant think straight, sick to the stomach…
          I opted out of a job in the early 90’s (weaver, was well paying with overtime) but I didn’t want to become a statistic (RSI to my shoulder)… I re-educated and it still hasn’t made much difference, because here I am now 20 years down the track, in the position I just wanted to avoid.

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  8. Sorry, above quoted article was November 24, 2011, not 2001.

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    • Is there any evidence of who hijacked this website?

      I agree about the AMS above as well as other assessors who report their pre-determined views in the media. The evidence in the WCC cases backs up the view they are examining people and allowing their own biases to determine the outcome rather than impartially allocating scores. There really should be a review by a Royal Commission and they can start with an audit of which assessors are preferred by which insurers and the statistics of how many times they favour the insurer usually against all treatment evidence.

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      Bashed and bullied April 25, 2014 at 11:42 pm
  9. Very interesting to just find out the Allianz general phone message says they may record both calls you make to them or calls they make to you. Has anyone ever been told by a case manager they are recording a call when they ring you? Is this legal if they don’t tell you at all?
    Is it legal to hear the message that says the call may be recored and then to be told after the conversation, the case manager recored the call? Shouldn’t they definitely tell you at the beginning of the call when they are recording or is saying “may” record enough to cover them?

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    Phone recording April 25, 2014 at 11:30 pm
  10. @ Bashed and bullied, I’m under Victorian Workover so their system must be different?

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  11. I’m in the process of lodging a complaint against an IME I was sent to who I was seen for exactly 6mins before he wrote a lengthy report full of inaccuracies which has prompted the complete cessation of all my medical & payments by the insurer. Uch, makes me sick to my stomach with anger that they can hold so much power over us despite not even being a specialist in the area of your injury let alone not examining me or even looking me in the eye between his smirks, snorts & arguments! I was in shock & still am.

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  12. See my blog article about IME assessments

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    • @Dr Peter Sharman – thank you so much for popping in and sharing your valuable insights – as an Occupational Physician- through your blog. Your articles re IMEs (the good, the bad and the ugly) may have been written in Tasmania, but apply all over Australia and the problem of hasty, superficial and frankly biased or skewed IME assessments and reports is indeed widespread. I think you covered the essence of this problem really well. One of my main concerns, which only adds fuel to the fire, is that since the inception of our Blog, we have come to see many ‘referral’ ‘cover letters’ from injured workers’ case managers to these IMEs. Often this ‘cover letter’ will subtly (to various degrees) state to the IME (outrageous) things like ” it has been suggested that there may be a psychological overlay...” These ‘cover letters’ appear pretty ‘standard’ and have clearly been written by a someone who has amazing manipulative ‘skills’. Obviously, when an IME receives such a cover letter, together with outdated medical information, or -often – extremely selective medical information about the injured worker, assumes the good old ‘stigma’ that we (injured sods) are all lazy, malingerers or fraudsters, taking advantage of the workcover system.
      One such a case still stands out: the injured worker suffered a very serious upper limb injury (>40% WPI), underwent 7 or 8 major surgeries, suffered numerous catastrophic complications (including several cardiac arrests on the operating table during several surgeries). Yet the cover letter to the “General Surgeon” (of course, not an orthopedic surgeon) stated in black and white that “it has been suggested that the workers has a psychological overlay…” (basically alleging malingering) and that the injured worker had suffered “a bruised shoulder” (that he had 7+ failed surgeries was omitted, as well as the complications). The general surgeon (the IME) was in fact so shocked and horrified with the ‘cover letter’ that he showed it to the injured worker at the appointment. He also showed the injured worker the accompanying ‘referral’ medical information, consisting of one 6 year old surgical report and a IME shrink report (nothing else). He further added that he had been in the ‘business’ of “IME” for 15+ years and that, to this day, was more and more shocked at the various tactics used by insurers (i.e. case managers) to attempt to obtain a ‘favourable’ report, through 1) withholding of critical medical information and 2) writing a cover letter, which pretty always states something along the lines of “…it has been suggested that…”.
      Thankfully for this injured worker, on this IME assessment, the IME was honest and rebutted all and any suggestions, and reinforced the severity of the injury and even that the worker could have claimed liability for ‘additional’ injuries.

      The question remains, how can so many so called “IMEs” not see through these dirty tactics and provide biased, fabricated, Xerox (copy paste) reports – with detrimental effects to so many genuinely seriously injured workers? Do these “doctors” not have a conscious? Are they ignorant? Or… as we believe, are they really in the business to make (good) money on the misery of injured sods. The more ‘favourable’ (for the insurer) reports they write, the more referrals they receive from that insurance company… and the more lucrative their ‘business’ becomes. We say shame on them, and wonder how they sleep at night.

      On that note, I (we) really look forward to part 3 of your outstanding article series: The good the Bad and the Ugly (IMEs)

      Thank you again for 1) starting your blog – Insult and Injury | Perspectives on Workers Compensation Issues and 2) sharing such invaluable insight through the eyes of a medical professional.

      We will add your blog to our “Friends” list (below in the Footer section), but rest assured your site has already been spotted and is already listed on our “Useful Links” page.

      (Dictated – blame spelling on Dragon)

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      Workcovervictim May 22, 2014 at 9:28 am
      • Thank you for your reply.
        I agree the wording of letters from insurers to IME’s can be a problem. I didn’t cover that aspect in my article.
        I am keen to try and put forward workable solutions to improve the problems. I recently posted a comment on IWSN site that gives you some indication of what I believe are the solutions. Here is the link to that comment.
        http://www.injuredworkerssupport.org.au/workers-compensation-review/#comment-89207
        The Twitter account that I use to comment on WC issues is Tasworkdoc – @observerWC

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        • @Dr Peter Sharman
          My workcover claim was in Tasmania. Having physical injuries from a workplace assault that lead to PTSD and depression, I am sure that you would be aware of some of the “experts” that I encountered in Hobart.
          Apart from the blatant misuse of IMEs, the insurers, as well as their rehab providers and their lawyers, frequently flaunt the system by deliberately breaching the Workers Rehabilitation and Compensation Act (TAS) – knowing that their is little chance of being chastised or fined because of the lack of resources to pursue such breaches (there also may be a lack of political will as well).
          On the other hand, if an injured worker, is a day late with submitting a certificate or other seemingly insignificant oversight, then they are threatened with, or actually submitted to, all sorts of punitive action.
          No-one hates being on workers comp more than a genuinely injured worker – if only the politicians can get this into their ideological narrow minds.

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  13. I have recently been on the recieving end of an inaccurate IME report. Only realising that I am not alone via the resources on this site (and thank you).
    My IME stated I was wearing a back brace , answered direct questions from my insurer in point form to which I am still not able to obtain the actual questions. One answer was that I had to relocate my residence to my mothers address ? Another section of his report was that I was 8 cm shorter than my actual hight (which of course they never measured to confirm). The fact that it was a standard consultation of around 7 minutes had forced me to make a complaint of his “fit for work” decision and also to question the insurers decision to accept his opinion even though the IME stated the final decision was up to my specialist who already stated that I was unfit !!
    The uncertainty of my personal situation (house payments and living) and the pressure of having to RTW even though I have to travel 220km return trip to work has taken its toll.. The thought of a bit of rope and a ceiling beam has crossed my mind more than I care to mention just to stop the shit .. But in trying to get help from my GP through psych referral my insurance company said they wouldn’t approve it before seeing there IME.. I ask the question though “is one doctors opinion not independent to another’s “?
    I give up

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    • @AXE, your GP can give you a referral to a psychologist outside of workcover, and if you are feeling so low you need to followup on this. Medicare will sort out the billing after acceptance, but you can’t be held to ransom waiting for approval.
      I also had thoughts of ending it all, but for my kids I may well have done, I already had sessions with a psychologist and once I told her my thoughts she called my GP and I was put on anti depressants same day.
      On your copy of the report mark any discrepancies and note the actual comments/facts…

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  14. Have QLD got a site or a campaign like this ?

    Desperate to find QLD’ers wanting to rise up and shake some corrupt doctors out of the system for starters then head for a mains of rotten Qcomp/Workcover

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    Why are QLD'ers ALWAYS behind August 24, 2014 at 6:54 pm