Medical and related services

Overview

An injury management consultant (IMC) is a registered medical practitioner experienced in occupational injury and workplace-based rehabilitation.

This guidance outlines:

• the role of the IMC
• what an insurer should consider when referring for an IMC file review or IMC appointment
• communication with the worker and the IMC.

The role of the IMC

An IMC is a facilitator who helps the nominated treating doctor (NTD), worker, employer, insurer and other service providers to progress a worker’s recovery at/return to work and optimise health and work outcomes.

An IMC assesses the situation, examines the worker (if necessary) and discusses possible solutions with the relevant parties. The IMC mediates with parties to seek agreement on actions and outcomes. IMCs are not responsible for directing treatment of a worker, although they may comment on treatment in respect to overcoming barriers to recovery at/return to work.

The functions of an IMC

Part 6 of the Workers compensation guidelines (the Guidelines) provides for the functions of approved injury management consultants. This includes IMC functions relating to:

• the nominated treating doctor
• the worker
• the employer
• other service providers
• the Workers Compensation Commission, and
• the IMC report.

See Part 6 of the Guidelines for further details regarding the functions of an IMC.

Special requirements to consider before an IMC appointment

An insurer should consider the following when arranging an in-person IMC appointment:

• accessibility – consider any mobility or injury-related issues, for example, whether the worker is able to use stairs
• travel – where a worker is required to attend a consultant’s rooms, the location should be accessible within the worker’s travel restrictions as certified by their NTD. The insurer should consider booking an examination time in the middle of the day if the worker is required to travel a long distance
• interpreter services – consider whether an interpreter is required
• cultural preferences – if the worker has special requirements relating to gender, culture or language, these are to be identified and accommodated.

Advising the worker of the appointment

As outlined in the Standard of practice S14. Referral to an injury management consultant, insurers are expected to provide the worker with written notice at least ten working days prior to the IMC appointment (unless a shorter timeframe is agreed by all parties).

In the meantime, the insurer can contact the worker by telephone and provide a verbal summary of the written notice, including:

• the date, time and location of the appointment
• the reasons for the referral to the IMC
• the purpose of the appointment
• seek the workers consent for the referral
• any preparation required, including whether they should take medical reports, x-rays/imaging and/or other relevant documentation to the examination.

Written notice to the worker

Insurers are expected to provide written notice to the worker prior to any IMC appointment. Refer to the Standard of practice S14. Referral to an injury management consultant for what information should be included in the written notice to the worker.

Reminding the worker of the upcoming appointment

The insurer may wish to remind the worker of the IMC appointment before the scheduled date.

If the worker advises that they are not able to attend, the insurer can reschedule or cancel the IMC appointment to avoid any cancellation fees.

Injury management consultant file review

Where a referrer identifies the need for an injury management consultation but does not believe it is necessary for the IMC to examine the worker, a file review may take place.

During a file review, an IMC assesses the situation using the information provided in the referral and contacts the NTD and other parties as required. A worker may wish to be involved in discussions with an IMC for a file review.

The referral should meet the criteria outlined in the Standard of practice S14. Referral to an injury management consultant.

Notifying the worker

Like the in-person IMC consultation, the insurer should notify the worker of the referral for the IMC file review as well as the reasons for it. The insurer is to explain:

• the role of the IMC
• that the IMC will be reviewing the worker’s file and discussing their case with the NTD and other parties (where relevant) to facilitate the worker’s return to work.

The insurer should ask the worker if they would like to be involved in discussions with the IMC. This may be a telephone call as part of a case conference with the NTD or relevant treatment provider. Alternatively, if the worker wishes to be more involved, the insurer is to offer an appointment with the IMC instead of a file review.

The worker should also be informed of who they can contact if they disagree with the referral.

The insurer should provide the worker and their NTD with a copy of the IMC report following the review.

When referring to an IMC for a file review the insurer should:

• contact the worker to advise them of the proposed file review, explain the role of the IMC and the reasons for the file review
• ask the worker if they would like to be involved in discussion with the IMC, either via a telephone call, as part of a case conference with the NTD or relevant treatment provider or, alternatively, if the worker wishes to be involved, offer an appointment with the IMC instead of a file review
• let the worker know they will be provided with a copy of the report from the IMC file review and a copy will also be provided to their NTD and any other parties involved in the injury management consultation.
• seek the worker’s consent for the file review
• take into consideration the injury type when deciding which IMC to engage
• avoid conflicts of interest between the IMC and the worker, NTD or employer.

See the Standard of practice S14. Referral to an injury management consultant for further information.

Sending claim documents to the injury management consultant

The Standard of practice S14. Referral to an injury management consultant outlines SIRAs expectations for insurers when making a referral to an IMC. The insurer must provide the IMC with sufficient information to support the referral, including:

• a detailed description of the reason for referral
• contact details for the worker, NTD and employer, and
• relevant documentation from the file to enable the IMC to understand the claim.

An insurer should provide claim information to the IMC at least ten working days before the scheduled appointment. The insurer should only provide the worker’s personal and health information that is relevant to the consultation.

The insurer should provide the IMC with:

• any previous medical examination reports
• the worker’s claim form
• certificates of capacity
• medical reports from the worker’s nominated treating doctor
• copies of x-rays, scans, radiology reports, surgical reports (where appropriate the relevant passages should be highlighted)
• the worker’s pre-injury and/or current job description.

Documents should be provided in a manner that facilitates review by the IMC. This means documents should be clearly set out and grouped according to information type and in chronological order, without duplicate reports or information.