Injury management consultants

An injury management consultant (IMC) is a registered medical practitioner who assists in the return to work process when differences arise between the nominated treating doctor, the employer, insurer and/or the injured worker. They assess the nature of the problem and attempt to mediate a solution through discussions with the nominated treating doctor.

Referrals to an IMC

An insurer or employer will refer a case to an IMC when:

the insurer and/or employer are unable to obtain the cooperation of the nominated treating doctor to assist in return to work
there is disagreement regarding the suitability of duties offered
the worker is not upgrading suitable duties
medical certification varies and return to work is interrupted.

A pro forma referral letter to an IMC can be found under 'further information'. All relevant reports and medical certificates should be attached to the referral to assist the IMC to determine the nature of the problem, the worker's medical status and rehabilitation progress.

An IMC does not become involved in commenting on:

the appropriateness of treatment or diagnostic procedures
issues regarding liability.

The role of an IMC

The role of an IMC is distinctly different from that of the independent medical examiner. An IMC is expected to assess the situation, examine the worker (if necessary), and discuss possible solutions with all parties (particularly the nominated treating doctor).

An IMCs role with each of the parties is outlined below.

Nominated treating doctor

Liaise with the nominated treating doctor regarding the injured worker's readiness for work, including:

diagnosis
management plan for the worker, including treatment and return to work
current work capacity
availability of suitable duties
how the NSW workers compensation system operates
the importance of early return to work.

Injured worker

Liaise with the injured worker regarding their return to work, including:

their recovery from injury

issues and problems at work
options for their return to work (including a possible tele-conference with the nominated treating doctor)
their expectation regarding recovery and return to work.

An IMC will often examine the worker to assist in their appraisal of the worker's capacity to return to work.

Employer

Liaise with the employer to confirm the availability and appropriateness of identified duties.

IMC reports

An IMCs report will outline the action taken and the outcome agreed with the nominated treating doctor, or suggest alternative action, such as the need for a specialist opinion or referral to an accredited rehabilitation provider. A copy of the report is to be made available to all parties – nominated treating doctor, injured worker, employer and referrer.

A pro forma IMC report can be found under 'further information'.

Outcomes from an IMCs assessment can be:

support of the nominated treating doctor's opinion regarding return to work management
recommendations regarding revision of the return to work plan and/or medical certificate (the nominated treating doctor remains responsible for providing amended medical certification)
suggested alternative action, if an agreement is not reached on return to work management.

IMCs and the Workers Compensation Commission

A worker or an employer can request the Workers Compnsation Commission (WCC) to resolve a dispute about the suitability of employment.

If there is an application to resolve a dispute regarding suitable duties, the WCC may request an IMC to conduct a workplace assessment and provide an opinion regarding the availability of suitable duties. These assessments are conducted within five days of receiving the request and a report is provided to the Registrar of the WCC within seven days of conducting the assessment. The report is available to all parties.

Appointment of an IMC

Selection criteria

An IMC must have:

registration as a medical practitioner in NSW
experience in workplace-based rehabilitation
knowledge of the NSW workers compensation system
good communication and negotiation skills
references from employers/insurers and unions.

Appointment process

The appointment process of an IMC is outlined below:

medical practitioner completes application form demonstrating ability on each of the criteria (see 'further information')
applicant provides names of referees, preferably employer and union representatives
WorkCover assesses application to ensure all criteria are met
WorkCover contacts referees
applicant advised of outcome.

Following appointment, an IMC must undertake training in negotiation/mediation skills arranged by WorkCover.

Applicants who are not successful in their application will be advised of the reason for rejection.

An IMC is appointed for three years, however, WorkCover may revoke the appointment on the following grounds:

complaints about performance found to be justified
non-performance as an IMC for 12 consecutive months
fraudulent conduct
withdrawal/suspension of registration as a medical practitioner
failure to perform the role of an IMC
failure to attend mediation and other training as required by WorkCover
such other reasons as WorkCover deems appropriate.

An IMC is required to seek reappointment by providing information to WorkCover regarding their activities as an IMC, together with referees who can support their appointment.

Complaints about an IMC

Complaints about an IMC are investigated by WorkCover's Provider Services Branch, as follows:

details of the complaint are discussed with the complainant and other parties, as appropriate
the IMC is invited to offer a response to the complaint
WorkCover assesses the information from all parties
the complainant and the IMC are advised of the outcome of the investigation.

Following the investigation, WorkCover may:

take no further action
refer the matter to the NSW Medical Board and the Health Care Complaints Commission to consider
refer the matter to WorkCover's Compliance Improvement Branch
revoke the IMCs appointment.