All about WorkCover independent medical examinations

A WorkCover independent medical examination involves undergoing a medical examination performed by an independent medical examiner (IME).

WorkCover insurers arrange for injured workers to be assessed by IME’s from time to time, and use the opinion of IME’s to make decisions in relation to WorkCover matters.

An IME will usually be engaged by the WorkCover Insurance company or self insurer.

While your treating doctors have the responsibility of treating your injury and helping you to return to work, the role of an independent medical examination doctor is to answer certain medical questions that the WorkCover insurer has requested that they answer.

Their job is to assess your injury and provide a report back to the insurance company.

In most cases, the independent medical examiner will not have any contact with any of your treating doctors.

They won’t provide you with any medical treatment.

What doctors are selected to be WorkCover independent medical examiners?

The WorkCover insurance companies generally will use the same doctors over and over.

These doctors operate in a range of medical fields in a vast array of specialities.

Some IME’s are doctors that no longer practice (as in, they no longer provide treatment to people), but this isn’t always the case.

Certain IME’s will have done specialised training that allows them to perform certain types of medical assessments.

An example of this is that some IME’s have done training that allows them to perform whole person impairment assessments (which are relevant to impairment lump sum claims).

Who organises independent medical examinations?

Independent medical examinations for WorkCover matters are almost always arranged on behalf of the WorkCover Insurer (or self insurer if applicable).

As such, it is the WorkCover Insurer who also pays for the cost of the appointment.

In what instances might I be asked to attend an IME?

There are a number of instances in which the insurer might ask you to attend an independent medical examination.

Here are a few of the common reasons:

• if the insurer thinks they need an opinion on the nature of the injury
• To determine whether a medical expense you’re wanting to claim is reasonable
• To determine whether surgery should be approved and paid for
• To assess your work capacity
• To assess your whole person impairment rating for the purposes of an impairment benefit (lump sum) claim.

Do I get a choice as to what IME I see?

No, the insurance company will organise the independent medical examination appointment for you and they will pick the doctor.

That being said however, if you have seen the doctor before and you were not happy with them, you can ask that the insurer reschedule the appointment with another medical practitioner.

If you have legal representation, you can pass your concerns on to your lawyer and they can discuss the issue with the insurer on your behalf.

How do I prepare for an independent medical examination?

Prior to the IME appointment, you should make sure you plan your trip and know your way to the appointment location.

This is particularly important if you are travelling from a regional area and the appointment is to occur in Melbourne.

Make sure you know how to get there and allow enough time to travel there.

IME doctors sometimes see many patients on the one day and if you are late, they may not be able to fit you in.

If you miss an independent medical examination, sometimes you can be given a non-attendance fee which can range anywhere from a couple of hundred dollars up to over $1000.

Ensure to bring any relevant scans that you may have had such as MRI, CT or x-rays.

This is of course if you are having an examination of a physical injury. The doctor may not look at them, but it can’t hurt to have them with you.

Prior to the appointment, make some notes on key things such as what treatment you have had in the past and what treatment you’re currently having, as well as a list of the medications that you currently take.

Prior to an IME appointment, depending upon the nature of the assessment it can be a good idea to speak to your lawyer and discuss with them what you can expect from the assessment. This helps you get clear as to what the important issues are, and usually helps reduce any anxiety you might have about the medical assessment.

Am I entitled to claim costs for attending a WorkCover IME?

If the insurance company has organised the IME appointment for you, then yes you are entitled to claim the costs associated with attending.

You are able to claim travel costs as well as any meal and accommodation costs.

If you need it, here’s the form you can use to claim travel expenses from the insurer.

Can my employer attend an IME appointment?

No, your employer or a representative of the employer should not be attending an IME appointment that has been arranged by the WorkCover insurer.

How long do independent medical examinations usually last?

The length of assessments depends upon the reason for the assessment and the speciality of the doctor.

For example, it is common for a psychiatrist appointment to take longer than say an orthopaedic surgeon appointment.

This is because typically, psychiatrists have more to unpack when it comes to a mental injury compared to an orthopaedic surgeon with a physical injury.

It is also common for an assessment of your work capacity to take longer than an assessment of your whole person impairment rating for the purposes of an impairment claim.

What happens after an IME?

Usually, you might need to wait anywhere from a few days to sometimes a couple of months (and in limited instances, longer) after seeing an IME before you hear from the insurer.

During this time, the IME will draft a report and send it to the insurer.

Depending upon why you saw the IME, the insurer may send you a letter and/or call you to discuss the IME opinion.

If you have a lawyer, sometimes they’ll send the report to your lawyer (such as in the case of seeing an IME for an impairment assessment) but this isn’t always the case so you shouldn’t expect your lawyer to automatically be sent every IME assessment that the insurer sends you to.

In most cases the insurer will not provide you with a copy of the independent medical examiners report.

If you do want a copy of the report however, you can ask the insurer for a copy and in most cases they will oblige.

How long does it take for the independent medical examiner to send their report to the insurance company?

Normally, you can expect the insurance company to have the report of the IME doctor within a couple of weeks from the date that they assessed you.

As mentioned above however times it can take longer.

Sometimes It might take longer if the issue or issues for which you were being assessed are complex or if for example the doctor requires further information in order to complete their report.

What if the IME has a different opinion to my treating doctor/s?

It depends on why you were being assessed by the IME.

Ultimately, it’s up to the insurer as to whether they elect to run with the opinion of their IME, or prefer the opinion of one or more of your treating doctors.

Typically however, if you are being sent to an IME by a WorkCover insurer, in my experience in most instances they’ll prefer the opinion of the IME over any of your treating doctors. This isn’t always the case but seems to be the case more often than not.

If a medical dispute exists and the insurer has made a decision in relation to your claim that you disagree with, you can ask the insurer to review their decision and/or lodge a request for conciliation.

What if you weren’t happy with the medical assessment?

If you are not happy with the conduct of the doctor you saw, you can contact the insurance company and relay your concerns to them.

In most cases they will then contact the doctor and ask for a response and you should receive a response from the insurer within a few weeks.

Do I have to attend an independent medical examination?

In most instances, the answer to this is yes. If the insurer has organised an independent medical examination, you will need to attend.

However, this isn’t always the case.

The arranging of the IME should be reasonable.

For example, lets say that you attended an IME for assessment of your right shoulder and the opinion of the IME was favourable for you.

If a month later the WorkCover insurer was to organise another assessment relating to the same issue, but with a different doctor, this would not be reasonable.

Here’s another example.

One of my clients had two medical assessments organised with the same doctor within a couple of weeks of each other.

Each assessment was arranged for different purposes.

My client requested the insurer to merge the IME appointments, but they initially did not want to. In the end however the insurer agreed that it was appropriate that the appointments be merged and my client only need to attend one appointment.

So, if you’re not sure whether an IME that has been arranged for you is reasonable, you should speak to your lawyer.

Conclusion

A WorkCover independent medical examination involves being medically assessed by an independent medical examiner (IME).

This is a medical assessment that is typically arranged by the WorkCover insurer or self insurer.

Insurers use the opinions of IME’s to make decisions in relation to your claim.

There are a number of reasons as to why you might see an independent medical examiner during your WorkCover matter.

Common reasons are: rejection of claim, addressing a certain issue with regard to an injury, assessing your whole person impairment rating as part of an impairment claim and determining your capacity for work.