Questions rising on unethical insurer behaviour to employees compensation claimants – Employment and HR

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The federal employee compensation system is difficult for applicants who are not represented. For workers with mental health injuries, the process can be particularly difficult and often re-traumatizing.

Employees who have made a claim to compensation payments must necessarily take part in assessments agreed by the insurer with doctors selected by the insurer. These appointments are known as Independent Medical Examinations (IMEs). The doctor produces a report that has a significant impact on an employee’s right to compensation.

A recent survey by the ABC looked at the behavior of psychiatrists hired by Commonwealth insurers to evaluate workers who alleged psychological injury.

It has been reported that some psychiatrists appointed by the insurer under the Comcare system have been the subject of longstanding complaints, including alleged bullying of workers who have made a claim and that workers are generally sent for an inappropriate number of IMEs become.

This means that workers who have already been damaged are in a particularly vulnerable position.

Under the Comcare system, an employee making a claim must attend these medical examinations if so arranged by the insurer. Failure to attend an appointment without an adequate apology could result in the employee’s claims being suspended. A disadvantageous cost structure can also be imposed on employees due to non-participation

Basically, there is a very good reason insurers should be able to send workers to an IME: they need information about the injury, its cause and associated disabilities, treatment needs, retraining ability, or return to work in order to get the claim right manage.

These doctors should be reliable; After all, they have an obligation to be impartial. You should adhere to the Expert Code of Conduct, which imposes a duty to provide independent assistance and impartial opinions. You cannot be a lawyer for either party.

In practice, however, an employee who has suffered a mental injury is particularly susceptible to deterioration in their condition. You need a certain amount of support. IMEs are inherently invasive and require workers to go through the events that caused the condition and extent of their disability. This can be traumatic at best, especially for workers who are already in need.

These are the workers who would benefit most from real assistance from an insurer to assist with their rehabilitation, meet their treatment needs and, when possible, help them return to employment. Indeed, increased scrutiny of psychological claims may affect these workers’ ability to properly manage their injuries.

It is often a faster, easier, cheaper and less invasive alternative for the insurer to obtain evidence from the treating physicians (e.g. treating general practitioners, psychologists and / or psychiatrists). This should be the first preference. However, this cannot always be managed, and there are circumstances when an IME is required, entirely appropriate, and cannot be avoided.

If you have been referred for an independent medical evaluation by an insurer and have any concerns about participation, we encourage you to speak to your attorneys.

If you or someone you know needs advice about the Comcare program, it’s important to speak to our personal injury team at Kells. We can help you determine your location and navigate the system.

The content of this article is intended to provide general guidance on the subject. A professional should be obtained about your particular circumstances.

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