Workcover independent medical doctors are bound by Service Standards
Workcover independent medical assessor (aka Independent medical doctors, IME, ME) are bound by Service of Standards, which is akin to a Code of Conduct. In Victoria, independent medical examiners are bound by Worksafe VIC Service Standards.WorkSafe requires Independent Medical Examiner’s (IME) approved to examine injured workers to comply with these Service Standards.
- An IME must treat people being examined with the same professional standards of care, consideration and courtesy that a private patient would expect (as covered by the Ethical Guidelines for Conducting Independent Medical Assessments 1). The standards of professional behaviour as outlined in the ‘Good Medical Practice: A code of Conduct for Doctors in Australia 2 (or any equivalent codes or guidelines applicable to allied health practitioners) must be adhered to during independent medical examinations, including:
- a) Being courteous, alert to the concerns of the person and ensuring you have the persons consent;
- b) Explaining to the person the IME;’s area of expertise, role and the purpose, nature and extent of the assessment to be conducted;
- c) Anticipating and seeking to correct any misunderstandings that the person may have about the nature and purpose of the assessment and report;
- d) Providing an impartial report;
- e) Recognising that, if the IME discovers an unrecognised, serious medical problem during the assessment, the IME has a duty of care to inform the person and/or their treating doctor;
- f) Being honest and not misleading when writing reports and only signing documents the IME believes to be accurate;
- g) Taking reasonable steps to verify the content before signing a report and not omitting relevant information deliberately;
- h) Preparing or signing documents and reports, within a reasonable and justifiable timeframe as per standard 6.3; and
- i) Making clear the limits of the IME’s knowledge and not giving opinions beyond those limits when providing an opinion
1 Australian Medical Association –Ethical Guidelines for Independent Medical Assessments 2010 –Revised 2015
2. Medical Board of Australia -Good Medical Practice: A Code of Conduct for Doctors in Australia, March 2014, page 19
Workcover independent medical assessor and lack of oversight
A WorkCover victims diary believes that our government should do a better job to ensure that all injured workers are treated fairly so that they have the best possible chance recovering and reaching maximum medical improvement following a work injury or work-related illness.
Injured workers are legislated to attend Independent Medical Examinations (IME/ ME or IE) when they make a workcover claim. Furthermore, injured workers are required to attend those independent medical examinations at “regular intervals”. “Regular intervals” is indeed a vague term, but essentially it means 1 to 2 independent medical examinations per year (according to lawyers). Needless to mention that many workcover case managers will request the injured worker attends an array of independent medical examinations, and often more than 1 or 2 per year. After all, workcover insurers use and abuse IME examinations to find a way to decrease, minimise, deny or cease injured workers’ benefits. In other words, workcover insurance companies go doctor shopping, until they find what they are after.
Unlike any other visit to a normal doctor, injured workers have no or very little choice (sometimes a list of three is offered) in who their workcover independent medical assessor might be, that decision is made by their workcover insurer. It is well known that workcover insurers have a list of their favourite independent medical doctors. That is those IMEs who will provide a report in favour of the workcover insurance company. That is also the reason why so many injured workers keep on flagging the same IME doctors over and over again. And the reason why you see the same independent medical doctors acting as “expert witnesses” in Court.
During an IME, vulnerable injured workers are also no longer ‘patients’ but are now ‘clients’ or ‘cases ‘ to whom the independent doctor owes no ‘duty of care’. Far too often the IME doctor provides a rather unqualified, biased or even shoddy assessment and report. Benefits are often discontinued based on a biased or flawed IME report and it can take months to years to have medical treatment and other workcover benefits reinstated.
Worse yet, our workcover system will also cancel an injured worker’s benefits for failing to appear at an IME assessment when requested to do so.
Injured workers should indeed be very worried when attending these workcover independent examinations because there is no real and reliable oversight by the Workcover Authority, nor the government. There is also no or very little way of knowing whether that certain independent medical assessor has multiple complaints about the quality of their work. We don’t see Workcover Authorities, such as WorkSafe VIC, publishing any complaints about IMEs, nor do we see public complaints about certain independent doctors by the medical regulatory body (eg. AHPRA). It appears to us that all this is kept out of the public eye and is classified as secret.
Finding information about an IME Doctor – IME List
However, the Australian Legal Information database does publish all Court verdicts and while it is a rather tedious process to sift through Court documents, you can find Arbitrators and Judges’s adverse comments, scathing remarks, criticism about certain IME doctors. Some have described what they are asked to accept as ‘evidence’ as “inaccurate, failed, misleading, defective, incomplete, even flawed”. Unfortunately, with many workcover cases settle out of court, and come with a non-disclosure disclaimer (a gagging order).
Note: You can also search for AHPRA’s (Medical Board of Australia) reprimanded doctors. Conduct a general Google search, view Google reviews and look up doctors on sites such as ratemds. (See our article Researching doctors)
How is the injured worker supposed to ferret out the information on medical regulatory body and out-of-court settlement censures that keep the public in the dark about the quality of the medical services provided to Australian injured workers? Adverse comments, scathing remarks, criticism and even reprimands about workcover independent medical doctors are deeply buried in Court documents which very few injured workers ever read.
We are kept in the dark about the qualifications and reputations of the so-called independent medical assessors and must attend those IME examinations at our own risk. For this reason alone, we firmly believe no injured worker should attend an independent medical examination without a support person (a witness) who can keep notes and records.
All this has worked out well for our workcover system and for those independent doctors who provide workcover insurers with the medical reports used to decide whether or not an injured worker is entitled to medical and like treatment and/or weekly payment. This lack of accountability has allowed a small group of notorious pro-workcover IMEs 9and expert witnesses) to freely conduct their examinations, write their reports and testify in court without fear of consequences. All the while those IMEs are giving workcover insurers and courts biased and substandard IME reports. Reports that are then used to dismiss countless legitimately injured workers.
Seriously injured workers will never get fair treatment until such time as all IME doctors are truly independent and impartial, providing logical, honest independent medical opinions, based on their medical qualification(s) and area of expertise.
Shoddy workcover independent medical examinations are an ongoing problem for injured workers. Some of the IME doctors, as well as medical and workers compensation authorities (the key architects of our workcover system), have the opinion that many injured workers exaggerate their pain, impairment and/or injuries for monetary gain.
Some of these independent medical ‘experts’ have been sketchy characters to say it kindly. Take for example the case of IME Dr Casikar. In the Court’s Decision, the Judge wrote:
- There are a number of troubling features about this case.
- First, notwithstanding that every specialist in the case took a history that Mr Fogarty injured his back when the straddle crane he was driving hit a pothole, Dr Casikar (see profile on rateanmd) did not take that history. Instead, he seemed to have a history that Mr Fogarty’s symptoms started spontaneously at work with no provocation at all. Such a history was not consistent with Mr Fogarty’s evidence and was surprising, to say the least.
- Moreover, Dr Casikar’s assertion that Mr Fogarty’s symptoms could have developed at about the same time or the same stage of his life, irrespective of his employment, was unsupported by any reasoning and stretched credulity to breaking, bearing in mind Mr Fogarty’s age and the lack of degenerative changes in his spine, something that Dr Casikar expressly noted. The basis for Dr Casikar’s assertion is not clear. Moreover, Dr Casikar’s suggestion that the proposed surgery was for degenerative changes in Mr Fogarty’s back was inconsistent with the objective evidence and further undermined the doctor’s credibility as an independent medical examiner.
- These matters raise serious issues about Dr Casikar’s objectivity that warrant investigation into his status as a WorkCover approved impairment assessor.
- Second, the general conduct of this matter has been seriously alarming. Notwithstanding Dr Casikar’s opinion, his report provided no proper basis for Allianz, viewing the matter objectively and fairly, to deny the claim. A fair reading of the history of the claim demonstrates a perfectly consistent story corroborated by complaints to first aid and strongly supported by all the treating doctors and by several objective investigations, namely, a CT scan, MRI scan and a positive discogram. Allianz had no proper reason for denying liability and should not have done so.
- Third, it is apparent that, notwithstanding the admissions made by Mr Taylor at the arbitration, Allianz has not paid the weekly compensation awarded to Mr Fogarty and has thwarted his attempts to have the surgery recommended by four specialists. Allianz is a fund manager under the NSW workers’ compensation scheme. It would (or should) have been well aware of its obligation to pay an award of the Commission for the payment of weekly compensation, which obligation continues notwithstanding the filing of an appeal under s 352. Its failure to do so in the present case is reprehensible and will be referred to the WorkCover Authority of NSW for investigation.
- Fourth, Allianz’s behaviour is all the more disgraceful given that it is obliged to act as a model litigant. That means more than acting honestly and in accordance with court rules, and more than lawyers acting in accordance with ethical obligations; it must be a “moral exemplar” (State of Queensland v Allen  QCA 311 at –; LVR (WA) Pty Ltd v Administrative Appeals Tribunal  FCAFC 90 at , , and –). It is obliged to pay legitimate claims without litigation. Mr Fogarty’s claim was, without doubt, a legitimate claim that should have been paid without the need for litigation. Why it was not paid should also be investigated.
- Fifth, the amendment of the award of weekly compensation could and should have been achieved by the application of the slip rule (s 294(3)), something that Mr Trainor sought to do in his letter of 22 August 2014. It is unsatisfactory that Allianz did not accede to that request, as it would have avoided the need for an appeal. That should also be investigated.
Some doctors whose sole source of income is through workcover insurer sponsored IMEs have, through their reports, disqualified many thousands of legitimate and vulnerable injured workers.
Adverse IME comments
aworkcovervictimsdiary used to have a publicly published IME list, where all known independent medical doctors were listed and allowed to be rated by injured workers – quite similar to the RateMD website. Unfortunately, we had to remove that IME list given the real potential of defamation lawsuit(s) against the owner of aworkcovervictimsdiary. As mentioned in our Gagging Orders, aworkcovervictimsdiary has in the past been threatened with lawsuits for alleged defamation by (notorious) independent medical assessors. Regardless of whether or not “defamation” occurred, the point is that one needs a lot of money to defend ourselves against such a lawsuit. For this reason, we ask you – all injured workers – NOT to name names of independent medical doctors on this website, unless it is part of an adverse comment made by a Judge in a Court of law, and as such part of the public record.
As such, diary of a workcover will instead be looking to Judges and Arbitrators to see what they have had to say on the topic of the quality some independent medical assessors who provided expert witness opinions in Court, through Court decisions. Click here to view our adverse IME comments.
All biased workcover independent medical assessors ought to be purged from the workcover system
Aworkcovervictimsdiary believes all ‘rogue’ IME doctors ought to be purged from the workcover system – if providing (on a fee for service basis) substandard, unqualified, shoddy, biased or flawed assessments to workcover insurers. We believe that any IME doctor who has been the subject of repeated adverse Court commentary or criticism due to unqualified, incomplete, illogical or biased assessments – that IME should be barred from participating in the workcover system. It would be really nice to see judiciary adverse comments concerning IME doctors made public, as opposed to leaving them deeply buried within lengthy Court decisions, which very few people actually read. It would be great to see a system implemented along the lines of if a certain IME doctor has been the subject of, let’s say, 3 or more scathing adverse comments, they are no longer allowed to provide expert opinions in Court.