What happens at an independent medical examination.

A letter asking you to see a doctor you have never met, chosen by the people managing your claim, can feel like a test nobody prepared you for. An independent medical examination (IME) is an assessment rather than treatment: a specialist reads your file, asks about your injury, examines you where that is relevant, and writes a report that answers questions from whoever arranged the appointment.¹ Knowing who asked for it, what the doctor has already read and where the report goes makes the day much easier to follow.

This guide draws on the official material from three schemes: WorkCover Queensland, WorkSafe Victoria and Comcare, which manages claims for Australian Government employees. The rules differ by scheme and by state, and other insurers have their own, so the letter you receive and the person managing your claim are the final word for your situation.

The insurer arranges the examination to answer questions about your claim

Most people meet an IME through a workers' compensation, motor vehicle or other injury claim. The organisation managing the claim books the appointment, and WorkCover Queensland explains that it does so to get more information, or to clarify parts of your injury or illness, so that it can make decisions about the claim.¹ Its fact sheet lists the common reasons as:

• deciding whether to accept a claim;
• understanding your injury and your treatment options;
• deciding whether to fund surgery or other treatment that has been requested;
• working out what work you can safely do while you recover;
• deciding whether a claim should continue or stop.

The doctor is chosen for expertise in the kind of injury or illness you have. In Queensland they work in their own private practice and are not employed by WorkCover, and the fact sheet puts their limit plainly: they give an independent medical opinion and make no decisions about your claim.¹ The decision stays with the organisation that manages the claim.

Attending is generally part of having a claim. Comcare tells employees that they must attend, that it asks only once it has run out of other ways to get the medical information it needs, and that compensation may be suspended if someone fails to attend or obstructs the examination without a reasonable excuse.² If you cannot make the appointment, WorkCover Queensland and Comcare both ask you to tell them as early as you can.¹²

The doctor has read your file before you arrive

Before the appointment, the insurer sends the examiner the medical reports and other information it holds about your claim.¹ In Victoria, the standards for examiners require the doctor to read every document sent with the referral, including medical, imaging and test reports, and to ask for more if something needed is missing.³ That file can be long, because it gathers letters from your GP and specialists, hospital notes, scan reports and therapy records from the whole course of your claim.

The referral also arrives with questions. The organisation that booked the appointment writes down what it needs answered, often about the diagnosis, the treatment you need or the work you can do, and Victoria's standards require the report to answer every question it was asked.³ Those questions shape the appointment, which is why the letter of instruction matters so much to the report that follows.

Because the file comes from many sources, parts of it can disagree with what you tell the doctor. Victoria's standards deal with this directly: the examiner must tell you about any inconsistencies in the referral material, such as a statement from your employer or surveillance material, and give you the chance to respond during the examination.³

The appointment is an assessment, so the doctor will not treat you

The Medical Board of Australia's code of conduct recognises that the usual relationship between a doctor and a patient does not exist when a doctor is paid by a third party to assess someone. It still requires the doctor to be courteous and alert to your concerns, to get your consent to the assessment and any physical examination, and to explain their area of practice, their role, and the purpose, nature and extent of the assessment.⁴ If the doctor finds a serious medical problem that nobody had recognised, the code says they have a duty to tell you or your treating doctor.⁴

The appointment can look like a long consultation, with the important difference that the doctor gives no advice or treatment. They may ask how the injury happened, what treatment you have had and how it affects your daily life, including questions your own doctor has already asked.¹ Comcare notes that the examination may take as long as an hour and need not be limited to the injured part of your body,² while WorkCover Queensland says some examinations are long and others very short.¹

Victoria's standards set out what you can expect in the room, and they are a useful picture of good practice anywhere:³

• at the start, an explanation of the purpose of the examination, the doctor's role and specialty, and the fact that the findings will go in a report to your case manager;
• a gown or other covering if you are asked to undress, with the doctor leaving the room or looking away while you do;
• a warning before any part of the examination that may cause discomfort or pain, with the reason it is needed;
• no comment on what the report will say, because the doctor must not tell you their findings or recommendations at the appointment;
• an audio or video recording only if both you and the doctor agree to it.

Those standards apply to examinations in the Victorian scheme, while the code of conduct applies to every registered medical practitioner in Australia.⁴ WorkCover Queensland's own advice for the appointment is to be open and honest so that the doctor has a complete picture, and to wear loose, comfortable clothing in case the doctor needs to examine an injury.¹

Support people, interpreters and travel costs depend on the scheme

The practical arrangements are where the schemes differ most, and the table below sets out what each one's official material says. Where a document is silent, the person managing your claim can tell you what applies.

A psychiatric examination usually works differently. WorkSafe Victoria notes that people attending one will normally be seen without family or friends, because of the personal and private nature of the questions.³ Comcare makes a similar point for any examination, suggesting that a companion may be more comfortable waiting outside because the doctor may ask personal questions. It also asks people not to bring children into the examination, and warns that arriving late can be treated as not attending.²

The report goes to whoever asked for it, and you can ask to see it

After the appointment, the doctor writes the report and sends it to the organisation that arranged the examination. In Queensland that usually happens within two weeks, sometimes after the doctor has referred you for scans or tests, and WorkCover may forward the report to your regular doctor to help with decisions about your treatment.¹

How you see the report depends on the scheme. WorkCover Queensland says that if you would like to see it, you can ask, and it will send the report to your doctor to discuss with you.¹ Victoria's standards note that reports are also provided to your treating practitioner, may be provided to you, and may be requested under freedom of information law.³

The report must be impartial,⁴ and in Victoria it must give reasons for every opinion and keep to professional opinion, without telling the insurer what decision to make unless it was asked a specific question about that.³ The examiner should not become your treating doctor afterwards either, because WorkSafe Victoria regards that as a conflict of interest.³

If you have a concern about the examination, raise it

If you believe the examination was not conducted professionally, start with the organisation that booked it. Comcare, for example, asks people to contact their claims manager, phone 1300 366 979 or use its online feedback form, and says it will investigate.² If you disagree with being asked to attend at all, Comcare lets you ask for that decision to be reconsidered.²

A concern about a doctor's professional conduct can also go to the health practitioner regulator. Ahpra receives these concerns in most states and territories, while in New South Wales they go to the Health Care Complaints Commission or the Health Professional Councils Authority, and in Queensland to the Office of the Health Ombudsman.⁵

The examiner's job is narrower than it can feel on the day

An IME can feel high-stakes, because the doctor is a stranger, the file is long and the report goes to someone else. The examiner's role is written down, though: read the file, explain who they are and why you are there, examine you with your consent, and answer the questions they were sent impartially, while the decision about your claim stays with the organisation that manages it. Your appointment letter and the person managing your claim can answer anything this guide has not covered.