Questions rising on unethical insurer behaviour

The federal workers compensation system is rough for unrepresented claimants. For workers who have sustained psychological injury, the process can be particularly difficult and often re-traumatising.

Workers who have made a claim for compensation benefits inevitably need to attend assessments arranged by the insurer with doctors chosen by the insurer. These appointments are known as Independent Medical Examinations (IME’s). The doctor will provide a report which has significant impacts on a worker’s claim for compensation benefits.

A recent investigation by the ABC was conducted in relation to the behaviour of psychiatrist who were retained by the commonwealth insurers to assess workers who had alleges a psychological injury.

Importantly, it was reported some psychiatrists who have been appointed by the insurer in the Comcare Scheme have been the subject of longstanding complaints including allegedly bullying workers who have brought a claim, and that workers are in general being sent for an unreasonable number of IMEs.

This leaves already damaged workers in a particularly vulnerable position.

Under the Comcare scheme, a worker making a claim must attend these medical assessments when they are arranged by the insurer. Failure to attend an appointment without a reasonable excuse may result in the workers entitlements being suspended. Workers may also incur an adverse costs order against you as a result of non-attendance

In principle there is a very good reason why insurers should be able to send workers to an IME: they need information about the injury, its cause and associated disabilities, need for treatment, ability to re-train or return to work in order to properly manage the claim.

These doctors should be reliable, after all they have an obligation to be impartial. They should adhere to the Expert Witness Code of Conduct which imposes a duty to provide independent assistance and unbiased opinions, they cannot be an advocate for either party.

However, in practice, a worker who has suffered a psychological injury is particularly vulnerable to an aggravation in their condition. They need a level of support. IMEs are inherently invasive and require workers to go through the events which caused the condition and the extent of their disabilities. This can be traumatic at the best of times, especially for workers who are already distressed.

These are the workers who would most benefit from genuine support of an insurer to assist their rehabilitation, support their treatment needs, and, if possible, help them to return to some kind of employment. The increased scrutiny of psychological claims may in fact be impairing the ability of these workers to properly manage their injury.

Often, a quicker, easier, cheaper, and less invasive alternative is for the insurer to obtain evidence from the treating doctors (such as treating GP, psychologist and/or psychiatrist). This ought to be the first preference. However this can’t always be managed and there are circumstances where an IME is required, is entirely appropriate, and cannot be avoided.

If you have been referred for an Independent Medical Examination by an insurer and have concerns in relation to attending, we recommend that you speak with your lawyers.

If you or someone you know needs advice about the Comcare scheme it is important to talk to our personal injury team at Kells. We can help you know where you stand and navigate the system.

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