IMEs in Victoria

Overview of IME in Victoria

Please take note that all IMEs are bound by a code of conduct!

What are Independent Medical Examinations?

IMEs (Independent Medical Examiners) are Healthcare professionals are approved by WorkSafe (now known as Victorian WorkCover Authority -VWA) to conduct independent medical examinations (of injured/ill workers)
The findings/opinions of an IME can be used in decisions relating to WorkCover (VWA) claims
According to the VWA, IMEs play a “critical role in ensuring that Victoria’s workers compensation scheme provides the right treatments and benefits to injured workers”

What is an Independent Medical Examination for the VWA?

Defined under Victorian Workers Compensation legislation:

“The Authority or a self-insurer may require a worker who has made a claim for compensation to submit at reasonable intervals to an examination by an independent medical examiner provided and paid for by the Authority or self-insurer.”

Who may perform an IME?

In this legislation independent medical examiner means:

  • a medical practitioner; or
  • a registered dentist; or
  • a registered physiotherapist; or
  • a registered chiropractor or a registered osteopath; or
  • a registered psychologist

who is approved by the Authority for the purposes of the section

“Approved by the Authority” and application process

  • An Independent Medical Examiner is appointed under the legislation
  • Must be approved by the Authority
  • Any suitably qualified practitioner may apply to be an IME
  • Selection criteria are published on the VWA website
  • From time to time the VWA undertakes active recruiting campaigns
  • Casual applications
  • “Areas of special need”

Selection Criteria for IME appointment

Mandatory criteria

  • Current registration with no conditions, limitations
  • Current member of a specialist college for a minimum of 5 years
  • A minimum of 5 years full time (or equivalent) work experience as a practitioner in his or her chosen discipline
  • A minimum of 8 hours practice each week in the area of practice in which the IME provides specialist opinion
  • Professional indemnity
  • Public liability insurance
  • Strong verbal and written skills and the ability to communicate with a wide range of professionals

Highly desirable criteria

  • Experience treating people in a compensation scheme context (including work-related injuries and illnesses, and transport accident (TAC) injuries)
  • Relevant post graduate qualifications
  • Commitment to advanced clinical practice demonstrated by the devotion of professional time to:
    >the instruction of students; or
    >active participation in formal special interest groups or networks; or
    >clinical research.

Appointment process of IMEs

  • The VWA receives written application
  • Checks for completeness and assesses against selection criteria
  • Appraisal of two or more submitted reports from applicant
  • Reference checks
  • Agreement signed and returned to VWA
  • Recommendation to Delegate of the Minister for appointment
  • Name added to list of IMEs with Specialty and areas of special interest
  • Agents (workcover insurers) and Self Insurers advised of addition

Current IMEs appointed (in 2013)

Total Number 310 IMEs

Common Specialties

appointed-imes-vic

Victoria WorkCover Authority has an IME Report Quality Assurance Program (aka as QAP)

  • rude-hostile-imeQAP was introduced in current form in 2009
  • All IME reports subject to review
  • An IME is selected for review
  • 5 reports selected randomly by the VWA and de-identified
  • Sent to two peer reviewers working independently of each other
  • Marked against published marking guide and free form comments
  • IME Manager and Senior Medical Adviser review marks and comments and assign a category for IME i.e. Cat 1, 2A, 2B or 3
  • 2B and 3 require improvements to reports and review in 3 months again

See Quality Assurance Program process

Organising an IME

  • An IME is organised by claims manager (eg workcover insurance case manager)
  • Arising from a claims case conference
  • Recommendation from a VWA Clinical Panel Medical Adviser
  • Recommendation from an Occupational Rehabilitation provider
  • Recommendation from an Employer
  • Recommendation from a “Panel Solicitor”

Organising an IME – reasons

To answer a medical question (usually many questions) to assist with
claims management :

  • Initial liability question –“Work relatedness” of the claimed condition
  • Treatment questions – Reasonableness and relatedness

Work Capacity Questions – Does the worker have a work capacity for

  • Pre injury duties and hours
  • Pre injury duties on reduced hours
  • Alternative or modified duties on pre injury or reduced hours
  • What restrictions may apply to employment

In response to a request from a treater or treater action, e.g:

  • Request for surgery or procedure
  • Delayed return to work (RTW)
  • Regression in RTW
  • Review of ongoing allied health services

The IME Experience

Worker’s responsibilities rights, and experience

  • The injured worker must submit to the examination under the legislation
  • Can be subject in special circumstances to review under hardship or medical provisions
  • Generally seen as a negative experience by the injured worker

RTW Co-ordinator

  • The Act imposes a duty to consult with injured worker
  • (CM notifies employer of intended IME)
  • Can assist with job description etc for IME
  • Make sure CM (Case Manager) has most recent medical certificates for IME
  • May receive edited parts of the report to assist in RTW

Treating Doctor

Can be seen as negative intrusion for most part by treaters

  • Not involved
  • Not notified
  • No input
  • May receive copy of report

Agent (workcover insurance)

  • Important claims management process
  • Standard questions (15 max)
  • Receives report and must review
  • May discuss with IMA and or TECH manager or MA
  • May send copy of report to treater
  • May send excerpts to employer
  • May use report as basis for terminating or reducing benefits

The IME

IMEs undertake work for a variety of reasons

  • Enjoyable work
  • Balances the work of practice
  • Financial
    HOWEVER
  • No therapeutic relationship between IME and Client (not a “patient”)
  • Must overcome negative feelings of client to establish rapport at outset
  • Must “over explain” everything being done during examination (no surprises)
  • Area of medical practice which has highest incidence of complaints

WorkCover Authority

  • Mandated under legislation
  • Integral part of claims management
  • Provides objective specialist medical opinion

Activities and Management

  • IME issues
  • QAP Program
  • Complaints process

IMEs – Dispute resolution

  • IME opinion vs. Treating GP opinion
  • Adverse decision

Avenues for dispute

  • Internal review by agent (or VWA review)
  • Conciliation
  • Medical Panels
The IME team at VWA
email: independent_medical_examiner@worksafe.vic.gov.au

Please take note that all IMEs are bound by a code of conduct!

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