Reconciling differing medical opinions

How do I reconcile differing medical opinions?

An independent medical examiner (IME) can be arranged by a WorkSafe agent for any number of reasons. Typically agents arrange these assessments to seek further guidance and clarification about a worker's capacity for work, work restrictions and treatment.

An IME's opinion can differ to that of a general practitioner (GP) for any number of reasons, but in many cases this occurs because the IME, as a specialist in the field (for example, an orthopaedic surgeon or psychiatrist), after reviewing comprehensive notes on the worker's medical history, forms a different view to that of the GP.

It is the agent's role to review the difference of opinions and take further action in respect of the worker's claim if appropriate. This usually includes forwarding the IME report to the worker's GP and communicating with them about the IME's recommendations.

Depending on the GP's response, an agent representative such as a case manager, injury management advisor or return to work specialist, often following consultation with a medical advisor (doctor), will then make decisions about the most appropriate course of action with respect to the worker's compensation entitlements.

This might include, but is not limited to:

• seeking clarification from the IME
• organising a GP return to work case conference
• organising for occupational rehabilitation services to commence or for alternative services to be considered
• recommending that an employer review whether return to work arrangements need to be revised, new arrangements made, or withdrawn
• scheduling an interview with the worker to discuss the worker's rights and obligations and enhance their chances of returning to work
• reviewing the worker's ongoing entitlement to weekly payments or medical and like services.

It is the return to work coordinator's role to ensure employer compliance with their return to work obligations under the legislation by continuing to take into account all available medical information, including both the GP and IME opinions, to plan the worker's return to work and to provide suitable or pre-injury employment.

This can be difficult where medical opinions differ entirely in their views about the worker's capacity. Therefore it is recommended that rather than self-selecting an opinion to follow, that you discuss with your WorkSafe agent as soon as possible how best to develop appropriate return to work arrangements in the circumstances.

You should then further consult with your worker any changes to these return to work arrangements and why these have been proposed.