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.
Did 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.