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)