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Do I have to go to a medical appointment arranged by the insurer or superannuation fund?

 


Do I have to go to a medical appointment arranged by the insurer or superannuation fund?

Whilst every superannuation fund and insurer approaches every claim in a different way, it is common that you will be asked to attend a medical appointment with a consultant doctor (or doctors) that the insurer or super fund chooses, before a decision is made on whether to accept or reject your claim.

The doctors the super fund or insurer chooses are usually specialist doctors and their qualifications vary depending on the nature of your illness and the issues in dispute in your case. The doctors may be neurologists, occupational doctors or psychiatrists (to name just a few).

What is an independent medical examination?

It is not unusual that you will be asked to attend appointments with more than one consultant doctor as part of the claim assessment. The super fund or insurer will often refer to these appointments as Independent Medical Examinations or IME’s and refer to the doctors as independent or IME doctors.

The independence of the doctors is not always certain. Often people are intimidated and concerned when they are asked to see consultant doctors and disappointed by the way they are treated by the doctors during the examination and then by the opinions which they set out in their reports.

For this reason, we are often asked, “do I need to attend the appointments?” The answer is not straight forward.

The starting point is that super funds and insurers are able to make reasonable enquiries relating to your health and your past, current and future work capacity.

Usually, it is reasonable that a super fund or insurer ask that you see a consultant doctor of their choice and sometimes the process can be useful for your claim. In some cases, we find that an assessment by a consultant doctor is useful as it can help to support your own treating doctor’s opinion about your work capacity or help clarify some issues that your treating doctors are unsure about. This is because sometimes the consultant doctors which the super fund or insurer will send you to are experts on the requirements of different jobs and the impact of different illness or injuries on your work capacity.

At other times the request that you see a consultant doctor can be unreasonable and the outcome of the appointment can appear to be predetermined. The doctor chosen by the super fund or insurer can be biased in the way that they assess the impact of your illness or injury on your work capacity.

Also, sometimes super funds and insurers will ask that you see a consultant doctor when there is more than enough medical material available to support your claim or you have already seen other consultant doctors (who support your claim).

Can I decline a request to see a consultant doctor?

Where there are good reasons to dispute the need to see a consultant doctor, you can object and argue that your attendance is not necessary.

Usually, you must provide reasons for your refusal and refusing can delay the assessment of your claim. Sometimes, it may be necessary to put your objection in the form of a complaint and use the super fund or insurer’s internal dispute resolution process.

Can I get financial assistance to attend medical appointments requested by the insurer?

You can ask the super fund or insurer for assistance to meet the cost and inconvenience to you in attending a consultant medical appointment. This assistance may come in the form of travel vouchers, reimbursement for train or bus travel or accommodation assistance.

What if I’m not happy with the opinion of the insurer’s doctor?

If you’re unhappy about an opinion of a consultant doctor, it is important to remember that the opinions can be challenged and are just one opinion for consideration in the assessment of your claim.

We recommend you also read our article on “What to do if my TPD claim is rejected”.

Help?

If your super fund or insurer is not willing to assist you to attend an appointment which they have arranged for you, or you are unsure about whether or not you need to attend an appointment or would like to refuse to attend an appointment, do not hesitate to get in touch with today’s blog writer, Tom Cobban, for some free advice.


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