Independent Medical Examiner Service Standards

WorkSafe requires Independent Medical Examiner's (IME) approved to examine injured workers to comply with these Service Standards.

General

  1. The relationship between an independent medical examiner (IME) and a person undergoing an independent medical examination differs from that in a usual practitioner/patient relationship. Notwithstanding this difference, it is expected that recognised professional standards and the applicable law will be adhered to at all times.
    1. WorkSafe requires IMEs approved to examine injured workers to comply with these Service Standards. Failure to comply may result in suspension or revocation of an IME's approval.

      Referrals and Appointments

      1. IMEs must accept a reasonable number of referrals to conduct independent medical examinations. Subject to leave, as a general rule, IMEs must have appointments available within 14 days of a request, or demonstrate that booked IME appointments are in place within 14 days of a request. Repeated unavailability of appointments without reasonable excuse may result in suspension or revocation of IME approval.
        1. The person to be examined must not be kept waiting for the examination for an unreasonable time. IMEs should aim to see people within 30 minutes of the scheduled appointment time. In the event that the person has not presented for the appointment time, it is at the discretion of the IME as to whether the examination will go ahead.
          1. IMEs should notify the referrer of any appointments that require cancellation as soon as is practical after they become aware of the need for the cancellation, to allow the referrer to reschedule the appointment with the next available IME.
            1. IMEs must only accept referrals or undertake an examination for conditions for which they are qualified and experienced to provide an expert independent opinion.

              Examinations

              1. Referrals

                IMEs should read all documents (including any medical reports, x-rays and investigation reports) sent with the referral and, if necessary, request the referrer to send additional material the IME considers necessary to ensure that the findings, opinions and recommendations from the independent medical examination are sound and complete. The reasons why the additional material is required must be articulated and the additional reading time may be invoiced in accordance with WorkSafe's IME fee schedule.

              2. Accessibility

                All IME rooms must be accessible to people with mobility issues (e.g. wheel chairs). If there are access limitations, IMEs must notify the referring party as soon as possible.

                If a person is unable to attend an IME's rooms, either due to access limitations or the person's medical condition, an IME may be asked to conduct an examination at another suitable location. This is subject to the IME's agreement with the referring party regarding the suitable location. Travel arrangements may be invoiced in accordance with WorkSafe's IME fee schedule.

              3. Interpreters

                The referring party will arrange for a qualified interpreter to attend the examination if required. It is preferred that family (including children under the age of 18 years) and friends do not act as interpreters. If difficulties arise with the interpreting arrangements during an examination, IMEs must immediately notify the referring party.

                IMEs must be sensitive to the presence of an interpreter if the person being examined is to be undressed and to ensure the person is afforded discretion as required by service standard 3.6.

              4. Third party attendance

                If a person requests the presence of a family member or friend for moral support during the examination, the IME may accept this request if the IME considers it appropriate in the circumstances. The support person should not be allowed to disrupt the examination. The support person may assist in clarifying aspects of a person's medical and injury history but they must not be permitted to interfere with the normal interchange between the IME and the person being examined.

                The person being examined or the IME may agree to a third party to be an observer to the examination, or to provide assistance during the examination.

                WorkSafe acknowledges that injured workers attending a psychiatric examination will normally be advised that they must be seen without family members or friends due to the personal and private nature of the questions asked.

              5. Length of appointment

                IMEs must allocate sufficient time to allow for a fair and comprehensive examination to be carried out. Extra time may be required if an interpreter is being used.

              6. Conduct during examination

                An IME must treat people being examined with the same professional standards of care, consideration and courtesy that a private patient would expect (as covered by the Ethical Guidelines for Conducting Independent Medical Assessments [1]).

                The standards of professional behaviour as outlined in the 'Good Medical Practice: A code of Conduct for Doctors in Australia' [2] (or any equivalent codes or guidelines applicable to allied health practitioners) must be adhered to during independent medical examinations, including:

                1. being courteous, alert to the concerns of the person and ensuring you have the person's consent
                2. explaining to the person the IME's area of expertise, role and the purpose, nature and extent of the assessment to be conducted
                3. anticipating and seeking to correct any misunderstandings that the person may have about the nature and purpose of the assessment and report
                4. providing an impartial report
                5. recognising that, if the IME discovers an unrecognised, serious medical problem during the assessment, the IME has a duty of care to inform the person and/or their treating doctor
                6. being honest and not misleading when writing reports and only signing documents the IME believes to be accurate
                7. taking reasonable steps to verify the content before signing a report and not omitting relevant information deliberately
                8. preparing or signing documents and reports, within a reasonable and justifiable timeframe as per standard 6.3
                9. making clear the limits of the IMEs knowledge and not giving opinions beyond those limits when providing an opinion

                A gown or other covering must always be offered if a person is asked to undress and an IME should excuse themselves or move out of the person's line of sight while the person is undressing.

              7. Facilities and comfort

                IMEs must ensure they are at all times presented in a professional manner, and facilities and equipment used to conduct examinations are clean, safe and fit for purpose.

              8. Expectation setting

                At the commencement of the examination, IMEs must explain:

                1. the purpose of the examination
                2. their role as an IME
                3. that their findings, opinions and recommendations will be contained in a report which will be sent to the referring case manager
                4. that they are impartial, and reassure the person that the IME report will record their objective clinical diagnosis and that it is not the IMEs task to decide the claims issue
                5. the specialty in which they practise and its relevance to the examination

                The person being examined must consent to the audio or video recording of examinations prior to the commencement of the examination.

                The recording of the examination is only to proceed if the person provides consent.

                IMEs must not make value judgements or personal comments, advise the person of the findings, opinions or recommendations to be made in the report.

                IMEs must clearly answer a person's questions about the purpose or relevance of any questions, procedures or other aspects of the examination.

                IMEs must forewarn people if an examination, test or procedure is required which may be considered or interpreted as intrusive, or may cause some discomfort or pain. IMEs should explain why the examination, test or procedure is necessary and reassure the person that it will not worsen their condition.

              9. Tests

                An IME may conduct non-invasive tests and imaging with the injured worker's consent if such tests or imaging are required to answer a question asked of the IME by the referring party.

                IMEs must not carry out tests of an invasive nature other than imaging. If the IME considers tests of this kind are required, this should be included as a recommendation in the examination report. As a general rule, tests of this kind will only be permitted where the findings of the independent medical examination would otherwise be unreliable.

              10. Personal attendance

                IMEs must personally conduct any independent medical examination and write IME reports with respect to people referred to them.

              11. Security

                In the event of a security breach, (e.g. threat to self-harm, threat to others, notable complainant), the IME must notify both the referring party and WorkSafe, irrespective of whether an injured worker is classified as a known risk or not.

                Security is available for support at examinations where an injured worker has been identified as being a known risk for harm to self or others:

                • Referring party will notify IMEs where there is a known risk about an injured worker.
                • IMEs have the choice to accept or reject a referral where there is a known risk.
                • If the IME chooses to accept the referral, the referring party will arrange security support for the IME. This includes having attendance by a security officer at the IME appointment. WorkSafe will cover cost for security attendance.
              12. Telehealth attendance

                Telehealth attendance means telephone or audio conference by the IME with the injured worker. Telehealth attendance for IME examinations will only occur where the IME:

                1. has the capacity to provide the full service through these means safely and in accordance with professional standards
                2. is satisfied that it is clinically appropriate to provide the service to the person
                3. maintains a visual and audio link with the person
                4. is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy
                5. where a medical examination is conducted by telehealth attendance the IME report must:
                  1. report that the IME medical examination was conducted via telehealth attendance
                  2. specify if the telehealth attendance was audio and visual, or audio only
                  3. state what software was used to conduct the medical examination by telehealth attendance

              [1] Australian Medical Association – Ethical Guidelines for Independent Medical Assessments 2010

              [2] Medical Board of Australia - Good Medical Practice: A Code of Conduct for Doctors in Australia, March 2014, page 19

              Conflicts of interest

              1. IMEs must avoid conflicts of interest.
                1. IMEs must not accept a referral or undertake an examination if a conflict of interest might arise, or be perceived to arise, unless the IME has notified the referring party and agreed in writing on a process to manage the conflict. It is not possible to give an exhaustive list of situations where a conflict of interest might arise, but some examples include:
                  1. if the IME has previously provided treatment or services to the person (other than in their role as an IME); or
                  2. the IME has a financial relationship or other involvement with the person's employer
                2. WorkSafe considers it to be a conflict of interest for an IME to provide treatment or services to a person after they have had an independent medical examination by that IME.

                  Contact with treating healthcare practitioners

                  1. An IME must not contact a person's treating healthcare practitioner without the person's written consent unless the IME has an overarching legal, ethical or professional obligation to do so. IMEs must obtain consent prior to contacting the person's treating healthcare practitioners for information or assistance to support the IME in providing sound and evidence based opinions.
                    1. If an IME contacts the person's treating healthcare practitioners, the discussion should be documented in detail in the IME report.

                      Reports

                      1. Templates

                        IME report templates are available on the WorkSafe website. IMEs should conform, as far as possible, to the template.

                      1. Content and structure

                        IMEs should consider the potential readership when preparing reports. Reports are mainly used by the referring party's claims staff, but reports are also provided to the person's treating health practitioner and may be provided to the person who was the subject of the examination, lawyersand the person's other treating healthcare professionals. Reports may also be subject to requests made under the Freedom of Information Act 1982.

                        IMEs must comprehensively address all the points raised or questions asked in the referral. It is mandatory that the questions and answers are included in the report so that the report can be read as a stand-alone document.

                        The report should:

                        1. be limited to matters of professional opinion and not contain comments about what decision the IME considers the referring party should make unless there is a specific question
                        2. be in plain English and avoid the use of jargon or language that is too technical. Where technical language is necessary, a brief explanation of what any technical terms or phrases mean must be provided.
                        3. provide an accurate diagnosis based on references to a detailed and accurate history and an appropriate and thorough clinical examination
                        4. contain clear and unambiguous professional opinions and, where required, recommendations based on science and with reference to best practice medicine or best clinical practice
                        5. present an evidence-based approach to evaluating symptoms, clinical findings and presenting recommendations including references to peer reviewed studies, current biomedical models or industry approved guidelines
                        6. note if there is insufficient clinical information to make a diagnosis
                        7. contain reasons for all opinions expressed
                        8. be consistent in that opinions should accord with examination findings
                        9. be independent and impartial, and not contain any value judgements or personal comments
                        10. contain only relevant information and not disclose any personal information obtained about the person that is not relevant to the clinical findings, opinions or recommendations
                        11. not contain descriptions of a person's appearance or demeanor during the examination or as otherwise observed except to the extent that it is relevant to the findings, opinions or recommendations made (e.g. as part of a mental state examination) and only where the relevance is articulated
                        12. be free of advocacy and/or bias for any party
                      2. Time for completion

                        1. Reports deemed urgent by the referring party must be completed and provided to the referring case manager within 2 business days as per the fee schedule. IMEs must be notified in advance and agree to accept a referral where an urgent report is required.
                        2. Reports relating to eligibility decisions are to be sent to the referring case manager within 5 business days of the examination, or within such time as agreed between the IME and referring party.
                        3. With respect to all other reports, unless otherwise agreed with the referring case manager:
                          • 90% of reports must be completed and sent to the referring case manager within 10 business days of the examination; and
                          • 100% of reports must be completed and sent to the referring case manager within 15 business days of the examination.

                      Cooperation with WorkSafe and agents

                      1. Complaints

                        IMEs must reply to any complaint received by WorkSafe within 10 business days of the IME receiving notification of the complaint. The complaint must be addressed in full and the reply completed in a format acceptable for review by all parties including the person making the complaint.

                      2. Quality Assurance Process

                        IMEs must cooperate and comply with WorkSafe in the peer review of their reports in accordance with WorkSafe's Quality Assurance Process outlined on the WorkSafe IME website and work to improve on areas for development identified by the peer reviewers.

                      3. Notice

                        IMEs may raise any issues or queries regarding the provision of IME services or their approval as an IME with WorkSafe via email: [email protected]

                      4. Training

                        IMEs must complete any training reasonably requested by WorkSafe within the timeframes communicated, unless otherwise agreed with WorkSafe.

                        IMEs must provide WorkSafe with at least 4 weeks' notice of annual leave or other extended unavailability to accept referrals via the above email address.

                      Fees

                      1. IMEs will be paid for the reasonable costs of independent medical examination services in line with the relevant policies and the WorkSafe Schedule of Medico Legal Fees, unless otherwise agreed with WorkSafe in writing.
                        1. In the event, that an IME has concerns about unpaid or returned invoices, it is recommended that the IME contact the referring case manager. If there is a significant concern or trend in the payment of invoices, then this should be raised with the WorkSafe via email: [email protected]

                          Court and Tribunal attendance

                          1. IMEs must be available to attend and give evidence in the Victorian Civil and Administrative Tribunal and in court proceedings. Some proceedings may be held in regional areas. This obligation continues beyond an IMEs term as an IME.
                            1. IMEs must be familiar with their obligations as expert witnesses.

                              Notification and registration

                              1. IMEs must notify WorkSafe immediately of any formal complaint made about them in a professional capacity, about any hearing or other proceeding in relation to the formal complaint and the outcome including the details of any disciplinary action taken in relation to them including (but not limited to):
                                1. under the Health Insurance Act 1973 (Cth)
                                2. by a hospital regarding clinical competence or professional conduct
                                3. by a professional body (e.g. a college)
                                4. by the AHPRA or a National Board
                                5. by the Health Complaints Commissioner
                                6. by a body or entity with which the IME holds an approval or other permission to undertake services similar to the IME services provided for WorkSafe (such as the TAC or Comcare)
                                7. any of the above in any other jurisdiction
                              2. IMEs must notify WorkSafe in writing within 14 days of any changes affecting their service delivery as an IME or eligibility to be an IME including (but not limited to):
                                1. the professional discipline in which they practise
                                2. the services which they offer
                                3. their practising location
                                4. anything which affects their ability to continuously meet the selection criteria to be an IME, including any change to weekly hours of practice
                              3. IMEs must notify WorkSafe immediately of:
                                1. any conditions, undertakings, limitations, reprimands or restrictions on their AHPRA registration; or
                                2. the suspension or cancellation of their AHPRA registration

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