Independent medical examiners
Information for legally qualified medical practitioners, or medico-legal providers, engaged to provide independent medical examinations under sections 36 and 57 of the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).
What are independent medical examinations?
Independent medical examinations have two key functions:
- To support a claims manager to obtain additional information and medical evidence in relation to an employees’ claim. These examinations are made under Section 57 of the SRC Act
- To support a rehabilitation authority (employer) to better understand an employees’ capacity to engage in a rehabilitation program. These examinations are made under Section 36 of the SRC Act.
In both cases the independent medical examination is intended to facilitate a safe and effective return to health and work for the employee.
Independent medical examinations are usually provided by legally qualified medical practitioners (general practitioner or medical specialist).
If you are an employee, see medical evidence to find out more about independent medical examinations.
Standards for independent medical examiners
Independent medical examiners must have the appropriate qualifications, skills and experience to provide the independent medical examination under the SRC Act. The specific standards required will depend on the type of medical examination being delivered.
Australian Health Practitioners Regulation Agency standards
The Australian Health Practitioners Regulation Agency (AHPRA) sets registration standards for medical practitioners. For most independent medical examinations these standards will apply.
Medical practitioners must hold current AHPRA’s registration (with no relevant conditions that would prohibit service delivery) in order to provide services in the Comcare scheme.
Comcare also sets general standards for all service providers.
Process of engaging an independent medical examiner
Step 1 - Need for independent medical examination identified
The need for the independent medical examination will vary depending on whether it is requested under Section 36 or Section 57 of the SRC Act.
The rehabilitation authority (employer) may request an independent medical examination under Section 36 of the SRC Act to understand an employee's capacity to undertake a rehabilitation program.
The claims manager may request an independent medical examination under Section 57 of the SRC Act to assist with determining or managing a claim.
If you are asked to provide an independent medical examination, you should be told under which section of the SRC Act the request is being made. If you are unsure ask the representative that engaged your services.
Step 2 - Independent medical examiner engaged
Once the need for the independent medical examination has been identified, the relevant person will source the services of an independent medical examiner. You may be approached by the rehabilitation authority (employer) or claims manager directly, or you may be engaged through a medico-legal provider.
As part of the engagement process, you should receive a range of information to support the examination process, including a case summary that provides information on the employee’s injury, the claim, treatment and capacity for work.
In addition to the case summary, you should also receive a series of questions that highlight the key information that is required from the examination. Additional documentation, such as rehabilitation reports, medical and diagnostic reports, reports from allied health providers or statements from the employee and employer may also be provided to support the examination.
If you believe you have a conflict of interest in relation to the requested independent medical examination, please advise the representative requesting the examination prior to conducting the assessment.
Step 3 - Independent medical examination conducted
It is important to:
- Conduct the medical examination at the agreed appointment time.
- Cover off all the questions that have been included with the case summary (where provided).
- Be courteous, transparent, considerate and respectful when examining the employee. The Australian Medical Association has published ethical guidelines on independent medical assessments that we recommend referring to prior to the appointment.
The employee may bring along a support person or escort with them to the appointment however you should have been advised of their attendance prior to the appointment. The accompanying person must not interfere or participate in the examination and if this occurs you may consider terminating the appointment.
If the employee does not show up for the appointment, or prevents you being able to perform the medical examination please advise the representative that engaged your services.
Step 4 - Complete report
Following the independent medical examination, a findings report should be completed. Please confirm with the representative that requested the examination whether there are any report writing requirements (including templates).
Reports must be of a high quality, concise, clear and accurate and the findings and conclusion must be evidence based, without bias or conflict of interest. Additionally, the report must address the questions asked, have clear formatting, contain accurate and appropriate details, indicate if treating doctor contact was conducted as part of the review, and clearly state the material considered.
When the report is finalised, provide it to the representative that requested the report, within the requested timeframe. The employee may request a copy of the report, however the process for releasing the report to the employee should be discussed with the representative prior to providing.
A comprehensive report will reduce the need for revisions, clarifications or further questions. A supplementary report may be requested if there is insufficient detail in the initial report. You may have to provide this at no cost.
Payment for services
Rates of payment
Payment for independent medical examinations depends on the type of examination provided.
How providers are paid
How you are paid depends on the representative that requested the examination.
If you are engaged through a medico-legal provider, payment will be made by them as per the terms of your contract.
If you are engaged by a claims manager or rehabilitation authority (employer) you should discuss payment arrangements with the representative that requested your services.
Remember, only submit invoices after services have been provided.
Independent medical examiners, and independent medical examination providers should have a clear and timely complaints resolution process. All complaints should be reported to the representative that engaged your services as soon as practicable.