Why is my IME report taking so long?

Why is my IME report taking so long

During a WorkCover matter, you will likely be asked to attend an independent medical examiner or IME.

This could be after you’ve lodged your initial claim during the claim determination period, or it could be after you’ve lodged an impairment claim.

Or, it could just be at a point where the insurer wants an opinion on whether a particular medical expense is reasonable and therefore something they should pay for.

Regardless as to what the IME relates to, you may find at some point that you see an IME and then wait and hear nothing.

This page will address why your IME report might be taking so long, and what you can do about it (and whether you should do anything about it in the first place).

How long should an IME report take to completed?

Generally speaking, we would say that if you’ve not heard anything in relation to an IME you attended within say three or four weeks from the date you attended, it would be perfectly reasonable to contact the insurance company and ask for an update.

You can do this by either sending an email to your claims manager or alternatively give them a call.

We do not recommend contacting the doctors rooms directly.

If you have a lawyer, it would be a good idea to contact them before contacting the insurer as they may have some insight into why you haven’t heard anything in relation to the IME report.

Some IME reports will take longer than others

There are some instances where the provision of an IME report may take a bit longer than usual:

Reports relating to complex matters

If your matter is complex, either medically or factually, or perhaps both, this can result in the doctor taking longer than normal to complete their report.

Matters that involve a psychiatric assessment

Psychiatric assessments usually take longer, and the reports are usually more detailed.

As such, it can sometimes take longer for a psychiatrist to send their report through to an insurer, compared to a doctor that is required to assess a physical injury.

Where a work capacity assessment is required

Sometimes when a doctor or other practitioner needs to assess a persons work capacity, it can take a little bit longer than normal for their report to be sent through because these can be quite complex reports.

Where further material is required by a doctor after an assessment

After an assessment, a doctor may require further information in order to provide an opinion and finalise their report.

They may need, for example, a copy of an operation report, or a particular imaging report or scan, or something from one of your treating doctors or health practitioners.

This can hold things up until the doctor has been provided with the material they need.

Where a doctor wants you to undergo further medical tests

In some instances, a doctor may need you to undergo a further medical test before they can finalise their report.

They may, for example, want you to undergo an MRI or other scan if you have a physical injury.

If you have an injury to your eye, for example, they may want you to undergo a specific type of test.

And until you’ve undergone the further test and the results of that test have been seen by the doctor, they will usually hold off from finalising their report.

Where a supplementary report is required

Sometimes what can happen is that the IME will provide their report to the insurer, and then the insurer after reviewing it will request that the IME provide a supplementary report.

This could be because the insurer found what they think might be an error and/or they want the IME to clarify something.

Or they may want the IME to expand on a particular point in their original report.

Sometimes the hold up is with the insurer

Sometimes the hold up is with the doctor, whereas on other occasions the doctor has actually provided their report to the insurer and the hold up is with them.

The insurer may not have actioned the report yet.

Sometimes, the insurers get busy and things can take a little longer than normal to be processed.

Or, they may have missed the report and it’s left sitting there.

The doctor may have finalised their report and the insurer may not have processed payment for the report yet so the doctor has not released their report.

Another possibility is that they have reviewed the report and they’re taking some time to determine what to do.

The person that is managing the claim may, for example, be seeking advice as to what the appropriate decision to make is in relation to your claim, taking into account the contents of the report.

Conclusion

There are a number of reasons as to why the IME report you’re waiting on may be taking so long.

It could be due to the nature of the assessment and how much work is needed to be completed by the doctor to finalise the report (eg: psychiatric injury reports will generally be much more detailed than those where a physical injury is involved).

The doctor may need further material before completing their report.

Alternatively, rather than the hold up being with the doctor, it may actually be caused by the insurer.

The insurer my have received the report but is taking some time to determine what decision to make in relation to your claim given what the doctor has said in their report.

Or, they may simply have not actioned the report yet.

In any event, we recommend that if you haven’t heard from the insurance company within say three or four weeks after you’ve undergone an IME assessment, it’s not a bad idea to contact them and find out what’s going on.

If you have a lawyer assisting you, perhaps give your lawyer a call first and they may be able to provide you with some insight into why the IME report is taking so long.

Please keep in mind that the information contained on this page should not be considered legal advice and no content on this site should replace the need to obtain advice tailored to the specific facts of your case. The facts of a case can significantly alter the advice that can provided. This site only provides general advice. Read more here.

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To contact Michael or Peter call 1800 746 442 or email [email protected]

Written by the Work Injury Site team