IME – Most frequent and vicious are Psychiatrist IMEs

Psychiatrist-IME1

It’s bad enough to suffer a psychological injury at work, or the ferocious retribution routinely meted out to these workers. But as is well known that, often, if the psychological injured worker tries to obtain compensation or remedy through the ‘justice’ system, they are likely to suffer further psychological injury from the system itself- and, in some cases, more severe than the actual original one. This is such a problem, that quite a few psychiatrists, psychologists and even lawyers  advice to psychologically injured workers NOT to try litigation.

IME – Most frequent and vicious are Psychiatrist IMEs

There are very biased and vicious IMEs (aka hired guns) in a variety of medical specialties, but they appear to be most frequent, and most callous, in psychiatry. This is probably because psychiatry is a ‘soft’, ‘unclear’ science, more open to (at times outrageous) opinions, because it lacks the hard evidence of, for example, X-rays, MRIs etc.

appointed-imes-vicDid you know that in Victoria there are (at least in 2013) 57 psychiatrist IMEs, more than any other medical specialty. Wonder why!

The hired gun IME Psychiatrist

Hired Psychiatrist guns are used in workcover cases where the injured worker is claiming for a psychiatric injury, and where the employer (insurer) wants to avoid liability.

Sending psychologically injured workers (and even physically injured workers) to a hired gun Psychiatrist IME can be an extremely effective way to discredit the injured worker together with their complaints.

Also, often, supposedly confidential IME reports are overtly or secretively circulated where they can do most damage (i.e employer).

A psychiatric examination is also often traumatising, especially an IME on a traumatic issue, because the injured worker is forced to (repeatedly) relive the trauma. Having to repeatedly recount and relive the trauma for medico-legal purposes will very often add another psychological/psychiatric injury. If the psychiatrist IME is an abusive hired gun, and if the injured worker is forced by the system, as many are, to see a number of them, the additional injury can be very severe.

Many workcover claimants develop (primary or secondary) psychiatric problems such as depression, anxiety, and post-traumatic stress disorder (PTSD), for which they need help, generally from a psychiatrist. If the trust that is needed for an effective therapeutic relationship has been damaged by a traumatic previous experience with a hired gun IME psychiatrist, the effect can be quite devastating, and a psych condition that should/could have been relatively easy to treat can become debilitating.

IME Psychiatrist hired guns in Workers’ Compensation

In wokcover situations the injured worker is generally claiming for post-traumatic stress disorder (PTSD), and the IME Psychiatrist hired gun’s task is to show that the injured worker does not or could not have such a condition, despite in some cases the precipitating event having been extraordinarily traumatic by normal standards, e.g. armed robbery, held at gun point; being trapped and having to cut off your own limb; terrible assault etc.

In these cases the hired gun  has to perform complicated mental gymnastics to show there is nothing wrong, or to justify unjustifiable decisions, however compelling the evidence that the injured worker is genuinely ill. (Also see Stress claims: Workcover or a separation package?)

If the injured worker shows signs that would normally be taken as symptoms of a psychiatric illness, the IME psychiatrist hired gun will, of course, interpret this as malingering.

A real example:

“The prominent feature at this interview was what I consider to be overacting. The appearance of great anguish was so excessive that I can only regard it as histrionic. It is my impression that [his complaints] are manufactured for the purposes of elaborating upon what may have been a genuine disorder in the past………….In my opinion the state of the patient no longer meets the criteria of PTSD, but rather impresses me more as malingering hysteria……”

Or the IME psychiatrist hired gun will provoke the injured worker and interpret their response as indicating anger or hostility rather than a legitimate psych illness.

A real example:

The injured worker’s account of the examination:

“I found Dr X’s attitude from the start to be provocative and intimidating. He frequently smirked when I replied to his questions, and the whole interview with him was more in the nature of an interrogation. At a later stage of the interview Dr X sat me in a chair and asked me to hunch up my shoulders. [Dr X has no orthopaedic qualifications or expertise.] I indicated to him that I was in pain and that pushing down caused me pain. He asked me to hunch up my shoulders again and I refused. He pushed down on my shoulders hard.”

Dr X’s report of that examination:

“He was bristling with anger and hostility. Although diagnosed as suffering from major depression by Drs A and B, I have reservations about the diagnosis and note he failed to respond satisfactorily to any treatment prescribed…..”

That injured worker subsequently killed himself, which would seem to indicate Drs A and B were right about his major depression. He was one of a series of suicides by injured workers (incl. whistleblowers) who had been examined in this manner by Dr X, and while we really can’t say without further evidence that Dr X’s examinations helped to cause those suicide deaths, it is undeniable that such abusive behaviour would have helped.

Features of hired guns

  • It appears that the majority of hired guns are male
  • they are authoritarian, and in many cases seem to have a real dislike and distrust of people who are in conflict with authority, as if being in such a situation is evidence the injured worker must be mad or bad.
  • Most do forensic, medico-legal work most or all of the time, i.e. they do not have ongoing contact with patients
  • and they work only for employers and/or insurance companies, never for injured workers. Some make a lot of money.
  • They are usually able to avoid any action being taken against them by e.g. the College of Psychiatrists despite sometimes numerous complaints from victims and other psychiatrists.

Tactics of hired guns

  • The conduct of a typical IME examination is aimed at avoiding the possibility of developing any rapport or empathy with the injured worker – the reverse of what should be normal IME psych examination.
  • The IME Psychiatry process will often starts with secret briefings from the employer (and the workcover insurance), often inaccurate and at time extremely misleading.
  • The IME psychiatrist will refuse to accept written information offered by the injured worker, and will definitely not allow a support person into the examination
  • The IME psychiatrist will quite often arrive or be late with no explanation nor apology
  • The IME psychiatrist will not introduce himself or otherwise make any attempt at normal politeness or making the injured worker comfortable
  • S/he will use distraction tactics such as pacing  round the exam room behind the injured worker, dropping noisy objects, or sitting with his feet up on the desk, eating his lunch.
  • S/he will be rude, hostile and adversarial in manner, sometimes yelling at the injured worker, accusing them of lying, and they may be verbally abusive, trying to provoke an angry reaction which can then be used as ‘evidence’ of a personality disorder or malingering,… depending what is required.
  • They will often use a standard report that is already on their computer, simply filling in the gaps
  • They will often ‘Verbal’ injured workers, e.g. a throw-away, leading question at the end of the interview on the lines of supposing they must have some bitterness about what has happened then becomes the focus of the report.

There is  one thing that hired guns  never do – try to check the injured worker’s information with other, independent, sources.

Once in Court

Once in court, psychiatric injured workers (eg bullied workers, whistle-blowers etc.) often face major problems with further bullying – an integral part of the adversarial system. Vulnerable injured workers are bullied by opposing defense counsel, cross-examined for days on end, about anything at all, no matter how repetitive or irrelevant (i.e. entire life history), regardless of their state of health – often until they collapse and have to give up the case.

Wouldn’t it be nice

  • If injured workers had at least a choice of the IME psychiatrist(s), i.e from a long list provided by the workcover insurance company
  • If injured workers had the right to take a support person to the IME, if not at least that the injured worker is allowed to record the interview/examination
  • If an IME psychiatrist who is rude and abusive towards an (any) injured worker, possibly causing further psychiaric injury, is immediately removed from the insurance company’s (and the workcover authority) list of ‘approved’ IMEs
  • If there was perhaps a panel of doctors, with the injured worker able to choose.
Did you have a bad experience with a Psychiatric IME? If so, what was the main issue (i.e rudeness, hostility, yelling…misleading/incorrect report etc.)


This post has been seen 2684 times.

13 Responses to “IME – Most frequent and vicious are Psychiatrist IMEs”

  1. I had to chuckle reading this…a moment ago I was reading a workers compensation case on the web about an IME psychiatrist who works in Sydney and Canberra.
    His name? “Dr Synott”
    …I pissed myself laughing, almost wet myself. You couldn’t get a more appropriate name for an IME!

    Thumb up 0 Thumb down 0

    • @KW – funny you mention this, as when I was compiling our IME List (he is on it: Synott, Dr Howe | Psychiatry | NSW) , I also cracked up. Was the case you read showing any bias from this Dr Synott? If so, mind sharing it? He might need a rating option.

      Thumb up 0 Thumb down 0

  2. One of the elderly Psychiatrist’s I was sent to see fell asleep several times during the appointment! I don’t know if this was done on purpose to provoke a reaction or not? I did feel like slamming a Book down on their desk at the time but thought I would be labelled as angry or violent and non co- operative.

    Thumb up 0 Thumb down 0

    • You should have run over and stole his notes and high tailed it out of there – LOL! What a beeping joke/disgrace! What was his report like?

      Thumb up 0 Thumb down 0

  3. Anyone know a little about the Law & IME’s? I have asked before but nobody responded. I think if I go to Concil and debate the issue about what is “reasonable” for IME exams I might end up with a Certificate to Court. I already have many but no money to follow thru (as they well know). So this is the new Act s27 and if I get to Court I want to know if that is “common law” and if so where do I look up precedents bc I think any previous decisions have a direct impact on your case – Case Law? I think it might be on AustLII? database but I do know how to drive that things for searches. Pleeeease help, Concil is a week away and this could help all of us if I’m correct, thnx in advance.

    Thumb up 0 Thumb down 0

    • @Marina/Sybil – just FYI, The new Victorian Workplace Injury Rehabilitation and Compensation Act 2013 (the WIRC Act) outlines the scope of benefits that can be claimed for injuries suffered at work on or after 1 July 2014.

      Injuries occurring prior to 1 July 2014 will continue to be regulated by the Accident Compensation Act 1985. (see aworkcovervictimsdiary.com/2014/07/new-workcover-victoria-legislation-1-july-2014/ )

      The Act unfortunately is very vague and only states that the workcover insurer can send you to an IME from time to time or at reasonable intervals. It is therefore very difficult to determine what reasonable means, but most lawyers agree that it is on average about one (1) IME per year to one (1) IME every two (2) years. It can be more often if your injury deteriorates or if you require(d) surgery. If you feel that the requests for IMEs are unreasonable you should raise a complaint with Workcover Authority.

      In WCV’s case, for example, she was sent to six (6) IMEs over a period of 14 months and every single IME has stated that she was unfit for work and all reports were consistent …

      Also see http://aworkcovervictimsdiary.com/2011/10/workcover-victoria-caught-out-doctor-shopping/
      May help although don’t have the actual ref.

      Thumb up 0 Thumb down 0

      • One IME a year I wish I have been to 12 in 3 years.

        Thumb up 0 Thumb down 0

        • @Tony….here is some good advice: ALWAYS FOI a copy of ALL of the information sent to the IME. Check the history the Insurer gives about your Claim as it is almost always wrong. Read their questions very carefully and see if they are medically & legally valid and relevant to that specific IME. Get a copy of the IME report asap afterwards and complain, complain, complain if anything is wrong. Usually the Insurer tells the IME what they are looking for from them, by providing it indirectly in the Claim History and questions. Quite often the questions are NOT medically relevant and therefore if the IME answers, then u have a right to complain bc they will use those things against you for years to come. There is a way now under Privacy Laws or something where you can insist that they change incorrect info on your Claim file. Always BEWARE of a supplementary report. The medical opinion can change dramatically and the Insurer somehow magically will get the IME to say whatever it is that they specifically wanted them to say. I have seen one Insurer type word for word what they wanted from the Ime and you guessed it, he just copied and pasted it onto a letterhead and got paid a bundle and yet again I got terminated. What a great “independent” Scheme this is!

          Thumb up 0 Thumb down 0

          • Thank you for that info I have been to 4 shrinks and all the rest in such a short period of time.The last SOB asked all about my love life and I refused to answer him I said I refuse to answer as it is of a personal nature and there is no relevense to my accident and injury and you are not willing to explain to me the reasoning for asking the question.He just eyeballed me and I did the same back,he continued on.

            Thumb up 0 Thumb down 0

            • @Tony Good for you Tony. They can’t ask that stuff now bc of Privacy Laws (well they can ask but you don’t have to answer). All they are doing is fihing for something else to blame other than your injury. Did u record the examination? How did the report come back? Did u get copies of everything?

              Thumb up 0 Thumb down 0

      • @WCV3 thnx for the info, will go and read those links. I heard from WorkCover Assist that “within” the Scheme they deem it to be reasonable every 6 mths unless as you say there has been a change to the injury or treatment. The VWA requires Agents to send long-term stable cases for an IME every 2 years.

        My injury is an old one so how come they would use s27 of the new Act to terminate my entitlements?

        I also have a fair bit of info I want to share about the IME process when I get a chance, there’s more sinister stuff deeper in the layers if you go looking for it.

        Thumb up 0 Thumb down 0

    • @Marina/Sybil, have you requested workcover assist?
      They do a great job, this may be too short notice at this time but may be worth talking to them…
      http://www.workcoverassist.vic.gov.au/contact-us

      Thumb up 0 Thumb down 0

      • @Woowoo, yes I always use WorkCover Assist. I have requested a very knowledgeable person I know as well. Must say I’m feeling rather ambushed bc they have re-opened all the old ones that have been suspended that I’m in no position to deal with atm. I noticed from my last Concil the tone there has definitely changed since the into of the new CEO. I had a Conciliator allocated whose job it was, was to try to reolve it before a conference was allocated (that’s fair enough). I found her rude and pushy initially, however, I spoke to her at length and things changed after that. I got my conference but again another Conciliator I knew from a previous one, who was determined NOTHING was going to go unresolved that day, either it was resolved or a Certificate was issued. I also found out that they no longer have any power over “s107A Access to Info” disputes so don’t waste you’re time with that one anymore just do an FOI instead. Also it’s clear the new CEO has her fangs into the ACCS now. I am very suspicious now and mindful that eveything that is tabled in that setting is there to have it legally examined as to how it would fair in Court. If Once everything was confidential and only the Conciliator got your info but now they give everything to the Insurer. Note: the insurer usually trun up with a blank piece of paper and a smart arse attitude. They are only gauging if the Conciliator views their actions in relation to the section of the Law challenged to see if it would be upheld at Court and also “what info/advice and argument you will produce in Court” to see if they can get away with their tactics. Out of all of them, I used to trust WorkCover Assist and the ACCS but now I don’t. Last conference I had a confidential email that I sent to WorkCover Assist (with instructions NOT to share) forwarded to all parties including the insurer. I don’t trust anyone now and have done an FOI on all parties. But more stress and financial hardship for me……just what they wanted to achienve!

        Thumb up 0 Thumb down 0