2.7.2 Independent medical examiners (IMEs)

An IME is specifically approved by WorkSafe to undertake a medical examination under the legislation.

An IME can be a:

registered medical practitioner
registered dentist
registered physiotherapist Registered physiotherapist means a person registered under the Health Practitioner Regulation National Law to practise in the physiotherapy profession (other than as a student).
registered chiropractor
registered osteopath
registered psychologist Registered psychologist means a person registered under the Health Practitioner Regulation National Law to practise in the psychology profession (other than as a student).
registered pain management specialist.

How IMEs are approved by WorkSafe

An IME can only be approved by WorkSafe if they meet strict selection criteria and must sign a WorkSafe declaration confirming that they will abide by a set of service standards.

IME approval is for a period specified by WorkSafe. IME approval is subject to a strictly controlled performance framework overseen and managed by the IME team in Health Strategy.

Queries about IME approvals can be directed to provider@worksafe.vic.gov.au.

Multi-purpose examinations - IIA and IME

Some IMEs are trained to also conduct independent impairment assessments.

See: Independent Impairment Assessments | Arrange an assessment for multiple purposes

2.7.2.1 Determine if examination is required

Independent medical examinations are arranged primarily for a variety of reasons, including determining whether a worker is entitled to compensation or to support the worker's RTW Return to Work activities and objectives.

WIRC s27

Before an IME is arranged the Agent should:

review available information on the file and seek guidance to determine if an independent medical examination is required
consider whether an MA may assist or whether contacting the worker's THP Treating Health Practitioner will provide the required information.

Note: If attempts to resolve an issue or obtain information from the THP have been unsuccessful, an independent medical examination may be considered. Document any action undertaken to obtain further information.

If a previous examination has taken place, consider whether a supplementary report can provide the information required.

See: Supplementary reports

2.7.2.2 Determine speciality of IME

The speciality of the IME is determined by:

the nature of the worker’s injury
the medical treatment and/or RTW circumstances or issues to be resolved.

A Medical Advisor can be consulted about the appropriate choice of speciality if assistance is required.

When there is a need to review allied health services for which there are no speciality IMEs or where multiple allied health services are provided a medical practitioner IME should be used.

Multiple medical specialities required

Advice should be sought from a suitably qualified person or Medical Advisor before multiple IMEs or a generalist IME is arranged.

Multiple IME examinations with different specialities may be required where:

the worker has multiple or complex injuries or a complex medical condition
a worker with a single diagnosis presents with a change in the nature or primary diagnosis of their injury or with a diagnosis additional to their compensable injury
a worker requests treatment, surgery or medication that appears unrelated to their injury and the information available from the treating practitioner is insufficient or indeterminate
an IME recommends a further independent medical examination with a recommended specialty about a specific issue
the Case Manager requires specialist medical or clinical advice which cannot be provided by a Medical Advisor or other suitably qualified person to make liability/entitlement decisions.

IMEs for mental injuries

An Agent may engage a psychiatrist IME for the purposes of assessing the following:

initial and ongoing liability on a claim
psychiatric treatment
capacity/management of RTW.

An Agent may engage a psychologist IME for the purpose of considering:

a psychology or mental injury treatment review.

Video Conferencing (VC) appointments are available with psychiatrists through certain medico-legal companies for workers who:

live in a regional or rural location and/or
are experiencing barriers (including medical) in attending a face-to-face examination.

Please note: In every instance where a worker might benefit from a VC appointment (as noted above) workers must be provided with a choice between attending a face-to-face IME or a VC IME before a booking is made.

All mental injury IME bookings are to be made through WorkSafe’s centralised booking team.

IMEs for Conversion Disorder/Functional Neurological Disorder (FND)

Conversion Disorder, also known as Functional Neurological Disorder (FND), is a medical condition that is characterised by neurological symptoms that are inconsistent with neurological pathophysiology and disease.

Diagnosis of FND typically requires the expertise of a Neurologist to determine any physical cause for the symptoms, followed by a Psychiatrist. A neuropsychiatrist may also appropriately diagnose FND.

Agents should ensure an opinion in both fields (neurology and psychiatry) is obtained when making liability/entitlement decisions relevant to a worker with FND (or claimed FND). Agents may utilise both treating specialist opinions and/or IME opinions from the relevant fields to support decision making.

2.7.2.3 Select IME & schedule appointment

Once the required speciality of an IME has been determined, the Agent can select an IME and schedule an appointment.

Psychiatric & psychological examinations arranged by WorkSafe

From 14 August 2017 all psychiatric and psychological examinations must be arranged by WorkSafe through the centralised IME booking system. This applies even if the worker has seen a specific IME previously.

IME independence

When selecting an IME ensure the:

primary consideration should be to match the speciality of the IME to the worker’s injury, the medical treatment, RTW or claims issue to be resolved
See: Determine speciality of IME
selection of IMEs should be undertaken in a fair and equitable manner without preference to particular IMEs
Agent must not be motivated by the opportunity to obtain an opinion from an IME who is considered to hold particular views on specific medical conditions or treatment issues
Agent must not exert influence on the IME about the outcome of the examination report.

Agents must have governance and control processes in place to ensure that this is the case.

Note: Employers must also not exert influence on the choice of the independent medical examiner and process.

Arrange an independent medical examination

Consider the following when arranging an independent medical examination.

Urgency of the examination

Requesting an IME to travel

Requesting an IME to travel to a required location should only occur under exceptional circumstances. An IME is not to be paid for travel costs unless the Agent has requested them to travel away from their usual practice locations.

One off approvals

There is no provision for retrospective or ‘one off’ approvals of IMEs except where a need for an interstate independent medical examination has been identified.

Where an interstate IME is required, the Agent must contact the Health Strategy IME team before any referral is arranged.

2.7.2.4 Advise worker of appointment

Give the worker at least seven days' notice of the examination.

Contact the worker to:

advise of the date, time and location of the examination, ensuring this is suitable for the worker
inform them of the IME's speciality and explain why they are being requested to attend
explain the purpose of the independent medical examination
explain that it is likely that the IME will require the worker to be fully vaccinated against COVID-19 prior to a face to face examination and the worker will need to provide proof of vaccination, adhere to wearing a face mask and comply with the Victorian Government QR code check-in system
advise the worker that if the vaccination or IME imposed COVID Safe requirements are likely to be an issue, an alternative such as a telehealth appointment may need to be arranged
reinforce their obligation to attend and that non-attendance may adversely affect their entitlements
reinforce the requirement to notify the Agent if there are circumstances that impact their ability to attend (e.g. illness, changed circumstances or hospitalisation) and that such contact should be made where possible, at a minimum of 48 hours before the appointment
advise the worker that a history of their injury will be provided to the examiner (e.g. medical reports, x-rays and other relevant documentation about the worker’s injury)
advise the worker they can take additional supporting documentation documentation (e.g. medical reports, x-rays and other revelation documentation about the worker’s injury) to the appointment however, inform the worker that the IME is under no obligation to review any additional information provided on the day of appointment.

Neuropsychologist Independent Medical Examinations

If the worker is attending an examination with a clinical neuropsychologist, also provide them with the following information:

A neuropsychological assessment is conducted by a specialist psychologist trained in neuropsychology.
Neuropsychological assessments are designed to measure brain functions including:
- memory
- concentration
- behaviour
- planning ability
- ability to conduct tasks.
The assessment involves a discussion/interview where the worker will be asked questions about their injury and other background information.
The assessment may include psychometric tests or tasks including:
- puzzles
- questions
- problem-solving activities.
The potential duration of the appointment could be up to four hours, and there is an opportunity for the worker to take a break during the assessment if required.

Confirm appointment details in writing

The worker must be notified in writing confirming details of the appointment. The letter sent to the worker should confirm the following details:

date, time and location of the appointment
name of IME and contact details
speciality of IME
reason for attending the independent medical examination
remind the worker they can take additional supporting documentation to the appointment, however inform the worker that the IME is under no obligation to review any additional information provided on the day of appointment
attach a copy of the brochure titled ‘Independent Medical Examinations for Injured Workers’ which informs workers of what to expect and may address any concerns
a map reference or train station location for the examiner’s rooms.

Remind worker of appointment

The worker should be reminded with a minimum of 48 hours before the scheduled appointment. Cancellations outside of these same time frames may incur a cost at the Agent's expense.

If a worker indicates that they may not be able to attend, check back with the worker leaving enough time to cancel the appointment before a fee is applicable.

If the worker is unable to attend, advise IME as soon as possible to avoid a cancellation fee.

The time frames where an IME can charge a cancellation fee can be found on the relevant IME fee schedule and cancellation/non-attendance item code descriptions.

See: Cost of Independent Medical Examinations | Fees payable for cancellation

2.7.2.5 Send relevant documentation to IME

Send claims information documentation to the IME at least five business days before the scheduled appointment to allow for sufficient preparation time.

Only disclose the worker's personal and health information that is necessary and relevant to the purpose of the examination.

Information forwarded to an IME needs to be clear and accurate and all documents must be legible.

The IME should be provided with:

details about if and when that IME has previously examined the worker
any previous independent medical examination reports that are not outdated
any THP reports, surgical reports and assessor reports (with relevant passages highlighted) including GP letters or referrals to specialists and specialist's letters to GP
x-rays, scans and copies of radiology reports
requests for acceptance of liability for proposed surgery or medical treatment (when applicable to the purpose of the IME)
Novus Medical Advisor referral and recommendation (when applicable to the purpose of the IME).

Other information that may be relevant includes:

worker's pre-injury and/or current position description
employer information, including details of current return to work planning and arrangements including suitable employment, any worksite assessment details
copy of accounts, if medical expenses are being queried
relevant OR Occupational Rehabilitation provider reports (eg a worksite assessment report)
previous claims history
the worker's Claim for Compensation form and Employer Injury Claim form
Certificates of Capacity (possibly first and most recent).

If you are unsure of what to supply to the IME, speak to your Injury Management Advisor The Injury Management Advisor liaises with Case Managers and stakeholders to provide expert injury management advice to support the management of a worker’s compensation claim./Clinical Advisor.

Ask IME appropriate & relevant questions

Ensure the questions that the IME is required to answer are appropriate and relevant to the:

purpose of the IME
speciality of the IME
worker’s circumstances and claim.

If a question is asked that directly relates to a specific document, ensure this document is sent.

An IME should not be asked to provide an opinion on matters outside their area of medical expertise.

For example It would be inappropriate for an Agent to request a surgeon IME to advise about a worker's psychological injury or state

Note: Medical practitioner IMEs can charge a fee for pre-reading over 20 pages.

2.7.2.6 Multi-disciplinary (MD) IME

The purpose of the MD IME is to provide an independent medical opinion on a proposed elective spinal surgery request. These examinations include 2 specialised doctors (Pain Management Physician and Spinal Surgeon) who will provide a report to support the decision making process of a proposed spinal surgery request.

Documentation

The WorkSafe Clinical Panel Send claims information documentation to the MD IME examiners at least ten business days before the scheduled appointment to allow for sufficient preparation time. The Clinical Panel will provide the Letter of Instruction template for the Agent to complete, and communicate with Agents to obtain any missing clinical information.

Only the worker's personal and health information that is necessary and relevant to the purpose of the examination should be disclosed.

Information forwarded to the MD IME examiners must be clear and accurate and all documents must be legible.

The IME should be provided with:

Surgery request
GP letter to surgeon/surgeon letter to GP discussing clinical symptoms and proposed surgery
X-Rays, CT’s, MRI’s (including bone scans), radiology report - all relating to spinal surgery. Please note workers should be advised they need to take physical copy (pictures) of their imaging/x-rays/scans etc. which could include film, disk or USB format.
any THP reports, surgical reports and assessor reports (with relevant passages highlighted) including GP letters and the specialist's letters to GP.
previous IMEs that the worker has attended within the last two years or latest IME report on file
Pain Management Program report (if applicable)
past post-operative reports regarding previous spinal surgery (if applicable).

Important information

The Agent is to advise the worker to take the physical X-Rays, CT’s, MRI’s (including bone scans) relating to spinal surgery on either film, CD or USB to appointment.
Examiners must see actual imaging, reports alone are insufficient to confirm diagnosis
MD IME examiners can propose alternative treatment options. Agents must send the recommendations to the treaters for review and advise worker.

2.7.2.7 Addiction Medicine Specialist (AMS) IME

Addiction Medicine Specialists (AMS) provide comprehensive care and review of people with a wide range of addiction disorders including drug and alcohol addiction, and pharmaceutical dependency. AMS IMEs provide expert opinions and recommendation(s) on a worker’s pharmaceutical dependency funded by the scheme, taking into consideration the worker’s injuries, psychological/psychosocial status and pain management.

Documentation

Agents should send claims information to the IME via the WorkSafe Clinical Panel at least ten business days before the scheduled appointment to allow for sufficient preparation time.

Only the worker's personal and health information that is necessary and relevant to the purpose of the examination should be included.

The IME should be provided with clear, legible and accurate documentation including:

GP letter
medication summary
any THP reports
previous IMEs that the worker has attended within the last 18 months or latest IME report on file.

2.7.2.8 Independent medical examination reports

The IME will prepare and send a report to the Agent within 15 working days of the examination.

Once the report is received, the Agent should review the report to ensure it addresses the questions asked.

Quality of report

Adequate

Where the IME report adequately addresses the questions asked, the Agent should action the report accordingly within seven working days of receipt.

Not adequate

Where the IME report does not adequately answer the questions that were asked, the Case Manager may:

consult with a suitably qualified person or Medical Advisor to interpret the report and the findings
return the report to the IME to complete the report to the service standard required
refer to WorkSafe where the Agent is not able to resolve the issues with the IME.

The Agent should also refer to WorkSafe (provider@worksafe.vic.gov.au) where the IME report does not meet the minimum service standard requirements for IME reports.

Send IME report to THP

Agents must provide a copy of the IME report including any supplementary reports to the THP except where:

the worker has requested that the report not be sent
the IME report would be exempt from release (eg where the IME has commented on surveillance in the report, the IME report would be considered an internal working document and exempt from release).

See: Exemptions from access to information

2.7.2.9 Verbal/interim reports

An Agent may request an IME to provide a verbal or interim report before receiving the final written IME report.

An interim report could be used where it would help the Agent in preparation for determining liability or the most appropriate medical treatment.

Unless exceptional circumstances exist, a verbal or interim report should not be relied upon for decision making purposes. A decision taking into account the IME advice should only be made once the full and final report is received.

Fee charged for interim report

An interim report is considered additional information to that of the IME examination and report. The IME can charge a fee to provide a verbal or interim report subject to Agent approval.

See: IME fee schedule

2.7.2.10 Supplementary reports

A supplementary report:

is a formal request for an IME to provide information additional to that initially requested or to answer additional questions not initially asked in respect of a worker
does not require the IME to re-examine or contact the worker to provide the additional information and
must also meet the same minimum service standards as a regular independent medical examination report.

Requesting a supplementary report

In determining whether to obtain a supplementary report, Agents should consider:

the length of time since the worker was examined
the nature of the additional information required

Where it has been more than six months since the original independent medical examination, the Agent should:

seek the IMEs advice as to whether they could provide a supplementary report or would need to re-examine the worker
confirm that the IME is still approved by WorkSafe - if not, the practitioner can only provide a supplementary report within 12 months of having examined the worker

Note: Under no circumstances is the practitioner permitted to re-examine a worker. If re-examination is required an approved IME must be selected.

When not to request a supplementary report

A supplementary report should not be requested where:

a previous report has not adequately addressed the questions asked by the Agent (ie questions not answered or do not make sense) or
the report is of poor quality.

See: Complaints against IMEs

2.7.2.11 Frequency of independent medical examinations

An Agent may require a worker to attend an independent medical examination at reasonable intervals.

WIRC s27(1)

Determine reasonable examination frequency

When determining the frequency of an independent medical examination, Agents should consider:

the interval between examinations is in line with worker’s injury (type, circumstances, severity and stability)
the need for ‘independent’ medical information to manage liability and entitlement issues in the context of a worker’s recovery, rehabilitation and RTW strategy.

More frequent examinations may be required where, for example:

there is an unstable injury
a change in circumstances or diagnosis.

The Agent must review available claim file information in consultation with the worker’s THP before organising any further independent medical examination to determine if the interval since the worker's last independent medical examination is reasonable.

2.7.2.12 Court proceedings

Panel firm providing advice

Where legal proceedings have not started but a panel firm is providing advice on claims management, Agents should liaise with the panel firm to identify if there are medical/liability issues the panel firm would like answered by any upcoming independent medical examination. A separate independent medical examination should not be arranged for 'legal' purposes.

All recommendations regarding 'reasonable intervals' apply in these circumstances unless the Claims Manual indicates otherwise.

See: Dispute Resolution

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