All about WorkCover medical reports

There are two main categories of medical reports that could be obtained during a WorkCover matter in Victoria.

The first is medical reports from independent medical examiners. These are typically obtained by the insurance company, their lawyers, or your lawyers.

The second is medical reports obtained from your treating doctors or other health practitioners that have treated you. Typically, these are obtained by your lawyer, the insurer, or the Accident Compensation Conciliation Service.

Medical reports from doctors and health practitioners that have treated you

Depending upon the circumstances of your WorkCover claim, it may be that medical reports are obtained from some or all of the doctors and other health practitioners (eg: physiotherapists, osteopaths, chiropractors) that have treated you.

If you have a lawyer, typically this is something that they will do on your behalf.

Prior to them doing so, you will need to sign an authority which the lawyer will send you. This gives them permission to obtain the medical report or reports on your behalf.

Sometimes, the WorkCover insurer will obtain medical reports from your treating doctors or health practitioners.

This is usually done when they wish to clarify a medical issue such as whether a particular type of medical treatment is still providing value to you.

Another instance where medical reports from your treating doctor or health practitioners may be obtained is during the conciliation process.

When you initiate the conciliation process, if the dispute involves a medical question, the Accident Compensation Conciliation Service will send you an authority to sign that will allow them to request medical reports in relation to your injury.

Generally speaking, if you have a lawyer that is representing you in relation to the conciliation, they may recommend that you not sign the authority as they will prefer to obtain medical material on your behalf, rather than leaving it to the ACCS.

Below are typical instances during the life of a WorkCover matter where medical reports from your treating doctors or health practitioners may be requested;

• If there is a medical dispute relating to the cause of an injury (eg: if the insurer has rejected your initial claim because they believe the injury is not work related).
• If the insurer has rejected your request for payment in relation to a particular type of medical treatment, or medical treatment in general.
• For the purposes of an impairment benefit lump sum claim.
• For the purposes of a common law lump sum claim.
• If there is a medical dispute in relation to weekly payments, particularly concerning your work capacity. For example, at the 130 week mark the insurer in order to terminate payments will need to establish that you have a work capacity.

Who pays for the cost of the medical reports?

The answer is it depends.

Typically what happens if you have a lawyer is that the medical provider will send a bill for the medical report to the lawyer.

Depending upon the medical providers speciality and the amount of work that needed to go in to completing the medical report, the cost can vary from a few hundred dollars to several thousand dollars.

Typically the lawyer will pay the medical report fee on your behalf.

There are then a number of ways that the lawyer can claim the cost (or some of the cost) back from the insurer.

Some of the typical ways are; during the conciliation process, during the impairment claim process if your impairment claim has been successful and during the common law process if you succeed in your claim.

If you have a lawyer and they request medical reports on your behalf but they have not been able to claim the cost of these reports back, depending upon the nature of the no win no fee agreement that you have entered into with that lawyer, you may be required to pay for the costs of the medical reports.

These medical reports are called disbursements.

IME medical reports

During the life of a WorkCover matter, the insurer, the insurers lawyers or your own lawyers may request that you undergo an assessment by an independent medical examiner.

The Independent medical examiner will then produce a medical report to be used in your WorkCover matter.

There are a number of occasions where you may be asked to see independent medical examiner during your WorkCover matter.

Some of the more common instances are are:

• Once you’ve lodged a claim, the insurer will typically organise an appointment for you to see you an IME for an opinion.
• Once you’ve lodged the impairment claim, you’ll be sent to at least IME for an opinion in relation your whole person impairment rating.
• If you pursue a common law claim, there is the potential that your lawyers and/or the lawyers for the other side may organise an appointment for you to be medically assessed by a specialist IME doctor.

These IME reports are typically more detailed than reports from your own treating doctors or other treating health practitioners.

These IME doctors will see you on one occasion (sometimes more) and will not provide medical treatment to you. Their job is just to perform a medical assessment and provide a medical report to be used in your WorkCover matter.

Who pays for the cost of the IME reports?

If the insurer has organised the IME assessment then they will pay the cost of the report. This is in all instances under the WorkCover system in Victoria.

If your lawyer has organised for you to be assessed, then what will happen is the lawyer will pay for the cost of the medical assessment and will attempt to claim the cost back during your matter, in a similar way they would do in relation to reports from treating practitioners (although they are more limited in when they can claim the cost of IME reports back compared to treating doctors and health practitioners reports).

If these cost cannot be claimed back then again depending upon the no-win no fee agreement that you have entered into, you may be required to pay some or all of this medical report cost.

Conclusion

There are two broad categories of WorkCover medical reports. The first is independent medical examination reports that have been obtained by the insurer, their lawyer or your lawyer.

The second medical reports from your treating doctors and other health practitioners that are provided medical treatment to you.