Procedure

Arranging an examination with an independent legally qualified medical practitioner

7.An independent legally qualified medical practitioner's opinion should only be sought where:

§the claimant does not receive treatment from a doctor with relevant qualifications, and/or

§the treating medical opinions are inconclusive, and/or

§further specialised opinion is reasonably required, and/or

§conflicts of opinion between treating doctors must be resolved.

8.Where a decision is made not to use a local or treating practitioner the reasons for this decision are to be documented on file.

9.To facilitate the prompt resolution of claims, legally qualified medical practitioners should be chosen who provide appointments and reports with minimum delay.

10.The Privacy Act requires that personal information collected by Comcare must be directly related to Comcare's statutory functions (Information Privacy Principle 1).  In dealing with a claim for compensation, only information directly relevant to the determination of that claim can be collected and stored.

11.Requests to specialists to undertake a section 57 examination should therefore include the following advice:

While it is acknowledged that it is important that you obtain a complete and accurate history from [the claimant] for the purposes of providing your opinion, it would be appreciated if you would exclude from your report any sensitive or deeply personal information obtained during the examination which is not relevant to your findings.

12.In cases where a claimant alleges that the case history provided in a specialist's report is inaccurate, the report should be returned to the specialist, who should be requested to comment on the alleged inaccuracies and to revisit the conclusions of the report if necessary.

13.Any complaints received about the conduct of a specialist during the course of a section 57 examination should be brought to the attention of the Operations Group in the National Operations Division

Claimants may be accompanied at examinations

14.To address concerns some claimants might have about medical examinations, they should be given the opportunity to be accompanied by another person at the examination.   The following standard paragraph should be included when notifying claimants:

If you wish to be accompanied at the examination by a friend, relative or other person, you should first contact [the claim manager] on [telephone] and appropriate arrangements will be made with [the specialist].  It is important that you note, however, that you or your companion must not in any way obstruct the examination and that any costs incurred in connection with your companion's attendance cannot be met by Comcare.

The SRC Act provides that where an employee refuses or fails, without reasonable excuse to undergo an examination, or in any way obstructs an examination, his or her rights to compensation are suspended until the examination takes place.'

15.Where a claimant wishes to exercise his or her right to be accompanied at the examination, the Claims Manager must first notify the specialist and make arrangements with the practice.  If the specialist does not agree to a third party being present at the examination, the appointment should be cancelled and arrangements made for examination by a specialist who does not object to the claimant being accompanied.

16.Should a specialist find it impossible to continue with an examination because of the behaviour of the third party, the specialist may terminate the examination and should immediately advise Comcare of the reasons.