Medical examinations

When there is inconsistent or insufficient medical information on the claim to make a decision, your claims manager may determine that you are required to attend an independent medical examination with a legally qualified medical practitioner (LQMP).

Comcare will only arrange for an independent medical examination when all other methods of obtaining the required medical information have been exhausted. The claims manager first considers the information on your claim file and information they are able to obtain from your treating medical practitioners. 

Before booking an examination

Prior to booking the examination, your claims manager will contact you to discuss the examination. They will discuss with you:

• the purpose of a medical examination and why it is required
• the type of speciality the medical examiner will need to conduct the examination
• the selection of the best suited medical practitioner to conduct the examination
• your availability to attend the examination including the location, date range and preferred time of day
• considering the nature of your medical condition, your preference in deciding between a face-to-face or video examination
• there may be practical considerations or medical preference as to how the examination is undertaken and your claims manager should indicate if this is the case
• if a face-to-face assessment is required, any mobility restrictions and/or transport needs you have in accessing medical assessment
• if a video examination is required, ensuring appropriate technical support is provided
• your preferences around having a chaperone, support person or interpreter present (note there will also need to be consideration of the nature of the assessment and the requirements of the independent medical examiner and the claims manager)
• your preferences around the choice of the medical examiner, including cultural preferences.

If you disagree with Comcare's selection of the medical practitioner/s to conduct the examination, you must provide your views in writing or verbally within 3 calendar days from the date of the request.

Frequency of examinations

Comcare cannot ask you to attend a medical examination for the same injury or disease more often than once every 6 months. There are some exceptions, including when:

• another medical practitioner has recommended a further examination or re-examination
• there has been a change in the 'employee's circumstances' as defined in section 4 of the Guide
• the injury requires multidisciplinary medical treatment (i.e. a complex case) and it is appropriate for us to require you to undergo more than one examination, with a different medical practitioner
• the assessor fails, for any reason, to provide a written report
• a request for a reconsideration of a determination is made but a reviewable decision in response to that request has not yet been made
• an application for review of a reviewable decision is made to the Administrative Review Tribunal (ART) but a final decision has not yet been made
• you do not undergo the examination or obstruct the examination
• you or your treating practitioner request an examination.

Attending your examination

Once the booking has been made, your claims manager will send a section 57 medical examination determination which includes:

• the details of the booking including location, time, and the LQMP doing the assessment
• the purpose and reasoning of the medical examination and the choice of the examiner
• your rights and obligations relating to the examination
• information regarding your attendance at a medical centre.

In the rare instances where long distance travel is required in order to attend a medical examination, the letter may include information about travel assistance such as providing details of flights and accommodation booked on your behalf.

Comcare will reimburse you for the cost of any reasonable travel expenses that you may incur in relation to your examination with the medical practitioner.

Please advise your claims manager if due to your compensable condition, you will be taking an escort with you to the examination or if you require a translator.

The medical report from your treating practitioner or from the independent practitioner usually addresses a set of questions asked by your claims manager. Your caims manager may seek support from clinically trained Comcare staff around these questions.

Your claims manager uses the information in the report to determine liability and assist you to return to health and work.

Your rights in relation to a medical examination

If you disagree with the claims manager's determination that you are required to attend a medical examination, you may request a reconsideration of the determination. If you disagree with the reconsideration of the determination, you may ask for review at the ART.

If you have a complaint about your examination

You can contact the person that referred you to the examination (usually your claims manager or rehabilitation case manager). You can also call Comcare on 1300 366 979 and ask for the Complaints and Feedback team or submit written feedback to Comcare via the online form or by emailing feedback@comcare.gov.au

Other options for raising your complaint include:

• Raise your complaint directly with the independent medical examiner, or their clinic.
• If your appointment was managed through a medico-legal provider, you can raise your complaint with the provider.
• If you have a complaint about the medical practitioner's behaviour, such as a concern that their behaviour is placing the public at risk, they are practicing in an unsafe manner or their health may be affecting their ability to make safe judgements about their patients, you may raise your complaint through the Australian Health Practitioners Regulation Agency.

For further information regarding medical examinations, please visit Scheme guidance - Section 57 power to require a medical examination under the SRC Act.