#comcare

[dantoombs]

Independent Medical Examinations (IME): What They Really Mean for Your Claim

First things first — what’s an IME, really?

Look, “independent medical examination” sounds neutral. Clinical. Thing is… it’s not your treating doctor. An IME is a one‑off assessment by a specialist who hasn’t been treating you, arranged by an insurer, employer, or sometimes a tribunal/court. The point is to get an opinion on diagnosis, treatment, capacity for work, and how much of your condition is linked to the injury. Useful? Can be. Stressful? Often. Manageable? Absolutely.

Worth noting: in workers’ comp, schemes like SIRA (NSW) and Comcare (Commonwealth) use IMEs a lot. Different rules, similar idea. The report lands with the decision‑maker and can influence treatment approvals, weekly payments, and impairment assessments.

Why you’ve been sent to an IME (and what that actually signals)

Here’s the deal. An IME usually means one of these is in play:

Clarifying diagnosis or treatment plan (surgery vs conservative care, physio frequency, medication changes).

Capacity for work (suitable duties, hours, restrictions) is unclear or disputed.

Causation questions (is this injury work‑related, aggravated by work, or unrelated?).

Permanency and impairment ratings ahead of settlement/benefit decisions.

Conflicting opinions between treating doctors.

Actually, small correction. An IME isn’t a gotcha by default. It’s a second opinion. But yes, the questions asked and the history supplied by the insurer shape the outcome. Which is why preparation matters.

What happens on the day — minus the mystery

The specialist reads a referral pack (your claim form, prior reports, imaging, employer info).

You’re examined, asked detailed questions about the incident, symptoms, treatment to date, work tasks, and daily limits.

The IME writes a report with opinions on diagnosis, treatment reasonableness, capacity, restrictions, and next steps.

That report goes back to whoever requested it (insurer, agent, or sometimes the regulator/tribunal). You should be told if decisions are based on it.

Pro tip: arrive early, bring imaging and a list of meds, and write down key events/dates. Fresh memories beat guesswork under pressure.

The big fears — and what’s fair dinkum, what’s not

“They’ll twist my words.” Contrary to popular belief, most examiners are professional. That said, accuracy helps. Short, factual answers. Don’t speculate. “Not sure” is better than a wild guess.

“It’s one report and I’m sunk.” Decisions shouldn’t rest on one report when there’s a solid treating history. If a decision is made on thin evidence, appeal frameworks exist.

“I can’t bring anyone.” Check your scheme rules. Some jurisdictions allow a support person (quietly observing, not coaching). Phone recordings are often restricted; get written permission first if that’s proposed.

“The doctor doesn’t even treat patients.” Some do, some focus on assessments. What matters is relevant specialty, proper methodology, and a transparent opinion.

This bit’s frustrating: a one‑hour snapshot can’t capture months of pain. True. But consistent clinical records, imaging, and clear functional limits go a long way.

How to prepare without overcooking it

Gather essentials

Timeline: incident date, first symptoms, first treatment, referrals, key imaging results.

Medications: names, doses, side effects.

Work demands: weights lifted, postures, keyboard time, shifts, driving.

Daily limits: standing, sitting, walking, stairs, sleep, concentration.

Describe function, not just pain Numbers help: “Can sit 30–40 mins before changing posture,” “Lifts 5–8 kg comfortably, 10 kg with pain,” “Sleep broken 3 times per night.”

Be consistent with your treating history New surprises without records look odd. If something changed recently, say so and explain when.

Don’t overdo “good days” or “bad days” “Most days X, on a good day Y, on a bad day Z.” That range mirrors reality and sounds credible.

Actually, let’s clarify that. It’s not acting tough to minimise symptoms. It’s not dramatic to emphasise limits. Just accurate, steady detail.

What the IME must (and mustn’t) do

Should: perform a proper clinical exam, consider your history, read the referral materials, and address the specific questions asked (causation, treatment, capacity, impairment).

Shouldn’t: promise treatment, change your meds, or argue about liability in the waiting room. It’s an assessment, not a consult.

If the exam felt rushed or inappropriate, make a calm note afterward (date, time, what occurred). Useful if a complaint or review is later needed.

How IME reports are used in decisions

Now, here’s where it gets interesting. Insurers weigh the IME alongside treating records, rehab provider notes, employer information, and sometimes regulator guidelines.

Treatment disputes Surgery, injections, extended physio — IME says yes/no/try X first. Insurer decides. If declined, dispute rights exist (internal review, then external pathways).

Work capacity Light duties, hours, or return‑to‑work plans. The IME’s opinion can trigger changes to payments or duties. If impractical or unsafe, push back with treating evidence.

Permanency assessments For impairment benefits and settlements, IMEs (or scheme doctors) provide percentage ratings. Methodologies are technical; small factual differences (range of motion, symptom consistency) shift results.

Worth noting: government frameworks exist for quality and independence in IMEs — think SIRA (NSW) guidance for workers’ comp and Comcare’s examiner expectations for Commonwealth claims. Handy to know standards exist, not just vibes.

Red flags that need a second look (and what to do)

Obvious factual errors Wrong side tested, wrong job tasks, missed imaging. Request correction or submit a written response with supporting records.

Outlier opinions without reasons “No treatment needed” despite ongoing objective findings? Reasons should be clear. Thin logic can be challenged.

Capacity that ignores actual duties “Fit for full duties” where full duties mean 25 kg lifts or confined crawl spaces? Provide a task analysis from your employer or rehab provider.

Selective history If the report omits surgery dates, major flare‑ups, or specialist advice, point it out — politely, with documents.

A short, structured rebuttal grounded in records beats a heated rant. Every time.

Real‑world snapshots (nothing fancy, just common)

A business owner injures a shoulder. The IME supports further imaging and targeted physio, not surgery yet. Insurer approves 8 more sessions. Function lifts; work hours increase gradually. Simple, sensible.

Someone with a chronic back injury gets an IME that says “fit for full duties.” Treating GP and physio disagree. A job‑task breakdown shows repetitive 15 kg lifts. A second opinion plus task analysis results in modified duties instead of a payment cut. Balanced outcome.

A family breadwinner with depression post‑incident attend an IME. The report minimises symptoms. GP notes and psychologist records show consistent moderate severity. Internal review overturns a therapy decline; structured return‑to‑work succeeds over eight weeks.

This always surprises people: the quality of your paperwork — not just your pain story — often decides outcomes.

FAQs (the ones people actually ask)

Can the IME treat me? No. IMEs assess. Treating remains with your GP/specialist.

Do I have to attend? Usually yes, if lawfully requested under the scheme rules. Non‑attendance can pause benefits. If the date clashes or the location is unreasonable, request changes promptly with reasons.

Can a support person come? Often yes, quietly observing. Check scheme or insurer policy first. Some exam rooms are small; support may wait nearby.

Can the IME force me to do painful tests? No. You can stop if pain is excessive. Say so plainly. The examiner should record tolerance and limits.

Will I see the report? Frequently, yes — especially if it affects decisions. If not provided, ask the insurer in writing.

What if the report is wrong? Send a written response attaching specific records, or seek a further opinion. Escalate via internal review, then external dispute options as available.

How many IMEs can they send me to? Depends on the scheme and reasonableness. Multiple IMEs without cause can be challenged.

So what does this mean for you?

Prepare like a pro: dates, meds, tasks, limits.

Be steady and factual on the day. No bravado, no catastrophising.

Check the report for accuracy; respond with records if needed.

Use dispute pathways if a decision leans on an unfair or thin IME opinion. Recently, the best outcomes came where people matched calm preparation with decent paperwork. Not flashy. Very effective.

Neutral next step

If an IME is looming or a decision has landed that doesn’t square with your treating evidence, seek proper advice from a Workers’ Compensation Lawyer. A short, focused review can prep you for the exam, pressure‑test the report, and map the cleanest pathway to challenge any shaky decisions.

Standard legal disclaimer

This article provides general information only and is not legal or medical advice. Workers’ compensation and personal injury laws vary by jurisdiction and change over time. Eligibility, benefits, and dispute pathways depend on your facts and your scheme (e.g., SIRA NSW, Comcare). Obtain advice from qualified professionals before acting or relying on this content.

[tearsofrefugees]

Two-year-old girl in immigration detention has teeth surgically removed

The federal workplace authority Comcare is also investigating the Department of Home Affairs for its treatment of Australian-born Tharunicaa, and her four-year-old sister Kopika.

[the13problems]

We need to recognize that there are exceptions to the rule that 'The customer is always right'.

Professor Duncan Chappell, Comcare Australia

[kauthenlegal-blog]

PVYW v Comcare - the final word

I have previously written about this unusual case, which was decided by the High Court Of Australia yesterday. The High Court decided that the plaintiff was not entitled to compensation as her injuries were unrelated to her employment.

This is an amazing decision - everybody I discussed this case with ( both from plaintiff and defendant sides ) thought this was a no-brainer and the plaintiff should succeed as she was on a work -related trip, staying at a motel paid for by her employer and engaging in a perfectly lawful activity.

The High Court obviously saw things differently and this case will have significant ramifications in relation to workers' entitlement to compensation.

Here's the transcript of an article published on 30 October 2013 in the Canberra Times discussing the decision:

Public servant loses sex injury compo claim

A Canberra public servant injured in a “vigorous” sex session in a country motel six years ago has lost her claim against the federal government for workers’ compensation.

The High Court has ruled in Canberra on Wednesday morning that the woman was not entitled to compensation from the federal workplace insurer Comcare because the circumstances of her injury were not related to her employment.

But after four years before the courts the case still divides legal opinion with two High Court judges disagreeing with the majority of their colleagues and arguing the woman should have been paid out.

The case sent shockwaves through the public sector and has big implications for bosses around Australia who send employees on work trips and for workers who travel as part of their jobs.

Lawyers for Comcare argued throughout the four-year legal saga that the public servant should not get taxpayer-funded compensation as result of a "personal choice" to have sex while on the work trip.

But the woman's barrister argued the public service, having sent the woman to the NSW country town, was liable for her welfare, even if she was injured while having sex.

The woman' name has been suppressed by the courts.

The bureaucrat suffered lacerations to her nose and mouth as well as "psychological injuries" when a glass light fitting was pulled from the wall of the motel room as she had sex with a local man in Nowra in November 2007.

The legal saga has rumbled on since 2009, through the Administrative Appeals Tribunal, the Federal Court and now the High Court.

The case has been dubbed "scheme significant" by Comcare bosses who are trying to stem a rising tide of compensation claims by public sector workers.

Appearing for the federal government at the High Court hearing in August, Commonwealth Solicitor-General Justin Gleeson, SC, told six judges that the sex activity was "in every sense a personal choice".

The public servant’s previous appeal to the Federal Court was successful when the lower court decided the Commonwealth Government, having sent the woman on the trip, was liable for everything that happened to her there, provided she was not engaging in misconduct.

But Comcare’s appeal to Australia’s highest court argued that the injury was sustained during an interval or interlude to the woman’s official duties and was not “compensable”.

In a judgment handed down in Canberra on Wednesday morning, the High Court upheld Comcare's appeal in a 4-2 majority decision.

Here's the link to the article: http://www.canberratimes.com.au/act-news/public-servant-loses-sex-injury-compo-claim-20131030-2wf3n.html#ixzz2jA2fRdW7

Here's the link to the High Court decision:

http://www.austlii.edu.au/au/cases/cth/HCA/2013/41.html

[kauthenlegal-blog]

PVYW v Comcare continued

I had previously written about this unusual case.

The High Court of Australia today gave leave to Comcare to appeal this matter.

Here's the transcript of today's article in The Age regarding this new development :

Sex injury compo case goes to the High Court

It started with a dinner date and a tryst in a motel room in the country, made its way to the Federal Court and now a notorious compensation case about a woman injured while having sex on a work trip will play out in the High Court.

The federal government's workplace safety body, Comcare, was granted leave on Friday to appeal, to seek a High Court ruling on the distinction between private and business activities when employees are travelling for work.

The appeal will examine a long-standing legal test used in compensation matters, which sets out how breaks between periods of actual work are considered when an employee is required to be away from home.

The female Commonwealth public servant at the centre of the case, whose name has been suppressed, was required to travel to regional NSW in 2007 and stayed at a motel booked by her employer.

She arranged to meet a male friend and, after going out for dinner, the pair went to her motel room and had sex.

In a statement in previous court hearings, the woman's sexual partner said they were ''going hard'' when a light fitting was pulled from the wall and fell on her. She suffered wounds to her nose and mouth, as well as psychological injuries, and has faced a lengthy legal battle to receive a payout.

Her claim was initially accepted by Comcare, but was revoked in 2010 and reviewed by the Administrative Appeals Tribunal, which found sexual activity was ''not an ordinary incident of an overnight stay like showering, sleeping, eating''.

The woman appealed against that decision in the Federal Court and won in April last year, a judge finding the injuries were suffered in the course of her employment.

Comcare appealed unsuccessfully in December and announced it would take the matter to the High Court.

Solicitor-General Justin Gleeson, SC, representing Comcare, said: ''The case is not simply about a particular form of sexual activity in the hotel room. If you think more broadly what is at the heart of it is an exercise of autonomy by an individual.''

The woman's barrister, Leo Grey, said the legal test did not need to be revisited.

''In our submission, the test has stood the test of time for 20 years,'' he said. ''The fact that this case has raised some unusual facts has not resulted in an amendment.''

Mr Grey said there should not be any moral judgment about the woman's activities.

Justices Kenneth Hayne and Stephen Gageler granted leave to appeal, on the basis that any previous payment to the woman be allowed to stand. The appeal may be heard in August.

http://www.theage.com.au/national/sex-injury-compo-case-goes-to-the-high-court-20130510-2jdcc.html

[kauthenlegal-blog]

PVYW v Comcare

For an injury to be compensable under WorkCover, you need to show that it arose out of or in the course of your employment. Usually, this requirement does not cause a lot of dispute. A recent case in the Federal Court of Australia however has caused quite a stir, mainly as a result of the unusual fact scenario.

The case of PVYW v Comcare is a matter arising under the federal workers' compensation scheme, but the same broad principles regarding entitlement to compensation apply.

In this case, an employee had been sent to a regional NSW town for work and was required to stay at a motel overnight. The employer had booked and paid for her accomodation. That night she arranged to meet a male friend who lived in town and the pair had dinner together. They then proceeeded to the employee's motel room where they had sex. Whilst enagaging in sexual intercourse, a glass fitting above the bed was pulled from its mount and fell on the employee, causing her injuries to her nose and mouth which required medical treatment.

The employee lodged a claim for compensation which was rejected. She applied to the Administrative Appeals tribunal which confirmed Comcare's decision, having determined that the injury had not arisen in the course of the employee's employment. In particular, the tribunal stated that " the employer had not expressly or impiedly induced or encouraged the applicant's sexual conduct that evening. Nor did the employer know or could reasonably know that such an activity was contemplated by her. The activity was not an ordinary incident of an overnight stay like showering, sleeping, eating, or returning to the place of residence from a social occasion elsewhere in the vicinity. Rather she was involved in a recreational activity which her employer had not induced, encouraged or countenanced. Accordingly, the applicant's injuries were unrelated to her employment, took place during her leisure time, and were of a private nature".

The employee appealed to the Federal Court which upheld the appeal and found that she was entitled to compensation. Justice John Nicholas considered that the Tribunal was wrong in requiring the employer to induce or encourage the activity in question, either expressly or impliedly. He stated that " if the applicant had been injured while playing a game of cards in her motel room she would be entitled to compensation even though it could not be said that her employer induced or encouraged her to engage in such an activity. In the absence of any misconduct, or and intentionally self-inflicted injury, the fact that the applicant was enagaged in sexual activity rather than some other lawful recreational activity while in her motel room does not lead to any different result ".

The full text of the decision can be found here: http://www.austlii.edu.au/au/cases/cth/FCA/2012/395.html

Comcare then appealed to the full bench of the Federal Court which on 13 December 2012 found on that there was no error in Justice Nicholas' decision and upheld his findings. In particular the Court said that " it is quite clear from his Honour's remarks (...) that the concept of a 'frolic of his own' is one which applies to wrongful acts. That was not the case here and the notion has no application to the present case. No approval, express or implied of the respondent's conduct was required in the present case. The views of the employer were irrelevant."

The full text of the decision can be found here : http://www.austlii.edu.au/au/cases/cth/FCAFC/2012/181.html

On 14 January 2013 Comcare released the following media release :

"Comcare has lodged an application for special leave to appeal to the High Court of Australia in respect of the Full Court of the Federal Court’s decision in Comcare v PVYW handed down on 13 December 2012.

A Commonwealth employee is seeking workers' compensation for injuries sustained after a light fitting was pulled from the wall of a motel during sex, on a business trip.

Comcare is taking this action to seek a High Court ruling on the boundaries between private and business activities when employees are traveling for work purposes. Workers need to be clear about their entitlements and employers should have an understanding of their responsibilities and how to support their staff."

The saga continues and I will return to this issue once the application for leave to the High Court has been determined.