IME Medical examinations are never truly independent

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The sad truth is that  medical examinations are never truly independent. Workcover insurance companies use the same doctors (IMEs) over and over again because they know ahead of time what the result will be. It is common for a doctor who performs an independent medical examination to find no evidence of an injury or to find that the injury it is not work-related, pre-existing or degenerative,  and even to find that no medical treatment (eg surgery) is required.

IME Medical examinations are never truly independent

How can an independent medical exam hurt me?

Workcover (insurers) pays all reasonable and necessary medical treatment for your work injury. Workcover insurers also pays wage loss (weekly payments) if you are unable work. Insurance companies frequently deny paying these benefits based upon the independent medical examination.

In theory, the “independent” examination is supposed to be used to help clarify your medical condition and whether your injury was caused by your work. It is used to provide a diagnosis, the treatment recommended, whether you require work restrictions, whether you can work at all and how much disability (impairment) you have as a result of the injury.

In practice, however, the IME is a tool used by the workcover insurance company to limit their liability. In other words, the Insurance Company has a “Master List” of IME doctors that they hire to perform the IME. They have used these doctors hundreds and hundreds of times. The doctors know what is expected of them and it is not to write reports that are sympathetic to your workcover case.

As we posted on our IME List page, we found an interesting but older (2004) parliamentary “Questions on notice”  where Senator Harradine asked in writing: How many specialists does Comcare employ to assist it in making determinations as to whether to continue liability or otherwise? How does Comcare determine which specialists it employs (as consultants or in any other role)? How does Comcare determine whether to discontinue using a particular specialist? Please provide a list of all specialists employed rude-doctor-imeby Comcare, their names, positions and company, and the dollar amounts paid to each for each of the last five years?  From this paper you can see how much certain IMEs have been paid by Comcare, reflecting the (over) use of some well known not so independent IMEs. For example, DR JOHN MICHAEL SABOISKY received $61,530  between the years 98/99 to 03/04.DR NEIL WILLIAM MCGILL was paid $60,863… Worth having a look at. See Answers to estimates questions on notice – additional estimates 2003-04.

Wouldn’t it be very interesting if all workcover authorities and their agents published their lists of IMEs and the dollar amounts paid to each one? Undoubtedly we would see the ‘preferred’ IMEs.

Anecdotally, it is also very interesting that injured workers participating on aworkcovervictimsdiary have repeatedly ‘flagged’ certain IMEs, the same IMEs over and over again. For example, have a look at the comments made on our “Karma Bus” page.

Your workcover benefits can basically be stopped regardless of what your own doctor says, even the best specialists in the field of your injury. But it’s common for an independent medical examination to conclude that your condition is not work-related (i.e. pre-existing) or that you can go back to work (without restrictions). Many IMEs even find no evidence of injury. It may be determined that your condition is “just part of the aging process” (degenerative)  or that your complaints are entirely subjective and there is “nothing wrong with you.”

The workcover insurance companies pay for reports that are favourable to them. The IME doctors are well aware of the fact that if they fail to provide the insurance company with (the majority of) favourable reports, they will not be sent future business. It is that simple.

And make no mistake about it, the IME examination/assessment is very expensive. The IME doctors receive typically $633-$917 (*) to say they examined you and to write their report for the insurance company. If they are asked to testify against you (in court), they receive often double or triple this amount. When you multiply this  by hundreds of workcover cases per year, it is easy to see why the IME doctors enjoy this lucrative piece of business. Most of these doctors make more from performing IME’s than they do in the rest of their practice. They will certainly not disappoint the hand that feeds them.

The truth is that these examinations are not really “independent.” Insurance companies use the same IME doctors over and over again, because they know what to expect. Some of these doctors earn up to half a million dollars per year and make a career out of testifying for (the benefit of) workcover  insurance companies.

Countless injured workers have reported that the independent medical examination (IME) takes no more than 10-15 minutes and that the IME doctor has very little interest in hearing about how the injury occurred, let alone the symptoms the injured worker is experiencing.

Many of these IME doctors make a career out of testifying for workcover insurance companies and earn hundreds of thousands of dollars per year. While injured workers suffer without medical treatment  and  weekly pay, these IME doctors get rich.

What about the IME doctor’s competence?IME3

Doctors have various reasons for deciding to work for an insurance company, but ( for many) their main goal is a (fat) paycheck. Whether they are seeking to augment their private practices or are retired (octogenerians) and need additional income, most are simply financially motivated.

It is also quite interesting to see that decent (very reputable/creditable) Doctors with specialist certifications (e.g upper limb surgeon; hip surgeon; spinal surgeon, pain specialist etc.) are not often found performing medical evaluations/assessments for workcover insurance companies.

Depending on his/her situation, an IME doctor may count on the continuing income from workcover referrals. If s/he disagrees too frequently with a workcover insurance case manager, the IME doctor may find him/herself -indeed- off the approved (and the preferred) list of IME doctors.

Some doctors who are mainly dealing with workcover (and TAC) claims are often considered “fringe” doctors. Many don’t keep up with the latest medical literature, pursue continuing medical education, or stay current in the latest medical technology. Some are general practitioners or general surgeons, with limited or no previous experience in for example complex orthopedic medicine. Many of them are old, really old – in their late seventies and even eighties and have outdated (non-evidence based) medical opinions.

The majority of workcover claims involve things like torn cartilage, herniated disks, stretched muscles and tendons, and other soft tissue injuries. Back injuries can especially be difficult to diagnose. Often determining the root cause of an injured worker’s back pain requires MRIs, CT Scans, other expensive diagnostic tools and quite often the injured worker will require surgery.

IME doctors know workcover insurance companies don’t like spending money on expensive diagnostics and expensive surgeries. They are expensive and (may) complicate the entire workcover claim. The $ seasoned $ IME doctor may not recommend those diagnostic or therapeutic services and treatments.

As a result, a good number of insurance company approved doctors (IMEs) are more likely to recommend injuries are treated with pain medication. Pills are much less expensive than surgery. Too often IME doctors don’t believe injured workers’ accounts of their pain and discomfort. To remain on the list for workcover insurance’s referrals, some IME doctors may even classify patients as malingerers, rather than diagnosing real pain issues. That’s why second opinions are so valuable.

Several circumstances may cause the insurance company to request that you submit to an Independent Medical Examination (IME) but generally speaking, evidence is needed to resolve a controversy about the injured workers’ condition and right to benefits, to deny the claim, or to extremely limit the amount and type of treatment the injured worker receives.

There is no such thing as a true IME.

Doctors hired to perform IMEs are paid by the same workcover insurance company handling your claim. In most cases, the case manager working your claim chooses the doctor you will be required to see. If requested by the insurance company, you must submit to an IME. Your refusal may allow the case manager to deny your claim or suspend/cease your benefits, incl. weekly payments.

The role of the IME is not to treat you. His/her job is – supposedly- to study all the medical notes and documents related to your claim, discuss your injury, and examine you. The examinations are traditionally very short, some lasting less than ten minutes.

Most doctors who perform IMEs have little incentive to take the necessary time to study all the medical documentation related to your claim. (In addition insurer’s will seldom forward all relevant documentation, but will only select certain medical information). Fees are based on the number of patients, not on the time spent on each case. Therefore, the more injured workers the IME doctor sees, the more money s/he is paid by the insurance company.

Do not lose hope

Do not lose hope if your workers comp benefits have been denied because of an independent medical examination. Recognise that these IME doctors do not have your best interests at heart and call an experienced lawyer immediately.

You should attend any independent medical examination that has been scheduled for you and try your best to cooperate. Explain how you injured yourself at work and about your symptoms.

An experienced workers comp lawyer can stop insurance company abuse and can challenge a bad medical opinion in court.You will always have the opportunity to challenge a bad medical opinion in court. You can present evidence from your own doctor(s) at this time. Fighting with the doctor at the independent medical examination will do you no good and can make your situation even worse.

Attend the independent medical examination with this in mind

As we’ve blogged a zillion times it is very important that you remember first and foremost that the IME doctor is “not your friend”. He is not concerned about your well- being. It is not uncommon for the IME doctor to act as a “claims investigator”, trying to dig up any information he can to further taint your claim (or injury/illness)  and thereby help the workcover insurance company. Thus, the general consensus is to say as little as possible to the IME doctor, do not volunteer any information. He doesn’t need to know about your hobbies, your personal life, and your holiday plans etc. Nothing is confidential.

As a side note, again, watch everything they do the day of the IME. Because the insurance company knows you will be arriving at a certain place, at a certain time, they LOVE to send their private investigators to the IME doctor (i.e. parking lot, office) to put surveillance on you, or in other words to film you. What they want to find is that you told the IME doctor something that was contradictory to what their investigator discovered. For example, if you tell the doctor you can’t stand or bend without severe back pain, or you can’t lift anything heavier than a carton of milk, don’t let the Private Investigator film you loading your trunk with cases of beer, or discard you walking stick 20 minutes after the IME. Some IMEs also conduct covert surveillance!

Back to the IME. It is important to beware of certain tricks the IME doctor will use to trip you up. One such test is referred to as “Waddell’s tests“. This means the doctor will perform certain “tests” on you, and will ask whether it hurts, when he knows it is impossible for it to hurt given the type of injury you had. For example, when a worker has a herniated disc in the low back, s/he may experience numbness, tingling and pain into the buttocks, the legs or the feet depending on which level the disc is herniated. The IME doctor will ask you if you feel symptoms in an area that lies outside of the distribution where the nerves from the spine lead down. If you respond that you have symptoms in the “wrong” place, he will conclude in his report that you “failed” the Waddell’s tests, or something along the lines. In other words, the IME doctor will “trick you” into saying it hurts. He then will conclude in his report that you were either exaggerating your problems or even “malingering”. So never exaggerate your symptoms. You will not be able to “fool” the IME doctor.

Despite the fact that the IME doctor actually works for the insurance company, you have no choice. You must go, and you must be courteous and polite. Do not under any circumstances call him names, make derogatory remarks, accuse him of being biased, or act uncooperative. These are deadly things to your case and will hurt you. The IME doctor will certainly write in his report anything that paints you in a negative light. This may be read by a Judge and Judge’s look on that very unfavourably. So, as much as you might like to express your thoughts to the IME doctor, be courteous and polite no matter what.

It is bad enough that a lot of what is said by injured workers is twisted or taken out of context. Not long ago an injured worker  told us how, as she said goodbye to the IME spcyhiatrist, the IME psychiatrist took her hand saying sympathetically. “I bet you feel like killing the b*stards sometimes.” The injured worker grimaced and barely smiled. You guessed it: The IME report came back with something along the lines: ‘the worker shook her fist at me, shouting he’d kill the b*stards‘(WTF!). Another injured worker reported that he had handed over a couple of medical reports and a letter from his psychiatrist (asking the IME to refrain from making the injured worker re-live the accident as it triggers severe panic and PTSD). The injured worker, seated across a low table from the IME psychiatrist slid the medical documents gently towards the IME (as had difficulty standing up with a freshly operated on leg and arm). You guess it, the IME reported that “he flung the documents at me”, going on about “anger”.

After the IME, the insurance company will receive the report from the IME doctor, generally within 14 days. You do have a right to it. Do not be afraid to request it under FOI. Remember, it will most likely be biased. It will almost always contain errors. What can you do if it is inaccurate or biased? Can you “explain” it to a Judge in your case? As much as you might think you can convince a Judge that the  IME doctor was biased or wrong, you simply cannot do it on your own, without your own doctor’s report and a good lawyer. Also always make a written complaint if the IME was rude, or frank mistakes are reported in the report (and ask to have them corrected). At least that way you will have a paper trail.

A lawyer who specialises in Workers Compensation may send you to a doctor who will thoroughly examine you, review your records and take the time to listen to you. They choose doctors who are not “in the pocket” of the workcover insurance company. Truly independent (medico-legal) doctors. They will review the “IME” report and set the record straight. They choose doctors who will not try to trick you, who will write multi-page reports, accurately outlining your entire medical history, treatment, diagnosis, and symptoms. These reports are your ammunition against the (biased) IME. Your lawyer will then have the doctor testify for you explaining to the Judge (if the matter goes to court) why the  IME is inaccurate and biased.  Not only do good lawyers know the right doctors to send you to, but they see the same (workcover insurance) IME doctors over and over, they know their backgrounds, they know their weaknesses, they  know how to discredit them.

With all of this in mind, good luck with your IMEs.

Many more IME articles can be found under the tag “IME”

 

(*) See for example, Workcover Vic (VWA) Medical Practitioners Fee schedule (July 2014)

 

[Article by WorkcoverVictim and WorkcoverVictim3]



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15 Responses to “IME Medical examinations are never truly independent”

  1. I’m in Victoria and have decided to make a formal complaint to the Victorian Workcover Authority about my visit to the IME to which the insurer referred me. I remember reading somewhere on your website how to go about this and the regulations to which IME’s are supposed to adhere. Could you please send me the link, to that page on your website, or tell me where the VWA would have that information online? I have also been told that the IME I saw no longer has any patients other than Workcover and although he calls himself a specialist [X] surgeon he no longer does any surgery. I gathered from reading what I saw published on your site (weeks ago, while I was still reeling from the outcomes of the IME’s report and wondering whether I should make a formal complaint) that the VWA prohibits IME’s from solely practising as an IME – that there was a % requirement for current non-IME practice in their field. Anyway, I would appreciate this information now that I have finally decided to make a formal complaint.

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  2. An interesting discovery I made recently is that you can request information about IME’s currently practising in various fields from the workcover authority. While they don’t (or won’t) provide you detail about the number of referrals and which insurers prefer whom, just having a list can come in very handy when researching for the inevitable next referral. In my case, I now have a list of about 60 psychiatrist IMEs in Victoria and have started compiling as much information on them as possible from RateMDs and other sources.

    If you have an IME happy insurer, you may find requesting lists of appropriate IMEs from your workcover authority will help you prepare for the inevitable fight when you’re referred to a hired gun.

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    • @Silver – Please consider sharing this information (contact us), as we’ve put a list together off all IMEs and impairment assessors we’ve able to track, and we can add a rating as well. Would be great to have as many IMEs as we can possibly find throughout Australia. By rating them we can also compile our own statistics (who is being used most).

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  3. Quite happy to share the initial list, and later the listing of whatever I’ve managed to compile and the sources I’ve compiled them from.

    If you can see my email address (submitted in my reply) please feel free to contact me there and I’ll send everything through. Glad it’ll be of some help to everyone.

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  4. I was sent to be seen by a female IME psychiatrist Ratnayake in Melbourne. Don’t know if anyone else on here has been seen by her, but total snake in the grass. She is the ultimate ‘cash for comment’ IME, will say anything, and I mean anything, to support the insurer. She spent an entire whopping 15 minutes with me, but when I eventually got a copy of her report I could swear she was talking about someone else. Apart from my name, pretty much everything else in her report was a fabricated. She quotes me on things I never said to her, said disgusting things about my family members that aren’t true and she made up. She made up what ever she had to. Ratnayake is a disgrace to the profession of psychiatry, dishonest and unethical.

    How can such a person as Ratnayake remain on the insurer “list” ???!!!

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    • @Bullied, Many injured workers have flagged Dr Ratnayake – see comments under our IME list page (previously posted under our Karma Bus page) she is now also listed on our IME list and you can rate her ‘service’.

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    • Please take my advice and do what i just did to her and any other supposed IME ask them if they object to you recording the interview she asked me why i wanted to record this interview and i said to her to keep her honest as she has a bad rep for lying. Ratanyake or what ever her name is, then jumped out of her seat and said then i am going to record it as well, and i said fine. If they object you then say to them well then i am putting you on notice that your report can not be taken for the truth, therefore rendering this whole exercise as useless.

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  5. Hi all

    I find this whole experience totally draining. I have read this report and it makes me sick to know that these so called doctors and insurances can or are allowed to treat people in this manner.
    I had a terrible experience with an IME – I reported him to the HCCC, who could not do anything, they referred my complaint to the Medical Council who believe that the conduct of this person is questionable and he will be having an interview with his peers. It seems that this is all the punishment that this guy will get. Workcover can not do anything until the result of the Medical Council has occurred – more frustration…. and in the meantime more people will be treated by this person, totally unfair
    In the meantime – this so called doctor is allowed to submit an incorrect report….
    I am so upset about this whole ordeal – I am sick of the lot…….

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    • @Yoli, being examined, let alone reading such shoddy IME report is truly sickening (literally), and that is an understatement. Many of us cannot understand how certain IMEs remain on the list of approved workcover IMEs, even though countless complaints have been filed by injured workers, and even in cases where the IME in question has been slandered in parliament or in a court of law.
      Not sure in what state you reside but ensure you write a formal complaint about the IME to workcover (authority). In doing so at the very least “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.
      Please consider rating the IME on our IME List, if s/he is not on the list or has no rating then we’ll gladly add it.

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      • My insurer sent me to an IME they knew was not impartial (one of the well known). I made complaints before I went predicting what he would do. I looked up cases he was involved in and predicted what he would do based on the evidence of what he has done to others. He did just what I predicted and worse. I then complained after I saw him and the insurer told me to make a complaint to WorkCover about him but they would not give me the report to prove it once they got it!!!. When I finally got the report the evidence of his fraud was pretty clear. We asked the insurer why they did not report him to WorkCover themselves as they agreed his report was crook. I asked them to do an audit to see how often he was doing this to injured workers. The insurer then advised, over the phone, they would not be using him any more. At one stage they were to send me to another well known IME (referred to above) but my own psychiatrist wrote to them and I was saved from that fate. Later, while I was in a psych ward they then threatened to send me to an “Independent Treatment Consultant” (no such thing!!) My husband told them I would not be attending the particular psychiatrist the insurer was previously going to use and my husband was told that psychiatrist was not being used after their internal audit. Because of my complaints and their internal audit to see if particular IMEs were being used regularly to deny claims two IMEs are no longer being used by that particular insurer and by taking this action it confirms the insurer knew they were using these IMEs unethically. Doesn’t that show the insurer was part of the conspiracy to obtain fraudulent evidence? The IMEs in question are so well known for their actions that when you mention their name to other doctors the other doctors demonstrate they understand what you are talking about. Make sure you always advise the insurer of any crook IMExaminations and ask them to put a complaint to WorkCover on your behalf. Ask if they are condoning the IME’s unethical/unprofessional actions and when they say no then ask them to do an audit to see how often the IME is used to deny claims. Put it in writing to the Operations or General Manager of the insurance company and explain their staff appear to be using “preferred” IMEs to deny claims and that your experience with a particular IME was so bad it exacerbated your injury (providing it actually was- no lies or exaggeration please) . Ask them to take action to prevent their staff subjecting other injured workers to the same thing. Put pressure on insurers to make them more accountable for the manner they are using certain IMEs. Forward all copies of your complaints to the insurer to WorkCover in your state to ensure everyone is more accountable for the use of IMEs who regularly deny valid claims. What is really appalling is that insurers fail to report unethical behaviours to WorkCover because if they did they would implicate themselves as they continue to use the same IME after they know there is evidence to support allegations made about a particular IME. This means the insurers are condoning fraud through lack of action and by then repeatedly using the same IME. I believe it is also mandatory for doctors to report other doctors if they suspect they are unprofessional but how often does this happen?
        The HCCC (NSW) also fails to act because they say the burden of proof is a criminal matter ie you must prove it beyond “beyond reasonable doubt” so it is really important that you make complaints every time an IME acts unprofessionally or unethically and that your complaints focus on the evidence to prove what you are saying. It is good to tell the IME you are recording the examination to keep them honest. This can then be produced as evidence if they know they have been recorded. If the IME turns the video camera on you telling you you must co-operate it would be very surprising if you or your support person pulled out a video camera or phone and you said you were all for transparency and you hoped he would co-operate with you!!

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        Make them accountable September 24, 2014 at 9:56 am
  6. Hi make them accountable,i went to an IME and the so called doctor didn’t ask any questions relevant to my accident very rude showed me no respect.His questions were how long had I been divorced why did the marriage break up who divorced who had I had any relationships since and how many,why didn’t I drink alchol,what money was I living on,tell me what has this to do with my accident.

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    • @Tony
      It has nothing to do with your accident bc what they are trying to establish is that something else has caused or contributed to your psych issues

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      • Yes marina I agree considering my divorce was 36 yrs ago the doctor also asked did I own my house and how old was my car.I know I will get a shit report do we ever expect anything else.

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    • @Tony, sounds like the one I was sent to recently… He was all sweet voice and caring type until I mentioned doing the Mindfulness Program through the pain clinic, then it was, ok we’re finished and out the door… MMMM ok!!!
      If he was trying to find something to pin my issues on, all he has to do is look at the accident I had and the treatment by workcover. Everything else in my life has made me who I am today and given me the tools to cope with this recent set of hurdles…

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