Some IMEs in NSW Shouldn't Be Eligible for Causation Decisions
In accordance with the State Insurance Regulatory Authority (SIRA) guidelines, the selection of an independent medical examiner (IME) must prioritize qualifications and current clinical practice. Specifically, the guidelines state that if the referral includes a question of causation or treatment, the independent medical examiner must be in current clinical practice. This requirement ensures that the examiner has up-to-date knowledge, practical experience, and familiarity with current standards of care.
An IME who solely focuses on conducting IME evaluations and does not engage in regular clinical practice falls short of meeting these criteria. Being in current clinical practice involves actively treating patients and staying informed about the latest medical advancements and treatment protocols. This active engagement in clinical work is crucial for providing accurate and reliable opinions on causation and treatment in workers' compensation cases.
It is important to note that this guideline was put in place before doctors were required to register with AHPRA. The intent was to ensure that the ease of registering as a practicing doctor is not confused with the necessity of maintaining active clinical practice. If the requirement for current clinical practice were merely about maintaining registration, the second part of the guideline would be redundant. Therefore, the guideline emphasizes the need for ongoing clinical work to ensure the highest standards of injury management and claims handling.
Without regular clinical practice, an IME's knowledge and experience may become outdated, limiting their ability to offer well-informed and relevant medical opinions. The lack of hands-on clinical experience can lead to an incomplete understanding of current medical practices and standards, which is essential for assessing causation and treatment accurately.
Additionally, the guidelines aim to protect the integrity of the workers' compensation system by ensuring that medical opinions are based on real-time clinical practice rather than theoretical knowledge alone. Regular clinical practice allows an IME to encounter a diverse range of medical conditions and scenarios, thereby honing their diagnostic and treatment skills. This diversity of experience is invaluable when making determinations about causation and treatment, as it ensures that the examiner's opinions are grounded in practical, contemporary medical practice.
To arrive at this conclusion, we undertook a thorough process of interpreting the guidelines by their intent, especially when the verbiage wasn't clear. This process included understanding the purpose of the guideline, seeking clarification from relevant authorities, using precedent and context, consulting with colleagues and experts, and documenting our interpretation to ensure consistency and transparency.
Therefore, an IME who solely conducts evaluations without participating in ongoing clinical practice does not fulfill the guidelines' requirement for current clinical practice. To ensure the highest standards of injury management and claims handling, it is imperative that independent medical examiners involved in causation examinations maintain active clinical practice. This ensures that injured workers receive the most accurate and up-to-date medical assessments, ultimately contributing to fair and just outcomes in the workers' compensation system.
#WorkersCompensation #IME #ClinicalPractice #InjuryManagement #Causation #SIRAGuidelines #MedicalExaminers #Transparency #FairAssessment
Elisha v Vision Australia Ltd HCA
3 周“Without regular clinical practice, an IME's knowledge and experience may become outdated, limiting their ability to offer well-informed and relevant medical opinions” They actually rely on this to reject claims. In Vic especially they use the DSM-IV which has been outdated for a long time. They do this specifically so that any new illnesses are excluded from liability.
Aged Care Advocate and Family Carer
3 周Richard, thank you for this post! This has, in my mind (opinion at this stage) opened up some very interesting questions within the aged care sector. Providers currently employee “Clinicians” these clinicians are used to make assessments on needs and consulted on items to assist with everyday living. Additionally, within facilities there only requirement is to be a “registered nurse” most of which we know are not trained with Dementia. The power they hold allows challenges to guardianships across the board and can also make claims that can stop families from accessing their loved ones in facilities. Your post now raises some interesting concerns and how they apply to those employed by private industry.
Here is a link to SIRA Guidelienes https://www.sira.nsw.gov.au/workers-compensation-claims-guide/legislation-and-regulatory-instruments/guidelines/workers-compensation-guidelines#part-7