Getting an Independent Medical Opinion for Workers Compensation

Published by Marshall & Gibson Lawyers on the 15 April 2015

If and when there comes a time you are injured at work and you’re considering making a claim for workers compensation, it may be necessary to seek an independent medical opinion. There are several reasons you may seek a medical expert opinion, such as your legal representative requiring a copy, your insurance company asking for another opinion, or WorkCover itself may ask for an independent assessment. What’s important to know is that getting the right independent medical expert can make a difference to your claim. It can determine your insurer’s ongoing liability, can impact upon the treatment you receive, and can even affect the level of support you may receive in your employment.

Some common questions are:

  • What is an independent medical opinion in a workers compensation case?
  • Where do you find an independent medical expert?
  • What happens when the expert is instructed?
  • How does it apply to your workers compensation case?

What is an independent medical expert and how do you find one?

The Australian Health Practitioners Regulation Agency (AHPRA) has a list of registered medical specialists. These specialists are generally experts that Workcover requires to examine you, and then they provide their medical report. In addition, you, your insurer, or a legal representative can also hire an independent medical expert from this registered list.

It’s important that you identify the relevant medical specialist for your injury so you can be properly diagnosed. As the expert is independent, this means the specialist medical expert should not be employed by the Workcover of your state. In that way, you can be more assured that the opinion provided is not one that has any potential of bias toward one party, and will consider and examine your injury objectively and impartially.

Be certain to check the credentials and experience of the expert you choose, however if they are registered as a medical expert with AHPA they generally do have the relevant credentials required.

What happens once an independent medical expert is instructed?

If a medical expert is to examine you and Workcover is arranging for that examination, then it’s likely that you will be contacted by the caseworker allocated to your claim. The caseworker should discuss with you what are some suitable dates for your examination, and to outline what will take place in the examination. If you have any questions, it’s important that you feel free to ask them. If you don’t ask: you’ll never know. Your caseworker should then arrange the examination appointment on your behalf. If you have had any previous examinations done or X-rays or MRIs etc., you should bring all of that material to your examination.

Once you are told when your examination will be, it’s crucial to meet that appointment. If you miss it without a reasonable excuse and without an appropriately timed cancellation, it could affect your workers compensation claim. It could even mean your payments are terminated or suspended until such time as you are examined again.

What does the independent medical expert do?

Independent medical experts are not there to provide advice to you or Workcover about your workers compensation claim. Their role is limited to their area of expertise, which is examining you, reviewing your medical condition, and providing an objective report of what they consider ongoing treatment of your injury ought to be. In providing this report, they will likely also provide an opinion on the time necessary for your recovery, when you could go back to work and, if you do, your ability to take on employment in the same context in which you left it.

What happens during the medical examination

If and when you do attend a medical examination, the expert should explain the purpose of the examination and their role within it. If they don’t, be sure to ask them about this.

You will likely need to provide them with test results of any outside tests you have had conducted on your injury, as well as any other medical reports you may have.

The examination is usually a bit more thorough than you may expect. You will likely be expected to discuss your medical history of your injury. Most importantly, you will have to cover how you became injured, your role and responsibilities in your employment at the time you were injured, your expectations as to when you would like to return to work, and in what capacity you would like to return. Any past medical history may be explored (depending on the nature of the injury), as well as any past psychological history or treatment (again depending on the nature of your injury).

The independent medical expert may require you to undergo further tests before they are in a position to finalise their report. If the expert is instructed by Workcover or an insurer, your consent will be required first but you should understand that if you don’t consent to the test then that may affect your workers compensation claim.

How will the independent medical expert affect your workers compensation claim?

As mentioned above, if you do not turn up to the appointment arranged for you or if you do not consent to any further tests required of you by the expert then this could result in a suspension or termination of your workers compensation payments.

Once the examination is finalised, the medical expert drafts their report and forwards it to you, your insurer, and (if applicable) the legal representative of the Workcover of your state.

This report will provide an opinion of your injury, the diagnosis, how you can be treated on an ongoing basis, and what capacity you may have to return to your previous duties in your employment. It will also include whether that role has to change because of a reduced capacity or whether, and what support can be put into place to allow you to return to your old job with the same responsibilities.

The report and opinion will shape your workers compensation claim. It will ultimately determine how long you ought to remain away from work, and when you can return.

Hiring an independent medical expert opinion can be the key player in your workers compensation claim. Often if you instruct a specialist legal team who have experience in workers compensation law, they will have the know-how to arrange for a medical expert to examine you. This means that you can have first access to an opinion with which to determine the strength of your workers compensation claim.