When you make a claim for workcover benefits, the insurer will demand that you undergo what it called an “Independent Medical Examination” (IME), but which we prefer to call an “Insurance Medical Examination”,or better yet, DME‘s or “Defense Medical Exams”, because the doctor (IME) is often far from independent.
These “independent” examinations are nothing more than“adverse” or “compulsory” medical examination. The bottom line is that these doctors are hired for one purpose and one purpose only – to either deny or minimise a workcover claim.
Disillusion yourself of any idea that the independent medical examiner is independent
However, our workcover insurers tend to misuse IME lists, selecting over and over again the same, but relatively few, notorious IMEs. We don’t see the workcover and their insurers readily wanting to give up their “privilege” of choosing their favourite IME and medical witnesses!
The IME is (sometimes) hired to destroy your case
Disillusion yourself of any idea that the independent medical examiner is there to help you. S/He is sometimes hired to destroy your case, for example to:
- find some cause of your problem (injury/illness) the workcover insurer won’t have to pay for,
- deny the existence of your problem,
- deny that your injury (illness) happened at work,or was caused in the workplace
- find that your problem falls within some sort of exclusion (i.e. stress claim and reasonable management action)
- show that you’re malingering (oh yes), or not following medical advice,
- deny the severity of your complaints, alleging you are, of course, exaggerating
- list “all the activities” you’re capable of, …
- smear you by showing you for example lied or concealed other accidents/illnesses/surgeries, even totally unrelated ones, etc.,
- challenge the prognosis of your injury/illness – in other words: for example cut you off>130 weeks weekly pay, force you to return to work, etc
- show that no further treatment is needed, a favourite! i.e deny surgery, deny pain treatment, psychology, etc
- minimise your disability / impairment (and rating!) and inability to work,
- criticise your treating doctor’s care, even the best specialists in the country
- find “inconsistencies” in your medical history….
Anyway, whatever the IMEs are called, the doctor who performs the exam will only testify about your injuries for the insurance company.
This examination, and the performing doctor, are anything but i-n-d-e-p-e-n-d-e-n-t.
It has been alleged many times that workcover insurance companies carefully and deliberately select which doctors (IMEs) they want to perform specific medical assessments.
Most of these doctors have -allegedly- frequently done work for that same workcover insurance company and typically work for insurance companies exclusively. These doctors, alledgedly- solicit business from the insurance companies by offering to do such ‘independent’ medical evaluations for them knowing that the insurance company will not refer patients to the doctor again unless the reports are favourable to the insurance company. This means that in order to stay in business, this ‘independent’ doctor, performing an ‘independent’ medical examination must be in the business of writing reports which ”negate” injury claims, and -alledgedly- serve only to bolster the workcover insurance company’s denial of your medical benefits. If this ‘independent’ doctor fails to write reports in accordance with the workcover insurance company’s specifications, then it has been suggested by workcover insuders that doctor will not be referred any more cases to review from the insurance company.
Actions speak louder than words, indeed!
Everything you do in the IME’s office will be observed and recorded
Everything you do in the doctor’s (the IME) office will be observed and recorded by the doctor and his/her staff. The doctor often incorporates simple activities into the examination, such as sitting on the examining table or taking your shirt off, as part of their mobility testing.
So, while you might think the doctor never saw you move, s/he did observe you take off your jacket and pull your shirt over your head, demonstrating certain mobility/function techniques. All of those observations are part of the exam, although not as obvious to you as other parts of the physical exam itself.
Be particularly aware of surveillance persons in the waiting room
Be particularly aware of surveillance persons in the waiting room.
It has come to our injured attention that the workcover insurance -in a letter addressed to the IME doctor preceding the medical exam of the injured sod- , asked the doctor (the IME) to “watch” an injured worker in the waiting room and document things such as opening up doors, sitting waiting for the examination, walking within the facility, etc.
Sometimes the IME may even drop something on purpose to see if you bend to pick it up. Remain observant and watchful of everything you do when entering (and leaving) the offices of an IME doctor. Stay seated and don’t walk around. (Unless you must stand up because of your inability to sit for a short period of time – then stand up, even lie on the floor if that’s what you do at home to relieve pain)
Some more tips
- Be on time for your IME
Keep your appointment. Your failure to attend the medical exam may result in your being responsible for payment of the doctor’s fee (!) or the suspension of payment of your medical bills, or suspension of your workcover claim!
- Be honest
Honesty is the best defense. The best way to “connect” with the IME is to be polite, cooperative, and above all, honest. If you lie (even the smallest of lies) or fake an injury or the severity of an injury during the exam, the IME doctor will be very quick to recognise your “deceit” and mention it very prominently in the report. Try to appear open and forthright by providing helpful and straightforward , but short answers. Also, attempt to make eye contact whenever possible. Although you need to pay attention to the IME doctor’s questions so you can answer them carefully, don’t appear nervous (no need!) After all, you know the answers to the questions, so try to stay relaxed.
- Prepare for the IME
Please, always check out the examiner on the internet for licensing/registration and/ or disciplinary problems. Many of these IME doctors are rejects who can’t hold a real job, or can’t get one because of prior discipline. Many are way over retiring age (i.e. octogenarians) who are no longer up to date with medicine. Object against the IME if you find any problems. (This can be done with the help of your lawyer who will argue that all IMEs are “independent”, so what is the problem sending you to an alleged biased one? Note that in the long run attending alleged “shoddy” IMEs can be in your advantage, as some of these IMEs’ reports do not stand up in a court of law.
Get organised! You must carefully prepare for this exam! Obtain and carefully review all the (medical) records from your treating doctor(s). Make sure that not material is omitted and remember that your case manager will only provide very selected material to the IME. If possible, have your lawyer or a friend grill you about your medical history, just as though you were going to a formal deposition.
One way to strengthen your case and be more relaxed during the IM Exam is to gather your thoughts so you can present your medical history in a logical and concise, but complete manner. Here are some subjects you’ll cover:
- Your medical history, including prior injuries, where applicable
- How the accident occurred
- What areas of your body were injured
- Your main symptoms
- When your injuries cause you pain
- Movements or activities that aggravate your injuries and cause pain
- Treatment or medication that makes your injuries feel better
- and activities that have been affected or limited by your injury
Review the summary before your exam, but do not bring the summary with you – lest the IME may think you are making up a story as you need to read your pre-prepared paper (!!!)
What the IME doctor will look for
Once you are called in for examination the IME doctor will typically conduct an interview to learn the history of your accident / medical condition, and then conduct a medical examination. At some point in time, the IME doctor is also likely to consult other medical records (selective!) provided before your arrival in relation to your case. During this process, the IME doctor looks for a variety of factors about you, the injured workcover victim, including:
- General Appearance – The IME doctor will observe you not only during the examination, but while you walk in the examination room, how you stand, whether you have any difficulty getting onto the examination table, whether you show any signs of distress while sitting on the examination table/chair, how you dress and undress yourself, your weight and personal hygiene, and anything else that the IME doctor believes relevant to your injury or condition. They have been known to purposely leave a dollar bill on the floor (or something else) to try to catch an injured worker bending over to pick it up, but perhaps not mentioning the accompanying grimace of pain. Some will even observe the way you get in and out of your car and walk across the parking lot. Be aware.
- Always be friendly and polite. Never express anger, but be firm. Don’t tolerate any abuse
- Meeting the IME doctor- The IME doctor will ask questions to formulate opinions about your injuries. Be careful that you understand each question before you answer it. For example, if the IME doctor asks, “How do you feel now?” you should find out if he wants to know how you feel that minute or at this point after the accident. You may feel pretty well at that particular moment, but may have had pain associated with your injury earlier in the day, so it’s important to be specific and accurate in your answers. Take time to answer all questions carefully. If a question is unclear or confusing, don’t be afraid to ask the doctor to explain or rephrase the question before you answer. If you make a mistake, correct it immediately. Avoid unnecessary elaboration. Remember that the IME doctor is hired by the workcover insurance company to help its case. So, while you should always answer a question politely, honestly, and completely, don’t ramble on or elaborate unnecessarily.
- Signs of deception/ exaggeration (of course) – The IME doctor will typically be on high alert for any sign of deception or exaggeration, and can be expected to report any impression that you intentionally or unintentionally exaggerate any symptoms.
- Objective signs of your injury – The IME doctor will typically review any medical imaging studies, such as x-rays, MRI reports, CT scans, and EMG nerve conduction studies, to try to find objective signs of injury – that is, objectively measurable damage or injury to the injured worker’s body. The IME doctor will also assess whether your subjective symptoms of pain and discomfort are “consistent” with the objectively verifiable signs of the injury.
- Subjective signs/symptoms of your injury – The IME doctor will often perform tests which require you to provide subjective indications of pain, discomfort, sensitivity or insensitivity. For example, an IME doctor examining for a lower back condition may have the injured sod perform a variety of movements which stretch or turn the back, and note the point at which the patient starts to report pain and the point where movement becomes limited by pain. The doctor may test the subjective signs and symptoms in several ways, or at more than one point during the examination, to see if any claimed pain level or point of disability /impairment remains consistent.
- Other Contributing Factors– The IME doctor can be expected to inquire about any other symptoms, ailments or injuries, including any which have occurred prior to or since the accident, which may have somehow contributed to the injury, or aggravated the injury or impaired recovery since the time of the accident. The IME doctor will also likely address any lifestyle factors discovered within this process, such as drinking, smoking, overeating, and recreational drug use, which may somehow contribute to the injury.
What you should DO at an IME
- Be truthful and cooperative with the IME doctor (even if you know he is a crook!)
- Be pleasant. At the same time, you should not behave in such a way that the IME doctor can say you were laughing during the examination (! – has happened to frequent flyers!)
- Be or at least appear concerned, serious and polite. Give the IME doctor accurate, but brief, history on how your accident or injury occurred.
- Give the IME doctor an accurate history of your job details and what you do in terms of lifting, bending, stooping, carrying, and walking, repetitive motion etc.
- If the IME doctor asks you about any previous injuries or illnesses you had before the present one, be honest and tell him the nature of any injuries you had, and whether you had surgery in connection with those previous injuries. On the other hand, do not volunteer information.
- Make sure the oral medical history you give the doctor is complete. If he cuts you off, tell him “Doctor, I have not finished my answer to your question. May I please complete my answer? Don’t you want to know the truth?” If the doctor persists in unfairly cutting off material answers, inform him you will leave. But be sure that you’re so right that a potential) judge will agree with you. Remember: THIS IS NOT YOUR DOCTOR. Anything you tell this doctor will not be confidential and can be used by the insurer against you.
- If the doctor asks if you have had any previous injury claims, you should say to him, “I’ve had previous injuries” (if that is true).
- If you are totally disabled, explain to the IME doctor that if there was any way you could be back at work, you would be there.
- Keep copies of any document you fill out or sign at the IME’s office, where applicable. Don’t assume the IME will keep your questionnaire. Many don’t, and that may be the only proof you have that you told the IME doctor about some part of your medical history or injury. So keep your own copy.
- This “independent” medical exam doctor is going to ask you many questions in great detail. Keep in mind to answer his / her questions as simply as possible. Yes or no answers are the best you can give. Try not to elaborate on any subject. Never guess! If you are unsure or do not know the answer to a question, simply state “I do not know”. If the IME is asking questions about your doctor, or your doctor’s opinion, tell the exam doctor to look in the file that was provided to him or her, all that information should be in it. It is also OK, if you are uncomfortable, to tell the IME doctor that all of your injury information is also in the file. You can keep repeating this as much as needed. IME doctors will try to get you to sing like a canary in hopes to get you to say something different.
- Anytime this physician touches you or makes you do something that hurts tell him/her loudly! If you do not make it known that what is happening is causing you pain, the IME doctor will write in his or her report that the injured worker did not have any pain. Make your pain known!
- Be aware that the IME doctor is sometimes performing the same test on you in more than one way! For example, the IME doctor may test your legs when you are sitting up and when you are lying down. This is the same test. Therefore, if you complain of pain inconsistently, the doctor is going to make note of it. Let the truth come out and you will obtain a more favourable report from the doctor.
- Wear your hand/arm braces, walking stick, and use any rehabilitative assistant devices like walkers, wheelchairs etc at least two days before the exam, the day of, and two days after the exam. Be watchful and mindful you are likely to be under surveillance for these days as well. Look for strangers in your neighborhood or unfamiliar cars following you during that time period. If you are on good terms with your neighbors, ask them to alert you if they are contacted by anyone out of the ordinary. Workcover insurance companies also use a ruse whereby they call you on the telephone and tell you they want to deliver some sort of mail or package. Be careful of strange phone calls.
- The questions and physical examination must be limited to the area which is “in controversy”. If you’re complaining of a knee injury, there is no need to do a pelvic exam. You may limit the length of the exam to a reasonable time. And you may refuse to discuss parts of your medical history which are irrelevant.
- During the entire examination, without the IME doctor knowing it, keep track of the time the IME doctor spends with you and what is being done during each time period. For example:
1:00 p.m. Arrive at the IME doctor’s office.
1:15 p.m. Appointment time
1:30 p.m. Go to examining room
1:40 p.m. IME doctor arrives in examining room
2:00 p.m. Interview ends, told to undress, IME doctor leaves
2:10 p.m. IME doctor returns and begins exam
2:15 p.m. Examination over
2:20 p.m. Leave clinic
What NOT TO DO at an IME
- Do not try to out-smart or fool the IME doctor. They didn’t go through all those years of medical school and residency and thousands of insurance IMEs to be fooled by someone who says ouch every time they move. Believe it or not, those injured workers who do get much less sympathy and even less credibility for their complaints.
- Do not volunteer any information not requested
- Do not discuss who is at fault in your case (if applicable)
- Do not discuss settlement (or litigation) of your case
- Do not allow the doctor to take X-rays or conduct other diagnostic tests (they are not allowed)
- Do not lie. That can undermine your whole case
- Do not drive yourself to the visit. Try to have your spouse, friend drive you or take a taxi
- Take a witness to the IME with you , and consider having him/her audiotape the proceedings, provided it is allowed under the law and the IME agrees to it. If the IME doctor refuses to allow the witness or the taping, consider refusing to proceed until they’re complied with. (If s/he refuses to comply, you may want to wait till the office closes or they call the police to eject you, to prove that you were prepared to proceed, and it was the IME who refused!). In the case of a proven shoddy IME, consider making it clear, in writing, to the workcover insurer that you will attend the IME, but with your witness and a recorder.
- Note that though the observer may monitor the exam, he may not participate in or disrupt it.
- Do not talk about your accident, injuries, insurance company or case in the IMEs office, in lifts, common areas (i.e. bathroom) or IME doctor’s waiting room.
- Do not wear dangling jewelry or earrings, do not wear make-up (or limit)
- Do not come to the IME doctor with hands that look they are dirty from working on a car or changing the oil, or gardening
- Do not come to the IME doctor with nicely painted fingernails (especially if you are claiming carpal tunnel or any other type of chronic pain syndrome)
- Do not jump on and off of the examination table at the IME doctor’s office
- Do not come in tight jeans or working boots. Men, don’t come unshaven. Ladies, don’t come with make-up on or wearing high heels.
- Do not leave the IME doctor’s office in a running trot or quick walk and jump into your car, because the IME doctor is probably watching you from his or her window.
- Do not use medical jargon or fancy terminology when discussing your case or describing your symptoms. If you are complaining of a neck injury, don’t twist your head back and forth when the doctor is moving about the room in an effort to follow his movements (!)
- Do not discuss money or any plans of retirement with the doctor
- Do not discuss your marital situation. Your married life is not relevant to the present examination
- Do not exaggerate your problems/symptoms
- Certainly do not moan, groan and wince or grimace in pain every time the IME doctor touches you. Be natural
- Do not ask the IME doctor for medication/pain meds
- Do not talk to the IME doctor about the insurance company, lawyers or the case managers
- If you have a bad back, don’t bend down and untie your shoes. Wear loafers and kick them off/slide them on
- Do not discuss with the IME doctor the amount of your claim/case or the amount of wages you used to make. Politely decline to do so by saying that the workcover insurance company has that information
- Do not discuss with the IME doctor whether you have any (court) hearings coming up on your case
- Do not discuss what you deserve for a settlement
- Don’t allow anyone but the agreed-upon doctor to conduct the exam. Allow no one else in the room except a nurse, your witness, and, if needed, an interpreter.
Do not expect a fair IME report
While a few IME doctors are highly professional, and seek to actually provide an objective evaluation, the vast majority of them know that they are being paid by the workcover insurance company, which pay their bills and expect that the position of the defence (the insurer) will be improved as a consequence of the IME report. If the IME doctor prepares a report you believe to be unfair, let your lawyer worry about it. You need to be principally concerned with what your treating health care providers tell you about your condition.
After the IME
After the exam, revert to helpless patient mode, and ask the doctor for his prognosis, recommendations for future treatment, and criticisms of care provided so far. A refusal to answer will be useful if you go to court.
After the exam, pick up all the cards, brochures, etc. available in the IME doctors office. If other patients appear to be waiting for IMEs, talk to them, and get their names and phone numbers. They may be useful witnesses.
Schedule an appointment with your own doctor later that day, in case a rebuttal of any adverse findings is needed. Have him send for a copy of the IME’s report as well, to check for errors and problems. If he’s willing to be really proactive, he can phone the IME and ask if he or she had any good treatment ideas. IME’s like to wield power over patients; they do not like to see a Jedi in the background!
Once the exam is over and you have left the IME doctor’s office, prepare a written summary containing the following information in as much detail as possible:
- What the IME doctor said to you;
- What you answered;
- What, if anything, was dictated into a tape recorder by the IME doctor during the exam;
- What tests or procedures the IME doctor performed – for example: If he measured grip, did he just have you squeeze his fingers, or did he use a dynamometer? If he measured symmetric muscle circumferences, did he measure up from the floor or a finger-tip to assure symmetric locations? Did he measure bending angles with a goniometer, or did he estimate them?
- How much time the IME doctor spent with you;
- What was done during each time period; and
- Any inappropriate or unusual questions or comments made by the IME doctor.
The IME doctor will prepare a report for the workcover insurance company describing his/her examination of you, along with his/her findings and opinions. It is quite rare (dare we say) for the IME doctor to determine that you were injured in the accident/manner you state, and/ or recommend any further treatment (incl. surgery).
Try to remember what goes on during the IM Exam in as much detail as possible, but don’t take notes in front of the IME doctor and be very careful bringing a tape recorder into the exam — that could make it appear that you are more interested in getting money for your injuries than in improving your health. It is extremely important to note the exact amount of time the IME doctor spends actually examining you because the IME doctor will prepare a detailed report regarding your injuries despite having only spent a short time actually examining you (sometimes 15 min).
As soon as you are home, sit down and write down every detail you can recall of your exam (i.e. time spent with a nurse/receptionist or IME doctor, questions asked by the IME doctor and your answers, tests performed by the doctor, etc.). We – injureds- understand that you cannot remember everything, but do the best you can. Nonetheless, your lawyer is most effective when he/she has as much information as possible regarding your case. You must provide that information to your lawyer. He/she is your advocate, not your private investigator. You are their eyes and ears, so give them as much information as possible, after all, the insurance carrier is doing the same thing to opposing legal counsel 😉
[post dictated by WCV+WCV3 and manually inserted on behalf of WCV]
Perspective – What do doctor’s think about Workers Compensation?
Posted on March 28, 2014 by Tasworkdoc
Through my work as an occupational physician, I regularly interact with doctors who have a variety of roles in the assessment and management of work-related injuries. Most often I am a member of a team of treating health professionals, but at times as an independent medical examiner, I provide analysis and critique of other doctor’s opinions.
I tend to see patients with injuries that take longer to resolve or require intervention including some who require spinal and other types of surgery. There are more frequently chronic pain patients than in general practice. As an independent medical examiner, I see workers involved in litigation, often having had a prolonged and frustrating period in the workers compensation system.
I have taken a particular interest in other doctor’s views about workers’ compensation issues and have surveyed views of local specialists who interact frequently with the system and participated in discussions with doctors who have concerns about managing patients within compensation systems. While I have not conducted a scientific study of doctors opinions, I can make a number of observations from my perspective.
Doctors have a spectrum of views about workers compensation including some who are cynical about any patient who claims workers’ compensation benefits. Most doctors with a focus on treatment and who interact with the system however are negative about the processes adopted by insurers and the opinions of independent doctors engaged by the insurers.
Doctors have concerns about increasing impositions from claims management practices and legal involvement. Some are reporting difficulty providing care under these constraints and some no longer see workers compensation patients for these reasons.
Doctors have expressed concerns about delays to the provision of appropriate care due to problems with access to consultant medical practitioners and, at times, control over selection of consultant level care by insurers.
Doctors express concerns that there are more requests from insurers to provide reports to justify investigation and treatment expenses. This extends not just to the costs of expensive procedures, but can extend to matters as simple an imaging investigation or the addition of a new medication.
Doctors express concerns that approval for recognised investigation and treatment procedures are often rejected or decisions delayed on the basis of clerical decisions or the opinions of doctors contracted by the insurance industry i.e., from independent medical assessors. There are often significant delays waiting for an insurer to obtain an independent medical opinion to approve a relatively straightforward investigation or treatment procedure.
Doctors are concerned that delays or rejection of funding for recommended treatment can have significant implications for recovery. This has negative consequences for the patient’s psychological health, compounding the risk of a poor outcome.
Doctor can become overwhelmed by requests from insurers for reports of a medico-legal nature. This can contribute to delays in timely responses from the doctors and reduces their availability to provide treatment and care.
Doctors express concern about reluctance by insurers to fund interventional pain procedures and some surgical procedures.
Doctors are concerned that rehabilitation providers lack independence from the insurers who directly appoint them and fund their services. They sometimes provide advice to the patients, insurers about treatment, or where to seek treatment, outside of their field of expertise. At times rehabilitation providers document an unrealistic ‘return to work’ goal without any understanding of the injury prognosis or discussion with the treating practitioners. This creates wrong expectations for those involved. Unnecessary attendance by the rehabilitation at every doctors appointment can waste time and resources.
Doctors are concerned that insurers often resist funding for retraining and redeployment when it is clear that an injured patient cannot return to their pre-injury work. The focus by insurers is often on return to pre-injury work without recognising when this is not achievable.
Doctors are concerned about unnecessarily confrontational systems to resolve claims where patients reach maximal medical improvement, but are unable to return to their pre-injury work. With the current system insurers can only resolve matters by seeking negative reports from independent doctors to bring matters to settlement. This can be a damaging process psychologically to the worker.
In summary, there are many concerns expressed by doctors about the workers compensation system in Tasmania. Doctors are a key part of the system to provide necessary care for injured workers. Withdrawal from the system by doctors can only degrade the outcomes achieved. The designers of our workers compensation system need to take into account doctor’s views, not just the views of the employers and workers and their representatives.