Ombudsman report on medical examinations

Comcare welcomes today’s Commonwealth Ombudsman report on improving the administration of Independent Medical Examinations (IMEs).

The Ombudsman initiated the investigation in 2021 after claimants raised concerns about Comcare’s use of IMEs to help determine claims under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).

Acting CEO Aaron Hughes said Comcare accepted all the report’s nine recommendations to improve IME administration, with a number of identified issues already resolved or being addressed.

The Ombudsman’s statement indicates Comcare needs until 2024 to close out the recommendations. To clarify, the 2024 date relates only to replacing Comcare’s claims management technology to achieve all aspects of the recommendations. This work is already underway.

“The Ombudsman’s assessment found our administration of IMEs is consistent with our obligations under the SRC Act, with no evidence of unethical decision making in our practices,” Mr Hughes said.

“The Ombudsman’s investigation reviewed our procedural frameworks and did not extend to our decision-making in practice. Comcare’s experienced claims staff and specialist allied health professionals ensure our exercise of the medical examination power is carefully considered.

“We recognise that we can improve our administrative frameworks for IMEs to ensure we support employees in reducing the length and severity of injury.”

IMEs can be required under section 57 of the SRC Act to assist with managing workers’ compensation claims. Common reasons for exercising the medical examination power include ensuring correct diagnosis, assessing liability, determining reasonableness and effectiveness of treatment, assessing capacity for work, and resolving disputes.

Comcare has been revising its IME frameworks and processes since 2019 and is now better placed to provide assurance to our stakeholders. This work includes:

  • Minimising the use of IMEs and improving engagement with treating health practitioners
  • Better sourcing of IMEs – improved clinical oversight of engagement
  • Enabling greater participation by claimants in the IME process
  • Establishing IME standards and data and reporting requirements for IME arrangements, allowing optimal oversight of use

Ombudsman investigation report: Comcare’s management of medical examinations

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