blog

Some background to the vexed question of psychiatric claims vs physical claims

June 30, 2019

I have been doing more research on the issue of widespread discrimination against claimants with psychiatric injury. I came across this paper, written by a lawyer that gives an interesting overview of the dilemma facing governments in dealing with these claims.

The writer states:

The main arguments against pure psychiatric injury claims can be summarised as follows:

1. The existence of mental harm is more difficult to prove than physical harm, and carries with it the associated risk of trivial and/or fraudulent claims. This is coupled with the traditional medical and cultural notions of extreme psychiatric response being hysterical and irrational, and so less worthy of compensation than physical injury.

2. Because psychological injury can afflict people beyond the range of physical effects of negligence, there is potential for a vast class of claimants arising from the one negligent act (that is, opening the floodgates).

3. Following on from (2) above, the imposition of liability in such cases burden the defendant with liability out of proportion to the negligence alleged, and thus produce iniquitous outcomes.[14] Further, the fear of liability may inhibit normal and desirable societal activities and interactions.
Historical development

Management of psychological claims

June 29, 2019

I came across this publication on the SafeWork Australia website.  I am preparing 2 talks at the moment, one on Work trauma and Work ‘stress’ and the other on discrimination against injured workers and motor accident claimants with psychiatric injuries.  I have been disappointed by the quality of some of the published material, this seems OK however.

Movement in the Faculty!

I have complained to the Faculty of Forensic Psychiatry about the marginalization of civil forensic psychiatrists (see report). Justin Barry-Walsh, the chair has been very responsive.  The definition on the College website has been changed. Forensic psychiatry is the subspecialty of psychiatry which interfaces with the law.  ( It did read – Forensic psychiatry is a psychiatric subspecialty relating to the law and the assessment of mental health in the criminal justice system). A survey of all the members of the faculty will shortly take place to understand the numbers of people involved, the scope of the work and what will be required in the future regarding conferences,training etc.

Discrimination against work and accident claimants with a mental health injury

June 4, 2019

For some time I have been interested in the various tactics used by governments to reduce the number of mental health claims in workers compensation and motor accident schemes. It is ironic that there is so much focus now on preventing discrimination against people with mental health problems, including, in Victoria, a Minister for Mental Health but, at the same time, there is fear and trembling that people with mental health injuries arising from work or motor accident will send the state bankrupt. In South Australia, for example an impairment benefit can only be paid for a person with “pure mental harm”, a person with a physical injury has to meet the threshold of 5% impairment for it to be considered a serious injury and to then receive a lump sum payment. A worker with a mental injury has to reach the threshold of 30% impairment and there is no lump sum payment!

I have found a table listing the exclusionary provisions for people with work-related mental health conditions in the states, territories and in New Zealand. It makes for interesting reading.

It is interesting to note that this is an international phenomena. For example the Purple Heart, awarded in the United States for injuries received in various circumstances is not awarded for people suffering from post traumatic stress disorder or from battle fatigue!

Have a look at this Guide to Concurrent Evidence in New South Wales

May 30, 2019

Henry Chen has written an informative guide about concurrent evidence in New South Wales that has applicability to other jurisdictions. In Victoria concurrent evidence appears to have had a limited effect although of course it is permitted as a court procedure. Concurrent evidence also is a procedure in the Administrative Appeals Tribunal. It does appear however that Sydney Is the hot tubbing centre of Australia!

Workshop in late August re Family Court Reports

May 26, 2019

Bob Adler, a very experienced child psychiatrist is running a 2 day workshop in late August for those interested in learning more about Family Court work including writing reports.  He will be assisted by Professor Mushin, a retired Family Court judge.  This will be a very valuable training experience.

A new fee schedule for psychiatrist IMEs! What does this say about the Victorian WorkSafe

May 24, 2019

We were all surprised when worksafe produced a new fee schedule as of 1 April, 2019. We had complained for years about the poor remuneration compared with other jurisdictions and the failure to respond to our concerns. There were ridiculous fees like being paid little over $40 for reading documentation. Out of the blue a new fee schedule for psychiatrists was sent to IMEs in April 2019. I suspect this is because IMEs have been leaving in droves and worksafe have recognised that there is less and less incentive to be involved in the system, not only because of the poor fee structure but also because of the bureaucracy, the sudden cancellation of appointments, the inadequate time to review paperwork and the resultant strained relationship. It will be interesting to see what happens to the retention of IMEs.

More discrimination against claimants with psychological injuries

May 6, 2019

 

The Canberra Times (5 April 2019) reported that Canberrans injured in a motor vehicle accident will not be able to claim any insurance for anxiety or depression caused by the crash, under proposed changes to the compulsory insurance scheme.

The Barr government Motor Accident Injury Bill passed in principle on Thursday, with the details to be debated when the Assembly resumes sitting next month.

The ACT government is ditching its common-law compulsory third party insurance scheme in favour of a hybrid, no-fault model. But there are significant concerns about some of the exclusions proposed. Photo: Rohan Thomson

But the ACT Law Society and ACT Bar Association have written to all parliamentarians highlighting fundamental problems with the proposed scheme.

Claimants will have choose between getting compensation for pyschological or physical injuries, meaning they cannot combine the physical and psychological injuries they suffer from the accident.

Their insurer only has to pay for one whole person impairment assessment as well, so if the injured person wants to be assessed for both physical and psychological injuries, they will have to foot the bill.

The definition of psychological injury also excludes psychiatric disorders such as depression and anxiety, meaning people can only get compensation for conditions like post-traumatic stress disorder or “mental shocks”.

In a speech that drew heavily from the Law Society and Bar Association letter, Canberra Liberals leader Alistair Coe described the exclusions as “appalling”.

“I cannot overstate the effect these changes would have,” Mr Coe said.

“The government has not addressed the significant issues raised by stakeholders and the Assembly inquiry. The Canberra Liberals believe Canberrans should continue to have access to a comprehensive CTP scheme that supports the rights of motor vehicle accident victims.”

The Law Society and Bar Association also said provisions that would allow children still getting treatment for their injuries four and a half years after their accident to pursue more benefits were easily circumvented.

“There is nothing to stop an insurer ceasing treatment and care after four years and five months and effectively avoiding the automatic consequences,” they said.

However Chief Minister Andrew Barr said insurers could lose their licence if they did not follow the rules set out in the scheme which state they must provide people with reasonable access to treatment and care.

“Now of course there is no such thing as a perfect accident insurance scheme and as we’ve said from the start of this reform project, we’re aiming to deliver a scheme that best reflects the prioirties and the values of this community,” Mr Barr said.

“We have been upfront in acknowledging there will always be trade-offs and competing views when emarking on an overhaul this significant.”

Mr Barr said of the 1500 people injured a year on Canberra’s roads, only about 900 could access the existing, fault-based system.

“The changes we are making would mean around 600 more Canberrans would be covered,” Mr Barr said.

However Mr Coe said this was only achieved by slashing the rights of not-at-fault drivers.

“Quality of life payments would be cut by 80 per cent. There’d be a 31 per cent reduction in loss of earning compensation, a 26 per cent decrease in care costs and reimbursement of private medical costs and public hosptial costs would drop 17 per cent and 6 per cent respectively,” Mr Coe said.

Expert witness issues – from a legal perspective

April 22, 2019

A web-site called ExpertsDirect an agency for expert witnesses of all types  has a good deal of information on its website relevant to expert witnesses. I have included in the Publications section 2 articles.  One is on Expert Witness bias and the other on lawyers editing Expert Witness reports.

The website is https://www.expertsdirect.com.au/blog

Psychosis and injury-a difficult conundrum

February 15, 2019

The issue of the relationship between psychosis and injury has always been difficult for psychiatrists to resolve. In general, my own view is that if there is a very close temporal relationship between the injury and the psychosis there could well be a relationship. Complications include premorbid symptoms, cannabis use after the injury and a previous history of psychosis. The matter is a little clearer with regard to traumatic brain injury.

The research literature in relation to psychosis following traumatic brain injury reveals that there is a causal link between the two. Some of the significant findings are:

  • Psychosis developing following traumatic brain injury is three times more prevalent than psychosis developing within the general population.(Batty, R.)
  • There is generally a latency period to the onset of psychosis, ranging from within the first year to even ten years post-head injury. ( Fujii, D.)
  • Onset of psychosis is generally been in the age range of 20 to 30 years, but reports have also been noted outside this range, including in the teen years. ( Fujii, D.)
  • There is an increased risk of developing schizophrenia following traumatic brain injury if there is a genetic predisposition to psychosis. (Molloy, C.)
  • Studies are reports of the potential for psychosis increases with the severity of the traumatic brain injury. ( Fujii, D.)
  • There is a greater incidence of psychosis with frontal and temporal lobe damage. ( Fujii, D.)

References

Batty, R., et al. (2013). Psychosis Following Traumatic Brain Injury. Brain Impairment. 14, 21-41

Fujii, D and Fujii, D. (2012). Psychotic Disorder due to Traumatic Brain Injury: Analysis of Case Studies in the Literature. The Journal of Neuropsychiatry and Clinical Neurosciences.24, 278-289.

Molloy, C, Conroy, R, Cotter, D, and Cannon, M

Is Traumatic Brain Injury A Risk Factor for Schizophrenia? A Meta-Analysis of Case-Controlled Population-Based Studies: Schizophr Bull. 2011 Nov; 37(6): 1104–1110.

 

Do pre-existing health problems effect recovery from accidents? Have a guess at the answer.

December 18, 2018

The TAC has provided us with the results of a new study.

Before I tell you about the study I want you to guess the answer to this question.

Do a person’s previous health issues (especially involving mental illness or drug or alcohol use) reduce their chances of a good recovery from an accident?  If you answered yes you are on the money.  Here is another blinding glimpse of the obvious.

This new study has shown how pre-accident health can impact a person’s recovery from a transport accident. By linking pre- and post-accident data, researchers at the Monash University Accident Research Centre have revealed fascinating insights into the factors that contribute to a person’s recovery.

Led by Dr Janneke Berecki-Gisolf and Dr Trevor Allen, the project looked at TAC clients’ physical and mental health service use and health service needs before and after their transport accident.

“A better understanding of what’s going on with someone’s health before the crash [will] help to understand why some people recover more quickly than others,” said Dr Berecki-Gisolf. “So to find out about someone’s health before the crash, rather than ask them, we did a data linkage study which actually shows patterns of health before and how that relates to recovery.”

In one section of the project, the researchers looked at hospital admissions data to discover how someone’s pre-accident health might affect recovery outcomes. This showed that pre-existing chronic pain was common and associated with a range of adverse post-accident outcomes. Those TAC clients who then had a delayed recovery experienced a subsequent onset of chronic conditions such as hypertension and depression.

The researchers also analysed Victorian records of mental health service and alcohol and drug treatment. They looked at the overall use of these services before and after the transport injury, as well as associations between mental health and drug and alcohol related issues and claim outcomes. This showed that pre-accident use of these services was significantly associated with more complex claims and delayed return to work.

Sponsored by the TAC through the Institute for Safety, Compensation and Recovery Research, the project will help the TAC more effectively identify clients who may be at risk and provide additional services to achieve better outcomes.

A Farce-The Faculty of Forensic Psychiatry

October 24, 2018

 

The faculty of forensic psychiatry is both a misnomer and a marriage of convenience. It is time to call a spade a spade and for a divorce to take place (see my detailed comments)

 

The faculty of forensic psychiatry is an attempt to combine two quite disparate groups, psychiatrist who work with offenders in the criminal justice system and psychiatrist who do civil assessments. Their only point of contact if that they provide reports to courts and other Tribunals.

I have worked in both areas, in the criminal justice system and as a psychiatrist doing civil assessments. I was the only psychiatrist at the Fairlea women’s prison in Melbourne for five years and have been a member of the Victorian Forensic Leave Panel for 20 years. I have also assessed many prisoners.

 

I have also done more than 20,000 civil assessments and I have been a co-author of the psychiatric assessment guide used in Victoria and South Australia.

 

I believe that this gives me some experience and insight into the issues that have arisen with the development of the Faculty. There is now no doubt in my mind that this marriage of these unlikely partners has proven to be a failure. It is clear that the committee of the Faculty of Forensic Psychiatry has little interest in those who do civil assessment. This is manifested by the training programs, the content of conferences and by the College website description of the faculty highlighting its fundamental purpose.

Forensic psychiatry is a psychiatric subspecialty relating to the law and the assessment of mental health in the criminal justice system

My attempts to remedy these issues have proven to be a failure. Psychiatrist who do civil assessments have no opportunity for any systematic training. No academic department has focused on providing civil assessment training, the faculty has provided a grab bag of criteria that may lead to membership of the Faculty. It continues to be a struggle for civil assessment psychiatrist to gain a foothold in conferences. Despite this situation there are a significant number who do civil assessment and have a desperate need for some systematic training and an opportunity to meet in a collegiate fashion and write about and discuss issues relevant to this area.

I believe the time has come for the inevitable divorce to take place. let the Faculty of Forensic Psychiatry go it own way and fulfil its self defined core task, assessment of mental health in the criminal justice system

Let those of us who are involved in civil assessments establish ourselves as a legitimate subspecialty. We should form a special interest group, the college only recognises specialist interest groups that exist in each state.. We will need some publicity to gain members. Such a group should include those who do civil assessments together with those who work in the area of occupational psychiatry as these two significantly overlap. By freeing ourselves of the burden of the Faculty of Forensic Psychiatry we will have the opportunity to run our own conferences, to obtain college funding, to develop our own training programs and, it may be that some academic department become interested in providing appropriate training courses when they realise that these are likely to generate significant fees.

 

What do we call people who’ve had a breakdown?

October 19, 2018

For many years I have been puzzled by the difficulty classified this group of people. With a co-author I wrote a book called “Falling Apart-living with stress breakdown” in 1989. I wrote this because of a sense of frustration.  The term ‘breakdown’ did not appear in the professional literature however many people told me that they had had a breakdown and it seemed to have some general meaning. Since then I have continued to be frustrated by the failure of any about diagnostic systems to come up with a diagnosis that encompasses this group. The term ;breakdown’ continues to elude any academic discussion. At the recent Faculty of Forensic Psychiatry conference in Sydney in September 2018 I presented a paper about this called “What do we call people who have had breakdowns? The diagnostic dilemma of long-term psychiatric disability‘. Click on the link to read the paper.

Expert Witnesses, some changes to immunity from negligence suits

September 16, 2018

In the context of revising my book,’The DIY’ Guide to Civil Forensic Psychiatry’ I came across a paper by Tina Cockburn And Bill Madden entitled

Expert Witness Immunity In Australia after Attwells V Jackson Lalic Lawyers: A Smaller and Less Predictable Shield?

This paper gives a comprehensive overview of the current situation regarding expert witnesses and liability in Australia.  By contrast with the UK, New Zealand and Canada where expert witnesses are not immune for negligence suits, in Australia we are still immune from negligence suit in relation to court work, and work done out of court which is intimately connected with the work in court. The latter is of particular significance in medical negligence litigation given that such claims most often resolve without a court hearing. However the the High Court of Australia in Attwells v Jackson Lalic Lawyers Pty Ltd upheld the advocates’ immunity from suit in negligence. Crucially however, the majority took a narrower approach as to the scope of the immunity by holding that it does not usually extend to negligent advice which leads to the settlement of a case by agreement between the parties. It is worth reading the article.

During the recent Forensic faculty Conference there was a paper given about the situation in the UK where it appears some expert witnesses have suffered draconian consequences! Let us hope the situation here remains unchanged.

 

South Australia Review of the RTW Scheme June 2018 – some comments

August 13, 2018

This review by Mr Mansfield is explicitly not to comment on government policy so his statement that ‘There would appear to be no rational reason for distinguishing psychiatric injuries from other types of injuries in terms of compensability or causation under the RTW Act.204 This is a policy position that merits review once the RTW Scheme has matured.” Mr Mansfield also commented on the government’s introduction  in awards for government employees that boost their benefits in certain situations, eg danger, He wrote that ‘the ‘modification’ of the RTW Act by those instruments, therefore, may in the future make the management of claims under the RTW Act in the case of Public Sector employees more difficult.”

Other issues regarding the Act were raised in submission

  • There is no combining of psychiatric and physical injury.
  • Work has to be the contributing cause rather than a contributing cause so any pre-existing psychiatric condition may make a claim void.
  • As compared with physical injury, there is no lump sum payment for psychiatric injury even if the PIA meets the 30% threshold for serious injury.
  • SA amendment July 2015 allows workers to choose their preferred assessor regarding Permanent Impairment Assessment (PIA) leading to only 6 assessors doing the bulk of the work.

The discrimination against workers with psychological injuries is blatant.  it was commented on in submissions from the SA branch of the RANZCP and AMA SA.

Pre-existing psychiatric impairment- problems with assessment

July 26, 2018

The issue of pre-existing psychiatric impairment is always difficult for examiners. The usual situation is that a person who has had problems with anxiety or depression and has had or has continued to have a course of psychiatric or psychological treatment or counselling.

In my view there are a number of matters that need to be considered including the following has there been a diagnosable psychiatric disorder?

Has the diagnosable psychiatric disorder required treatment?

Has the diagnosed psychiatric disorder lead to any area of impairment? The examiner has to look to see has there been any problems with regard to employment, relationships, recreational activity, drug or alcohol abuse or other significant behavioural issues such as gambling, aggression, withdrawal and unexplained physical illness.

It is not sufficient for the examiner to say that on the basis of how this person was after the accident it is likely that they had a pre-existing impairment. The examiner has to demonstrate that prior to the accident the pre-existing impairment was manifested by a reduction in level of function or had been diagnosed by a competent clinician.

The task of the examiner is to determine all these factors in the period prior to the accident or incident that led to the claim.

The examiner is then required to determine whether there has been any change with regard to this pre-existing psychiatric disorder. Is factors indicating any change would be a deterioration in function such as ability to work, relationship difficulties, the development of drug or alcohol-related problems that seems to be arising from this pre-existing condition and any changes in treatment for the pre-existing condition such as an increase in medication, an altered frequency of treatment, hospitalisation and so forth.

The examiner can only determine these matters at the time of the examination. It should be a critical part of the examination for the examiner to closely question the claimant’s level of function in the period prior to the incident or accident.

When examining the claimant the stamina has to separate out that impairment arising from the work or transport accident injury as opposed to that impairment arising from the pre-existing condition or an unrelated subsequent condition. This relies on data such as the matters described above. The examiner should be able to provide sufficient data to make a convincing case to a layperson for the presence absence of any pre-existing psychiatric disorder bearing in mind that the presence of a disorder does not necessarily mean any level of impairment. The examiner has to bear in mind that there is a difference between having a psychiatric diagnosis and having a level of impairment.

For example a person who has had a significant depressive disorder but has been appropriately treated and has been on maintenance medication for some years with no reduction in their quality of life including their work capacity, their relationships and their recreational enjoyment cannot be regarded as having any level of impairment. It may be that if that person stopped taking medication their condition would deteriorate and what they would then have some level of impairment but this is a matter of conjecture. The critical issue is that even if they are taking medication is there any pre-existing level of impairment?

 

In terms of assessing the level of impairment arising from the pre-existing condition at the time of the examination the examiner should look at those symptoms due to the pre-existing impairment and attempt to relate them to the descriptors and the GEPIC and on that basis form an opinion as to what class and to what level in that class this pre-existing impairment now rates.

The examiner is then required to subtract that from the whole person impairment (bearing in mind that the whole person impairment relates to pure mental harm as consequential mental harm will have been removed.

Twisting the tail of the tiger

May 31, 2018

From me to WorkSafe

Thursday 24 May 9.30am

Thank you for this interesting document (see previous post).

To  avoid misgendering, the use of gender-neutral pronouns such as they, them or their may be more appropriate in some circumstances. Gender-neutral pronouns, such as ‘zie’ and ‘hir’, may also be used. Most importantly, pronouns used should align with those requested by the person and should be used consistently. If you are unsure, respectfully ask the person what their preferred pronoun is and ensure that you use this pronoun when communicating.

There are some issues that require clarification. Could you provide the context in which these terms would be used. Could you also indicate the difference between ‘zie’ and ‘hir’, when they should be used and how these words are pronounced. This information would make it easier for IMEs when dealing with people who do not regard themselves as fitting into the system of binary genders.

WorkSafe response

Thursday 24 May 10.00 am

Thanks for contacting the Independent Medical Examiners (IME) Team.
Your enquiry is important to us and we will be in touch within 1 business day.

From me to WorkSafe

Monday 28 May at 5.30pm

I have not received a response to my email sent on Thursday, can I expect to receive a response soon?

WorkSafe response

Tuesday  29 May

May We apologise for the delay in getting back to you, we have referred your questions to a different business unit for review as this document was created by a different area of WorkSafe. We hope to have an answer for you shortly.

On it goes

WorkSafe

Wednesday 30 May at 3.45pm

Re: Clarification of article within IME Insight May 2018

To clarify further, the standard number of questions you should receive within the referral letter is 12. The Agent may request additional questions however they should not exceed a total number of 15 (questions).

From me to WorkSafe

Wednesday 30 May 4.46pm

You advise that agents should ask no more than 15 questions.  How does this reconcile with the New mental Injury Eligibility Questions?  There are 13 main questions and a possible 25 subsidiary questions.

WorkSafe response

Wednesday 30 may 5.00pm

Thanks for contacting the Independent Medical Examiners (IME) Team.
Your enquiry is important to us and we will be in touch within 1 business day.

Friday 1 June 2018

 

No response to either query!

Instructions on language from WorkSafe Victoria

May 21, 2018

In its most recent communication WorkSafe Victoria has advised IMEs about appropriate use of “gendered” language.   I make no commentary other than to note the threat if you do not comply.  Who would be an IME?.

The full document reads as follows.

Gendered language

WorkSafe has developed a guide for IMEs about the appropriate use of gendered language.

Binary male/female language expressed through gender specific terms, such as husband/wife, and gendered pronouns, such as he/she, do not always appropriately reflect our community diversity.

The Guide

This document provides Independent Medical Examiners (IMEs) with a guide to the appropriate use of gendered language.

Binary male/female language, expressed through the use of gender specific terms, such as husband/wife, and gendered pronouns, such as he/she, do not always appropriately reflect the diversity of our community.

What does it mean to misgender a person?

The Victorian Government’s Inclusive Language Guide defines misgendering as:

Using language to refer to a person that is not aligned with how that person identifies their own gender or body. Most but not all intersex and trans people who identify as male prefer to be referred to as ‘he’. Most but not all intersex and trans people who identify as female prefer to be referred to as ‘she’. Some people prefer to be described with their first name only or a non-binary pronoun such as ‘they’ rather than a gendered pronoun.

To avoid misgendering, the use of gender-neutral pronouns such as they, them or their may be more appropriate in some circumstances. Gender-neutral pronouns, such as ‘zie’ and ‘hir’, may also be used. Most importantly, pronouns used should align with those requested by the person and should be used consistently. If you are unsure, respectfully ask the person what their preferred pronoun is and ensure that you use this pronoun when communicating.

Misgendering of a person may amount to a breach of the IME Service Standards. Please refer to ‘Conduct during examination’ in the IME Service Standards for more information.

November 2017

Who would be an IME in Victoria?

May 6, 2018

This year I decided not to apply to become an IME with WorkCover. Some years ago I had been an IME with the TAC but I notice that I had had no referrals for six months or so and contacted the TAC and was told that I had resigned! I protested about this and demanded to see what had been written. “Oh no, you resigned over the phone!” It was clear I was not wanted and this was a way of removing me from the scene. I continued to apply to be a WorkCover IME but the experiences of working with WorkCover led me to deciding not to reapply. Those who have reapplied both for the TAC and WorkCover have found it a demeaning experience. They have had to be interviewed in person by a functionary, there has been no input from anybody in the profession. They have had to agree to an onerous contract(called a declaration) in which they must abide by the fee schedule.  To give you an idea this is what is said about dispute resolution

If a dispute arises in relation to my provision of services as an IME (other than a notice given by WorkSafe under clause 26 of this declaration), I or WorkSafe may request that the following dispute resolution process be utilised:

a) In the first instance the dispute will be discussed between myself and the WorkSafe’s Manager, Provider Performance and Quality;

b) If the dispute remains unresolved the matter will be referred to the WorkSafe’s Director, Worker Support and Health (or his or her nominee) and myself or my nominated representative;

c) If the dispute remains unresolved, it will be submitted to a mediator. The cost of mediation will be shared equally between WorkSafe and the IME; d) Where the parties to the dispute cannot agree on a mediator, the Chief Executive of the Law Institute of Victoria (or his/her nominee) will be asked to appoint a mediator; e) The above process will be carried out within 30 days of notification of the dispute.

WorkSafe Victoria have no interest in your safety and make no provisions for dealing with this issue.  The fee schedule is lower than any other state or territory.

WorkSafe Victoria- dialogue with psychiatrists II – another bit of chicanery

March 13, 2018

During 2017 WorkSafe Victoria invited the Victorian committee of the College Faculty of Forensic Psychiatry to meet and discuss a number of issues including who should do IME work, documentation, questions asked, timing, security, and even fees. We had two meetings, I posted my thoughts at that time, they proved to be prescient! We were to have another meeting in July that did not proceed and we heard nothing further.

All IMEs then received a document  dated 31 January, 2018 that included several attachments.

Dear IMEs,
At WorkSafe we are looking for better ways to work with our IME’s.
It is important to us that you are kept up to date with relevant and useful information to support you in your roles as IME’s with WorkSafe.
Strategic Communications
Firstly, we are trying a different approach to the  way that we will communicate with you to keep you informed about important updates through our IME Insight.
In this issue:

  • Mental Injury claims and the updated questions for Psych IME’s (see attachments)
    · Conflict of Interest: Have you got the processes in place to mitigate Conflict of Interest?
    · Recruitment Process (Update of the waves & dates)

We want to hear from you
Have ideas or feedback on how we can support you in your roles or to let us know if this type of update is useful, please contact independent_medical_examiner@worksafe.vic.gov.au
(See attached file: IME newsletter – issues one – jan 18.pdf)(See attached file: New Mental Injury IME Question Effective 18 December 2017.docx)(See attached file: New Mental Injury Questions A Guide for Practitioners V1 Dec 2017.docx)(See attached file: New-IME-Mental-Injury-Questions-IME-Coms V3 2018 (002).png)
Kind Regards
WorkSafe IME Provider Engagement Team

One attachment was the newsletter called ‘IME Insight’ dated 1 January 2018, a one-page document stating that there were new mental Mental injury questions

Another was “the New Mental Injury IME Questions” of which there are eight questions but so many sub- questions that in all there are a total 36 questions. There is also a guide to these questions, These questions in this guide were developed by the following:

Karen Chapman | Project Co-ordinator

Chris Lyons | Provider and Quality Co-ordinator

Dielle Felman  | Consultant Psychiatrist MBBS (Hons), MPM, FRANZCP

Dr Felman was placed in a difficult position.  She was asked to give advice about these questions but had no involvement with the Forensic faculty committee and was essentially speaking for herself.

The chair of the forensic faculty Victorian committee then contacted Lisa Boyd,who had been running the process and was told “We are looking for a very broad-based approach to liaising with psychiatry”; having the Forensic Faculty as the point of liaison does not seem to fit with this!

So much for consultation – Not happy Worksafe. It is consistent with my experiences with WorkSafe extending over 25 years.  I have been a member of the AMA VWA/TAC committee during much of this time and it is the same old story, bullshit consultation (to tick the box) and on they go doing what they intended doing all along.  I have decided to not re-apply to be an IME.