Unlike a broken bone, psychiatric injuries or mental conditions often do not have “objective” findings (eg. visible on x-ray). Psych injuries are mostly assessed based upon what the injured worker says, and his/her history, and as such are more open to ‘interpretation’. These workcover stress claims are frequently declined or terminated, and mainly via the use of psychiatric IME doctors.
Workers comp insurance companies will often claim that there is no work-related psychiatric disorder or mental illness. They will frequently refer to psychologically injured workers as “malingerers,” or suffering from “burnout,” or have made a “personal choice” to cease work or suffer from a pre-existing mental condition. Very often the injured worker’s work-related psych injury will be blamed on something/anything else but the injured worker’s work or workplace.
In a recent case, a workcover insurance company claimed that an emergency department nurse who suffered severe PTSD and anxiety (following attempted strangulation by a patient) and who became terrified of caring for intoxicated and drugged patients out of fear she would be killed by one of her patients merely had ‘become tired of being an emergency room nurse’!
Needless to mention that the workcover insurance company used the Independent Medical Examination (IME) process to reject this injured worker’s perfectly legitimate workers comp claim.
Unfortunately, the workcover IME misuse continues. Workcover insurance companies know who the “friendly” doctors are – including the ‘friendly’ IME psychiatrists, who typically will support the workcover insurance company’s position.
Psychiatric independent examinations for work-related mental injuries and conditions are probably the worst kind of IME any injured worker can undergo.
Workcover insurance companies will frequently use the following tactics to manipulate the IME Psychiatrist:
- Require the IME psychiatrist doctor to rely on earlier and/or outdated medical reports that the workcover insurance company knows are incomplete or inaccurate
- If an injured worker has undergone psychiatric or psychological tests by their own treating psychiatrist or Clinical Psychologist, workcover insurance companies will try to cover-up positive psychiatric test results, not disclosing those results to the IME psychiatrist doctor or even to the workcover insurance company in house ‘medical advisor’. The IME and the workcover insurer will then deny the claim
- Workcover insurance companies will also abuse secret, aggressive surveillance, when there is no basis to order the surveillance, and misusing the results.
- Workcover insurance companies will also often mischaracterise the injured worker’s occupation, tasks or its duties to the IME psychiatrist doctors
- Workcover insurers will not require psychological tests or additional tests (which should be standard practice when a diagnosis is in dispute)
Workcover IME Psychiatrists will frequently use the following tactics to discredit, deny or minimise a psychological injury or condition:
- The IME psychiatrist will not spend sufficient time with the injured worker. How long does it take to sort out the many factors needed to determine causation, impairment, and treatment needs of a patient (injured worker) whom a doctor as never ever seen? Anything under 1.5 to 2.0 hours is likely inadequate. If you think about it, forensic experts in criminal cases spend dozens, even hundreds of hours getting to know and understand the criminal. The information needed to render a well-informed opinion about a worker who claims to have suffered a work-related psych injury cannot be obtained in 20 -40 minutes!
- The workcover IME psychiatrist will also not spend enough time reviewing an injured worker’s records, incl. medical file and medical history, but they will rather rely on what little, selective material is being sent by the workcover agent, together with insinuating leading questions. Have both medical and mental health records been reviewed? We often hear from genuinely psych injured workers that their records from medical providers noting some symptoms of depression or anxiety, and causally (and often casually!) attributing the symptoms to some domestic or un-related event being misused by IME Psychiatrists and workcover insurers to claim pre-existing mental conditions. For example, if you suffered post-natal depression 10 years ago, and this was mentioned in your GP’s file, you can be sure that they will use that to say your current mental condition is due to that. A good IME report must not only note these records but must evaluate their basis and value in context. Also, request for and review of records preceding the injury is important.
- Workcover IME Psychiatrists often fail to identify peri-injury, and post-injury stressors: It is important that all other possible contributing work-related stressors be detailed and accounted for. For example, if a worker loses a limb in a work accident and develops depression secondary to the disabling injury, that should be clearly mentioned in the IME report, rather than blame this injured worker’s depression on ‘falling off his tricycle when he was 4 years old’. Emotional distress can arise out of a stressful work environment and/or in response to an actual physical actual injury. Other life stressors, including post-injury financial and social consequences of the workplace injury, must also be accounted for. And, we are of the opinion that IME psychiatrists should refrain from seeking prior life stressors or traumas (e.g., a childhood trauma) in order to blame those on the injured worker’s current mental state, and assuming predisposing vulnerability factors.
- Workcover IME psychiatrists do not conduct Psychological testing of injured workers. For one I can say not a single IME shrink conducted any formal psychological testing on me. Why not? What is the rationale for not conducting psych tests on injured workers who claim to suffer from a mental condition? We also believe it is difficult to determine the appropriate use and interpretation of psych test results without direct consultation with the injured worker’s treating psychologist or psychiatrist.
- Workcover IME psychiatrists may use words such as ‘ exaggeration’, ‘ malingering’, ‘inflated’ etc. but in fact never conduct any malingering test. There are several widely used and standardised assessment instruments for assessing symptoms exaggeration or malingering so why are they not used? In addition, we believe observation, consistency of records, assessment of collateral information is necessary to make a determination about the validity of an injured worker’s claimed psych condition, and not a single 20-40 min ‘examination’.
- Workcover IME psychiatrists will often try to blame the injured worker’s genetic and environmental vulnerability to his/her legit work-related mental condition. That includes ‘family history’. We strongly advise all injured workers to refrain from volunteering any information to an IME psychiatrist – your marriage is fine, your parents are fine. At the very least turn the question back to the focus area – read our article: Grilled by an IME psychiatrist, answer like a politician
- Mental status examination of the injured worker tends to be very brief. This section appears in most psychiatric IME reports, with the intent of describing what is observed about the injured worker on examination. While it should incorporate things like apparent emotional state, is s/ he forthcoming with information, or guarded and defensive?; signs of anxiety, depression, PTSD etc, we often only see brief descriptions of the colour of our hair, that we were ‘ hostile’, ‘casually dressed’, etc. Importantly, we believe that the observed emotional state and the matching reported symptoms and function are seldom addressed in full. Rather IME shrinks tend to take things out of context and may for example list all the symptoms of PTSD (every single one) but make the diagnosis of ‘adjustment disorder’ and not PTSD.
- A description of symptoms supporting the diagnosis is not only critical but these symptoms-should they accord with the criteria set forth in the DSM manual- should be enough to make the diagnosis. So why to IMEs write ‘adjustment disorder’ when they list all symptoms and criteria for PTSD? We also believe IME reports should also include a detailed description of the day-to-day function of the injured worker. Can the injured worker socialise, travel, engage in hobbies, or do housework? And please, have some respect for serious physical injuries as well! Many IME psychiatrists really have no regard for physical injuries. That’s OK in a way as their focus is on your mental condition, however, how on earth can you not include the psych sequelae of a serious physical injury, the physical injury alone and make an opinion on the work capacity of a seriously physically injured worker? I once sat there, with my right leg in a cast, my right shoulder in a sling, in severe pain barely 10 days post-op and going septic – that she (the IME shrink) ‘was not interested in my physical injuries’, but ‘ needed to assess whether I could engage in rehabilitation and return to work’.It wasn’t funny. My depression was blamed on my mother not visiting me from overseas (!) and not my severe pain, loss of career, loss of hobbies, loss of joy as I once knew it; and my genuine PTSD from the physical assault which crippled me for life was referred to as an ‘adjustment disorder’.
- Again, dear IME psychiatrists, please ensure you make the correct diagnosis. Is it really just an adjustment disorder or a driving phobia? The diagnosis of PTSD is the sin qua non of psych injury arising out of workplace events. Why? Because it is the only psychiatric diagnosis that clearly denotes causation. Many workplace injuries and their circumstances do truly meet the criteria (a stressor must involve not only “threat to the physical integrity of self or others,” but the individual’s emotional reaction at the time must include “intense fear, helplessness, or horror.”), yet many IME psychiatrists will go to great lengths to avoid using the word PTSD, for that reason (you see, workcover insurance company would be very unhappy as PTSD is pretty clear cut and compensable)
- Lastly, many workcover IME psychiatrists will undertake misguided Permanent Impairment Ratings or Assessments and blame as much as possible on secondary (non-compensable) psych injuries.
These above lists fall well short of the many other tactics used, however, we do hope it gives you some idea as what to expect.