At some point in almost every injury claim the insurer will ask you to see a doctor it has chosen. In CTP and public liability claims the Acts give the insurer that right and require you to cooperate with reasonable requests; in WorkCover claims the insurer can require an examination for the purposes of the claim, and permanent impairment is assessed by a doctor or the Medical Assessment Tribunal. The examination is called independent, but the doctor is retained and paid by the insurer, and the report is written for the insurer's use.

Key points

  • You must attend reasonable examinations; refusing can stall the claim or lead to benefits being suspended.
  • The examiner is not your treating doctor: nothing said is confidential, and the report will be used to test your claim.
  • You are entitled to be told the purpose of the examination, to have a support person in most cases, and to see the report in due course.

What the Acts allow

The Motor Accident Insurance Act obliges a claimant to comply with an insurer's reasonable request to undergo a medical examination by a doctor the insurer nominates, and the Personal Injuries Proceedings Act contains an equivalent duty. The requests must be reasonable: an insurer cannot send you to an unlimited series of examiners in the same specialty, or to a location that is unreasonably far, without justification. The Workers' Compensation and Rehabilitation Act allows the insurer to have you examined for the purposes of assessing the claim, and non-attendance without reasonable excuse can result in compensation being suspended.

What actually happens

The examiner will take a history: how the injury happened, treatment since, current symptoms, work, and daily activities. There will be a physical examination for a physical injury, or an interview for a psychological one. The appointment is usually shorter than people expect. Some examiners are courteous and thorough; some are brisk. Either way the report will address the diagnosis, whether the injury was caused by the accident, whether it is stable, the degree of permanent impairment, and the effect on work.

How to approach it

Be accurate and consistent. The examiner has your medical records and your earlier statements, and inconsistency is the single most damaging thing that can come out of an examination. Do not minimise symptoms out of politeness, and do not exaggerate. Describe a typical day, including what you can do and what you can no longer do or do with difficulty. Answer the question asked. If you are not sure, say so. Note the time the examination started and finished, and what was examined, as soon as you leave; a brief note taken the same day is useful if the report later describes an examination more thorough than the one that occurred.

Your rights

You can ask what the examination is for and who requested it. You can usually bring a support person, though not to answer for you. You should not be asked to sign anything at the examination. The insurer will disclose the report to your lawyer under the claim process, and your lawyer can respond to it with your own evidence, including a report from a specialist of your choosing. In WorkCover claims, a disputed assessment of impairment can be referred to the Medical Assessment Tribunal, whose decision on medical matters is binding.

Frequently asked questions

Do I have to attend the insurer's doctor? Yes, if the request is reasonable. Refusing without good reason can stop the claim progressing or suspend benefits.

Is what I tell the insurer's doctor confidential? No. The examination is for the insurer and the report will be used in the claim.

Can I get my own medical report? Yes. Your lawyer will usually obtain reports from independent specialists to put alongside the insurer's.

Sources

  • Motor Accident Insurance Act 1994 (Qld), s 46A (medical examinations) — legislation.qld.gov.au
  • Personal Injuries Proceedings Act 2002 (Qld), Chapter 2 Part 1 Division 2 (claimant's duties, including medical examination) — legislation.qld.gov.au
  • Workers' Compensation and Rehabilitation Act 2003 (Qld), Chapter 3 (examinations and suspension for non-compliance), ss 179–189, Chapter 11 — legislation.qld.gov.au
  • Motor Accident Insurance Commission, Claims process — maic.qld.gov.au