The following “Guest Post” submitted by “Mad Chef” highlights that Independent medical exams (IMEs) are among the most disputed components of our troubled workcover system, and offers some tips on how to challenge an IME/insurer’s decision (in VIC).
The independent exams were – without doubt- designed to flush out injured workers who exaggerate injuries or get unnecessary/unreasonable care, and there is no question that some (about 1 in 100) of that goes on.
As a check or test on what an injured worker’s own (treating) doctor determines, workcover insurers are allowed to order a supposedly neutral (as in independent) examination by a doctor they choose and pay for.
But we all know from fellow injured workers’ own experiences that the IME reports are routinely skewed to benefit workcover insurers by minimising or dismissing injuries.
Let’s face it, sometimes you go in (to an IME) sit there for 8-20 minutes and out comes a 5-page detailed exam that the IME in fact never did.
“There are some noble things that can be done in medicine without treating. But some IMEs are certainly not one of them.”
Challenging IME / Insurers Decision in Vic – experience
By “Mad Chef”
The Independent Medical Examination / Examiner (IME) decision can be devastating when it is so rigged and biased it should be laughable, except when is is our health held in their corrupt hands.
I recently challenged a very corrupt IME in [VIC], after [the workcover insurer] sided with him (the IME doctor) even though his reasoning was preposterous!
MY [limb] injury is pretty bad and will only get worse and must be fully replaced (My 2 surgeons opinions) so know after 2+ years on crutches my [other limb is failing], to the point that my activities are now severely restricted- about 4 hours a day of doing stuff, exciting stuff like having a shower, making breakfast- yep living the high life!!!!!!!!!!!!!!!
This corrupt IME stated, “the worker had no symptoms in [other limb] prior to injury to [initial limb injury] and [other limb] would almost certainly resolve if the [initial limb injury] settles down. The pain in the [other limb] is not as bad as the [initial injured limb]. (Doh!) “The worker should have a home based exercise program (I have been attending physio [ for >20 months] at this time).
All this was decided by the IME BEFORE he even looked at the imaging!! Three times during the interrogation he stated no need for surgery. I left in tears and begged him once more NOT to deny the surgery as I would end up in a wheelchair unable to walk at all.
So the IME report was accepted by WC, I challenged it at Conciliation (ACCS Vic), pointing out that there were 10 major mistakes and the MRI that was referred to had the WRONG NAME on it!!
The Conciliator agreed that this would not stand up in court as it was grossly inaccurate.
MY rep from ACCS advised me that the agent won’t budge on the original decision- normal practice s/he said.
He told me the Conciliator would force them to take it to Medical Panel. S/he did and the agent was pretty shitty about that.
The Medical Panel noted the IME medical report and stated in their findings that “The Panel came to a different opinion to that of the IME” based on imaging and R[initial injured limb] ongoing deterioration being the primary cause.
Basically they admitted to the IME report being rubbish.
It is worth challenging these idiots. Now Medical Panels are no fun and unfortunately their decision is final and binding!
My Conciliator rang me to let me know 1/2 the surgery was approved and I would have to accept it.
WIN WIN my SCM stuffed up and approved ALL of the surgery– undermining the Panel. HA!
The joke of the whole system is what they spent denying surgery: costs they incurred:
- >$300 accommodation
- >$500 Taxi ride to [city] and return
- 5 Meals
- the Medical Panel costs (2 Ortho Surgeons and 1 Professor) – (note: Medical Panels cost around $5000 in flat fee)
- The IME cost
- My SCM costs and time
- The conciliation cost and 12 months fighting it all
For an operation which they were charged LESS than $2000 (they emailed me the bill by mistake!)
We are dealing with a corrupt and moronic system.
If they were running their own businesses, these SCM’s would be BROKE!!!
Keep up the fight!
You may also be interested in our article “Tips to defend an IME opinion or report”
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