Independent medical examiners Victoria complaint process

IME-complaint-Victoria

According to WorkSafe Victoria (now called the Victorian WorkCover Authority) they take all independent medical examiner (IME) complaints seriously. They claim to review and respond to each complaint received from an injured worker. Outlined in this post is the complaints handling process for IMEs, as well as the IME Service Standards and their “Declaration”…

Independent medical examiners Victoria complaint process

IME-complaint-VIC1

IME-complaint-VIC2

IME-complaint-VIC3

View the VWA original document ” Independent Medical Examiners complaint process” (pdf)

Of interest is that the VWA states on its website that IME (Applicants) must have at least five years of clinical experience in their area of speciality and be currently working at least eight hours of clinical practice each week. Experience in working with compensable clients is an advantage. We doubt that all IMEs are still working in clinical practice, particularly referring to those above the age of 70 years and, yes, even 80!

 IME Declaration

An Independent Medical Examiner must also be approved under section 112 of the Accident Compensation Act 1985 and will be required to sign the Independent Medical Examiners declaration. The declaration applies terms, conditions and standards including participating in peer reviews for quality assurance purposes.

The declaration:

Independence

Alert1. I understand that I am, and must appear to be, independent of WorkSafe, WorkSafe’s authorised agents under the legislation, self-insurers under the legislation and the legal representatives of the preceding entities. I agree to take all reasonable measures to ensure I maintain my independence.

2. I will notify the WorkSafe immediately if I believe there has been an attempt by anyone to inappropriately influence a report arising from my independent medical examination.

Service standards

3. I will adhere to the IME Service Standards published on the WorkSafe website and updated from time to time.
4. I will make all reasonable efforts to attend relevant forums and seminars organised by WorkSafe at my own cost

Fees

5. I will provide the services and charge the fees for those services in accordance with the WorkSafe Schedule of Medico Legal Fees as indexed or revised from time to time and contained in the WorkSafe Schedule of Medico Legal Fees or as otherwise published, unless otherwise agreed with WorkSafe. I understand that the payment of invoices will normally be made by the report requestor within 30 days of receipt of the IME report.

No bias or prejudice

Alert6. I agree to act without bias or prejudice and I will seek to ensure that workers are not treated in any manner which disadvantages them because of their origins, background, sex, physical, mental or intellectual impairment or in any manner that contravenes the Equal Opportunity Act 2010 (Vic) or other anti-discrimination legislation.

Quality assurance program

7. I will cooperate with WorkSafe in the peer review of my IME reports in accordance with the quality assurance process outlined on the WorkSafe website and agree to abide by the outcomes of any quality assurance reviews. I acknowledge that a failure to meet the required quality assurance standards may result in the discontinuation of referrals to undertake independent medical examinations.

Complaints made to WorkSafe

8. I will cooperate with WorkSafe in the processing of any complaint arising in my role as an IME. Where requested by WorkSafe, I will respond to complaints in writing.

Secrecy provisions

9. I acknowledge that the secrecy provisions in the legislation apply to me as an IME

Privacy

10. I agree to be bound by and to comply with the Information Privacy Act 2000 (Vic) (IPA) and the Health Records Act 2001 (Vic) (HRA) with respect to any act done or practice engaged in by me as an IME in the same way and to the same extent as WorkSafe would have been bound by them in respect of that act or practice had it been directly done or engaged in by WorkSafe.

11. In particular I agree that I will not collect, use, disclose, store, transfer or otherwise handle ‘personal information’ or ‘health information’ as defined in the IPA and HRA respectively that I collect in connection with my role as an IME except to the extent that such collection, use or disclosure is reasonably necessary for the performance of the functions and obligations of an IME and only then in accordance with the provisions of the Privacy Act 1988 (Cth), the IPA and the HRA.

12. I will comply with such reasonable policies, directions, requests or enquiries relating to the collection, use, disclosure, storage, transfer or handling of personal information or health information as are notified by WorkSafe from time to time.

13. I will promptly notify WorkSafe of any suspected breach of privacy including an inadvertent breach.

Confidentiality

14. For the purposes of this declaration, ‘confidential information’ means all information (whether or not in a material form) that is treated by WorkSafe as confidential; and disclosed by WorkSafe, WorkSafe Agent or self-insurer to the IME or which the IME becomes aware of while providing services to WorkSafe as an IME.

15. I will only use confidential information for the direct purpose of providing services to WorkSafe as an IME in accordance with this declaration and WorkSafe’s service standards.

16. I will not disclose confidential information to any person except if I am required to do so by law or as required to my employees, advisors and insurers who have a need to know for the purposes of me fulfilling my obligations as an IME and who, before disclosure, have been directed to keep confidential information confidential

17. I agree to notify WorkSafe immediately on receiving correspondence of any kind about confidential information or requiring the disclosure of confidential information.

18. Subject to any other legal obligation, I will deliver up to WorkSafe immediately on request, or at WorkSafe’s direction, destroy, all confidential information, including any copies of confidential information stored in any medium, which is in my possession or control.

Advertising

19. I will not use my role as an IME or my association with WorkSafe for any commercial or advertising purposes.

Indemnity

20. In addition to any other right, power or remedy provided by law to WorkSafe to be indemnified by me, I agree to indemnify (= To compensate for loss or damage!!! Read between the lines guys!!!) WorkSafe from and against any:

a) liability incurred by WorkSafe;
b) loss of and damage to property of WorkSafe; and
c) loss or reasonable expense incurred by WorkSafe in dealing with any claim against it including legal costs and expenses on a party and party basis and the cost of time spent, resources used or disbursements paid by the WorkSafe arising from any fraud, illegal or criminal act or omission (eg a criminal assault) or gross
misconduct or any act or omission not covered by my professional indemnity or public liability cover or insurance whilst acting in my role as an IME. This indemnity will be reduced to the extent that any act or omission of WorkSafe causes or contributes to the relevant liability, loss, damage or expenses.

For the purposes of this declaration, ‘gross misconduct’ means any act or behaviour of an IME that in the opinion of WorkSafe is considered to be:
a) a risk to the health or safety of any person or to the reputation, viability or profitability of any organisation or business; or
b) reprehensible or unprofessional behaviour including intoxication, use of illegal drugs and the use of foul or offensive language

Amendments

21. I understand that the IME Service Standards and WorkSafe Schedule of Medico Legal Fees may be added to, amended or altered by WorkSafe from time to time and that WorkSafe will inform me of any changes as soon as is reasonably possible.

Referrals

22. I understand that there is no guarantee that I will receive any referrals to conduct independent medical examinations.

23. I understand that I am at liberty to accept or decline any particular request by WorkSafe, WorkSafe’s authorised agents under the legislation, self-insurers under the legislation and the legal representatives of the preceding entities to undertake an independent medical examination.

24. I understand that I may request at any time that WorkSafe cease referring its workers to me for independent medical examinations.

Discontinuation of relationship

25. I understand that WorkSafe may discontinue its relationship with me as an IME at any time if:

a) I do not comply with this declaration; or
b) I do not comply with WorkSafe’s service standards; or
c) I no longer meet the selection criteria to be an IME; or
d) my conduct is, in the reasonable opinion of WorkSafe, likely to harm the reputation of WorkSafe; or
e) WorkSafe determines that my professional conduct renders me unsuitable to carry out independent medical examinations

26. I acknowledge that feedback gathered from time to time by WorkSafe from its workers about their experiences at independent medical examinations conducted by me may be taken into account in considering whether my professional conduct renders me unsuitable to carry out independent medical examinations for the purposes of this clause.

Dispute Resolution

27. If a dispute arises in relation to my provision of services as an IME, I or WorkSafe may request that the following dispute resolution process be utilised:

a) In the first instance the dispute will be discussed between myself and the WorkSafe’s Manager, IME Services;
b) If the dispute remains unresolved the matter will be referred to the WorkSafe’s Chief Executive (or his or her nominee) and myself or my nominated re presentative;
c) If the dispute remains unresolved, it will be submitted to a mediator. The cost of mediation will be shared equally;
d) Where the parties to the dispute cannot agree on a mediator, the Chief Executive of the Law Institute of Victoria (or his/her nominee) will be asked to appoint a mediator;
e) The above process will be carried out within 30 days.

Awareness of clinical framework

28. If applicable to my area of practice, I will maintain an awareness and knowledge of the ‘Clinical Framework for the Delivery of Allied Health Services’ (as amended from time to time) and how it applies to the provision of services to workers by allied healthcare professionals.

Period of arrangement

29. My role as an IME will end on 31 March 2015 unless it is reviewed or ended before then in accordance with this declaration.
Signature:
__________________________

Download the Independent Medical Examiner Declaration (VIC)

Independent Medical Examiner Service Standards

1. General

1.1 The relationship between an independent medical examiner (IME) and a person undergoing an independent medical examination differs from that in a usual practitioner/patient relationship. Notwithstanding this difference, it is expected that recognised professional standards and the applicable law will be adhered to at all times.

2. Appointments

2.1 Appointments must be available as soon as practicable after receiving a request for an appointment.

2.2 The person to be examined must not be kept waiting for the examination for an unreasonable time. IMEs should aim to see people within 30 minutes of the appointment time.

2.3 IMEs should notify the referring case manager of any appointments that they need to cancel as soon as is practical after they become aware of the need for the cancellation.

Alert2.4 IMEs should not accept referrals, or undertake an examination, if they are not qualified and experienced in the specialty for which the examination has been arranged. IMEs should notify the referring party as soon as is practical after they become aware of an inappropriate referral.

3. Examinations

3.1 Referrals:

IMEs should read all the documents (eg medical reports, x-rays and investigation reports) sent with the referral and, if necessary, request the referring case manager to send additional material the IME considers necessary to ensure that the findings, opinions and recommendations from the independent medical examination are sound and complete.
The reasons why the additional material is required must be articulated.

3.2 Accessibility:

It is expected that all IME rooms are accessible to people with mobility issues (eg. wheel chairs). If there are any access limitations, IMEs must notify the referring case manager as soon as possible.

3.3 If a person is unable to attend an IME’s rooms, either due to access limitations or the person’s medical condition, an IME may be asked to conduct an examination at another suitable location. This is subject to the IME’s consent and subject to reaching agreement with either the referring case manager about the suitable location and travel arrangements.

3.4 Interpreters:

The referring case manager will arrange for a qualified interpreter to attend at the examination if this is required. It is preferred that family (including children under the age of 18 years) and friends do not act as interpreters. If difficulties arise with the interpreting arrangements during an examination, IMEs should immediately notify the referring case manager. Examiners are requested to be sensitive to the presence of an interpreter if the person to be examined is to be undressed and to ask the person being examined about the appropriateness of the interpreter
being in the room during this time.

3.5 Third party attendance:

AlertIf a person insists on the presence of a family member or friend for moral support during the examination, this may be acceptable provided that the IME considers this appropriate in the circumstance. The third person should not be allowed to disrupt the examination. There should be no objection to the third person assisting in clarifying aspects of a person’s medical and injury history but they should not be permitted to interfere with the normal interchange between the IME and the person.

The person being examined or the IME may consider that it would be appropriate for a third party to be an observer to the examination, or to provide assistance during the examination.

TAC clients/injured workers attending a psychiatric examination will normally be seen without family members or friends because of the personal and private nature of the questions asked.

3.6 Length of appointment:

IMEs must allocate sufficient time to allow for a fair and comprehensive examination to be carried out. Extra time may be required if an interpreter is being used.

3.7 Conduct during examination:

AlertIt is expected that an IME will treat people undergoing independent medical examinations with the same professional standards of care, consideration and courtesy that a private patient would expect.
A gown or other covering should always be offered if a person is asked to undress and an IME should excuse themselves or move out of the person’s line of sight while the person is undressing.

3.8 Expectation setting

At the commencement of the examination, IMEs should explain:

(a) the purpose of the examination;
(b) their role as an IME;
(c) that their findings, opinions and recommendations will be contained in a report which will be sent to the referring case manager;
Alert(d) that they are impartial, and reassure the person that the IME report will record their objective clinical diagnosis and that it is not the IME’s task to decide the claims issue;
(e) the specialty in which they practise and its relevance to the examination.

IMEs should not make value judgements or personal comments, advise the person of the findings, opinions or recommendations to be made in the report, or recommend treatment.

IMEs should clearly answer a person’s questions about the purpose or relevance of any questions, procedures or other aspects of the examination.

IMEs should forewarn people if an examination, test or procedure is required which may be considered or interpreted as intrusive, or cause some discomfort or pain. IMEs should explain why the examination, test or procedure is necessary and reassure the person that it will not worsen their condition.

3.9 Tests

Non-invasive tests and imaging may be undertaken with the TAC client’s / injured worker’s permission when required to answer a question being asked of the IME by the referring case manager.

IMEs should not carry out tests of an invasive nature other than imaging. If IMEs consider tests of this kind are required, this should be included as a recommendation in the examination report. As a general rule tests of this kind will only be permitted where the findings of the independent medical examination would otherwise be unreliable.

3.10 Personal attendance

IMEs must personally conduct any independent medical examination and write IME reports.

4. Conflicts of interest

4.1 IMEs must not accept a referral or undertake an examination if a conflict of interest might arise, or be perceived to arise unless the IME has notified the referring case manager and agreed, in writing, on a process to manage the conflict. It is not possible to give an exhaustive list of situations where a conflict of interest might arise, but some examples are:
(a) if the IME has provided treatment or services to the person previously (other than in their role as an IME); and
(b) the IME has a financial relationship or other involvement with the person’s employer.

4.2 The TAC and WorkSafe consider it is a conflict of interest for an IME to provide treatment or services to a person after they have had an independent medical examination by that IME.

5. Contact with treating healthcare practitioners

5.1 An IME should not contact a person’s treating healthcare practitioner without the person’s written consent. Written consent is not needed if the IME has an overarching legal, ethical or professional obligation.
IMEs are encouraged to obtain consent and to contact treating healthcare practitioners if it will assist the IME to provide a sound, evidence-based opinion.

5.2 If IMEs contact treating healthcare practitioners, the discussion should be documented in detail in the IME report.

6. Reports

6.1 Templates

IME report templates are available on the TAC and WorkSafe websites. IMEs should conform, as far as possible, to the template.

6.2 Content and structure

IMEs should consider the potential readership when preparing reports.
Reports are mainly used by TAC and WorkSafe Agent claims staff, but reports may also be provided to the person who was the subject of the examination, lawyers and treating healthcare professionals. Reports
may also be subject to requests made under the Freedom of Information Act 1982.

IMEs must comprehensively address all the points raised or questions asked in the letter of referral. It is recommended that the questions and answers are included in the report so that the report can be read as a stand-alone document.

The report should:

a) be limited to matters of professional opinion and not contain comments about what decision the IME considers the TAC or WorkSafe Agent should make unless there is a specific question;
b) be in plain English and avoid the use of jargon or language that is too technical. Where technical language is the only option, a brief explanation of what any technical terms or phrases mean must be provided;
c) provide an accurate diagnosis based on references to a detailed and accurate history and an appropriate and thorough clinical examination;
d) contain clear and unambiguous professional opinions and, where required, recommendations based in science and with reference to best practice medicine or best clinical practice;
e) present an evidence-based approach to evaluating symptoms and clinical findings, as far as practicable;
f) note if there is insufficient clinical information to make a diagnosis;
g) contain reasons for all opinions expressed;
h) be consistent in that opinions should accord with examination findings;
Alerti) be independent and impartial, and not contain any value judgements or personal comments;
j) contain only relevant information and not disclose personal information to the extent it is relevant to the findings, opinions or recommendations;
k) not contain descriptions of a person’s appearance or demeanour during the examination or as otherwise observed except to the extent that it is relevant to the findings, opinions or recommendations made (eg as part of a mental state examination) and only where the relevance is articulated;
Alertl) be free of advocacy and/or bias for any party.

6.3 Time for completion

a) 90% of reports are to be completed and sent to the referring case manager within 10 working days of the examination unless otherwise agreed.
b) 100% of reports are to be sent to the referring case manager within 15 working days of the examination unless otherwise agreed.

7. Fees

7.1. The TAC and WorkSafe Agents can pay the reasonable costs of independent medical examination services in line with the relevant policies and the TAC/WorkSafe Schedule of Medico Legal Fees, unless otherwise agreed with the TAC or WorkSafe in writing.

7.2. In the event, that an IME has concerns about unpaid or returned invoices, it is recommended that the IME contact the TAC Customer Service Centre or the referring WorkSafe Agent. If there is a significant concern or trend in the payment of invoices, then this should be raised with the Manager IMEs.

8. Court and Tribunal attendance

8.1. IMEs must be available to attend and give evidence in the Victorian Civil and Administrative Tribunal and in court proceedings. Some proceedings may be held in regional areas. This obligation continues beyond an IME’s term as an IME.

8.2. IMEs must be familiar with their obligations as expert witnesses.

Below is the Expert Witness Code of Conduct ( also see the PDF format here)

expert

9. Notification and registration

9.1. IMEs must notify the TAC/WorkSafe immediately of any formal complaint made about them in a professional capacity, about any hearing or other proceeding in relation to the formal complaint and the outcome including the
details of any disciplinary action taken in relation to them including (but not limited to):

a) under the Health Insurance Act 1973 (Cth)
b) by a hospital regarding clinical competence or professional conduct
c) by a professional body (eg a college)
d) by the Medical Board of Australia
e) by the Health Services Commissioner
f) by the Australian Health Practitioner Regulation Agency

9.2. IMEs must notify the TAC/WorkSafe in writing within 14 days of any changes affecting their service delivery as an IME or eligibility to be an IME including (but not limited to):

a) the professional discipline in which they practise
b) the services which they offer
c) their practising location
d) anything which affects their ability to continuously meet the selection criteria to be an IME, including any change to weekly hours of practice.

9.3. IMEs must notify the TAC/ WorkSafe immediately of:

a) any conditions, limitations or restrictions on their registration; or
b) the suspension or cancellation of their registration

Download the IME Service Standards>>

The IME Manual – and more resources

The links below outline the contents of VWA’s IME manual.

Visit the VWA’s section on IMEs on their website

 

Related article

workcover-complaintsHow to complain about WorkCover Victoria



This post has been seen 792 times.