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 by 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.
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.
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.
(*) See for example, Workcover Vic (VWA) Medical Practitioners Fee schedule (July 2014)
[Article by WorkcoverVictim and WorkcoverVictim3]