Is There a Crisis of Confidence in IME Assessments?

While I personally have had concerns about the ‘quality’ of many IME assessments for some time, I did not realise how widespread the concerns were about the fairness of such assessments until relatively recently.

Injured workers representatives are certainly concerned, both through traditional union representation and the social media networks that have arisen in recent years. Social media sites have been outspoken in their criticism of IME assessments – inferring that almost all such assessments are unfair. WorkCover Victims Diary (based in Victoria) runs a website that has been particularly critical of IME opinions and has resorted to naming and shaming those practitioners who they say are biased.

I am increasingly aware of concerns by treating GP’s and specialists alike. It is acknowledged by most medical practitioners that bias is frequent in IME reports. Many rehabilitation providers will also privately express concerns, yet rarely publicly because their funding is largely controlled by insurers or claims agents.

I have discussed these concerns with insurers. They seem to be the only party without current concerns, apart from some IME assessors themselves. It has been acknowledged to me that in the past insurers could obtain reports to suit their purposes, but they say that the situation is fairer now. 

While it might be tempting to dismiss the concerns of injured workers groups as hysterics, whinging and victim behaviour, I am not so sure. 

Through my own work I come ‘face to face’ with the opinions expressed in IME reports and, at times, the IME assessors themselves. This occurs when I am asked to comment on IME opinions as a treating practitioner or independent assessor. At times I attempt direct dialogue with an IME assessor, although this is rarely ‘allowed’ by the system. I also have the opportunity to critically review IME opinions presented before a court or tribunal in the course of preparation to offer my own opinion and prepare for cross-examination.

I can recall an IME assessor some years ago expressing the opinion that a relatively rare medical condition being claimed as work-related was caused by the use of eye drops. The assessor failed to state that the particular condition is much more likely to be idiopathic i.e. without known cause or due to trauma, rather than due to the small amount of a drug that might be absorbed systemically from eye drops . The assessor confidently stated the eye drops (a non-work related medication) were the cause, without any discussion about other possible causes. This cleared the insurer of any liability. To me it seemed convenient to declare a non-work related cause rather than acknowledge an unknown cause where the insurer might potentially be liable.

The case above illustrates two issues.

1) Privacy principles make analysis of independent opinions difficult

I can’t provide any more details of this case without risking the breach of privacy principles. While such principles are important and necessary, they prevent objective analysis and public discussion about quality and impartiality of independent opinions.

2) Medical obfuscation

The case illustrates that an assessor can wrongly attribute causation that might not be obvious to a non-medical person. The opinion might seem reasonable to the person being assessed or the insurer or claims agent that requested the report. The ‘medical truth’  might only come out if the matter was heard before a formal legal decision-making body. In the majority of such assessments this never occurs, or if it does, it is far too late to influence acceptance of liability for appropriate treatment.

A more common thread in IME assessments is that the workers’ claimed condition is due to underlying/pre-existing degenerative disease, even though there was a clear precipitating injury and no pre-existing symptoms, satisfying the legal definition of causation in most jurisdictions.

Similarly many IME Assessors don’t accept many surgical procedures and other types of intervention as reasonable in the face of contrary opinion from currently-practicing specialists in the field. 

The problems referred to above have significantly dented confidence in the fairness of the current systems to determine liability and reasonable treatment for injured workers. While justice might eventually prevail through our courts system, that process is too slow for most people. Often they have sustained significant damage through psychological stress or delayed treatment before matters are brought before the appropriate court or tribunal.

In a series of blog articles entitled:

IME ASSESSMENTS – THE GOOD, THE BAD & THE UGLY

over the next few weeks, I will analyse these issues in more detail as follows:

1. WHAT IS AN IME ?

2. CURRENT ISSUES WITH IME’S?

3. FIXING THE SYSTEM – ARE THERE ALTERNATIVES TO IME’S?

Look out for my posts.

Comments and discussion welcome.

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About Tasworkdoc

As an occupational physician in private medical practice in Hobart, Tasmania - the southernmost state of Australia, I see workers referred by their general practitioners with various types of work-related injuries and diseases. These are mostly musculoskeletal injuries, both of traumatic and gradual onset as well as various associated psychological disorders. With interaction with patients for treatment and providing advice about rehabilitation, I have the opportunity, first-hand, to observe interactions between individual patients and compensation systems. I also conduct independent medical assessments, including impairment assessments for musculoskeletal injuries and asbestos-related disease compensation. This provides another perspective of workers within compensation systems.
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16 Responses to Is There a Crisis of Confidence in IME Assessments?

  1. Soula says:

    Great post and many questions left unanswered. From my ‘injured worker’ perspective (7 years and a fair amount of IME’s later) there are many odd facts about these ‘assessments’ and one from the outset is that the WorkSafe Agent is the body that sets the IME’s questions. The Agent also hires the examiner and is left to manage this whole scenario which quite often dismisses any of the injured worker’s own reports, even the GP’s capacity report. And then there’s the scenario when a worker’s injury is not assessible as an impairment or disability (thanks to the removal of the Pain Chapter from the AMA Guidelines) to which I am a living experience and left standing at the Impairment Assessment feeling like I had a tooth ache with examiners focusing on my feet. Way off the mark… is this what these IME’s took an oath for? How can anyone work to such limiting medical guidelines knowing fully they aren’t able to help a patient… Not one has had the decency to write to the Agent that they were unable to assess me (why would they? It’s not like they have to see me again). But this is where I have it wrong, an injured worker isn’t a patient once they hurt themselves at work, they become some sort of criminal.

  2. Pingback: Is There a Crisis of Confidence in IME Assessments? » The Injured Workers Support Network

  3. Kerrie Daly says:

    Thank you so much it is a problem VERY well known to us injured workers, if you could see my file through the years with mainly insurance doctors and the amount of conflicting ideas that are biased to the benefit of the insurer the mind boggles, I both have and havent got medical issues according to them it goes back and forth like a ping pong ball and it has stopped my current doctor WC GP knowing what is happening, my neck injury has not been checked till now since 2004 or 2005 and has got to bilateral radicular problems c6 and could have been dealt with long ago as my MVA was 2003! If not for the “hired gun” persuasion of IME (not speaking of course of real doctors trying to do their job) I would have had considerably less nervous breakdowns due to stress on top of PTSD, I would have known a more correct physical diagnosis of my physical spinal injuries and how to deal with it.
    On the internet, I have looked up a couple who were quite cruel and I must say slanderous in their “reports” to help the insurer get their way. I have never been able to get to court nor had enough money to pay for workcover reports for myself to fight back but should injured people have to fight so hard while so unwell? One dubious psychologist made me fill in questionnaires for ages while I have neck injuries and hand problems, kept going to the phone saying “yes she’s here will call you when shes leaving”, leered down my top on the way out his door with a dirty grin, then wrote the sort of report that went against my psychiatric care and said the same things I found (on the internet) he said about another in court (he lost) about me!

    Unprofessional in the least. According to some of the IMe’s I was forced to see (I literally panic and throw up when I am forced to see them!) have spinal injuries then I dont I have fybramyalgia from the accident but I am “fine” to work, then I dont then I have CPRS, then spinal again but not bad enough back and forth it goes even within the insurer’s doctors ranks. Then the psychological doctors conflict also. My WPI percentage also varied greatly, it is an unfair measure of pain and yes suffering by the ones unfortunate enough to be injured and noone is stopping these guys! Some of the worst will say “well how did you get to this appointment if you are injured or unwell” if we don’t go our pay is cut off and we cant pay our rent or feed our kids, I have to take Valium before I go as I don’t trust I will get a doctor who cares about the patient, not after what I have been through, they are traumatizing. Imagine the money wasted fighting me that could have been used instead to help me!

    Doctors are a great profession that does much good in the world but not when they trade their ethics for lots of bonuses from insurers and by use of reports “attack” injured workers in an unfair, biased, and cruel manner. We were workers, we deserve the right treatment.

    Thank you doctor for bringing this up, if you were nearer to NSW you could see the mess of IME reports I have against me when I just want to get well not adversarial conflict of interest that is being fought by while being “treated” by an insurer who only wants to win.

  4. Kerrie Daly says:

    The pre-existing degeneration with no pain nor pre MVA symptoms has been used on me also

  5. Kerrie Daly says:

    I hope you don’t mind Doctor I have sent link to David Shoebridge of the greens who wishes to assist injured workers, finds your views very interesting and who will be assisting me in replying to the government about injured workers issues, I love that a doctor is showing the foresight to raise these issues long long overdue:)

  6. Tasworkdoc says:

    Thanks Kerrie, The reason for writing the blog is to publicise the issue, so please feel free to circulate to anyone interested. I know David Shoebridge is interested, he has responded to some other issues that I raised previously.

  7. Anthony Stewart says:

    Hi Doctor My name is Anthony Stewart. Thank you for bringing this Matter out into the open. I have a Facebook page with 194 Members!! also most of which are injured workers the page is called WorkCover Problems I was made aware of you page by one of my page members. Thank you because when you are Inju. red you think that maybe these unscrupulous IME’s are possibly right with their diagnosis. You don’t expect someone who has taken an oath to help people will Lie and Deceive. Once again thank you for your support!!! thank you sincerely.

  8. Tasworkdoc says:

    Thanks Anthony
    I have focused on using Twitter, rather than Facebook, perhaps I should use both! There will be more on the subject of IME’s from me soon.

  9. Justice Seeker says:

    Hi Dr Sharman,
    My husband and I are victims of the WC system IMEs and AMSs and we have plenty of evidence that proves the corrupt nature of the use of iMEs. At present we are waiting on replies to our complaints and we have been subjected to so much obstruction and delaying of responses by the insurers, WorkCover, employer and the WCC it only serves to make me very unwell as well as prolonging the whole thing. We have been in contact with David Shoebridge as well as other politicians who attended Injured Workers Support meetings and we intent to pass all to further authorities. It has all become so complex it is almost unmanageable. We are unable to even finish all our complaints due to each step exposing more and causing me to be psychiatrically unstable with suicidal ideation.
    Please contact me privately via email

    • Tasworkdoc says:

      Thanks Justice Seeker
      I am trying to contact David Shoebridge direct. He seems to be the only politician around Australia actively taking an interest in these issues. I know that many people suffer terribly from the to and fro processes with IME assessments and what I hope to do with this blog is to raise awareness particularly at a political level about the problems. Workers Compensation should be an effective health care system for workers, but at present I think it falls far short.
      Peter Sharman

  10. Kerrie Daly says:

    http://www.injuredworkerssupport.org.au/strong-investment-returns-deliver-a-boost-to-workers-comp-scheme/#comment-83473 for your perusal doctor, not one injured worker asked about how “helped” we are, they have just been kicking injured workers off if they dont reach IME’s 30% and onto pensions and medicare.

  11. Tasworkdoc says:

    Thanks Kerrie
    I don’t think the strength or weakness of the investment market should have any direct bearing on the quality of care provided through any workers compensation system, but I do recognise that in tough times insurers will look towards cost savings by being ‘harder’ on claims to try and save money and protect their ‘bottom line’. This is probably false economy as adding ‘Insult to Injury’ will worsen outcomes and ultimately increase the insurers costs.
    Peter Sharman

    • Kerrie Daly says:

      Yes doctor you are correct about the investment market, we are under the workers compensation situation, the agents for the government are not independent, they are insurance companies. They want to win at all costs, even if the economy was booming, they prefer to spend more money fighting the injured than helping them, I have had more than enough conflicting reports from IME’s that the insurer wanted, but as most of the time on wc I only got a bit over $200 per week till last year I could not see enough doctors to tell the truth and be objective on what happens to people in serious car accidents. I originally thought that they sent me to their IME’s to help me, till they started intimidating me and writing reports to discredit me when I was actually telling the truth. The government keeps scaring the community with The “unfunded liability” fear, that is like telling a young couple that before they borrow from the bank for their first home they better have 110% of the amount for the home. something is unbelievably wrong with this system. why after 11 years with neck and other pain, and mri’s did it take till a doctor who was there when mine wasnt to find out I am not crazy, I do have radiculopathy c6, just got cortisone to the left side (mri shows bilateral) and the anesthetic reduced the pain in that part of my neck,the pins n needles left half of my trapezius and lessened symptoms in my left arm so far ( only got it yesterday) they have been playing dangerous games with my health Doctor. Not amused.

  12. Kerrie Daly says:

    As to retraining,I am a very good artist, I put in for a total of FOUR years for an online graphic design course as traditional is very difficult to do when you cannot lift your arm for long without pain so a mouse is easier for me, the claims officers kept “losing” my paperwork to do the course,so i did my own course, bought my own computers and software to do so and am teaching myself both photoshop and 3d to work from home in videogames, I have tried to adapt, I am now coping with worsening symptoms to neck and hands from sitting at the computer, I cannot go back to my old job as an assistant in nursing lifting, and showering and feeding and assisting the disabled due to my spinal injuries and other injuries. I love what I am teaching myself I have been training under Ryan Kingslien of zbrushworkshops.com who has worked in cg in movies. now even that is getting way to hard to further degeneration of my spine. Here is my online art gallery kerrieanndaly.deviantart.com every work has been painful but I am trying to do what I am good at and not lose my dream since 3 years of age to be an artist. I asked my latest claims officer if this counts toward my part of responsibility in my claim, she said no, I have a chance volunteering on a videogame with an NDA with Bethesda (skyrim, Oblivion, Morrowind among other videogames) this apparently does not count. Doctor I am at a loss. I may need spinal fusion and that will be a huge fight too, so what do they want from me?

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