Please complain against a more notorious IME

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Most workcover authorities state on their websites something along the lines that Independent Medical Examiners (IMEs) should provide unbiased, accurate and comprehensive information and be carried out with dignity and respect for the injured worker.Although injured workers have experienced poor IME assessments we are surprised how few formal complaints are filed, particularly for some of the more notorious IMEs.

Please complain against a more notorious IME

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Unfortunately, it appears that quite a few IME providers have not read the workcover authority’s website, and importantly the IME declaration nor the IME service standards. (click here to read the IME declaration and service standards in Victoria).
Although injured workers have experienced poor IME assessments we are surprised how few formal complaints are filed, particularly for some of the more notorious IMEs.

Have you filed a formal IME complaint?

Why did you not file a formal IME complaint?

Complaints about the IME examiner’s conduct or the examination itself should be sent to the Workcover Authority of your state in the first instance.

In Victoria, where a person wishes to complain about the conduct of an independent medical examiner, they should first complain to WorkSafe (now called Victorian WorkCover Authority – VWA) and address their complaint to:

Manager – IME Service Branch, Rehabilitation and Medical Services Division WorkSafe
See website for postal address

You can file a complaint by simply writing down your concerns.

The Workcover Authorities (are supposed to) keep the complaints in a file for each doctor. It appears that Workcover Authorities seem to take these complaints seriously, at least once there are several formal complaints regarding a particular examiner (IME).

When filing a complaint, provide the IME examiner’s name, date of exam, your name and claim number. Be courteous, factual and detailed in your complaint letter.

For example, you may say something like:

“I had to wait 45 minutes for a rushed 8 minute exam. The doctor (name) was rude and discourteous making comments that I am lazy and trying to work the system, accused me of lying and kept cutting me off when I tried to answer his questions. He did not want to look at the radiological films I brought, and pushed my arms (legs, knees, hips, etc) to increase my range of motion, causing significant pain that lasted for days.”

IMEs that act unprofessionally and rush through exams can cause significant harm to you and other injured workers over many years.

Provided all injured workers file a formal complaint about a more notorious IME, we have a chance that this IME will no longer be allowed to undertake independent assessments, or that the IME will be provided with some ‘training’ and be monitored.

If injured workers made complaints about a certain IME, those complaints will – at the very least- appear to indicate a pattern of behaviour that is unacceptable and below the professional standards expected of a certain medical examiner.

The legislature mandated that workcover authorities develop standards for the conduct of independent medical examinations, including guidelines for the appropriate treatment of injured workers during the examinations. It was and is the intent of the legislature that independent medical examinations be conducted fairly and objectively by qualified examiners and injured workers to be treated respectfully.

Unless injured workers file formal complaints, this callous behaviour and misconduct will continue. By filing complaints with the Workcover Authority, you are protecting many future injured workers from this doctor.
Additionally, these examiners really should not get away with this type of behavior!

In an attempt to help injured workers file a formal, written complaint about a rude, biased, incompetent (etc.) IME doctor, we have drafted a couple of sample complaint letters:

Sample complaint letters re a biased IME

IME Complaint Letter 1 extract

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 a police 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 severe pain. He asked me to hunch up my shoulders again and I refused. He pushed down on my shoulders hard….

IME Complaint Letter 2 extract

I had to wait 45 minutes for a rushed 8 minute exam. The doctor (name) was rude and discourteous making comments that I am lazy and trying to work the system, accused me of lying and kept cutting me off when I tried to answer his questions. He did not want to look at the radiological films I brought, and pushed my arms (legs, knees, hips, etc) to increase my range of motion, causing significant pain that lasted for days.

Formal IME Complaint Letter 3

State of [Victoria]
WorkCover Authority (eg. Victorian Workcover Authority (VWA))
Manager – [IME Service Branch, Rehabilitation and Medical Services Division WorkSafe/VWA]
Address:
Your Name:
Your Claim Number:

Note (you can use “I” or “the Complainant”) to refer to yourself in the complaint letter; and you can use “IME Doctor name” or “the Respondent” to refer to the IME doctor you are complaining about. Also, this sample letter can be amended to use to lodge a formal complaint with eg the Health Care Commission; AMA Board etc.

Independent Medical Examiner Complaint

Dear,

I [Name], (or Complainant) hereby wish to file this [administrative] complaint before the [WorkCover Authority] against [Respondent] doctor [X], and in support thereof allege:

1. I am addressing my complaint to [the state’s workcover authority] charged with regulating the practice of independent medical examiners

2. At all times material to this Complaint, Respondent (or the IME doctor) was a [eg orthopedic surgeon] within the state of [eg Victoria], having been issues license number [x].

3. Respondent’s address of record is [xxx] (where you saw the IME doctor).

4. On [date] I [or The Complainant] was involved in an accident/incident at work, for which liability was accepted by [insurer name].

5. As a result of the [date] workplace accident (or incident or illness) I (or the Complainant) sustained injuries to [i.e neck, back, right shoulder…] for which I sought [eg orthopedic] care and treatment from [treating doctor].

6.On [date], my  insurer [name] required me to attend an independent medical examination (IME) with doctor [name] (or the Respondent) pursuant to [section of the Act in your state].

7. On [date], the IME doctor [name] (or Respondent) performed a physical (could also be psychiatric) examination on me.

8. During the course of the [date] examination [IME doctor name] was provided with an [MRI] of my left shoulder which indicated I had a [rotator cuff/labrum/whatever tear].

9. During the course of the [date] examination [IME doctor name or Respondent] was provided with an [MRI]of my neck/cervical spine (whatever) which indicated I had  [disc herniations].

10. IME Doctor [name] (or Respondent) prepared a report regarding my physical examination on [date].

11. IME Doctor [name] IME report did not mention my [MRI] findings.

12. IME Doctor [name] IME report concluded that [“further eg chiropractic / physiotherapy / surgery/ whatever is not clinically reasonable, related and medically necessary”] in association with my [date] work injury.

13. Either the IME Doctor [name] did not view the MRIs I provided, or in the alternative, the IME doctor [name] did not appreciate the significance of the MRIs.

14. IME Doctor (name) did (or not) obtain radiological reports related to the MRIs prior to writing his/her report.

15. A reasonable prudent, impartial/independent [specialty -eg orthopedic surgeon/occupational physician/ whatever] doctor/specialist performing an IME under similar circumstances and conditions would have viewed the MRIs and appreciated the clinical significance of the findings.

16. A reasonably prudent [orthopedic surgeon – whatever] performing an IME under similar circumstances and conditions would have obtained (or viewed) radiological reports related to the MRIs prior to writing their report.

17. A reasonably prudent [orthopedic surgeon – whatever] performing an IME under similar circumstances and conditions would have determined that further [physiotherapy/chiropractic treatment / surgery/ whatever] was medically necessary and reasonable in light of the MRI findings.

18.In the alternative, IME doctor [name] was aware of the MRI findings and simply chose to leave them out of his [date] report to mislead or deceive any recipient of the report regarding the full extent of my injuries.

Complaint # 1: Alleged negligence

19. [Workcover authority or Petitioner] re-alleges and incorporates paragraph one (1) through seventeen (17), as fully set forth at length herein.

20. [Section X, Legislation applicable] subjects a [orthopedic surgeon] to discipline for the failure to practice [orthopedic] medicine at a level of care, skill and treatment which is recognised by a reasonable prudent [orthopedic surgeon] as being acceptable under similar conditions and circumstances.

21. IME Doctor [name] [date] physical examination of (myself /me / the Complainant) fell well below the level of care, skill and treatment which is recognised as being acceptable by  a reasonably prudent (orthopedic surgeon) under similar conditions and circumstances, in one or more of, but not necessarily limited to, the following ways:

(a) By failing to review the MRIs provided by myself, or in the alternative, failing to appreciate the significance of the MRIs;

(b) By failing to obtain radiological reports regarding the MRIs performed on [myself]; and, or

(c) By determining that future [physiotherapy/ chiro/surgery/whatever] care was not warranted for my treatment.

22. Based on the foregoing, IME Doctor [name] violated [section X of the legislation / code / whatever]

Complaint # 2: Making misleading, deceptive, untrue or fraudulent representation in the practice of (orthopedic surgery / IME)

23. [Workcover authority] re-alleges and incorporates paragraph one (1) through fourteen (14), and paragraph eighteen (18), as fully set forth herein.

24. [Section X of legislation, code, whatever] subjects a [orthopedic surgeon/IME/whatever] to discipline for making misleading, false, deceptive, untrue or fraudulent representations in the practice of [orthopedic surgery / IME / Whatever].

25. IME Doctor [name] made misleading, deceptive, untrue and/or fraudulent representation by failing to mention the results of the MRIs performed on me/myself in his/her [date] report, thereby misleading or deceiving recipients of the report regarding the true extent of my injuries.

26. Based on the foregoing, IME Doctor [name] violated [section x of the legislation/code, whatever] by making misleading, deceptive, untrue, or fraudulent representations in the practice of [orthopedic surgery/ IME / whatever].

WHEREFORE I (or the Complainant) respectfully request that [Workcover authority] enter an order imposing one of the following: temporary or permanent suspension of [IME Doctor name] accreditation to undertake [workcover authority] independent medical examinations,  issuance of a reprimand, placement of [IME doctor] on probation/supervision, corrective action, refund of fees billed or collected, remedial education and/or any other relief [Workcover Authority] deems appropriate. (so basically here you write what remedy you seek).

SIGNED this [day] of [month], [year]

Your name, claim number, address , phone, email

 

Download the sample letters (Word)

 

 

[Post by WorkcoverVictim and WorkcoverVictim3]



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