Independent Medical Examinations: Frequently asked questions

rude-doctor-ime

In this post we have compiled a few frequently asked questions we receive from injured workers with regards to independent medical examinations (IME). These include: Can an IME judge you or down you in his/her report; Can an IME opinion override the medical opinion of your doctor?

Independent Medical Examinations: Frequently asked questions

question-workcoverCan an IME judge an injured worker or down an injured worker in his/her report?

answer-workcoverFact: the IME has no doctor-patient relationship with an injured worker, so he can say whatever he wants in his report to the workcover insurance. But, don’t panic, the more the (biased) IME  states in his/her report that is beyond the medical facts, the less believable his/her whole report becomes, especially should the matter proceed to court (it is not the first time that certain well-known biased IMEs have been laughed out of Courts).

Some lawyers relish cases where the IME doctor wrote all kinds of medically irrelevant BS (bullsh*t) in the report, and made personal judgments about the injured worker. If—for example—an IME  judges an injured worker based on their tattoos, it clearly implies that s/he did not judge you based on your medical condition, and that  is good for you (the injured worker)!

Can the IME do it? Yes!  The IME is allowed, and even required, to state his/her conclusions in the particular injured worker’s case. However, the unprofessional things the IME did (or example nasty or inappropriate remarks made about an injured worker’s tattoos) make it reasonably likely that the IME’s conclusions will not carry much weight with the trier of fact. For example, a tattoo has no bearing whatsoever on whether the injured worker needs pain medication (vs being automatically labelled as drug-addict).

Dismissive conclusions from a 5-15 minute diagnosis mean little. If an injured worker has a drug history, s/he should of course not take narcotics (unless prescribed by a pain specialist for a specific injury). In a nutshell the IME’s judgment on an injured worker’s tattoos (or other “features”) has no relevance, and can be used against that IME!

question-workcoverCan an Independent Medical Examiners (IME) medical opinion about an injured worker’s work-related injury override the medical opinion of the injured worker’s own treating doctors and top specialists?

A case example:

I was injured on the job in (months) of this year. Approx. (month) I returned to work with restrictions. (3 months later)  my employer terminated my suitable duties, which places me back on workover payments. An examination with an IME has been scheduled (in 6 weeks), but I do not return to my doctor until (7 weeks). Can the IME’s decision stop my weekly payments?

An other case example:

On (month), my employer conducted meeting, which  is supposed to be an ongoing dialog with me the injured worker and my employer to find reasonable accommodations/adjustments for me to perform essential work duties. I am a bus driver and my injuries were to both shoulders. My doctor placed me on suitable/modified duties, until (month), restricting my driving. Once my suitable/modified/alternative duties were terminated, the  workcover insurance carrier for my employer decided to send me to an IME. I have found that these Examiners are never ‘independent’. It seems that the employer is trying to force me back to work before my doctor has cleared me to do so.

answer-workcover If the IME doctor releases you to full duty then, unfortunately, the workcover insurance company can (and will) terminate your benefits such as weekly payments. If  you don’t agree or if your own treating doctors and specialists still want you on restricted duty then you will need to request a dispute resolution (i.e. Conciliation/ Hearing before the workers comp commission to decide the issue.)

If you do not have a lawyer at this stage, this would also  be a good time to hire one.

Workcover insurance companies use IMEs to try and force a favourable medical opinion they can use to cut off benefits in workers’ compensation cases.

Legally, an IME is just a separate medical opinion from someone who is not the injured worker’s treating doctor. By itself, IME reports are not considered authoritative. However, workcover insurance companies will almost always take the approach that if an IME says your do not have a physical impairment, or that your injury is not work related, or you are fit for work, then that somehow justifies them in terminating your medical benefits (i.e. even deny surgery) of weekly payments. Again you can appeal any decisions your insurance company (case manager) has made based on a (biased) IME report. Depending on the state you live in, this can be Conciliaton, arbitration etc.

The sad reality is that

The Case Managers (who have no medical training), employed by the workcover insurers, and the Return to Work Coordinators have the right to withhold treatment recommended by specialists, or to over-rule evidence based treatment based on thorough medical knowledge.
Advice from the most senior Medical Staff in the country can be over-ruled by Case Managers, and often Orthopaedic or Neurosurgery is delayed or never done on the whim of a Case Manager “who decides that it is not necessary.” Insurers regularly use Medical Advisers that are known to provide reports favourable to the Insurer. These appear to be used to prevent reasonable care to injured workers, especially if the injury is complex,or has been ongoing for a significant period….Read more

 

 



This post has been seen 1659 times.

7 Responses to “Independent Medical Examinations: Frequently asked questions”

  1. Never trust an IME, repeat NEVER trust an IME no matter how nice they APPEAR. Mostly likely your IME will be asking you questions prepared by the insurer company legal people to obtain evidence against you. Therefore it is essential that you provide them with an accurate written summary of facts and symptoms concerning the circumstances of your injury and carefully consider verbal responses so that the IME cannot conveniently forget to include or distort these important facts in their report. Record the meeting, take a friend (support person), clearly document events of the meeting both during and afterwards and then pray for mercy!

    I provide the above based on my experience of 16 IME attendances (numerous different injuries) and successful litigation.

    Thumb up 0 Thumb down 0

    • @JayLitigator – thanks for your valuable tips and reminders. Keep them coming!

      Thumb up 0 Thumb down 0

    • Yes but once you have the interview recorded and the ime writes a fraudulent report, what/who to then?

      Thumb up 0 Thumb down 0

      • @Young Gun – the most important thing to do first is to make a formal, written complaint against IME

        If a worker is concerned about the conduct of a s112 (VIC) 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.

        The second thing is to point out all and any “discrepancies” and untruths in the IME’s report, in writing. Do so directly to your case manager, cc to her/his team leader and attach a copy of the corrections to your formal written complaint. Request the IME make corrections. If not (they usually don’t bother) at least you have written evidence of the “mistakes” in the IME’s report, which can be used later (i.e. Disputes, Court etc)

        The third step is that your lawyer can also help you where there is gross misrepresentation of facts (i.e. based on hard evidence such as x-rays, tests, and even recording).

        Remember that you can appeal any adverse decision made by your insurance, i.e based on a dodgy IME report, in Vic you go to Conciliation.

        Also see FAQ worksafe Vic – complaints

        Whilst the above example used here applies to VIC, same or similar procedure exist in all states.

        Also never forget you are NOT alone, stay in touch and kick butt like the rest of us!

        Thumb up 0 Thumb down 0

        Workcovervictim June 21, 2014 at 2:50 am
  2. Hi,
    I attended an IME and found that the IME had a report which had been conducted in 200* by another Government Agency who had nothing to do with worksafe, the report was about a condition l have dating back to 197*-197* which has no direct connection to my 200* injury. I have no idea how this report came into the possession of the IME, but am concerned that the IME will use the information in a negative way.
    I have forwarded correspondence to the Worksafe Agent concerned, requesting the return of the report and to the Freedom of Information Commissioner to seek the legality of another body having a document/report and passing it to a third party without consent. So far have not heard from any party , as far as l understand the Act information/reports such as mention can be obtained only for the primary purpose, in this case being in relationship to the 200* injury, and a request should be forwarded to the individual for consent of use of the information/report. Should be interesting to see what the outcome will be.
    Any comments would be most welcomed.

    Thumb up 0 Thumb down 0

    • @ Peter – the IME would have been given the report by your claims agent.

      I am guessing that the report you are referring to is something like a report done in relation to say a previous TAC claim or the like made by you.

      Remember that when you lodged your WorkCover claim form you signed a Consent for WorkCover to obtain medical information etc about your from 3rd parties. So you have actually provided your consent for the 3rd party to provide the said information/reports to WorkCover. WorkCover (thru the claims agent) would have obtained the report via this consent.

      It’s standard practice for WorkCover use these consents to obtain anything and everything about your medical history. There is nothing illegal about what they have done or them doing this as unfortunately you have provide your consent to the 3rd party to release of the documents to WorkCover.

      If you have had previous claims with TAC or the like, you can guarantee those reports and claim info will absolutely be obtained by WorkCover.

      Your request for WorkCover to return the report to the 3rd party will fall on deaf ears, as unfortunately they were legally entitled to obtain the report and to keep it.

      Thumb up 0 Thumb down 0

      • This is interesting, as I tried to get a copy of some records from a MVA I had in Qld in the 80’s, I was told they (hospital) don’t hold copies of reports past 7 years. I can’t remember the name of the solicitors I saw back then and thought there was no other way for me to get that information, so if there has been a claim are we able to request a copy through FOI?

        Thumb up 0 Thumb down 0