Fact: many injured workers encounter unreasonable delays in obtaining diagnostic and medical treatment. The workcover system continues to delay access to medical care for workers who are injured or who become ill on the job, due to delays caused by all too frequent cumbersome IME processes and often frivolous challenges and appeals by workcover insurers, which have also resulted in a backlog to dispute or appeal hearing schedules.
In addition the pre-approval (i.e. for surgery) requirement enables insurers to undermine medical recommendations and common sense as they can delay approval and therefore compensation for treatments just about indefinitely.
Injured workers encounter unreasonable delays in obtaining medical treatment
The delays in approving medical diagnostic and treatment procedures frequently increase costs when there is a deterioration of the affected injured worker’s health or medical complications. Long delays in treatment often result in the injury lasting longer and getting more severe.
Another result of these delays is the psychological stress it puts on the injured worker… to always be considered a fraud or an exaggerator until proven otherwise.
These obscene delays are also causing (good) medical providers to leave the system, due to lengthy periods of non-payment for services rendered, and frustration with refusal to approve accepted diagnostic and treatment procedures.
In today’s climate we find workcover insurance companies imposing hard nose tactics during the claims handling process. This ideology of deny, delay, defend is for the sole purpose of swelling the ever growing profit margins of the insurance industry. One such tactic is -of course- the “Independent Medical Examination (IME).
Workcover Authorities ought to collect and share data, supervise the content and rigour of IME reports/assessments, and better regulate IMEs
Countless injured workers are misled to believe that IME’s are independent and/or impartial. Designating a doctor hired by the workcover insurer (or authority) as an “Independent” medical examiner should be prohibited, period. Instead, such doctors should be clearly identified as “insurance” medical examiners.
Workcover insurers schedule IMEs (after IMEs, after IIMEs) to allegedly review whether the injury or illness is really related to work, the degree of temporary or permanent impairment, and the appropriateness of medical diagnostic and treatment procedures. The IME does not engage in any treatment, but typically does a rather cursory examination, documentary review and ‘interview’ of the injured worker. Unfortunately, many of these IME findings often lead to a significant cut in benefits, be it weekly payments or medical and like benefits.
In addition, by (over) using IMEs, there is a need for the injured/ill worker to continuously prove the severity of their injury. Many such IME doctors will view injured workers injuries as non-serious, or – commonly- as ”inconsistent” with the injury. The practical result of this is under-treatment and a failure to meet the injured worker’s medical needs. Another result is obviously the enormous psychological stress it puts on the injured worker to always be considered a fraud or an exaggerator until proven otherwise.
What’s worse, these independent medical examinations can (and often do) also lead to major delays in obtaining approvals for diagnostic or medical treatment procedures. And these delays can cause medical complications which ultimately cost more than the original treatment itself!
We believe the current system of IMEs often interrupts the timely provision of medical care and weekly payments benefits to injured workers.
As far as we know, no jurisdiction reviewed the quality of medical information, so in other words there is NO quality assurance! There is no systematic review of these IME reports and no feedback to these ‘assessors’. Those IME’s who send problematic reports (even those with errors and missing information) are not targeted nor reviewed.
In the absence of a fully independent regulatory overseeing body, who should be assuring quality, supervising, reviewing and scrutinising the content and evidence-based “rigour” of IME assessments and reports,…
We cannot understand why lists of IMEs are not made public… but can only guess…
Currently, there are no real requirements for insurers to have an evidential basis for ordering an IME. They will often not even bother to contact injured workers’ own treating doctors and specialists, and even if they do they will inevitably question the opinion and recommendations of even the best practitioners in the field.
This has led to the routine use of IMEs. The current rules basically allow workcover insurers to cut benefits including medical treatment unilaterally, based on the findings of one IME, until there is a dispute hearing (Conciliation, Medical Panel, Arbitration, Court etc).
We strongly believe the cost of -yes-frivolous IMEs is a significant financial waste in the system.
Furthermore when a more serious injury occurs, it is also common that a number of medical specialists may be involved, such as experts in orthopedic care, pain management, and psychology. However, it is common that workcover insurers will deny treatment and reduce or cease weekly wage benefits based on opinions from IMEs who do not even have accreditation in relevant areas of specialty!
[Article dictated by WorkcoverVictim and manually transcribed on her behalf]