Archive | IME

RSS feed for this section

Requests for independent medical examinations (IME)

Quite often, a claimant (you) and a workcover insurance “adjuster” (i.e. your case manager) will have widely different opinions about the seriousness of an injury. Most disagreements arise over long-term or permanent effects that the workcover insurance adjuster does not believe are as serious as you describe them to be or as your treaters (and yes, even other IMEs) have described them.

Often the workcover insurance adjuster will ask you  to be examined by a doctor, designated by the workcover insurance company, to provide (yet) another medical opinion about your injury.

Because the insurance company has to pay a doctor for such an examination, cost- conscious workcover insurance adjusters do not request them very  often. But, when they are desperate – as they are in my case – they can ask you to attend an independent medical examination far to often (in my case I have attended 6 or 7 IME’s over a period of 18 months!!!).

Although these second opinions are referred to by workcover  insurance people as “independent medical examinations” (IMEs), they are anything but  independent. The doctors who conduct the  examinations are chosen—and paid—over and over again by insurance companies because they almost never find anything seriously wrong with an insurance claimant!

An IME  is usually a bad sign and you are required to submit to an IME! The law (ACA 1985) unfortunately only states that workcover can submit you to IMEs at ‘reasonable’ intervals. What “reasonable” really means is difficult to define however most solicitors I have spoken to agree that we’re looking at 1 IME every 1 to 2 years.

In addition the case managers at workcover are not medically trained, and there is NO requirement for them to have any kind of medical or nursing training, yet they make decisions about your injuries and work capacity, MFG!

Dealing with a request to attend an independent medical examination

If workcover sets up an IME for you, you can do some things to protect yourself during the exam—and afterward, if the report the doctor submits is  inaccurate or harmful to your claim.

  • Ask your case manager for a COPY of their IME POLICY
  • Bring a friend. See if you can get a friend or family member to go with you. Explain to them ahead of time what the IME is about and what you would like them to do. Thy can take notes on  exactly what time the doctor begins and ends the exam, what medical history or other questions the doctor asked you, what tests the doctor performed and how long they took, and other details that you might not remember. This person can act as a witness if you later have an argument  about the fairness or accuracy of the examination (see below). Having another person present also sometimes keeps the doctor from being rude or  intimidating with you.
  • Counter a bad report. IMEs are conducted by doctors who regularly work for the insurance company. These doctors want to make the insurance company happy so that they can continue getting these lucrative exams referred to them. That means their reports to the insurance company tend to minimise the extent of work victims’ injuries. If that happens to you, there are several things you can do and say during your negotiations with the workcover insurance to counter the bad report.
  • Ask  for  copy of the report .You should  refuse even to discuss the report with your case manager until you have a complete copy—not just portions of it or the case manager version of what it says.
  • If the examination was in any way unfair -very brief or superficial, or taken without first getting a thorough medical history from you or your symptoms—then point this out to the case manager/workcover. And tell the them that the friend or family member who attended the IME with you can support your contention.
  • Point  out  to workcover any inaccuracy or  incompleteness in the report, as an indication of its unreliability as a true measure of your injuries. If possible, use material from your own medical records to point out the problem.
  • Contrast for the case manager the very brief extent of the IME with the much more significant time your own doctors have spent diagnosing and treating your injuries
  • If the IME report is extremely negative and the case manager is relying on it heavily in denying you a fair outcome (i.e. fitness for work  when you are not fit etc), you may want your own doctor—preferably a specialist who has been treating you—to write a response. Show your doctor the IME report and ask if the doctor would be willing to write a letter countering it. Be aware, however, that your doctor is likely to charge you for preparing a response. Find out in advance how much you will be charged so that you can decide whether what your doctor is willing to write seems worth the cost.
  • Ask  for information about the doctor’s relationship with the insurance company. Put in writing to the workcover agent/case manager a request for: the number of IME referrals the insurance company has given the particular doctor over the previous fve years; the amount of money the doctor is paid for each IME; how many IMEs the doctor has performed for defense lawyers over the same period. There is no way workcover will provide you with this information. But refusing to provide it may put workcover on the defensive a bit in relying on the report while negotiating a fair(er) outcome with you.

Additional reads: Article Extract Workcover legislation review in WA (posted by a visitor yesterday)

Making (non)sense of Independent Medical Examinations

I am desperately trying to make sense of the reason(s) why my case manager from hell has send me yet again to an independent medical examination (IME). Anyone able to make sense of this?

According to the Claims manual, If the information is sufficient to resolve the medical or treatment issues then a  s112 report is not required.

My case manager requests I attend a physical IME

22 May 2011

My case manager you wrote to me that “I note you have made several comments about your physical condition but I am only interested in assessing you psychiatrically“. WTF 😉

This after a) I underwent an MRI in March showing serious deterioration (ruptured ligaments) b) my treating orthopedic specialist knee surgeon requests approval for major surgery (which I eventually did not undergo because after numerous failed surgeries and many serious complications I am too scared). However, when my case manager requested I attend a psychiatric IME I asked her why on earth she was not sending me to a (more appropriate) physical IME.

9 July

I attend a psychiatric IME and the report states that I am totally unfit for any work for the foreseeable future. The report also stated that I must have taxi transport as I am unable to drive or take public transport without the risk of serious further injury.

10 July

“We are arranging a further physical assessment because it has been 12 months since your last assessment.” WTF 😉

18 July

“We will make a decision about your eligibility for taxi transport to and from medical appointments once we have reviewed both the physical and psychiatric independent assessments” A shrink assessment for taxi??? WTF 😉

19 July

“The physical assessment will be with Dr X – X Orthopedic Surgeon on the [date] @ [time]”.

26 July

“Mr X has called to advise he cannot consult on the [date] and due to the fact he was not available for some time we have arranged an appointment with Dr XX on [date] @ [time].”

“You will be sent a  letter with all Dr XX details. He is an Orthopedic surgeon and based on all the information you have been providing  regarding your injury we believe it is necessary to have the injury assessed based on my conversation with your specialist orthopedic knee surgeon.” WTF 😉

27 July

“Mr XX is a general Orthopaedic Surgeon whom I have requested to provide an objective clinical opinion, taking into account all the information we have available from your claim file and the information you and your treating doctors have been providing us regarding your injury and my conversation with your treating specialist knee surgeon.”

I replied as follows: ” you must provide me with a written request to attend an IME, and provide me with the reasons for the IME (with a surgeon who does not have expertise in knee injuries. You also need to give me (written) sufficient notice for the IME appointment  with date, location, explanation for the IME. As explained earlier I will undergo numerous scans and tests the day before which have many side effects such as vomiting and dizziness and there is a high possibility that I will not be fit to attend the IME the next morning. Can you please reschedule the IME.”

1 August

Please find attached a copy of the letter for the appointment with Dr XX on [4 days later] @ [time]. The appointment details are as advised in an email on 26.7.2011.
You have an obligation under WorkCover to attend IME appointments in relation to your work related condition. If you are unable to attend the IME due to prior a medical appointment, you will need to provide information from your doctor confirming this. WTF 😉 I told her!

When I looked at the “formal letter of IME appointment” …

The “reasons for the IME” were (WTF???)

In addition the letter states that Dr XX is an orthopedic surgeon (specialised in KNEES). However, Dr XX is NOT REGISTERED as a “knee” specialist, nor “shoulder & elbow”, nor “hand” specialist. He is not even registered as a “trauma” surgeon, but is registered as a GENERAL orthopedic surgeon.

Also, I  had  been scheduled to be reviewed/examined physically by the Medical Panel, on 16 August, just a week after the IME.

Questions

  • Why did my case manager send me to a physical IME? Considering that I was in any case certified unfit by the recent psychiatry IME for the foreseeable future.
  • The IME of 1 year ago, with no less than a BOWEL surgeon (I kid you not) detailed in his report that I had a catastrophic injury, a useless limb (this before the further deterioration) and had ‘no current work capacity” and – most importantly stated that “the worker needs to be sent to specialised knee surgeons for surgical opinions”
  • Why change the reasons for the IME like underwear? Why can’t they just be honest?
  • Why the need for an “objective assessment” of my knee after having personally spoken to my top knee specialist surgeon (who told me that this case manager had dared to challenge his opinion that a) I am totally unfit for work, b) I really need taxi transport and c) recent MRI’s objectively show the catastrophic damage/deterioration of my injury. How can they ask a general orthopedic surgeon- who is NOT specialised in knees- for an”objective assessment” of a highly specialised and advanced, very rare and devastating knee injury, in a young person,  that already required 9 operations and is deemed ‘at end stage’ (requiring prosthetic implant)
  • Why the need for an IME a week before a Medical Panel Examination (which overrules anything anyway).

Can anyone shed some light on this?

When I receive a copy of the IME report, I will share the real reasons for the IME (questions they asked) with you. I am curious!

Helpful-Tips-workcover

Independent psychiatric examination (IME psychiatry): don’t get fooled

When can workcover send you to an Independent Psychiatric medical examinations (IME)

According to the Claims Manual, (under the ‘claims Management Segments) an s112 examination,aka an independent medical examination (IME) conducted by an IME psychiatrist may be appropriate only in the following circumstances:

  • the case manager, in consultation with the technical manager is not confident that the advice (from the IMA or Medical Advisor provides sufficient evidence (from the treating practitioner, worker and employer) to establish the diagnosis and/or casual relationship or
  •  the information (from the treating practitioner, worker and employer) is conflicting or inconsistent.

Whilst the Act clearly states that workcover (your case manager) should seek answers to her/his questions first via discussion with your treating GP, psychologist or psychiatrist, they will inevitably try to send you to an IME psychiatry as often as possible (i.e. every 6 months) in the hope to find a loophole.

Continue Reading…

Independent Medical Examinations (IME) under WorkCover

About Independent Medical Examinations (IME)

Independent medical examinations are arranged primarily to determine whether a worker is entitled to compensation, or if the worker has a continuing entitlement to compensation. So, it’s not about you or your health, but about cutting off any benefits such as your weekly payments, ceasing your physiotherapy, psychology entitlements, or simply to find a loophole in the most corrupt system to get some IME to certify you fit -even if your own medical treaters, even super specialist deem you unfit for all work.

read more about IME’s in the Claims Manual

 

When can WorkCover send you to an Independent Medical Examination?

When should the Agent send you to an IME

“When assessing whether a (s112) IME examination is necessary, the agent should consider that the examination will:

  • strategically contribute to the management of the worker’s claim, and/or enhance RTW opportunities by addressing specific identified medical and/or treatment issues, and/or identify future medical/treatment management needs
  • provide required specialist advice not previously held or available via alternative sources, including the worker’s treating practitioner or specialist “

(Extract from the online Claim’s manual)

Note the word ‘strategically‘ … this simply means that the workcover agent  (your case manager) is (getting) desperate with all the overwhelming evidence (in your favour) and is in panic mode to send you to an (often inapproriate) IME to find a way to cut off your benefits and/ or to have you certified fit.

Interestingly the Claims Manual also states that your case manager should consider an IME when the IME will provide “required specialist advice not previously held or available via alternative sources, including the worker’s treating practitioner or specialist”.

In  2009, the revised Guidelines state that referral for an independent medical examination is only appropriate when information from the treating medical practitioner(s) is inadequate, unavailable or inconsistent and where the referrer has been unable to resolve the issues related to the problem directly with the practitioner(s).
If an injured worker submits a report from an assessor of permanent impairment regardless of whether they are the worker’s treating medical practitioner and questions regarding that assessment arise, they are to be posed to the assessor in the first instance. If the response from the assessor is inadequate, unavailable, inconsistent or not received within 10 working days, a referral to an independent medical examiner may proceed.

The Act also states that the IME needs to be specialised in the field of the worker’s injury (i.e. for a hand injury a hand surgeon).

Why are they sending me to an IME?

I find it extremely disturbing that (my) case manager only sends me to an IME,when she (as an uneducated, non-medically trained clerk really) is cornered by overwhelming evidence from my own treaters, and needs a way out!

Can you explain why case managers usually send you to IME’s that:

  • have nothing to do/are not specialised in the field/area of your injury
  • have far less experience in the type of your injury than your own (super)specialist

In my case for example, I have a purely and very specialized orthopedic injury which a general orthpedic surgeon is unable to treat (they referred me to a super specialist centre). So, why do you think that my case manager NEVER sends me to a super-specialist in the field, not even a general orthopedic surgeon, BUT to a general surgeon? General surgeons deal with guts! (i.e. bowel, gall bladder, appendix and things like warts).

What do they hope to gain by sending me to a general surgeon who has no clue about my injury?

On more than one occasion a very old (more than 75 years) ‘general surgeon’ told me that ‘he had never heard about the particular grafting methods used in my injury’ and ‘could not understand the relationship between my limb number 1 and my limb number 2- whilst I had tendons removed from limb number 1 to transplant in limb number 2. This is frightening and yet these people have to write a report about you and decide whether or not you are fit for work, you can or can’t do certain work, if the treatment you are receiving is appropriate and if they can cut off some benefits and entitlements.

On another occasion I received an email from my nasty case manager to say that she ‘…was not interested in my physical condition…’ after I had told her that my injury had taken a turn for the worst and after my super specialist had requested approval for major surgery.

She knew for a fact that I was unfit for all work from a physical perspective yet decided to send me to a psychiatrist ‘to assess my return to work and engagement in rehabilitation” DUH???? Assume I was certified fit for work from a psychiatric side, what f*** difference would it make, given that I am unfit for all work from a physical side?

More recently I was told by my case manager that I was to attend an physical IME. When I asked her why she simply stated that it had been 1 year since my last physical IME (with the bowel doctor). This is obviously not a sufficient reason.

I asked my super specialist (surgeon) to personally speak to my case manager to discuss with her any questions she may have and to ensure that she knew that I am currently unfit for all work, and that I need home help and taxi transport. He explained to her in what way the injury had further deteriorated and that my condition was very serious.

Right…

Next thing (2 days later) I hear (apart my super specialist telling me that he spoke with my case manager whom he said was a ‘nutter’ and ‘quite something’) from my case manager that I need to attend an urgent physical IME with a general orthopedic surgeon. She is still unable to give me a (valid) reason as why I need to attend and what it is she hopes to gain out of an assessment by a doctor who is not specialised in the type of injury I have.

I can only assume (again) that my case manager is not happy about my deteriorating condition and inability to work and hopes that a non-specialist might have the corrupt or bribed conscious to state that I am fit for work/some type of work, so that she can cut off some or all of my benefits.

Ironically there has been no need to send me to an IME  for a period of 5 years, in-spite of having deteriorated so badly that I have had to undergo 6 major operations to this injury. No-one questioned this, nor if I was safe and in a ‘suitable work environment’… I mean how do you explain 6 operations in 4 years? Well the reason it was not deemed necessary to send me to an IME was of course that I continued to work in between those surgeries…

I would love to hear your thoughts about the so called IME’s!

Do I have to attend an Independent Medical Examination with the doctor chosen by work cover?

A few months ago, I was asked by my case manager to attend yet again an independent medical examination (IME), with the same doctor I had seen 6 months before.

My experience with this “independent doctor” was so traumatic that I refused to be examined again by the same doctor. There was no way on earth I would ever go to this independent doctor ever again.

Being fearful of loosing my weekly earnings (read: being well aware that if you do not attend an IME your weekly payments may be suspended or ceased), I decided to consult my lawyer on this rather delicate matter.

Well, I am very pleased to let you know that we (my lawyer) were successful! I did not have to see that same, rotten (excuse my language) independent doctor but was given permission to attend the IME with another doctor (specialised in the same area). Oh boy, what a difference this made 😉

Keep this in mind if they send you to some previously seen horrible jerk of an ‘independent medical doctor)!

Got any tips and tricks? Please share them with your fellow workcover victims – and let’s try to make our lives a little bit better!