When you lodge a workers’ compensation, motor vehicle accident, or personal injury claim in Queensland, you’ll probably hear the term independent medical examiner. During the course of any compensation claim it’s normal to receive a letter that requests an independent medical examination, but if no one has explained this you might be left feeling nervous or unsure. You haven’t done anything wrong; this is just a step in the compensation process that helps the insurer to assess your claim.
An independent medical examiner is a medical specialist such as a doctor, psychologist, or allied health professional who is appointed to assess a claimant’s injuries or condition. They’re often engaged by insurers, defendants or their legal representatives. As their role is to provide an objective medical opinion, their report can have a significant impact on your compensation claim outcome.
When is an independent medical examiner used in Queensland?
An independent medical examiner may be used across a range of compensation cases, including:
You may be referred to an independent medical examiner if there isn’t enough information from your treating doctor, an assessment of permanent impairment is required, the insurer requires an opinion in response to your own medical examination report, or clarification is required to resolve any conflicting opinions on medical treatment.
The examiner may be requested to assess the extent of your injuries as well as your ability to work, ongoing treatment needs, and whether your accident is a result of the incident (e.g. working conditions or a car accident).
Even if you have a dedicated medical professional, an insurer, employer, or legal team may still request that you attend an appointment with an independent medical examiner. This is not to provide treatment, but to help guide decisions about your claim with information from an objective doctor. When your lawyer refers you to an independent medical examiner, this is to ensure they are able to build your case to attempt to ensure that you receive the full compensation you’re entitled to.
If an independent medical examination is requested, you will need to attend for several reasons. These include providing objective information for:
- claim acceptance
- a better understanding of your condition and treatment requirements
- confirming whether an insurer should fund requested surgery and treatment
- identifying work capacity and safety during recovery
- an estimate of how long the injury or condition effects will last
- Providing medical assessments to assist in assessing damages in your claim.
Psychological injury claims
Independent medical examinations are often requested for psychological and mental health injury claims. This is to provide an objective diagnosis, assessing the severity of your mental health condition, and to determine the contributing factors. For more information about this type of claim, read our guide for psychological injury at work.
How is an independent medical examiner selected
The independent medical examiner selected for your case will be a specialist with qualifications relevant to your injury or condition. If it is requested by an insurer, they will pay the cost of the examination. If your legal representative requests an independent medical examiner, they will either pay or you will pay up front and be reimbursed by the insurer later.
What to do if you’ve been asked to attend an independent medical examination
If an independent medical examination is requested, you are legally obligated to attend. You’ll need to confirm the appointment as soon as possible, take documentation relevant to your condition such as medical and work history, and have information ready about what caused the injury. We also recommend talking to your lawyer to help prepare you for the appointment.
What does the appointment involve?
During your appointment the independent medical examiner will review relevant information and examine your injuries or condition. They will ask you a range of questions about your medical and working history, what caused your injury or illness, and how it is affecting your life now. They won’t provide any advice about treatment or opinions about your injury as their role is to document information for the claim process. After your appointment, the examiner will prepare a report outlining their findings and provide it to the party who requested the assessment.
What if their report isn’t fair?
While independent medical examiners provide objective opinions, sometimes questions may be raised about report findings. It’s important to know that you have the right to request a copy of the report, and your regular treating doctor can respond to it if necessary. Your lawyer will also review the report to assess how it will affect your claim and determine whether it should be disputed, further questions posed or a further responding report obtained.
An example is if the report determines that you are ready to return to work by a certain date when you’re not. If you are worried about your recovery and feel like you’re being forced back to work too soon, talk to your doctor to see what options are available to you. If this is in the context of a damages claim, speak to your lawyer.
Receiving a request for an independent medical examination might feel daunting, but understanding the process makes you realise it’s another part of the process. The goal is to move your claim forward with an objective assessment. The most important thing is to talk to your lawyer, prepare with medical records and work history, report and respond to all questions consistently and obviously be honest during the appointment.