Elita Gluscevic
June 11, 2024

The Significance of an Independent Medical Examination in WorkCover Claims

Are you or your loved one involved in workcover claims? When you are involved workcover claims, it is very plausible that you will have to attend an Independent Medical Examination (IME).

An Independent Medical Examination plays a significant role in workcover claims and personal injury claim processes. So, it is essential you understand what an Independent Medical Examination is, its importance and relevance to your workcover claim. Understanding Independent Medical Examinations will help you know what to expect in such examinations and follow the process without errors.

The aim of an IME is to provide an objective evaluation that assists in medico-legal issues and claims. In this article, our independent medical examiner at Lex Medicus will help you understand an Independent Medical Examination, its significance and your roles in it.

Independent Medical Examination

Understanding an Independent Medical Examination

An Independent Medical Examination involves a specialised medical appointment where a medical specialist evaluates your injuries and the treatment needed, and determines the impact of the injuries and treatment on your well-being.

In other words, an Independent Medical Examination provides the insurer with an independent opinion regarding your injury and treatment to assist with decisions on your rehabilitation, recovery, return to work, and entitlements to compensation. Independent Medical Examinations are made under Section 57 of the Safety, Rehabilitation and Compensation Act.

An Independent Medical Examiner is a medical specialist with qualifications relevant to your injury. Such a person does not replace your nominated treating doctor. Their duties are to evaluate your injury or condition and provide an independent report based on the evaluation’s outcome. They have no responsibility for treating you as a patient.

The organisation or person requesting the Independent Medical Examination is called the ‘referrer.’ The examination can be arranged by various referrers involved in your workcover claim, including your insurance company, the person, or organisation you are claiming against, and your legal representative.

The referring party or referral pays the cost for this examination, be it the insurer in your case or your legal representative. Where the Independent Legal Assistance and Review Service refers you while helping you resolve an insurer dispute, the body may pay for the Independent Medical Examination cost.

The referrer must select a qualified medical doctor specialised in your kind of injury. The referrer must also ensure that an appointment for the IME can be made within a reasonable period and as close to your house as possible. The referrer must provide the examiner with all relevant information to assist them in the examination.

Significance of an Independent Medical Examination

Independent Medical Examinations play significant roles in matters relating to workcover claims to determine an employer’s liability level and to justify the amount of compensation you are entitled to as an employee. Independent Medical Examinations are significant in workcover claims as they perform several purposes, including the following:

Provision of an independent opinion on worker’s injury and treatment needs: An IME helps to provide the compensating authority, such as your employer, with an independent opinion regarding your injury and treatment, which is required to assist them with decisions on your recovery, return to work, and entitlements to compensation foHi Brian r the injury suffered.
To secure additional information: An IME supports a claims’ manager in obtaining additional information or medical evidence regarding an employee’s claims.

Performance of a confirmatory role: An insurer or employer may arrange an IME for confirmatory purposes. This infers that an IME can be used to confirm diagnosis and determine the connection between a disease or injury and employment. It may also be arranged when recovery from the injury is not progressing as expected and to support your return to work activities.

Provision of a better understanding of an employee’s capacity in a rehabilitation program: An IME supports an employer or rehabilitation authority in better understanding an employee’s capacity to engage in a rehabilitation program.

Facilitation of a safe return to health and work: An IME aims to facilitate an effective and safe return to health and work for the affected employees.

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