Worker’s compensation NSW: What is an independent medical examination (IME)?
When you’re on worker’s compensation in NSW, you will need to undergo an independent medical examination (IME) from time to time. This may be arranged by either the insurer and/or the solicitor acting on your behalf. The purpose of this blog is to help you understand what an IME is.
What is an independent medical examination?
An IME is an examination conducted by a State Insurance Regulatory Authority (SIRA) approved independent medical examiner, who is a specialist with qualifications relevant to your workplace injury. For example, this could be a neurosurgeon, psychiatrist, an ears, nose and throat specialist.
An IME may be required to provide an independent medical opinion regarding:
- the diagnosis of your workplace injury;
- causation of your workplace injury;
- your capacity to work
- your need for reasonably necessary medical treatment; and
- what your level of whole person impairment is arising from the injuries you sustained at work.
It is very important to understand that an independent medical examiner does not replace your nominating treating doctor regarding treatment of the injuries you sustained in your workplace accident. As a result, they are not permitted to provide you with medical treatment when you see them for your worker’s compensation claim. They are also not allowed to offer to treat you as a patient of theirs.
Upon seeing the independent medical examiner, they will provide the insurer and/or your legal representative with a medico-legal report which will set out their medical opinions regarding your workplace injury.
When will I need to attend an independent medical examination?
When you get injured at work, you will be required to attend an IME from time to time for both the insurer and/or your legal representative of your worker’s compensation claim. You are required to attend an IME:
- When the insurer is determining whether it will formally accept or decline liability for your worker's compensation claim. You can read more in our earlier blogs:
- When the insurer is determining whether it will approve a request for reasonably necessary medical treatment expenses (such as surgery). You can read more in our earlier blog:
- When the insurer would like to obtain an update regarding your recovery to work and/or your capacity to work.
- When you have instructed your legal representative to challenge an insurer’s dispute notice (section 78 notice) and/or work capacity decision.
- When you have instructed your legal representative to investigate and lodge a permanent impairment claim with the insurer. You can read more in our earlier blog:
Do I need to attend an independent medical examination?
In short, the answer is YES.
If you do not attend a scheduled IME, the insurer can take the necessary steps to stop your weekly compensation payments. It can also cause unnecessary delays in your matter.
If you fail to attend an IME for your legal representative, you may be liable to pay a non-attendance fee.
What are my rights when asked to attend an independent medical examination?
Under Part 7 of the Workers Compensation Guidelines, the insurer is required to do the following when it comes to organising and/or notifying you of your IME appointment.
- The insurer is required to give you a choice of three (3) independent medical examiners to choose from. If you fail to notify the insurer of your choice, it has the right to choose an IME of its choice.
- The insurer is required to notify you in writing of the IME appointment at least 10 working days prior to the examination taking place. Additional notice should be considered for regional or rural workers. If a shorter time is required due to unavoidable or exceptional circumstances (e.g. an urgent request for treatment), this reduced timeframe must be agreed upon by all parties.
- In the written notice, the insurer is required to provide:
- specific reasons for the examination;
- date, time, and location of the appointment;
- name, specialty and qualifications of the IME;
- contact details of the IME’s offices and appropriate travel directions;
- likely duration of the IME examination; and
- what to take (x-rays, reports of investigations/tests, comfortable clothing to enable an appropriate examination to be conducted).
- The insurer must allow you to be accompanied by a person other than your legal representative. This person, however, cannot participate in the IME and may be required to leave the IME if requested.
- The insurer must notify you when it is the independent medical examiner’s routine practice to record the IME on audio or video and that you must either consent or decline this before the IME takes place.
- The insurer is required to pay for any reasonable costs in attending the IME appointment (including but not limited to wages, travel, and accommodation). This may include pre-payment of travel and accommodation expenses. If you are unable to travel unescorted, this may include expenses for someone to accompany you.
- The insurer is required to meet any special requirements relating to gender, language, or culture.
If the insurer does not comply with all of the above, you are entitled to lodge a complaint with the Independent Review Office on 139 476.
Who will pay for the independent medical examination?
If the insurer requires you to attend an IME for the purposes of your worker’s compensation claim, it will pay for the cost of the medico-legal report.
If your legal representative organises for you to attend an IME for the purposes of challenging the insurer’s dispute notice and/or investigating your permanent impairment claim, the cost of the medico-legal report is paid by the Independent Review Office IRO.
In very rare instances, you may be required to pay for a medico-legal report upfront and be reimbursed by the insurer at a later date. It is very important to note that should this occur, the IME is only permitted to charge for the cost of their medico-legal report in accordance with the Workplace Injury Management and Workers Compensation (Medical Examinations and Reports Fees) Order 2024 (which is renewed each year).
What will happen during the independent medical examination appointment?
The independent medical examiner is required to review the letter of instruction and relevant information provided by the insurer and/or your legal representative. They are also required to obtain information from you and conduct a medical examination.
At the IME medical appointment itself, the examiner may ask you to provide them with the following information:
- your past and present medical and work history;
- any treatment you have received, are receiving or are considering;
- what caused your injury; and
- how your injury affects you now.
The examiner needs to understand the extent of your workplace injury or illness and how it is affecting your life. It is important that you cooperate as much as you can with requests for information. Be straightforward and clear; don’t worry if you forget anything during the interview. Just do the best you can.
What happens once I have attended the independent medical examination?
After you have attended the IME appointment, the independent medical examiner will provide their medico-legal report to the insurer and/or your legal representative. Upon receipt, the insurer will provide a copy of the medico-legal report to your nominating treating doctor.
You (or your nominee, e.g. your lawyer) can request a copy of the medico-legal report, together with copies of the supporting documents that were provided to the examiner (if it is relevant to a decision made by the insurer to dispute liability for your worker's compensation claim and/or reduce your weekly compensation payments).
What can I do if there are problems during the independent medical examination itself?
If you are not happy with anything during the IME itself, you should communicate your concerns to the independent medical examiner immediately.
If you are not able to resolve your concerns with the independent medical examiner, you should ask for the medical examination to stop so that you can speak to the insurer and/or your legal representative.
If you wish to make a complaint about an independent medical examiner, you can contact any of the following:
- the referrer (i.e. the insurer and/or your legal representative)
- SIRA Customer Service Centre on 13 74 72;
- your Union;
- the Health Care Complaints Commission;
- the NSW Medical Board; or
- the Australian Health Practitioner Regulation Agency.
Get help from a worker’s compensation lawyer?
If the insurer has arranged for you to attend an IME, you should seek legal advice to ensure that it has complied with its obligations and to discuss the potential impacts that may arise in respect of your worker's compensation claim.
Similarly, if you have any questions regarding the IME process, you should contact your legal representative before your scheduled medical appointment to give yourself time to obtain answers to any queries you may have.
Contacting Hall Payne Lawyers
You can contact us by phone or email to arrange your consultation; either face-to-face at one of our offices, by telephone or by videoconference consultation.
Phone: 1800 659 114
Email: general@hallpayne.com.au
This article relates to Australian law; either at a State or Federal level.
The information contained on this site is for general guidance only. No person should act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your particular circumstances. For further information, please do not hesitate to contact Hall Payne Lawyers.
Get in touch with today's blog writer:
Alexandra Rogers