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IME and the culture of over-assessment, over-deny, and over-abuse

Independent medical examinations are frequently over-used by WorkCover insurance companies. These so-called independent medical professionals are brought in by a WorkCover insurer that wants to challenge the injured worker’s benefits or treatment needs.

WorkCover has a culture of over-assessment, over-deny, and over-abuse of power including over-use of independent medical examinations

As the injured worker, you have little choice in when an independent medical examination will happen and/or how this happens, and if you don’t attend the examination then your benefits and treatment are suspended until you do.

WorkCover insurers are supposedly not to abuse their fiduciary power by assessing you, the injured worker, for everything you request or need! Unfortunately, Workcover insurers seem to have a hard time believing that some people are actually genuinely injured. They abuse the independent medical examination as a way to “prevent fraudsters”, but in actual fact, they use and abuse it for the sole purpose to find a way to contain costs! Avoiding to pay your rightfully entitled benefits and/or compensation – simple as that.

If you are subject to an independent medical examination you can expect the chosen independent medical doctor to be looking at your situation from a WorkCover insurance lens, often trying to find ways to negate or dismiss your needs. These independent medical assessments are often short, sterile, and the IME doctor often leaves you in the dark about their opinions. Some can come across as very friendly and caring only to write the most inaccurate report, others have been reported to be rude and dismissive during the examination. A few are honest.

It’s important to remember that the WorkCover insurer has to send you to a qualified IME doctor – someone experienced in the field of your injury. Unfortunately, many IME doctors are not qualified to assess you for the injuries you have, but it may be difficult for you to know this at the time.

How best to handle a request for an independent medical examination

The best way to handle the requested independent medical examination is to be proactive and preventative.

Ensure you are not over-treating with your own doctors and/or service providers. If you don’t need to attend weekly physio because it simply doesn’t work, then don’t and discuss this with your doctor. If the prescribed medication is unhelpful, or you don’t take it, then please don’t ask for the prescription. Don’t go to hydro 3 times a week if it’s no longer necessary. In other words: If your need for a benefit drops, be honest about this and ask your treating providers to reflect this in their notes.

If you are motivated to return to work, in whatever small capacity, then chances are also that your Workcover insurer will not constantly challenge your requests for a certain benefit. This means that they are less likely to send you to yet another independent medical examination.

However, that being said, even with these proactive and preventative strategies, some WorkCover insurance companies have a culture of over-assessment, over-denying, and over-abusing their power.

The reason is simple and that is that WorkCover insurers are in the sole business of making money. As such they will look at any way possible to mitigate their losses, including their financial liability towards you! Decreasing or ceasing any benefit you have is a win for them.

So, if the independent medical examination is going to happen anyway, there are some other things you can do to try and make the best of it.

  1. First, ask the WorkCover insurer to forward you a copy of the IME doctor’s resume. Read this over and see if this doctor appears qualified enough to assess you given your personal injuries or illnesses. If they don’t forward you the IME doctor’s resume, by all means, research the IME doctor using Google, AHPRA, the AMA, and, if interested, have a look on RateMDs and the Australian Legal Information Institute database too. For example, if you suffer from a complex orthopedic injury to your shoulder, you should be sent to an IME doctor who is an orthopedic surgeon specialised in shoulder injuries. A General Surgeon is simply not good enough. If you have concerns, voice these to your WorkCover insurer and ask for someone with more experience in your areas of injury (be it brain injury, chronic pain, mental health, etc.). Your insurer may – of course- not honour your request, but at least you have outlined your concerns.
  2. After the independent medical examination, read the report thoroughly and highlight any errors or mistakes. Send your WorkCover insurer (and/or your lawyer) a document outlining all the gross discrepancies and ask for these to be corrected… Provide copies of the reports to your treating team if applicable and ask them also to review these and render a response.
  3. As a final option, if the examination and report are wrong, harmful, or just plain negligent, consider again that these professionals have a regulatory body that is responsible for monitoring their practice. File a complaint, including one to the WorkCover Authority in your state (e.g. WorkSafe VIC), highlighting your concerns with the examination, the errors in their findings or report, and perhaps even their lack of experience in your area of injury if applicable.
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