IMEs Insurance Doctors

Updated 6 Dec 2018

Also know as Insurance Doctors

What is an IME?

It is an examination scheduled by your employer, its insurance carrier or third party administrator. The purpose of the IME is to obtain information about your injury from another source in order to evaluate or contest your injury.

How is it independent?

It (usually) isn’t. We prefer that you think of the examination as a “defense medical examination, or insurance doctor’s examination”. The insurance company selects the doctor who is going to perform the examination from its list of (alleged) preferred ‘approved’ doctors.

Who performs these examinations?

Doctors of all variety of skill and training do these examinations. Typically, we see doctors who are just starting out in practice and doctors who are winding down their practices (there are many doctors way past retirement age). These are -allegedly- doctors who are looking for another way to add to their income by doing these independent medical examinations. A smal group consists of doctors who actually enjoy the work, which frequently involves testifying in legal matters. It has been suggested that money, and the promise of future income may well influence certain inedpendent medical opinions. Medicine is not an exact science. There is often room for reasonable doctors to come to different conclusions about the same case. That is why people seek second opinions. If an examining doctor could go either way on an opinion, do you think that he is going to go your way or go in favour of who actually pays for the examination?

Is the examining doctor required to follow the rules of the medical profession?

Yes and no. Because the doctor will not treat you, no doctor-patient relationship arises as a result of the examination. What you tell the doctor is not privileged. The doctor has no legal duty to you. So, if his opinion is wrong, he cannot be sued. The doctor will not tell you what the doctor thinks and will not answer your questions. But, the doctor needs to be able to show that the examination was done according to normal protocols and that he reached his conclusions in a medically reasonable manner, otherwise the doctor’s opinion can be rejected by the court as inadmissible or as unbelievable. There is a lot of room for manipulation of the outcome.

IMEs

For those who are not familiar, workcover claims/case managers are able to require an injured worker to attend an appointment with a medical practitioner or specialist for a so-called independent medical examination. The claims manager may or may not provide the medical specialist with the injured worker’s claim file or other (relevant) medical reports that have been undertaken. The ‘independent’ medical examiner will be asked to answer one or more questions relating to the existence and management of the injured worker’s medical condition.

The subsequent report of the independent medical practitioner, provided it complies with the relevant guidelines, can then be used to determine the injured worker’s entitlements and in any relevant legal proceedings. An injured worker must attend the independent medical examination, for failure to do so would be considered a breach of the obligation of mutuality and could result potentially in the discontinuance of weekly payments.

There is no real specific provision in the Workers Rehabilitation and Compensation Act dealing with IMEs and, as such, there is no realistic limitation on the justification for the number of independent medical examinations that a case manager can require an injured worker to attend…

It is alleged that ome IMEs have a reputation for being  “pro WorkCover”; that is, they are more likely to provide a report that is favourable to the claims manager’s interests (workcover insurer) and hence detrimental to the injured workers.

We found an interesting but older (2004) parliamentary “Questions on notice” where Senator Harradine asked in writing: How many specialists does Comcare employ to assist it in making determinations as to whether to continue liability or otherwise? How does Comcare determine which specialists it employs (as consultants or in any other role)? How does Comcare determine whether to discontinue using a particular specialist? Please provide a list of all specialists employed by Comcare, their names, positions and company, and the dollar amounts paid to each for each of the last five years? From this paper you can see how much certain IMEs have been paid by Comcare, reflecting the (over) use of some well known not so independent IMEs. Worth having a look at. See Answers to estimates questions on notice – additional estimates 2003-04.

 

How to prepare yourself for an IME

You may want to start by reading our popular but factual article entitled Disillusion yourself of any idea that the independent medical examiner is independent to get a good idea of what we are talking about (and dealing with) here!

There are quite a few things you can do to protect yourself during and independent medical examination (a must read)

Refusing to attend an IME / complaining about an IME

If your case manager/workcover insurance has requested you attend a well-known hired gun for an “independent assessment”, you may be able to refuse to see this IME, it is your right to refuse to be examined by a certain IME and your lawyer can help you to be send for examination to another independent doctor, on the argument that ‘all IMEs are supposed to be independent, so what’s the problem?’. However, generally speaking you would need to have ample hard evidence that the IME you are to see is -allegedly- biased. This can be in the form of a proper publication (news article, journal article, TV etc) showing a clear ‘conflict of interest’, but you can also make a case in the event this IME has for example prior convictions etc…

If you believe the IME has ill-treated you, please make a formal complaint. You must do this in writing to the workcover authority, and also to the medical board in your state.

If a worker is concerned about the conduct of a [s112 (VIC)] IME examination, they may make a complaint (best in writing) to the workcover authority.

Complaints may include allegations of any of the following:

  • causing unnecessary pain in an examination
  • complaints of an examiner’s manner
  • incorrect reporting
  • inappropriate behaviour

Also make a written complaint to your insurer (case manager/cc Team Leader) and request the IME makes corrections to his/her report.

For more info on how to make a complaint see FAQ WorkSafe Vic → Workcover Vic Complaints

Similar processes apply in all states.

If the worker has lodged a complaint and specifically requested not to be referred to the IME again, agents should seek an alternative IME for future examinations.

And remember that you can appeal any decision your insurer has made based on for example an IME report!

 

Good luck with your IME’s…. make sure your read the articles under ‘IME’ for some good tips and insights and how to prepare and protect yourself during those dreaded examinations.