Improving the IME process – some thoughts

injured-worker-on-workcover-system

As you well know aworkcovervictimsdiary is very hard on workcover insurance companies and the workcover system. Perhaps we ought to stop picking on the insurance companies, the various claims people and processes, and even the Independent Medical Assessors (IMEs). Well, let’s try and think outside the box and ask ourselves how we could improve some processes. This article covers some random thoughts and recommendations to improve the IME process.

Improving the IME process – some thoughts

  • IMEs should be more independent, if the IME does not favour the insurance company then they won’t be used again – so make sure all IMEs are truly independent and objective
  • IME doctors should not be ‘hired guns’ for workcover insurance companies – in other words, independent should mean just that: a second opinion determined by a doctor not on the “payroll” of the workcover insurer
  • Perhaps not allowing any doctor to undertake IMEs if they earn more than 20% (or a certain percentage) of their income from doing workcover insurance examinations
  • Obviously stop those doctors who only (or mainly) do IMEs and whose reports are too often, clearly, biased. Don’t hire IMEs who only do IMEs as they may become jaded or biased. Hire specialists who really take care of patients on a day to day basis
  • Use doctors and specialists, who are still in active practice, and who take care of patients of the same type as injured workers – in other words: workers with injured spines should see spine surgeons. It’s important to use an IME in the exact same field
  • Set up a Board of qualified IMEs and randomly assign IMEs to an injured worker, rather than letting the insurance company pick the IME.The qualified IMEs should hold full licenses and have no ‘restrictions’ posed upon them, or lost any ‘privileges’ by the AMA Board, and should actively practice
  • Allow the injured worker to select from a short list of IMEs and have the injured worker pay 50% of the exam fee
  • A non-biased ombudsperson could aid in the IME process, not a medical or legal person
  • The IME examinations should be video taped and stored
  • The injured workers medical records (all), including x-rays, CTs, MRIs etc should be in the IME’s office, at least 1 week before the examination
  • Perhaps have all injured workers at first assessed by an IME (and not their treating doctor)
  • More objectivity on the part of the IME as well as  stronger standards
  • The preposterous conclusions set forth by the IME doctors should be open to peer review and they need to be accountable when they veer off from established medical opinion
  • Make the process more impartial: the IME should not be allowed to know who is paying for the exam
  • Questions (from the insurer – eg cover letter) should be more applicable
  • Do not ever allow the workcover insurer to contract with or even select the IME, if so the system will remain corrupt
  • Only use truly impartial doctors, use practicing doctors and specialists rather than the so common semi-retired, non-reality based doctors
  • Reports tend to be from old (some into their eighties), retired doctors who see only in black and white, and many are not up on current medical matters, incl. current treatment methods for pain management, or even complex/novel ortopeadic treatment
  • Unless the IME doctors are independently paid (that is: not by the workcover insurance), the whole IME process is a farce
  • Have a kind of “lottery” so the workcover insurance company can’t pick the IME
  • Some mechanism must be in place to safe guard the integrity of the IME
  • Have truly independent IMEs – they are always the same doctors saying the same things (eg that surgery is not indicated, that the injury is not related to work). The IMEs appear to be chosen by the insurer because they say what’s best for the insurer
  • IMEs should be selected (from a pool) randomly and on a rotating basis, in order to get a fair representation of the profession, in an unbiased manner
  • Have a lottery, make it a duty. Make it a no payment Detach the doctor (IME) from the insurance company
  • IME doctors should put the patient (injured/ill worker) first at all times, ahead of the workcover insurance company. They should not ever try to protect the insurance company. They should all be honest and thorough. Think injured worker first
  • Those IMEs who totally disregard honesty should be eliminated from the process. Consider having the state refer to an IME doctor rather than the insurer and the whole attitude towards fairness and honesty would likely improve
  • Get rid of the (few) nutters doing most of the IMEs. If an IME doctor loses a certain amount of cases then don’t allow them to undertake more IME examinations. The reason these IMEs don’t succeed is because they are either wrong incompetent, dishonest or all three
  • Always contact the primary injured worker’s doctor(s) when planning to order an IME
  • Make the whole process independent – someone else apart from the workcover insurer should have veto power. Pay IME doctors from an impartial pool
  • Insurers must make questions relevant to a particular condition and stop ‘word processing’.
  • Privatise the workcover system and have the injured worker pay for it
  • Insurance companies should stop rushing injured workers to IMEs so soon and so often – the IME paid by the insurance company will most likely tell the insurance company what they want to hear to get more referrals and big money
  • Set up a separate Panel – at least IMEs are not perceived to be paid for by the insurance company
  • If the IME didn’t know who was paying the bill, workcover or the injured worker, the IME might be more objective, less inclined to have already decided the answer before even seeing the injured worker
  • There is just nothing independent about wokcover insurance companies paying doctors to do IMEs
  • Have the state (or even the AMA) appoint IME doctors from a panel and not the insurance company. IMEs are hired by insurance companies because they tend to side up with the insurance company
  • Records sent to the IME should be complete and current (up to date)
  • Move towards eliminating the obsolete and intrinsically adversarial workcover system
  • Always allow a friend, spouse etc to be present during the entire IME
  • Figure out a way to keep insurance companies from using those IME doctors whose opinions are predominantly in favour of the insurance company
  • IME should be appointed and paid by a neutral body/agency
  • Get rid of “IME mills”
  • Let the injured worker choose who to see for an IME to make it truly impartial
  • Only use doctors who are currently practicing and on staff at some hospital instead of using ‘medical whores’ whose only function in life is to provide workcover insurance companies with un-dependent examinations that support their views regardless of the data/evidence
  • It often seems as though the workcover claims person (eg case manager) is not familiar with the medical issues as evidenced by the fact that referrals are often made to specialists who are not appropriate to answer the question(s), eg asking a general surgeon to make determinations about a back injury or complex orthopaedic injury
  • Have IMEs done by the same type of doctor, rather than having for example an orthopaedic surgeon review neurosurgery cases
  • Provide for retrospective reviews of the IME examiners who are in frequent discordance with attending/treating doctors/specialists
  • Video and audio tape all examinations for an impartial, random review by an independent peer group
  • Review  the financial incentives of the IMEs who chronically agree with the insurance, even review their earnings

Over to you

 

[Post dictated by WCV and manually transcribed on WCV’s behalf]



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3 Responses to “Improving the IME process – some thoughts”

  1. As someone sent to an IME the infamous Dr Doran Samuell a shrink who works exclusively for insurance companies or the actual workcover bodies, I did some research prior to my visit.

    I was horrified to find he saw no patients and derived all his income from writing biased reports on patients. I looked at the doctor ratings and again was horrified to see some of the comments and then in response, since the doctor never see’s private patients some clearly fictional positive reviews.

    I ask why the hell would one send a person to this man, the man who wrote for Amanda Vanstone for $30,000- a report that children in detention, Jailed and Adults … the same suffer no ill effects. Whether we like or dont the boat people, I think any reasonable person can agree being detained is NOT a positive thing mentally. Yes it may be their own fault, but for a shrink to even suggest it was amazing. It was not know he was paid for his opinion till latter.

    He then went on to attack every academic who claimed the opposite. Having a child aged 10 locked up in an overcrowded detention center is not a good thing. Dr Samuell went on to CLAIM that detainee’s were receiving adequate mental health treatment in the detention centres and attacked anyone whilst being paid for expressing some concern about either the effects, or the dismal lack of care they were given.

    All the time being paid by the Immigration minister to do this , Amanda Vanstone the now diplomat representing Australia in Italy as the Ambassador. As Italy has a boat people crisis itself maybe Vanstone can advise them as well.

    What happened is that weeks latter after this [censored] IME had even attacked the credentials of some of the most respected academics and people in the field, a woman turned up in DETENTION called Cordelai Rowe. She was AUSTRALIAN and had spent nearly 6 months falsely detained in detention … NOT receiving any treatment as Dr Samuell claimed and by accident they discovered her. She obviously was seriously mentally ill, but got NO CARE and was detained for 6 months.

    This is the IME the Insurers love to send you to if you have a mental issue. Dr Samuel is rude, arrogant and bombastic. If one expects a fair hearing, think again, reduced to tears, a bumbling mess unable to even correctly name my ex employer, he declared me fit and well. Despite 3 other IME and psychiatrists reports totally contradicting his views he was dismissive of the one he was aware of.

    Workcover already warned had arranged another IME with someone who was independent and his view was polar opposite than the first one the paid for DR SAMUELL.

    So far, 3 IME’s and two polar opposite of this [censored] IME, two doctors, one Psychologist again similar poor findings, but the Insurers IME … this [censored] IME who would declare Pol Pot sane does and says exactly what the insurer wants for $2,000- a visit. This if disputed is even better for Dr Samuell who gets $5,000- a day at any hearing at the WCC.

    In the meantime the person with a psychological injury is DENIED their claim, further violated by in effect being called a bloody liar and to deny an income of less than $450- a week v a disability pension much the same is what the insurer spends $2,000- on this for, then spends $15,000- in legal fees for the insurers paid lawyer then barrister. then spends $5,000- on surveillance as they did which actually proves not a thing.

    In the meantime the person goes from bad to worse. No different if its a physical injury and to pay IME’s who use the system to generate 100% of their income via this means is not unusual.

    Dr Samuell is the worst of the worst. I am sure if asked about others held in detention over the last 100 years his views would be NOT the same.

    In the end all of it is a joke only for the benifit of the lawyers who get paid no matter what, the barristers the same and in NSW the lawyers even if you win dont get paid. Same too for the IME doctors who the insurer will attempt to send you too as many as they can but YOU CAN OBJECT to the WCC and they will send you to one of their own. You may not like what the IME they send you to says but at least you dont get sent to someone with a 99% track record of dismissing all symptoms either declaring them as fakes, or fit or the classic someone who is drooling from the mouth and has been for 2 years and unlikely to improve in any meaningful way will recover if treatment is given. By doing this the insurer after a few months declares all is well, gives you a full ability to work when your worse than ever and cuts off benefits.

    the process is then repeated and you must go back to the WCC and do it all again and the insurance company agent gets paid again. the lawyer gets paid again, the barrister gets paid again, you get sent to a monster IME again.

    The worst case of a shrink I heard was the fireman injured and horrifically burnt on the job. he had physical issues and sadly he looked like freddie kruger and developed deep depression and many other mental issues. the IME … declared him fit and saw no issues mentally with the poor man.

    TWO lessons if you research your IME and its a [censored] like Dr Samuell or the person himself and I use that term very loosely describing him, but if your research shows the IME is one of the paid insurers ones which it will be 100% of the time, YOU CAN refuse to see him and get them to suggest another. And another until they are sending you NOT to a monster who writes 99% of his assessments in the insurers favor but someone who does it 80% of the time.

    Of course if there was NO vested interest in it for the doctor, and they were impartial, YES some would write what we did not like, saying our injury or condition was not as bad as we think and treatment would help. But at least I suspect at worst the odds would not be 99/1 but 50/50. Since the financial rewards are NOT there and we bloody well want to get better anyone who actually gets to the IME visit stage is likely 99% to be STUFFED and NOT ON SOME FREE RIDE AS IS IMPLIED.

    IME’s like surveillance which they spend $10- million to investigate an amazing 5,000 plus cases each year in he larger states and only get 4 prosecutions out of is the waste of MONEY this gravy train for the IME’s and Lawyers for the insurers and Barristers for the insurers are on. At the bottom of this each step the AGENT insurer takes they take a massive cut.

    Allianz gets paid for processing your claim, paid for hearing appeals which are 99.99% denied, then hires a law firm which they Bill workcover for at $500- an hour but pays the actual lawyer at $400- an hour, charges for the case manager to oversee the thing, pays the barrister at $1,000- an hour whilst only paying the barrister at $900 an hour.

    On and on it goes pigs feeding at a trough. So far to evade what may have been $25,000- a year in much needed support I suspect the insurer has cost Workcover and billed them for $50,000- and put the injured person through the wringer as a result.

    Workcover is intended to get people injured at work, back to work. Its not about enriching IME’s like Samuell or Law firms like we encounter or barristers we eventually encounter. By the time 2 years latter its heard, the chances of what may have been a recover within 12 months is NOW due to lack of treatment likely NEVER to get better or cost 5 years treatment.

    This is the Workcover system. NONE of this has to do with the care or duty of care to the injured person. With less than 1/1000 cases of fraud or ripping off the system, the media and perceptions … UNTIL your the injured person dictate how a law firm able to get rid of as many cases as it can by delaying them, or sending patients to IME’s who are paid for cretins is what the system is.

    Sad but true.

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    • @David, a lot of very valid points indeed.
      Sadly this IME has and continues to be repeatedly flagged by many injured workers, and others (even those allegedly abused in church).
      People MUST put formal complaints in. The more the better. We will (try) and write a sample letter that can be used as a ‘template’ to guide you with IME complaints over the next few days, with legal input.

      PS we did censor some too extreme language

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  2. An AMS in NSW is the only person who can review you for a final decision. If you have a condition they have no experience in, they are, by virtue of their speciality in an area of the body,such as neurologist who can look at arms and legs, but has no experience in MS for example-can still give an opinion. That’s ridiculous. They don’t know what to look for!

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