Not that long ago we happened to stumble upon a submission by a group of independent medical psychiatrists who undertake independent medical examinations of injured workers for workcover insurers. Those IME psychiatrists did believe that the Australian Health Practitioner Regulation Agency (AHPRA) should NOT have investigative powers into the content to Psychiatric IME reports; however they agreed that AHPRA is the appropriate body to investigate the conduct of IME doctors.
Complaints about the content of IME reports should be specifically excluded from investigation by AHPRA.
We did find this opinion quite baffling, as most complaints made by injured workers about IME psychiatrists concerns mostly the content of the independent medical reports, and not as much the conduct of the IME doctor. Why the content of psychiatric independent medical examination reports is specifically not to be peer-reviewed, scrutinised, vetted or investigated, despite numerous injured workers complaints, then we believe the authors of those reports may well have something to hide.
Injured workers’ perception of workcover IME Psychiatrists
We believe that injured workers’ main issues with workcover independent medical examinations by psychiatrist include:
- frequently findings of “pre-existing” mental health abnormalities or conditions, even if they do not exist and would have never existed had the injured worker not been involved in a workplace injury. (Fact is, most injured workers were active and well-functioning to high-functioning members of the workforce prior to being diagnosed with whatever pre-existing mental conditions, out-of-the-blue). The frequent pre-existing mental disorders found by IME psychiatrists appear most often when the IME is undertaken on behalf of workcover (as opposed to on behalf of the injured worker or the injured worker’s lawyer). For many injured workers, this appears to be quite an obvious bias in favour of the gainful workcover insurer. in other words, the IME psychiatrist writes nonsense (eg. fabricates subtle or frank mental health conditions) to help the workcover agent discontinue or reduce medical treatment, or to help workcover insurers to terminate a perfectly legitimate claim. If you think about it, an IME who writes in favour of the workcover insurance company is likely to receive many more referrals. If they don’t write mostly in favour of the workcover insurer, they won’t be asked to write IME reports again (which means no referrals and no lucrative IME report$$$).
- Many injured workers who have been submitted to a number of IME psychiatrists believe that the content of their reports is not reliable and should not be relied upon. (most often because vital medical information missing, there are frequent mistakes, omissions, no psychiatric tests are done, the IME did not gather a full medical history (eg. a call to the injured worker’s treating GP, treating clinical psychologist or treating psychiatrist if they had any; aks or additional information from the workcover agent etc.), the IME relied solely on what the workcover insurer provided them (outdated medical information, or limited/selective medical information coupled with deceiving, misleading and insinuating lead questions)).
- Many injured workers feel insulted, humiliated, overwhelmed, angry or stunned when they read their IME psychiatrist reports. Many have told us that IME reports tend to read like a case of mistaken identity. For many injured workers their very first experience with a psychiatrist is with an independent medical psychiatrist. Many solely physically injured workers are routinely sent to IME psychiatrists by workcover agents. Still bruised, battered, bleeding, freshly operated upon, in pain, in shock, stunned by what has happened and how their injury has/will change their life, only to be told that they suffer from a psychological overlay, because they are not getting better as fast as the workcover agent wants, or worse
- A normal psychiatrist provides a comprehensive assessment as well as treatment of mental illness or condition. The IME psychiatrist, on the other hand, does not provide a normal patient-doctor relationship, and no treatment is given. It is very important to know that there is no confidentiality either! Many injured workers are not really aware of this major difference in role and ignorant and honest as most are they may fall into certain traps, such as for example disclosing things against their best interest. I recently read a court case whereby a non-English speaking injured worker had attempted suicide after having suffered severe physical injuries. She innocently mentioned (under the IME’s lure) that when she was young she felt she was being followed. Now, she actually referred to the fact that in India, where she came from, her father and her brother would “chaperone” her (as in following her, watching her) when she was around 17-18 years old, to make sure she would not meet another man (other than the one that had been arranged for marriage). But the IME psychiatrist wrote in her report that this poor injured worker suffered from underlying paranoia (as in pre-existing paranoia) which was enough to explain her suicide attempts away. Isn’t this just immoral and unethical? How can any psychiatrist, any human for that matter, pluck such deceiving mental “illnesses” out of the air, to please the hand that pays them? In addition, the IME said she was fit to work on a psychological basis (but had just tried to commit suicide! And had a 2nd attempt as well). How twisted is this? This poor injured worker ended up losing what little psychological/psychiatric treatment she was receiving from workcover, based on that skewed report. It took her months to get the matter to court where the Judge thankfully dismissed that IME’s “expert opinion, which he said “did not sit comfortably with him”.)
- Many injured workers are shocked and disgusted by certain independent medical psychiatrists’ reported deceit and innuendos. When reading such reports, many ask themselves if the IME had gotten things wrong and/or had confused them with someone else. Often the person described in such IME reports is not ‘you’ and a lot of what is written will bear no relation to the answers you may have given during the assessment. Some IME psychiatrists’ deductions are simply wild and in complete opposite to your own psychologist or psychiatrist.
- We believe that at times the lengthily delay in obtaining a copy of an IME psychiatrist’s report is deliberately done to allow time for the IME psychiatrist to literally dissociate from the person they actually assessed.
- Some IME psychiatrist reports are totally ridiculous, with the main focus on trying to show that your mental status has never been stable; that chronic pain conditions are fabricated in your mind and certainly not caused by any workplace accident, no matter how serious. Often, only the negative aspects, and those embellished, of your childhood, marriage etc will be highlighted together with specifically chosen comments strung together to give the overall impression that your whole life was horrible, your family was terribly dysfunctional and worse.
- I too have had the displeasure of reading some of my own IME report(s) wide-eyed, becoming aghast and feeling like I was reading some trashy, dramatic novel. I was dumbfounded by what was written, just like you and countless other injured workers, and angry beyond words that someone in such ‘professional position’ could actually get away with concocted untruthful reports, thereby contributing to the destruction of an injured worker’s life.
Many IME psych reports seriously lack professionalism and ethics – thereby fulfilling their task for the workcover insurer admirably.
Beware when undergoing a workcover independent medical examination with a psychiatrist
Remember at all times that the IME psychiatrist is not an injured worker’s counsellor. Keep the focus of the IME examination on your accident, or incident and the subsequent related injury/injuries. Too often, so-called IME psychiatrists will use a fake sympathy with the goal to draw in an injured worker so they open up about OTHER (trivial) issues, such as family problems, childhood problems, dysfunctional parents or relationships etc. and will attempt to use those non-work related issues and not the accident or injury as the cause or part cause for an injured worker’s mental health status and inability to return to work, thereby doing a fabulous job for the workcover insurance company. Many IME psychiatrists will judge everything an injured worker says, does, has done, including facial expressions, appearance and even how you dress. The reason is to come up with ANY reason, other than your injury, or accident, for your current disability or impairment. Ensure you keep the focus of your answers to your work injury and injury, never elaborate, never volunteer any information that is unrelated to your work injury. Don’t say or do anything that the WorkCover insurer, through an IME or by any other means, can use to undermine you.