A really effective way to annoy a worker on compensation payments (or any worker for that matter) is to not pay them properly. It is even more effective if the worker is already on legislated step-downs in their weekly payments or if their injury has already caused pain, anxiety or stress.
A very effective strategy to change a worker’s focus from recovery to their legal rights is to suggest that they might be dishonest or not entitled to claim compensation. Keep in mind that, contrary to populist belief, most people hesitate to claim compensation because of the associated stigma, particularly if they previously have had a bad experience.
My statements above are based on my experience talking to 100’s (probably 1000’s) of workers over the last 30 years of clinical practice, but I can’t back it up with properly conducted research. Discussions with clinicians who treat patients in compensation systems support my observations.
In 2001 The Australasian Faculty of Occupational Medicine/The Royal Australasian College of Physicians, Health Policy Unit published a report – ‘Compensable Injuries and Health Outcomes’.
In the Executive Summary the following appears:
“Although most people who have compensable injuries recover well, a greater percentage of these people have poorer health outcomes than do those with similar but non-compensable injuries. There is sufficient good quality evidence to show this to be true, and significant agreement among practitioners in all relevant fields (medical, legal, insurance, government oversight bodies) to support the evidence and to suggest that a complex interaction of factors is responsible for this. However, research into causes of poor health outcomes for these people is fragmentary and inconclusive. Not enough is known of the effects of different types of compensation schemes or different methods of management of cases (by all practitioners involved) to allow the development of a ‘best practice’ model.”
In the report recommendations the following appears:
“Develop a research strategy with the aims of:
◆ identifying key features of compensation design which are likely to impact on health outcomes
◆ determining impacts on health outcomes
◆ developing options for scheme design that optimise health outcomes and are cost-effective.”
WorkCover in Tasmania apparently don’t have a budget for supporting research at present, although in the past I understand they have funded some University of Tasmania research.
The ISCRR in Victoria, jointly funded by TAC/WorkSafe Victoria. apparently have an annual budget of $2-3M for research relevant to OHS and RTW. ISCRR has funded the HECS Study, looking at the health effects of compensation. Here is the link to a summary:
http://www.iscrr.com.au/reports-pubs/research-reports/hecsonepagesummarysept2013.pdf
The study looks at the relationship between stressful claims experiences in compensation systems and, in particular, the role of claimant vulnerability. This is a study of a cohort of hospitalised injury patients, so the findings might not be applicable to workers with a less serious musculoskeletal injury that make up the majority of workers compensation claimants.
The study confirms that a significant number of claimants (53%) found their claims experience to be stressful, including significant numbers finding the number of medical assessments stressful (27%). The study found that the risk of poor prognosis was increased in those with claims-related stress. PTSD suffered were particularly vulnerable. It is encouraging that the authors recommended the need for redesign of claims procedures and processes.
The study is observational rather than an intervention study with a control group. A more comprehensive study with a different design might provide a lot more useful information, but might be more expensive and require the co-operation of insurers or claims agents.
Collie et al make editorial comment on the health effects of compensation:
Evaluation of a compensation claims management intervention for improving recovery from traumatic injury, Injury, vol. 43, no. 9, pp. 1335-6.
The authors state:
“Multiple studies have demonstrated that interaction with the compensation system via the injury claims management process has a substantial impact on the health and well-being of injured persons, particularly in the area of mental health. The anti-therapeutic effects of injury claims management processes has been demonstrated in multiple jurisdictions.
The potential positive impact of system-level legislative change in injury compensation systems on the health and wellbeing of injured persons has been demonstrated. However, the effect of changes to injury claims management processes are rarely studied”
I am unaware about how much is spent on such research in other Australian jurisdictions, but it seems that investment in research into alternative models of claims management is lacking, especially when compared to the amount of money spent in the various compensation systems around Australia (about $20M annually in Tasmania alone)
A useful starting point would be a prospective study of cohorts of injured workers to compare health outcomes with different approaches to claims management. A cohort subject to current claims management practice could be compared to a cohort where medical approaches to decision-making for treatment and management are utilised. This would help tease out the impact of the traditional confrontational liability-driven legal model of claims management on health outcomes.
If it was possible to quantify any detrimental effects of claims management practices such as IME assessments, claim disputes and covert surveillance on health outcomes (or duration of incapacity) an objective debate about the best approach to design of our compensation system could ensue. Such information would mean that claims management practice costs could be understood by the financial organisations that administer claims i.e. the insurers and claims agents.
My conclusion:
THERE IS A LARGE, BUT BARELY VISIBLE, ELEPHANT IN THE WORKERS COMPENSATION RESEARCH ROOM – THE IMPACT OF CLAIMS MANAGEMENT PRACTICES ON HEALTH AND FINANCIAL OUTCOMES
Quote for the day (doctors like the example of smoking) :
‘JUST BECAUSE IT IS LEGAL DOESN’T MAKE IT A GOOD IDEA” –
Insult and Injury 
Another great post @Tasworkdoc. I believe the elephant is present in all Workers Compensation system’s rooms/offices. The ignored issues are endless and no one seems to be able to ask the hard questions or demand the hard work to rectify the system’s many downfalls. I imagine the elephant will have to sit on the staff if he/she wants attention. Of course he/she must be prepared for his/her burial though… a typical way this system works out its problems. Either ignored or buried?
Thanks Soula
Perhaps a series of ‘elephant’ drawings can be added to your portfolio?
Thanks to ISCRR CEO Alex Collie for this update:
Peter, stimulated by the 2001 report (Compensable Injuries and Health Outcomes) I wrote an article in which I tried to find answers to some of the questions that were then being discussed. Here are some of my random thoughts.
After revisiting the article (http://pudendalnerve.com.au/website/wp-content/uploads/2012/08/Talmud%20on%20PI%20comp.pdf) and observing what has happened to Workers’ Compensation in Australia, I must say that I am pessimistic that the current situation can be improved, even through rigorous research. In fact, I would hazard a guess and say that we are witnessing the death throes of the grossly distorted and convoluted systems that are in place.
Now that statutory bodies have to a large extent outsourced the responsibilities for ensuring best practice claims management to the commercial sector, it seems to me that key stake holders are in the thrall of claims management agents and their parent insuring bodies.
Rehabilitation providers have become disillusioned when they find that in order to stay in business, they have to pander to the wishes of third party payers. Therapists have to justify every intervention on the basis of the available evidence for its efficacy. This is not a bad thing but it does not seem to apply to medical practitioners who perform spinal interventions of dubious value.
Independent Medical Examiners (an oxymoron!) also need to toe the line and adhere to the cook-book styled “Guides to Assessment of Permanent Impairment” or they will be swiftly rebuked. By way of compensation, their level of remuneration is far in excess of that being paid to most treating medical practitioners.
As you know, “pain” has been taken out of the equation whereas psychological and psychiatric conditions have been re-badged as “impairments” that are to be assessed on a scale of self-reported “disability”. This sleight-of-hand seems to have escaped the notice of everyone in the system. The separation of the world of the body from that of the mind is firmly embedded in the systems. “Pain” has been excluded from both.
Finally, the culture in which the systems operate now appears to be one in which everyone has to watch their back to make sure that the accusation of “rorting” the system is not leveled against them. Of course, the compensation claimant is still the number one target.
The “elephant in the room” is the puppeteer who is pulling the strings to which we all must dance.
Thanks John
I am a little more optimistic that change can be achieved. In Tasmania with a smaller system where the parties can interact directly there are better prospects, but significant changes to ‘governance’ of workers compensation will need to be legislated to give greater weight to achieving health outcomes. Even the insurers are becoming concerned about the costs and hopefully they can be convinced that claims management practices that affect health outcomes are contributing to their costs. Perhaps something can be achieved. I won’t give up yet!
Peter, I hear that insurers are now funding research that has been pioneered in NSW by Professor Michael Nicholas, who believes that those claimants who might have long term disability can be identified within the first week or so following their injury. This is done by administering validated Questionnaires, such as the Orebro Musculoskeletal Pain Screening Questionnaire (short-form).
The other trend I have noticed is for larger employers to bypass the rehabilitation industry that feeds off the WC system and to engage health professionals to administer to the needs of their injured employees.
By the way, you may be interested in the comments of Sir John Collie (no relation to Alex?) in his book “Fraud in Medico-Legal Practice” (1932): “Many deserving cases do not receive proper consideration because unworthy persons have expended upon them the sympathy and help which are the legitimate right of the true sufferer … Naturally the amount of compensation paid is reflected in the premiums demanded, and therefore, unless unjust claims are sternly repressed, the burden upon the community will be greater than it legitimately should be. This work deals with a dark side of human nature, and does not admit of the display of that sympathy which I trust all genuine cases receive.”
This is the important role that our society has assigned to Independent Medical Examiners and it has always been so in our systems of Workers” Compensation.
The first challenge is to admit that not only is there an elephant in the room but that someone needs to clean up the pile of elephant dung that has been building up in the corner and is stinking the place out.
Workers compensation makes people sick, the emotional trauma + the mental exhaustion + the physical destruction that workers compensation brings into the lives of injured workers is intolerable.
The workers compensation system churns injured workers and generates vast amount of income for the providers to the industry for little to no relevant or sustainable outcome for the injured worker.
Worse the employers who have no choice but to pay the levies required under legislation also lose out because the system does not adhere to its duty of care.
I am always amazed that more employers simply do not demand to know why there is a large number of non-treating medical opinions and reports that impact on the overall cost of the claim and in turn increase the levy paid by the employer.
The good news is that there is an option- I know this because I wrote the option.
It is called Craig’s Table funding is now being sought to bring Craig’s Table into being because to be brutally honest I am tired of trying to put out the raging inferno that workers compensation has became.
I would say the most detrimental effect on me was the management of me as an injured worker. First by my workplace after my psychological injury when my return to work program was totally disregarded and the problems were allowed to continue till I could take no more till I was medically retired and had to rely on the workers compensation system. In the beginning I was supported but after a while I began to be treated as though I was stupid and my case managers began suggesting how I should be treated, telling me things such as “Exercise is good for you. Have you tried that?” Have you tried another medication?” “Why don’t you move to another town?” I have PTSD, depression, anxiety as well as separately disc protrusions in my cervical and lumbar spine requiring surgery.
I know my self well and tried to explain it was my psychological claim that impacted on my ability to manage my physical claim. No case manager believed that and they tried to convince me my pain impacted on my psychiatric condition. I tried to explain I was a great successful teacher with the same pain and physical injury for ten years and I managed it well while I was psychologically well.
I am the type of person who breaks an ankle, straps it up and puts my foot up on the wall so I can finish painting the house, which I have done. It never mattered how much pain I have been in if I had to work I turned my mind to the work and away from the pain.
I have my own four children and I looked after them well. I loved teaching with all my heart and it was my creative passion. I loved the kids and felt their excitement when they achieved something. I taught in a school where children who attended were abused physically, emotionally and sexually and I came to terms with the fact I was powerless to enact change in their personal lives so I came to terms with this by determining the best day of their lives would be that day with me, in my classroom. Those children knew that and that is what I did. I had a little seven year old raped before school put her self on the bus to get to school so she could be in my classroom. She sat up straight injured, bleeding and in pain just so she could have that day with me. That was overwhelming to me and I cried because i couldn’t bear the thought of what had happened to her and that it was happening to lots of other children in my care and I cried because I was so privileged to be able to give her the love and care and that made her feel safe in my classroom and that for her it was a place outside her life of pain and trauma. I taught children like that for 16 years and there were many, many sad, sad things and I survived because what I did mattered and the other teachers around me cared just as much as I did. This all changed for me when my employer played politics with the lives of these children. Things were covered up we were told not to go outside the system. Things got out of control. Staff either died or left,new staff didn’t understand the trauma of the children. Traumatized children lashed out and put others in danger. The employer hounded us to do a better job when no one could do more. Children roamed the grounds breaking things and throwing rocks through the windows of the primary school. It just went on and on and we were told not to suspend because the rates were to high and demonstrated political failure. We were told to cover it up. It got worse and worse. I still managed my class and taught them till my ability to make decisions was taken from me and I was made powerless by things I cannot refer to. That day I went to school and I began to cry and I cried for six months because I could not protect the children any longer. I moved to another school to save myself and my family but lived with the enormous guilt that I betrayed the children I tried to protect and I remembered them pleading “Please don’t leave us?” over and over.
It took me a long while to get better and bit by bit I clawed my way back to become the teacher I was. I began to take back control of my life and taught with passion again although there was always pain in my heart for what I had left behind. For four more years I taught well until there was a new teacher came to the school. She bullied the children and they came to me. I went to my principal he failed to act. Their parents went to the principal. He failed to act. Finally he took some action but she continued. I held my self together but I began to feel powerless. The area director advised my principal to wait and I was directed to collect the evidence so they could get rid of her. Can you imagine how that was for someone like me to be told to allow children to be bullied? I couldn’t do it and I wouldn’t. I was totally disempowered and I started crying. I wanted to kill myself because again I couldn’t protect the children. I broke down and began having panic attacks at the thought of what the teacher might do to children in my class. I asked for help and no one would help. The other teachers were too afraid to become involved. One day i couldn’t get out of bed and I couldn’t go to school. After a while I got myself better and got back to school and went over the heads of my superiors and made complaints. I was on a return to work but it was ignored and I was then bullied by my superiors. This went on for the next two years and even though the teacher was removed from the system nothing was done about the lack of action from my superiors and I was treated as though I was the wrong doer for exposing it till I could take no more and my depression and anxiety was chronic and the PTSD symptoms got worse and worse.
The case managers treated me as though I was a fraud and argued with my doctors and made my psychologist justify every move she made. The insurer wrote to my psychiatrist asking why I was not better and if he thought I should have new medication or a new psychologist. The case managers were constantly changed and I had six psychiatric assessments. I had a case manager who rang me and talked to me for an hour trying to counsel me herself because she was doing a psychology course. My interactions with the insurer made me worse and I began to have panic attacks when the phone rang or if there was an email from them. They just did not allow me time to heal. I had to justify why I was injured. They did more and more until the only way out was to go through the legal process. This involved lies by the insurer, their solicitors and their hired gun IME. It was all so bad I ended up in a psych ward because I wanted out. The case manager even fought with my psychiatrist about her approval of my hospitalization while I was suicidal in the psych ward,
The system is punitive. You are made unwell not because you seek compensation but you seek compensation because the system make you unwell and it is a means to get out of the system. No one considers that compensation is the path you have to take to get your life back when the rest of the system fails because the people managing it treat you as a worthless, stupid, fraud when you are not.
It feels the same to me as when no one would act to stop the teacher bullying the children and I was directed not to act myself. This caused me great trauma and because I could not act outwardly it went inward making me worse.
Making people powerless is the best way to ensure ill health and studies seem to overlook this aspect and portray the injured worker as somehow keeping themselves unwell so they can get money. That is not the case. I would rather I have no money and be able to live on my own terms. I did get out of the system but I am still unwell because of the damage done to me and because people think and say “You must be better now that you have been compensated!” I don’t. I feel angry because doing right and having courage to stand up for what is right took away my life and made me live in fear.
I still want to make other people see it is wrong to make people powerless and wrong to use power to take away the rights of injured workers and I will get out of bed each day so I can help it all stop. I’ve tried to kill myself four times because of what the insurer did to me so it is my belief this is where the problem lies. Don’t look at the injured, Look at those managing the injured and see how this can be done in a better way!
Thanks for the thoughtful blog Peter, you’ve hit on a few of my favourite themes. I really believe the workers compensation system creates secondary disability and dehumanises workers. Once a worker has their integrity questioned, whether it be by having to attend an (oxymoronic as John has noted) ‘independent’ medical evaluation or by an act as simple as raised eyebrows by a sceptical employer or an insensitive question from a claims manager who has too many claims to manage properly…what choice do they have but to strive to prove they’re unwell? Once an injured worker takes this path, and their focus is on justifying their injury (physical or psychological), what effect does this have on their capacity to recover optimally? How does the constant energy required to prove ill health leave a worker viewing themselves?
John, I’m a fan of Michael Nicholas and measures designed to predict long term disability but if my theory about secondary disability is correct, then all workers are at risk of secondary disability. In recent years, I have had the opportunity to persuade some of my employer clients to let me speak with their workers within 24 hours of injury. The approach I advocate is simple but not well aligned with the wc system sanctioned approach. Instead of burying them in process and forms and claims/legal/medical jargon I ask them how they are, what happened and how they feel. Then I do something the workers compensation system sucks at….I listen to their response. I have to try really hard (& it doesn’t come easily but I’m slowly improving…) not to jump into “telling” them what they should do. I work hard at establishing a respectful relationship and when they start to ask questions, I try to give them choices. Above all, I’m mindful of their need to retain control of their own destiny and recovery.
Justice seeker, if I’ve understood your story correctly, it stinks of system induced disempowerment.
Yes as I was a “whistle blower” in my workplace and the supervisor who directed I let kids get bullied and get the evidence to get rid of the teacher got a couple of very big promotions and then when I went again and made further complaints the cover-ups went on until I was finally told there were questions I had asked that I would not be getting the answers to! Then the investigator made a private phone call to me and reassured me of confidential matters and told me the people concerned had quietly gone into retirement!!! The supervisor disappeared from his $240000 job without any acknowledgement so I know he was told to get out but it is my guess he went off onto a great super package without further discipline!
There was also a matter where there was lack of action and then cover-up of indecent assault of female students by a male student. The principal would not suspend the boy (12) because the boy’s father said he had spoken to one of the girls and it wasn’t that bad!!! This was reported to me as woman’s contact person by the assistant principal who was too distressed to make the complaint herself because the students were in her class. Once again I made complaints to the Area Director (different one) and made a complaint in a meeting. The first thing I was asked was “Don’t you want to give the boy a chance?” I was horrified and then more horrified when I was advised it was at the discretion of the principal to notify of sexual abuse between primary students in my state. I advised my principal and the director it was a police matter and mandatory police notification in VIC schools. After this meeting I was further abused and yelled at over the phone for “sticking my nose into school business” by my principal! My principal actually rang me at home while I was on WC to do this!!! I was further bullied because again I did the right thing.
When I finally brought up what I was told about it being the principal’s discretion to notify sexual abuse between primary students with head office in my state, they refused to provide me a direct response and would never either confirm this or state it was not the case, indicating to me it was true.
All my attempts at re-empowering myself so I could get better actually made me more unwell but the more they covered up the more disturbed I was and the more I could not exist without wanting to fight it. This would of course make me ruminate and have nightmares about the children at school when they were abused and the violence we witnessed and when my life was threatened intruders who entered regularly from the street to rob us or to bash students etc. Of course as well as this the case managers attempts to have me justify my illness only served to reinforce the PTSD aspects when I had to repeat it all. This all made me more unwell.
I think some case managers just bully you to either get you out of the system or in the hope you will kill myself. When one of mine argued with my psychiatrist he told her if he let me out of hospital as she pressured him to do, and I killed myself he would make sure her name was the first on the coroner’s report. Here she was bullying me out of the psych ward using the new legislation as an excuse to make it clear it was her decision whether I required continued treatment and when my psychiatrist did not agree with her and told her so she then complained about my psychiatrist. Her supervisor advised me she was “in tears” and I was blamed for upsetting her!!! She then got the insurer’s solicitor to get onto mine to pressure me to get out of hospital. That only made me worse and I required four more weeks hospitalization until I was out of danger of suicide.
After many complaints to the insurer about their staff and their unethical actions in regard to the use of the IME (to whom they provided no treatment reports) the insurer then had to fight my employer to settle my claim after all their attempts to discredit me failed.
I have continued to make waves and one day I will get it all out into the media, but not till all those involved are properly dealt with. The insurer has already notified me they are going to re-train their staff so they actually know what is in the WorkCover Guides they have not been following so that is something!
The point is if I had been supported along the way instead of everyone destroying me to cover their own mistakes then I would be still doing my job instead of spending time in hospital, on medications and writing complaints.
What happened to me was wrong and the information we have gathered highlights how far people will go to cover-up wrong and how far they will go to ensure injured workers remain injured.
One of the worst things is that because I was so unwell I was not able to get it altogether to make a complaint to WorkCover about the workplace breaches and when I finally did they would not accept it because there is a three year statute of limitations for WH&S breaches to be investigated!!! If I was in a coma for this time would they still fail to investigate when I woke up? I have been extremely unwell and as with most injured workers with serious injuries the last thing you are able to do is to make complaints so I find this legislation at odds with the Anti-discrimination Act. I asked the CEO of WorkCover about this but she didn’t even reply showing how bad this system really is in many respects. On the other hand we have had good support from the General Manager WC division until she went on leave however the relieving person is not so interested in what is going on.
Sorry I have gone on again and I thank you for allowing me to provide the point of view of a victim of the workers compensation process. How can anyone get better under such circumstances?
The matter is not simple but without everyone working to expose this type of thing there will never be change.
Justice Seeker there is a better way, there is a holistic way and there is a empathetic way within workers compensation to handle everything that you have described.
The challenge is that the system has long since forgotten just what it is in place for and who it is meant to serve and protect.
Thanks for all the comments received.
I have been reading a recent systematic review by Kilgour et al ‘Interactions between Injured Workers and Insurers in Workers Compensation Systems’ Thanks to ISCRR CEO (and co-author of the review) for bringing it to my attention.
http://t.co/gMO4lmtL2l
This review highlights all the issues familiar to doctors who treat patients in the WC system. So perhaps the researchers are onto it! Still need some intervention studies to demonstrate that a different approach to claims management will reduce the impact on health outcomes. My belief is that the systems need to be completely redesigned, rather than just trying to change insurer behaviour. The attitudes and behaviour of insurers is driven by the structure of the system, financially driven – hence the overemphasis on liability.
Perhaps I should have called the article “The Elephant in the Insurer’s Office” not the “Research Room”. Perhaps the elephant in the research room is a pygmy!
Hi Doc,
All my treating doctors/psychologist/physiotherapists have at one time or another expressed the fact they hate and would prefer not to do workers compensation because of the interference from the insurer into the treatment and management of their patients. Some doctors just will not take on workers compensation cases and some try to talk you out of making a WC claim or will only see you privately because they say you will be made worse while on WC. How about a survey to all AMA members with regard to the impact of the insurance process itself on patients?
In one meeting we attended, a WorkCover staff member stated she was injured at work but that she would not put in a WC claim because she saw what happened to people on WC! That should be an eye opener!!!
Peter, could I also recommend the following…”Breaking the web of needless disability”, published in the journal, Work…
http://iospress.metapress.com/content/y50n1479vj054364/
James anything written by Robert Aurbach is well researched.
There is another book that will be released later this year I am not sure when however I do know it is brilliant because I have already read it.
The book is called “Living Abled” by Dr Chris Bingham and Henry Bennet.
Sadly even the most positive workers with a ‘non disabled’ attitude are squashed in the current system and I’m proof. Been trying to return to work now for 1.5 years and have nothing but obstacle after obstacle. I’m currently post conciliation where we’re meant to be settling on a weekly figure to be paid. The insurer is arguing I’m worth more. Regardless, throughout the whole process I’ve been unpaid, treated as though I’m doing the wrong thing and as a positive self employer, treated like a criminal.
This system can be given as much positive reading as we all would like but the truth is no one is interested in applying it, there is no formula set out to apply it. The endless patches applied to this broken system only indicate to me more money is being lost.
I found this document a while back (thank you John Quintner) and from what I’ve experienced, it’s never been used. Certainly not in my case: http://www.pudendalnerve.com.au/website/wp-content/uploads/2014/03/Clinical_Framework%281%29.pdf
Let’s see what this week brings, a pending courtcase date? And all just so I can get back to work against all the odds. Honestly, I know now why people walk around with neck braces, they wouldn’t dare rock their boat. It certainly hasn’t been worth forfeiting my full payments that were certified for life just so I can attempt to rebuild our business. Idiot! Keep your neck braces on injured workers, there is no incentive, in fact more hell to face trying to get back to work within this system.
Soula this system has to change, I am tired of seeing injured workers destroyed by the very process that is meant to benefit them.
How true! The problem is very simple. No disputes for the insurer’s solicitors means no money for them. They engage those willing to comply with providing fraudulent IME reports because that creates evidence to cause a dispute. Most people will know who is willing to supply a biased report. I could list off a few names and many in the system could tell me if they were crook IMEs or reasonable ones. In injured workers meetings the names are as well known to the injured, as they are to solicitors and other doctors. We now know what is even going to be said in the report before someone sees certain assessors. I totally predicted what one IME would say to the insurer before I went to see him. He lived up to expectations to the point he excelled in deceit and trapped himself with his own dishonesty and the insurer had to dispense with his services and report him themselves. The question is why would an insurer spend $20 000 with assessments and court costs to prevent an injured worker from $1500 worth of physiotherapy or psychology a year. Very easy, the solicitor for the insurer engaging the assessor they know will say the person needs no treatment will still get paid whether they win or lose.
If the court throws out a bad report there is no consequence for those involved. Arbitrators and judges give no weight to evidence from many IMEs who provide evidence contrary to all the treatment evidence. In one case a certain IME was berated and the judge stated he did not believe his evidence and the judge made mention of the fact the doctor had charged out 28 hours work in a 24 hour day ensuring he had no credibility. He is still doing that as an IME. He double booked me and I saw him for ten minutes and four or five other people I know saw him for around the same. Can you imagine how much he racked in for that 28 hour day!!
Start providing treatment on the basis of what the treating doctors say and do a cost analysis to determine whether fighting something will cost more than the treatment itself.
There are even cases where the IME is impartial and supports the treating doctor but the insurer’s solicitors still dispute and take it to the WCC in NSW only to be chastised for wasting the Commission’s time but there are no consequences for this. My own case was like this. The solicitors disputed my claim, then sent me to the IME giving their own opinion to him with absolutely no current treatment evidence from my thick file so the IME could provide what they wanted, which they did, and then the report had to be thrown out so we went to the WCC with not one scrap of evidence against me. We were there all day and at the end of the day the insurer took away their offers because I would not be blackmailed into certain agreements. Then the head of the insurer became involved and overturned his own solicitors actions. The employer supplied me documentation agreeing they had done the wrong thing but then they wouldn’t agree on the settlement amount the insurer worked out. In the end the matter was settled at a much greater cost to the insurer. There is a model litigant policy in NSW but no one follows it or even cares because cases such as mine would be settled long before the solicitors racked up the costs for disputing the matters.
Tasworkdoc is right we need to start all over again!!!
In Tasmania the AMA is pushing for major changes so that medical management is under the control of the treating doctor, not IME’s who are currently only accountable to the financially-driven insurers. Where there are disputes over reasonable medical management, a Medical Panel of impartial recognised practicing specialists should decide. Rehabilitation providers should be part of the treatment team, with the worker and doctor having a say in the choice of provider. The provider shouldn’t be appointed by the insurer to act as their agent – which is the current reality in many cases.
Yes I agree. My husband and I met with the GM of WorkCover and made similar type suggestions as well as having blind assessments where, if there is an IME they don’t know who referred the person or WorkCover have a centralized system to allocate the assessors for the legal purposes. One of the worst things is when you go to an AMS, appointed by the WCC,(totally impartial) and he is working in a huge medico legal office where he also carries out his IME work for one side or the other. The problem is the interference in treatment. No one considers if the person was injured out of the workplace it is accepted they treating doctors are competent enough to manage their patients so why, suddenly, is the treating doctor seen to be so incompetent in WC matters they need an IME opinion to see if they are treating the injuries properly?
I was so lucky to have had doctors and a psychologist and a physio who was willing to do the hard work of standing up to the case managers who bullied me. I also must say I had three IMEs who did a good honest assessment of my psychiatric condition for the insurer!! One saw me for two and a half hours and he was totally honest in expressing what caused my psychiatric state. While I was in the psych ward and the case manager argued that i should be put out the insurer had an IME ring my psychiatrist to discuss why they should continue to approve my hospitalization my psychiatrist told him very simply “Because sometimes people who are suicidal kill themselves don’t they!!” I had no further trouble after that because he accepted my psychiatrist opinion which was exactly what was stated to the case manager in the first place!
My husband was also injured at work and has C3/4 and C5/6 disc herniations impinging causing pain down his arms and into his hand etc as well as having had four right should ops including a bone graft, acromioplasty etc as well as a left should op. His right and left shoulder tendons are paper thin with perforations in them. The right biceps has reattached itself in a lower section of the bicipital groove and it flicks in and out of the groove. He had a reaction to one of the poly screws and it caused the inflammation and a cyst. He also had a reaction to gentamyacin given in the last operation leaving him with vertigo, tinnitus, tachycardia and increased blood pressure. He has had 28 assessments with a range of scores depending on the assessor and whether they did the tests correctly or whether they biased the report. He had scores for should ROM that his own doctor could not even force his shoulder to achieve passively. The MRI reports were straight out misrepresentations in some cases to say there was no injury seen at all and some assessors left out the relevant part of the treatment evidence with one even questioning whether he had had any operation at all. His scores ranged from 7% WPI to 34%WPI and I can tell you my husband was not the one being inconsistent!! We then went to the State library and did a lot of research into the AMA 5 and NSW WorkCover Guides and it opened our eyes as to the inconsistencies of the application standardized ROM test methods with applicable score charts. We have spent a fair amount of time getting all our information together to show the WCC and WorkCover and have some interested polies as well.
Apart from me being made so unwell and with all that happened to me we have spent the last five or six years trying to highlight just how bad this system really is. There really needs some serious investigation as it either borders on fraud or is fraud and that is part of the cost loss to the system. If injured workers and treating doctors were doing what some of the assessors are doing they would be in gaol or at least not practicing medicine!!
There are some great IMEs as there are great treating doctors and we can all be thankful for that, but sadly it is almost impossible for a disempowered or uneducated injured persons to understand or to prove what goes on when they meet a “hired gun”.
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