Have you been told by your workers compensation insurer you have to attend an Independent Medical Examination? Find out what your rights are.
What is an IME?
An Independent Medical Examination (also known as an ‘IME’) is usually arranged by your workers compensation insurer or lawyer for the purpose of gaining an independent opinion regarding your injury and claim. IME’s can be asked a broad range of questions, including regarding:
IME’s are often asked to comment on a whole range of treatment which may be recommended by your treatment providers; from appointments with providers such as psychologists and physiotherapists, to major surgery. A common question put to an IME is whether the treatment is reasonably necessary, which is the legal test set out in section 60 of the Workers Compensation Act 1987 (NSW).
It is also common for IME’s be asked to give an opinion about your work capacity, for example, whether you are capable of returning to your pre-injury role or whether you are capable of performing alternative duties and/or hours. Sometimes IME’s will liaise with your Nominated Treating Doctor, which may inform their opinion.
Often insurers will ask IME’s questions which will assist them to determine whether they are liable for your injury. For example, they may ask the IME whether your condition was caused by and/or related to your employment, as opposed to a pre-existing or unrelated condition.
IME’s who are accredited by the State Insurance Regulatory Authority (SIRA) can also assess your permanent impairment resulting from an injury. If you meet a certain injury threshold (for most NSW workers, the threshold is 11% Whole Person Impairment or greater for physical injuries and 15% Whole Person Impairment or greater for psychological injuries) you may be entitled to lump sum compensation.
Under workers compensation legislation, you are required to attend IMEs as requested by your employer or insurer. However, most insurers in NSW are required to comply with the Workers Compensation Guidelines when arranging an IME. Part 7 sets out mandatory obligations of insurers, including:
- All referrals for IMEs must be arranged at reasonable times and dates, with adequate notification given to you;
- You must be advised in writing at least 10 working days before the examination takes place;
- The insurer must advise you in writing of the reason for the examination, the name, specialty and qualifications of the IME, and the likely duration of the appointment, among other things;
- The location is to be accessible to you and within any travel restrictions set by your Nominated Treating Doctor;
- If you have any special requirements relating to gender, culture or language, these are to be identified and accommodated;
- The insurer must meet any reasonable costs associated with travelling to the IME appointment, including any loss of wages, travel and accommodation costs.
What to do if required to attend an IME
If your insurer has arranged an IME, you should seek legal advice to ensure the insurer has complied with its obligations and to discuss the potential impacts on your claim. For advice regarding your workers compensation rights and entitlements, contact our expert workplace lawyers today on 13 43 46.