Independent Medical Examinations

Information for employers and workers

An independent medical examination provides an independent opinion about a worker’s injury and treatment to assist with decisions about recovery and return to work and entitlements to compensation.

An independent medical examiner (IME) is a medical specialist with qualifications relevant to a worker’s injury. They are not employed by ReturnToWorkSA or the claims agent, and they cannot treat or offer to treat the worker.

Do they replace a worker’s treating doctor?

An IME does not replace the worker’s treating medical practitioners. An IME reviews the worker and provides independent opinion about the work injury.

Why may an independent medical examination be necessary?

It may be necessary:

• to obtain information not available from the treating doctor; or
• to provide an opinion about issues raised in discussion with the worker’s treatment team; or
• In preparation for a future assessment of permanent impairment.

NB: an independent examination is not for the purposes of assessing permanent impairment entitlements.

Who pays for the independent medical examination?

ReturnToWorkSA, its claims agents or a self-insured employer will pay for the independent medical examination any necessary costs, reasonably incurred of attending the examination (e.g. travel).

Who makes the referral?

ReturnToWorkSA, its claims agents or a self insured employer will make the referral. They will select an appropriately qualified medical specialist with expertise in the worker’s injury.

Before the examination a referral will be sent to the IME containing information and questions necessary to better understand the extent of the injury or illness and how it impacts on work. Those questions include things like:

• the relationship between an injury and employment;
• past and present medical history as it relates to the work injury;
• the cause of the injury or condition;
• any associated conditions;
• how the injury impacts the worker;
• current treatment and its effectiveness.

NB: a worker’s legal representative may also refer for an independent examination.

Can the examination be via telehealth

The examination must be face to face with the IME. Telehealth examinations are not appropriate for independent medical examinations.  An exception may be made if the worker has a psychiatric injury and requires and independent medical examination.

What are workers required to do?

Workers are required to attend the independent medical examination. Refusal to participate or not attend may impact on their entitlements to compensation.

When preparing for the independent medical examination the following things are important for a worker to remember, such as:

• confirming the appointment with the referrer and discussing any special needs such as an interpreter; and
• wear comfortable and appropriate clothing for the examination;

What happens during an independent medical examination?

The IME is required to conduct the examination in a respectful and professional manner, making all efforts to preserve modesty and not exacerbate the work injury or cause pain. Workers are not expected to undertake any activity that cannot be done safely during the examination.

Workers can bring an adult support person. They should not answer questions or contribute to the examination unless there is difficulty communicating or physical assistance is required.

What is an independent medical examination report?

The IME will produce a report based on examination of the worker, and the information provided by the requestor.

The report will be provided to the worker and, upon request, their employer and treating doctor.

What is the process for providing feedback or making a complaint?

To make a complaint or provide feedback about any aspect of the independent medical examination experience the first step is to speak with the referrer, usually the claims agent. If matter remains unresolved there are instructions here- external site about making a complaint  or call ReturnToWorkSA on 13 18 55.

More information about independent medical examinations for workers can be found here- external site