Independent medical examiners
Independent medical examiners are registered medical practitioners who provide impartial medical assessments in the NSW workers compensation system.
COVID-19 update: SIRA has issued guidance material for both referrers and examiners to consider for independent medical examinations and reports during the COVID-19 pandemic:
- Guidance for referrers - Independent medical examinations and reports during the COVID-19 pandemic
- Guidance for examiners - Independent medical examinations and reports during the COVID-19 pandemic
SIRA has also updated the 2020 Medical Examinations and Reports Fees Order 2020 No.2 to introduce specific item codes for examinations conducted via video.
In brief
A referral to an independent medical examiner occurs when medical information is inadequate, unavailable or inconsistent, and the referrer has been unable to resolve the problem directly with the practitioners involved.
As an independent medical examiner, it is not your role to provide advice to workers about their condition, treatment or workers compensation claim. Instead your role is to examine the worker and provide independent commentary on the worker's injury and/or treatment.
Your report may include advice on accepting a claim, the insurer's ongoing liability, the worker's level of capacity for employment, ongoing treatment and the degree of permanent impairment (where applicable).
If you believe another type of treatment might assist the worker, it is recommended you mention it in your report and you may contact the worker's nominated treating doctor to discuss treatment options.
The report must be forwarded to the person who requested it and the worker's nominated treating doctor.
Publications you might need
- Workers compensation guidelines
- Workers compensation guide for medical practitioners
- Workers compensation medical dispute assessment guidelines 2019
Fees and invoicing
Payments for independent medical examinations must be in accordance with the gazetted fees in the relevant fees order below current at the time of assessment:
What your invoices will need to include
- worker's first and last name, and claim number
- payee details
- ABN
- name of the medical practitioner or service provider who provided the service
- SIRA workers compensation approval number or medical practitioner's Health Insurance Commission provider number (where applicable)
- date of service
- SIRA workers compensation payment classification code or AMA item number where applicable. Refer to either the claims technical manual for:
- service cost for each SIRA workers compensation payment classification code or AMA item number and service duration (if applicable)
- date of invoice (must be on the day of or after last date of service listed on the invoice)
To prevent delays in payment, these details will need to be provided on all invoices.