Types and purpose of investigations

As part of the claims process, you may be required to participate in factual or medical investigations.

There are four main types of investigations that may be used on psychological claims. If you are required to participate in an investigation, your case manager is obligated to explain the reasoning for the investigation.

On this page

Key takeaways

Factual investigations

Independent Medical Examination (IME)

Injury Management Consultation (IMC)

Independent Psychological Consultation (IPC)

Key takeaways

The four main types of investigations:

  • Factual investigation: an independent investigation to determine the facts surrounding an injury or incident.
  • Independent Medical Examination (IME): An IME is conducted by a medical specialist with expertise in certain types of injury. Their role is to review your injury and provide information to help with decisions about the diagnosis, rehabilitation, recovery, return to work and entitlements to compensation.
  • Injury Management Consultation (IMC): An IMC is a collaborative review conducted between an Injury Management Consultant and your doctor when there is a specific return to work or injury management issue that is unable to be resolved.
  • Independent Psychological Consultation (IPC): An independent psychologist consultant provides an impartial peer review of treatment to ensure the treatment is effective and suited to the current diagnosis and symptoms.

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Factual investigations

Purpose

Factual investigations involve the use of a third-party service provider to determine the facts surrounding an injury or incident in the workplace. They are typically used to:

  • gather information around an incident where there is unclear or limited information available
  • clarify that you meet the legislative definition of a worker.

Process

In most cases, the investigator will commence interviews to take statements from yourself, any eyewitnesses and/or any relevant supervisors or managers. Both yourself and the employer will be afforded the opportunity to nominate witnesses who can provide statements.

The investigator will schedule a meeting with each of the elected parties to take statements. Once the interviews are concluded, the investigator will send a draft statement back to the participants to read and sign their respective statements to confirm it accurately reflects the interview.

The investigator may also gather employment documents, and if necessary, attend and inspect the premises. Each of the statements and supporting evidence will be provided to the claims service provider (CSP) alongside a comprehensive report.

The claims service provider will always try to get the necessary medical information from your treatment team. They allow 10 business days for your treatment team to respond to their requests for information. If the claims service provider does not receive a response, they may need to proceed to an external investigation.

Initiating these investigations does not mean your claims service provider does not believe your version of events, they intend to seek professional medical advice and guidance.


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Independent Medical Examination (IME)

Purpose

An independent medical examiner is a medical specialist with expertise in certain types of injury.  For a psychological injury, an IME will be conducted by a Psychiatrist. Their role is to review your injury and provide information to help with decisions about the diagnosis, rehabilitation, recovery, return to work and entitlements to compensation.

The CSP will look to utilise an IME when they believe the information from the medical practitioners is inadequate, unavailable or inconsistent, and the CSP is unable to resolve the problem directly with the practitioners.  For example, if the CSP has requested a report from your Doctor and had no response, they may feel it’s appropriate to refer for an IME to understand how best to facilitate your recovery.

Process

Your CSP will let you know when they are considering a referral to an IME. You will be provided with three different IME Doctors to choose from. Where possible, these options will be within a reasonable travel distance from your primary place of residence.

The assessment is usually conducted in a face-to-face setting (or sometimes via telehealth). Your CSP will have provided your elected IME Doctor with some documentation ahead of your assessment so they have some background knowledge. The assessments typically run for one hour and will cover topics such as the workplace injury, your medical history and background, your treatment and return to work.

Following your assessment, the IME Doctor will provide a comprehensive report to your CSP. Your case manager can provide your treatment team with a summary of the report and afford them the opportunity to provide their feedback.

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Injury Management Consultation (IMC)

Purpose

An IMC is used on claims to address queries relating to capacity and when there is complex return to work and injury management barriers that can't be resolved via the treatment providers on the claim. For example, when:

  • recovery or return to work goals are confused – when there is no clear direction on the claim in terms of return to work
  • the injury or workplace environment is complex
  • there are communication issues between parties on the claim – including yourself, the employer, and the treating doctor
  • there is a conflict between the treating doctor's recommendations and the workplace requirements
  • there are unexplained changes in work capacity on the Certificates of Capacity – such as downgrades in capacity with no reasoning provided by the doctor
  • there is a disagreement about the suitability of work being offered at the workplace.

Process

For psychological injuries, accredited IMCs that can be used include psychiatric doctors and occupational physicians. The CSP will determine which type of Doctor to refer to based on the complexity of the presenting problem.

There are three different stages of IMCs that can be referred to by the CSP:

  • Stage 1: Involves the IMC Doctor completing a comprehensive file review and providing a report with recommendations to the claims service provider
  • Stage 2: An IMC Doctor will review the necessary documentation sent across by the CSP. Following review, the IMC Doctor will have a discussion with your Doctor to discuss the concerns raised and recommendations to overcome any barriers and move the claim forward.
  • Stage 3: An IMC Doctor will assess the situation, examine yourself and try to mediate a solution by discussing the issues with all stakeholders, including the employer and the treating doctors or providers (if involved).

Each of the above stages is concluded with the development of a comprehensive report with the IMC Doctor's findings and recommendations. A copy of this report will be provided to your doctor.

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Independent Psychological Consultation (IPC)

Purpose

IPC’s can be utilised on psychological claims to provide an impartial peer review of the treatment that is ongoing on the claim.

An Independent Psychological Consultant is a registered psychologist who has experience in the assessment, treatment and management of work-related injuries and can review and discuss the current treatment plan with your psychologist.

Areas discussed may include:

  • the type of treatment and its effectiveness for your injury
  • the frequency and duration of treatment and whether this is appropriate and effective
  • whether the treatment continues to be reasonably necessary
  • any barriers or psychosocial risks
  • any return to work concerns.

Process

There are three types of IPC reviews:

  • Stage 1: The IPC Psychologist will review the necessary medical documents sent across by the CSP and provide their recommendations for ongoing treatment.
  • Stage 2: A file review is completed, and the IPC Psychologist will schedule a discussion with your psychologist to discuss all aspects of your treatment plan and recommendations moving forward.
  • Stage 3: The IPC Psychologist completes a file review, completes a face-to-face assessment with yourself and concludes with a discussion with your psychologist.

Once their review and/or assessment is completed, the IPC Psychologist will provide a comprehensive report to the CSP with their findings and recommendations.  A copy of the report will also be provided to the treating psychologist for their records.

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