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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

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.

Safe Work Australia – a useful guide to nationwide trends

October 12, 2017

I try to look at the website of Safe Work Australia because it is full of information about nationwide issues and issues in particular states. There is a comparison of the various workers compensation schemes in the different states and a plethora  of statistical information. It is well worth a look.

For example they are attempting to develop a nationwide system of impairment assessment (including the PIRS)

Permanent impairment

When someone sustains an injury it may result in a permanent impairment.

A prerequisite to determining the level of permanent impairment is the understanding that it shouldn’t be decided until the claimant has improved as much as is possible; that is when their impairment has become stable or isn’t likely to improve despite medical treatment.

  • In addition to the assessment principles laid out in the AMA Guides, scheme legislation also provides substantial guidance on how to determine whether or not impairment is permanent.

In 2013, we made recommendations to the Ministerial Council on nationally consistent arrangements to assess permanent impairment, which were agreed to by the majority of jurisdictions in early-2014.

As a result we are now developing a national permanent impairment guide and a system for updating it, as well as developing a training package for medical practitioners who want to become permanent impairment assessors.

 

Workers’ compensation statistics Australia 2014-2015

April 13, 2017

The most recent Worker’s compensation statistics were released by Safe Work Australia in early 2017. The three industries with the highest number of serious claims were labourers, community and personal service workers and machinery operators and drivers.
A serious claim is an accepted workers’ compensation claim for an incapacity that results in a total absence from work of one working week or more. Claims in receipt of common-law payments are also included. Claims arising from a journey to or from work or during a recess period are not compensable in all jurisdictions and are excluded.

Surprisingly there is no mention of claims for “stress” or mental injury recorded in the summary, buried within the document is the following;

Diseases led to 10 per cent of serious claims and the most common diseases were mental disorders (5.7 per cent).

A higher percentage of female employees’ serious claims arose from mental disorders (over 9 per cent for females versus just under 4 per cent for male employees).

Mental stress accounted for 5 750 claims, some 5.4% of the total number of claims. Mental stress as apercentage of total claims has been consistent for many years

Number of serious claims by nature of injury or disease, 2000–01 and 2009-10 to 2014–15p

Nature of injury or disease 2000-01 2009-10 2010-11 2011-12 2012-13 2013-14 % chg 2014-15p
Mental disorders 6 620 8 095 8 735 8 355 7 680 6 685 1% 6 130

 

Serious claims: median time lost (working weeks) and compensation paid by mechanism of injury or disease, 2000−01 and 2009–10 to 2013–14

Mechanism of injury or disease 2000-01 2009-10 2010-11 2011-12 2012-13 2013-14 % chg
Mental stress 11.4 15.2 16.6 16.6 16.5 16.0 40%
Mechanism of injury or disease 2000-01 2009-10 2010-11 2011-12 2012-13 2013-14 % chg
Median compensation ($)
Mental stress $14 500 $24 200 $26 200 $26 600 $27 200 $26 400 82%

Summary of statistics
 Preliminary data show that there were 107 355 serious workers’ compensation claims in 2014–15, which equates to 6.5 serious claims per million hours worked.
 Between 2000–01 and 2013–14, the frequency rate of serious claims fell by 33 per cent from 9.5 serious claims per million hours worked to 6.3.
 In 2014–15, the frequency rate for male employees was 7.2 serious claims per million hours worked, while the frequency rate for female employees was 5.5.
 In 2014–15, the three occupations with the highest number of serious claims per million hours worked were Labourers (18.6), Community and personal serviceworkers (12.4), and Machinery operators and drivers (11.8).
 In 2014–15, the three industries with the highest number of serious claims per million hours worked were Agriculture, forestry and fishing (13.7),

Construction (9.8) and Manufacturing (9.3).
 In 2014-15, injury and musculoskeletal disorders led to 90 per cent of serious claims and the most common were Traumatic joint/ligament and muscle/tendon injuries (43.8 per cent). Diseases led to 10 per cent of serious claims and the most common were Mental disorders (5.7 per cent).
 Muscular stress while lifting or handling objects caused 32 per cent of serious claims in 2014–15, while Falls, trips and slips led to 23 per cent of serious claims.
 Between 2000–01 and 2013–14, the median time lost for a serious claim rose by 33 per cent from 4.2 working weeks to 5.6. In 2013–14, the median time lost for a serious claim was 5.4 working weeks for male employees and 6.0 working weeks for female employees.
 Between 2000–01 and 2013–14, the median compensation paid for a serious claim rose by 94 per cent from $5 200 to $10 100. In 2013–14, the

median compensation paid for a serious claim was $10 900 for male employees and $8 900 for female employees. When accounting for wage inflation, however, median compensation paid for serious claims increased by 23 per cent between 2000–01 and 2013–14, directly comparable with the increase in median time lost.
 In 2014–15, the bodily location most commonly affected by injuries and diseases that led to serious claims was the Back (21 per cent). Other common bodily locations were the Hand, fingers and thumb (13 per cent), Shoulder (11 per cent), and Knee (10 per cent).
 The rate of serious claims per 1000 employees is highest in metropolitan areas (10.6 claims per 1000 employees)
 Between 2009-10 and 2014-15, 69 per cent of serious claims in Agriculture, forestry and fishing occurred in regional areas, while 61 per cent of serious claims in Mining occurred in regional and remote areas. In the same period, 85 per cent of serious claims in Finance and insurance services occurred in metropolitan areas.
 Human agencies were the most common breakdown agency for serious claims in metropolitan (13 per cent of all claims) and regional areas (13 per cent), while Outdoor environment (16 per cent of claims) and Road transport (13 per cent) where the most common breakdown agencies in remote areas.

Senate Inquiry into complaints mechanism administered under the Health Practitioner Regulation National Law

January 16, 2017

On 1 December 2016, the Senate referred the following matter to the Senate Community Affairs References Committee for inquiry and report:

The complaints mechanism administered under the Health Practitioner Regulation National Law.

The terms of reference are:

  1. the implementation of the current complaints system under the National Law, including the role of the Australian Health Practitioner Regulation Authority (AHPRA) and the National Boards;
  2. whether the existing regulatory framework, established by the National Law, contains adequate provision for addressing medical complaints;
  3. the roles of AHPRA, the National Boards and professional organisations, such as the various Colleges, in addressing concerns within the medical profession with the complaints process;
  4. the adequacy of the relationships between those bodies responsible for handling complaints;
  5. whether amendments to the National Law, in relation to the complaints handling process, are required; and
  6. other improvements that could assist in a fairer, quicker and more effective medical complaints process.

The focus of this inquiry is the implementation and regulation of the complaints mechanism administered under the Health Practitioners Regulation National Law. Submissions outlining details of individual cases or complaints may assist the committee in identifying broader systemic issues for investigation. However, the committee has no power to investigate, advocate for or resolve individual cases. To protect the privacy of submitters, the committee has resolved not to publish any submissions outlining individual cases

Please note: All correspondence, submissions and other evidence provided to the committee’s previous inquiry into the medical complaints process in Australia is available to the committee for this inquiry. This means that submissions accepted by the committee for its previous inquiry do not need to be re-submitted.

Submissions should be received by 24 February 2017. The reporting date is 10 May 2017.

If you are considering lodging a submission to this inquiry you should consider the guidance on preparing a submission to an inquiry available on the Senate website.

Committee Secretariat contact:

Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600

Phone: +61 2 6277 3515

Victoria – TAC has developed a website for ‘health care providers”

December 9, 2016

The TAC has developed a useful website for ‘health care providers”.

This page provides useful information, such as updated fees, policies and industry events.

You can also choose your profession from the drop down list to access information

specific to you.

For example the link to IMEs brings up:

Independent Impairment Assessors – TAC – Transport Accident Commission

Independent Impairment Assessors (IIAs) are medical practitioners specially trained

to conduct impairment assessments.

These assessments are required for a person injured in a transport accident, who have

made a claim for impairment benefits,

as a result of sustaining a permanent impairment.

Impairment assessors, play a critical role in ensuring the TAC provides timely and equitable

lump sum benefits to a person

injured in a transport accident.

Becoming an Independent Impairment Assessor

All IIA’s must undergo specific training.  Training is delivered by an accredited training provider

approved by the Minister for the TAC.

The course offers:

  • Administrative information on the assessment of impairment
  • Theory and practice of assessing impairment

For further information about the training course, visit AMA Victoria or email iat@amavic.com.au

Providing services to the TAC

Upon the successful completion of the impaiment assessment training course, you can request

to provide services by directly contacting us.

Fees

The TAC can pay the reasonable costs of impairment assesment service as detailed in the

below fee schedules:

Doctor fights back against Internet Troll

September 29, 2016

We are familiar with various websites that rate those who do independent medical examinations. Some of these posts are incorrect and indeed defamatory.

Here is an example of comments from the workcovervictimsdiary Website.

Those IMEs who totally disregard honesty should be eliminated from the process. Consider having the state refer to an IME doctor rather than the insurer and the whole attitude towards fairness and honesty would likely improve

 Get rid of the (few) nutters doing most of the IMEs. If an IME doctor loses a certain amount of cases then don’t allow them to undertake more IME examinations. The reason these IMEs don’t succeed is because they are either wrong incompetent, dishonest or all three

Dr Alan Jager has sent us a post about a successful application to shut down such a website.  It makes interesting reading

Al Muderis v Duncan [2016] NSWSC 1363 saw the applicant, an orthopaedic surgeon, make an interlocutory application to to restrain the continued publication on the internet of material he alleges is defamatory of him. The defendant had not responded to correspondence and was not represented at the interlocutory hearing.

The application arose against the background of a complaint by a patient to the Health Care Complaints Commission, which was dismissed. A medical negligence claim was also made and dismissed.

Later the patient pleaded guilty to offences of intimidation and using a carriage service to harass, menace or offend. He was convicted and sentenced to four months imprisonment suspended on conditions. An apprehended violence order was made prohibiting the patient from assaulting, molesting, harassing or threatening the doctor, engaging in any other conduct that intimidates him, or stalking him. The AVO made specific reference to operation of a website.

The court made orders as requested by the medical practitioner, including an order directed to the website host registration entity. The website now appears to have been taken down.

Victorian ombudsman damning of work safe agents and some IMEs

September 20, 2016

The Victorian Ombudsman has released a report regarding an “Investigation into the management of complex workers compensation claims and WorkSafe oversight”

 

This report is very critical of practices of WorkCover agent’s particularly with regard to doctor shopping and is unsparing in its criticism of certain IMEs in particular with regard to their bias and poor quality reports. The report is a damning with regard to actions taken by work safe about IME reports that are inadequate. Based on the reports the following recommendations relevant to psychiatrist were made. A copy of the full report is available in publications and a summary is also available.

 

Recommendation 14

Implement changes to the current IME system to:

  1. prevent agents from selectively using ‘preferred IMEs’ or
  2. provide injured workers a choice of the IME with the appropriate speciality, by whom they are examined.

Recommendation  15

Amend its IME complaint handling policy to provide scope for examination of complaints where a worker does not provide consent for the complaint to be provided to the IME, which may include the referral of the matters raised to the IME quality assurance division for intelligence gathering purposes.

 

Recommendation 16

Amend the IME quality assurance process to:

  1. ensure IMEs subject to a high number of complaints are peer reviewed
  2. document the process by which WorkSafe will review an individual claim file where significant deficiencies are identified in relation to an IME’s report, to ensure a worker’s entitlements have not been unreasonably rejected or terminated based on the

The onerous provisions of the Victorian Transport Accident Act have been removed!

August 25, 2016

The Transport Accident Amendment Act 2016 was enacted in mid April 2016 (see effect of changes). The Act reverses the provisions enacted in the Transport Accident Amendment Act 2013 that limited the right of families of people who die or are severely injured in transport accidents to seek compensation for psychological injury.

The requirement that claimants with psychiatric injuries needed to seek treatment for three years before they can bring a serious injury claim has also been reversed. It did not recognise that many people suffering from mental illness find it difficult to reach out for assistance. Furthermore, it was especially difficult for claimants living in rural areas who may have limited access to mental health services.

This is a victory for common sense

American Board of Independent Medical Examiners AMA 5 Training in Melbourne- Who cares

May 26, 2016

I was astonished to receive an invitation from eReports to attend a weekend workshop in Melbourne conducted by Prof Mohammed Ranavaya, president of the American Board of Independent Medical Examiners. The training will be on the transition from AMA 4 to AMA 5.

 

As far as i’m aware there are no plans In Victoria to change from AMA 4 to AMA 5 and furthermore I notice that the section with regard to psychiatric impairment rating is from 345 to 4:30 PM on 23 July, 2016, the Saturday of the week end of the course and last for 45 minutes. Considering that there is virtually no difference between AMA 4 and AMA 5 with regard to chapter 13 what is there to be said? Furthermore no jurisdictions in Australia, apart from in the Northern Territory, use chapter 13. In Victoria and South Australia the GEPIC is used and in other states the PIRS.

 

The cost, from what I could work out is US $595 for the Saturday, the two workshops on Sunday total US$750 and the fee for the examination from 5:30 PM to 9 PM is $995 and for the non-physical examination from 530 to 7 PM is $350. You we please today that if you sign up for everything you receive a $100 discount.

 

The problem of course is that AMA5has been used widely for years apart from in Victoria where no changes are planned to move to AMA 5. I have difficulty understanding why anybody would bother.