The do's and don'ts of a workers compensation' Independent Medical Examination

An Independent Medical Examination ('IME') is a common part of a workers compensation claim ¹.

An IME is an impartial medical specialist, who is engaged to provide an independent opinion about your injury and claim.

The IME is arranged by a 'referrer' being either a solicitor or the workers compensation insurer. An IME appointment can be arranged to provide an opinion on:

• Your diagnosis;
• The cause of your work injury;
• Your need for medical treatment needs;
• Your capacity for work;
• Your level of whole person impairment ²

Do I have to attend an IME?

You are obliged to attend an IME in certain circumstances, however the insurer is obliged to attempt to obtain the above information from your treating doctors before referral to an IME is appropriate.

If the insurer arranges an IME, you are generally entitled to a choice of three qualified doctors.

If you receive notification of an IME, you should contact Carroll & O'Dea Lawyers for free advice as to whether you should attend and to assist you in selecting the preferred IME. Please note the choice of three doctors does not apply to self or specialised insurers.

What kind of questions will be asked?

Before you attend the assessment, the IME is briefed with a letter of instruction and copies of relevant clinical records.

It is likely the IME has read this material in advance of your assessment, and will therefore have a brief background of the circumstances in which you are attending.

The IME is, however, required to confirm this preliminary information with you.

The IME will therefore start by taking background information, including:

• Your employment history;
• Any previous / pre-existing / comorbid injuries or conditions.

You may then be asked questions about your work injury, including:

• The circumstances of your injury;
• Your ongoing symptoms and disabilities;
• Your work capacity;
• Your treatment needs.

How long does an IME take?

There is no timeframe within which the IME is required to undertake their assessment. The assessor can take as long as they need to properly conduct the assessment.

Usually they allocate up to 1 hour for the examination, although most examinations do not take that long.

In general, you should assume you will be examined for approximately 30 minutes, and potentially up to 1 hour.

Do's and Don'ts

You should:

1. Bring your radiological imaging. The IME has likely been given a copy of the report arising from your imaging, however they would benefit from seeing the images themselves. The images are rarely made available to lawyers or insurers, and you should therefore bring a copy of the films to your assessment. If you have them in soft copy only, you should bring a device which will allow the IME to review the images.
2. Wear comfortable clothing. If you are attending an IME for a physical injury, you should wear loose and comfortable clothing so that the IME can assess you.
3. Prepare by having a think about how your injury affects your daily functioning. This includes any impact upon your ability to work, perform household chores, care for dependents, participate in recreational and social activities, drive, and travel. This may not be relevant to your assessment, however it is handy to consider these matters in case the IME asks.
4. Bring a support person, if you need one. Your support person can be anyone you like, although it is usually a partner, family member or friend. Your support person cannot be your lawyer as that may impact the independence of the assessment. If you do decide to bring a support person, you should advise the referrer ahead of time so they can notify the IME. A support person is not entitled to advocate for you. They cannot answer questions from the IME on your behalf, and their role is to support you during the examination.
5. Know and be clear about your limits. The IME is required to conduct an examination of you. If you have a physical injury, this may include manipulation of your injured body parts. In order to avoid further injury, you should notify the IME if their examination is "too much". Of course, the assessor is a qualified medical practitioner, and they will be well placed to determine whether the examination is aggravating your condition, however they will benefit from your honest feedback and you should not be afraid to share this.
6. Arrive early to the appointment. This will allow you time to complete any necessary consent forms and to relax before the examination commences.
7. Notify the referrer if you are unable to attend the appointment. Many appointments have cancellation or non-attendance fees if they are cancelled within 7 days, without adequate reason. To avoid this, you should notify the referrer as early as possible.

You should not:

1. Contact the IME directly, outside of the examination. All contact should be made through the referrer – whether that is the insurer or your lawyer.
2. Unreasonably refuse to answer questions or engage in the assessment. If you are unsure about your obligation to attend an IME, then you should contact Carroll & O'Dea Lawyers for specific advice about your obligations. If you receive advice that you should attend the IME, then it is important you engage in the examination. If you feel that you cannot participate in the assessment, it is important you notify the IME of the reasons for your refusal. If the IME feels they are unable to examine you as you refused to participate, they will terminate the assessment and notify the referrer. You may then be required to attend a further examination or potentially be at risk of having your weekly benefits suspended.
3. Seek medical advice from the IME. An IME is not intended to replace your treating doctors. You should defer to the advice of your treating doctors.
4. Lie or exaggerate. The assessors are required to provide an opinion as to whether there is any evidence of exaggeration, symptom fabrication or functional overlay. The assessor will provide an opinion as to whether the pathology and symptoms have an organic basis. You should be up front and honest about your symptoms in order to assist the assessor in forming their opinion.
5. Push yourself. During the examination, the doctor may ask you to perform certain movements. If at any time you experience severe pain or do not think you can do what the doctor has asked of you, you should bring this to the doctor's attention.

What happens after the examination?

The IME will provide their report to the referrer, which will contain their opinion based on the examination.

There is no timeframe that the IME is required to provide their report. Usually, it takes 3-6 weeks.

If your solicitor has arranged the appointment, you can expect to receive advice as to what the report means for your workers compensation claim.

If the insurer has arranged the appointment, you will only be given a copy of the report if the insurer relies on the report to decline any aspect of your claim. Otherwise, the insurer will review the report and implement any recommendations.

Complaints about the examination

If you do not feel comfortable or feel unhappy with the examination, you should raise this with the doctor during the assessment.

If you wish to take a complaint further, you can make a written complaint by contacting the following:

• The referrer (i.e. your solicitor or the insurer);
• If you are a member of a Union, you can advise your workplace delegate;
• SIRA Customer Service Centre;
• the Health Care Complaints Commission;
• Australian Health Practitioner Regulation Agency;
• NSW Medical Board ³

Conclusion

We appreciate that it can be stressful attending an IME, especially when you do not know what to expect.

Footnotes

¹ https://www.codea.com.au/publication/what-is-an-independent-medical-examination-and-its-role-in-your-personal-injury-claim-in-nsw/.
² https://www.codea.com.au/publication/understanding-whole-person-impairment-in-your-workers-compensation-claim/.
³ https://www.codea.com.au/publication/what-is-an-independent-medical-examination-and-its-role-in-your-personal-injury-claim-in-nsw/.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.