Some workcover IME doctors are of the strong view that the Australian Health Practitioner Regulation Agency (AHPRA) should NOT have investigative powers into the content of their IME reports. They are happy to have alleged complaints about IME doctors’ conduct investigated by AHPRA but are adamant that the content of their reports should not be scrutinised. We believe that this is exactly the problem, as most injured workers have serious concerns about the content of said IME reports, and not so much about the conduct of IME doctors. We have a feeling that certain workcover IME doctors are under pressure from their clients namely the workcover agents, and the IME companies or “mills”.
IME doctors will likely be put under subtle and not so subtle pressure to produce a favourable opinion and report. Worse, they may sometimes be pressured to change an opinion. If they give in to these pressures the best case result is that their own credibility (and viability as an independent medical examiner) will sooner or later be destroyed.
Are IME doctors under workcover pressure?
Diary of a workcover victim believes that all independent medical doctors who undertake workcover independent medical examinations of injured workers are inevitably under some sort of pressure from their clients or referrers – which are the workcover insurance agents and, for some, the IME company (eg. MLCOA and similar) they work for.
IME doctors must feel the pressure and demands from the workcover insurer, and, if they work for an “IME mill” those demands and pressures as well. We believe these pressures would reasonably include:
- Time pressure: IME doctors are required to finish their IME reports within strict time limits (fast)
- Ethical/moral pressure: IME doctors appear to need to be flexible – that is modify and edit their IME reports and opinions to meet the “needs” of their clients.
If an IME doctor works for an IME “mill”, the IME mill – who sources the IME work and focusses on the quantitative aspect of the business (the more IME reports, the better), the IME doctor also pays a percentage fee to the IME “mill” for referring work to them. It has been alleged that IME companies take anywhere between 20% to 40% of the IME report’s fee. It has also been alleged that some IME companies require their outsourced IME doctors to provide their initial IME reports (and opinions) in WORD format, which can then be amended, edited, changed! Not only that, but it has also been alleged that some workcover agents require the IME doctor to send their IME report in WORD format for the same reason. This makes us – injured workers- feel pretty queazy indeed. One would think that an independent medical doctor would be “independent” and take full ownership and responsibility for his or her IME report, including his/her opinion and at the very least send their IME report out in PDF format, uneditable.
The workcover IME doctors’ pressure explained
1. IME doctors and Time Pressure
As there are thousands of workcover claims and cases every year, IME companies (eg. MLCOA and similar) and private, cherry-picked IME doctors must be under considerable pressure by workcover insurers (eg. Allianz, EML, etc.) and possibly courts etc., to get their independent medical reports done “quickly”. while there is nothing wrong with this requirement perse, we do believe that the time pressure may well lead to what we, injured workers, perceive as copy/paste IME reports; IME reports that read like a case of mistaken identity; shoddy IME reports and, obviously, low-quality IME reports. If we think about this, we can’t help but believe that the very busy IME doctors (those in high demand for their favourable work), undertake the IME work for the lucrative $ide of it, and not for a professional challenge. They don’t have time to undertake a comprehensive review of the injured worker, including reviewing the injured worker’s entire medical history related to the worker’s compensation injury, making the necessary enquiries (eg. ask the workcover insurer to provide additional information etc.). The end result is that those IME doctors do a very poor job, and in doing so, frequently ruin their own professional reputation within the industry. A truly independent medical examiner would either ask for additional time to prepare a comprehensive, well-structured, thorough and logical IME report or simply refrain of accepting the assignment if the client is unwilling to give them more time. Just reading Court decisions will give any injured worker a fast idea into the quality of those so-called IME reports.
2. IME doctors and Ethical Pressure
The most insidious and unethical, illegal and downright nauseating form of pressure by IME companies and some workcover insurance agents is perhaps the demand to alter, change, or modify the IME report or the IME doctor’s opinion. While we can appreciate a request to correct typos, incorrect names, dates, claim numbers, addresses, age etc. we do find it absolutely corrupt that the requesting party (IME mill and/or workcover insurance company) pressures the IME doctor to change or modify his/her professional opinion. The IME mills do this to gain “new business”, it is simple as that. The more IME reports they can generate the more profit they make. The more favourable the reports are for the client – the workcover insurer – the more referrals they will receive. It is a business with the sole goal of making money, and loads of it. Despite the temptation to “keep the client happy” and keep the IME work flowing and the business thriving, independent medical doctors should never ever change or modify their opinions and IME reports at the request of workcover agents and/or IME companies. At the end of the day, the IME doctor remains responsible for his/her IME report and opinion and, if and when called to provide expert evidence in court, it is ultimately their reputation (along with the industry) that gets tarnished, some times to irreparable levels. We know of one such IME doctor who was caught out in court as having written two completely different opinions in IME reports about the very same injured worker, depending on the “client” it was fabricated for. How sick is that?
Over time, those IME doctors who do an honest job and call the issues as they see them will be able to maintain their integrity, credibility, and have long successful careers and will be seen as reliable, credible expert witnesses on Court. But those who change and modify their IME reports, come up with ridiculous opinions which are illogical, incomprehensible, laughable and not defensible, will burn themselves as judges find them not to be believed or credible. Some IME doctors have been literally laughed out of court! While those kind of IME doctors discredit themselves and lose their own reputations, they are the ones who criticise and blame various injured workers’ websites, even attempt to sue injured workers for publishing adverse commentary; complain to doctor rating sites (eg. RateMDs) and beg regulatory bodies not to “investigate” the content of their reports.
3. IME doctors and Economic Pressure
There has definitely been an increase in IME companies and we believe that the pressure for IME doctors to perform IMEs as inexpensively as possible is also becoming a problem. Those IME companies (or “mills”) are in the business to churn out as many IME reports as possible and take a percentage fee from each IME doctor who gets to do the independent medical examination and/or report. We believe there may well be some fierce competition going on, which may increase the pressure of cost. Perhaps that is the reason why more IME doctors chose to do down and dirty shoddy, fast IME reports, as they will make their money by churning out volume. Those IME doctors who “write” 5 to 10 IMEs a day in an IME “mill” may well never recover his/her bad reputation. Many of these IMEs are well known as not-credible in our courts. Perhaps, unfortunately, a lot of workcover cases settle out of court, which means that these rogues can continue to bang out endless so-called IME reports for pure financial gain.