When making a compensation claim for injuries sustained in a public place, in a work-related incident, motor vehicle accident, or when making a disability claim, part of the process requires the claimant to attend appointments with a medico-legal expert. The medical professional will assess the extent of your injuries. These reports form part of the evidence required to validate your claim and determine what compensation you should receive. Claimants need to carefully consider their statements when attending these appointments to ensure their injuries and health needs are recorded accurately, writes Compensation Lawyer, Yasmine Chalvatzis
Medically assessing a claimant’s injuries is a standard part of the claim’s process and may be arranged at any time during the course of a claim once their injuries have stabilised.
In theory, medico-legal experts are supposed to be independent and look at cases from all angles, give honest, evidence-based opinions, and avoid their personal views or conflicts of interest which could influence a truly, independent medical assessment.
In reality, if a medico-legal practitioner has been employed by the defendant’s insurance provider or WorkCover in a personal injury lawsuit or has an established relationship of consistently working for the same insurer, it is hard to ignore the potential for bias. This bias may cause the expert’s assessment to diminish the severity of the injuries, a tendency to attribute the symptoms to pre-existing conditions, and disregard evidence that supports a claimant’s position. Insurance companies and WorkCover have medico-legal ‘panels’ or stables of doctors that they regularly use to provide reports in claims. It is a lucrative business for the doctors giving these reports on behalf of the insurers and it is very difficult for them to be completely ‘independent’ when such large amounts of money are involved. It is hard not to conclude that the insurance doctors are ‘singing for their supper’ when providing their reports.
In our decades of experience supporting clients with personal injuries claims, we have witnessed questionable behaviour from insurer-appointed medico-legal experts. This conduct fundamentally undermines their presumed independence and ability to give an impartial, and accurate assessments of claimants’ injuries.
In one matter involving a client who lost their parents in a tragic car accident, our client suffered severe Post Traumatic Stress Disorder. The insurers’ medico-legal expert assessed our client to have just 5 per cent ‘whole person impairment’, after discounting the percentage by 10 per cent due to their assertion of pre-existing conditions.
Once our client was assessed by our medico-legal specialists, they concluded our client had 40 per cent ‘whole person impairment’ with no reduction for any pre-existing impairment.
Such a marked difference in assessment clearly demonstrated the insurer’s specialist underestimated the severity of our client’s psychiatric impairment in favour of the insurer.
This could have been incompetence because they did not question our client deeply enough about their depressive thoughts of hopelessness, guilt, nihilism and being a burden on people. Nor did they consider our client becoming too anxious to drive, and their need to remove themselves from society, having social withdrawal and social avoidance.
Too often, it may not be incompetence alone or even at all, but rather as we have come to recognise; a sustained pattern of insurer medico-legal experts demonstrating consistent and systematic denial of claimants’ injuries and across-the-board, inaccurate documentation of claimants’ statements in their meetings. As these meetings are invariably one-on-one, they are not subject to independent verification of the what the claimant has said.
We frequently hear from clients who, upon receipt of the medical assessor’s report, are distressed that what they have told the medico-legal expert has, at best, been wholly misinterpreted with multiple inaccuracies. Even worse, and most detrimentally to our clients’ claims, the medico-legal expert has fundamentally downplayed the extent of their injuries, leaving clients feeling disbelieved, questioning themselves and of course, left in a pejorative situation upon which to then make their claim.
This irresponsible and evidently biased behaviour in favour of the medico-legal experts’ paymasters, is even more outrageous when we consider the people making a claim have suffered debilitating physical and psychological injuries and have been through what has probably been the most traumatic period of their lives.
Claimants are often recovering from their injuries and attempting to piece their lives back together when they are forced into a situation where they must then find the mental strength to adequately “justify their claim” when attending these assessments.
To discover an alleged “independent” medical expert who may have appeared sympathetic in their meeting and seemed to understand their injuries, subsequently reports that they are doing better than what they are, can have a distressing effect on the physical and mental recovery from their injuries. It’s hard for anyone to not feel believed at the best of times. For claimants recovering from serious injuries, it can be devastating and feel like a set-back.
At Attwood Marshall Lawyers, we support our clients throughout the claim’s process to ensure that they are suitably prepared for medico-legal assessments and are protected from any tactics used by bias assessors. It’s about knowing what to expect when going in, and understanding the process and what the assessments aims to achieve.
What you need to know to prepare for a medico-legal assessment
A medical-legal assessment is an appointment with a doctor or a specialist who will assess your health condition, injury, or illness resulting from an incident.
This assessment is done for legal purposes and is used to provide expert evidence in personal injury claims, including workers’ compensation claims, CTP insurance claims for motor vehicle accidents, public liability incidents, medical negligence claims, abuse claims or disability claims.
The medico-legal expert will have access to your medical records and all relating medical evidence in your matter. The assessor will not just look at your recent medical history related to the injury or accident, but historical medical records as well, reviewing any pre-existing medical conditions. This may feel unnecessary and intrusive. It’s easy to question why the assessor might ask you about something which occurred years ago, and you feel is either irrelevant or moreover, none of their business.
It is important to remember this appointment is for legal purposes, not for treatment. It can be easy to confuse the two and to feel at ease to share your thoughts and experiences in the same way you would be your treating doctor. However, you must remember this doctor is not contributing to your treatment, their sole purpose is to assess your injury and produce a report in order for the lawyers and/or insurers to quantify your claim.
During a medico-legal assessment, keep it factual and detail the injury. The aim is to gather information to determine the extent of your injuries, your treatment needs, and the level of potential impact that your injuries have had, and may continue to have, on your life and ability to return to work.
Attwood Marshall Lawyers – a leading compensation law firm
When you’re supported by one of our dedicated compensation lawyers, you can rely on knowing we are here to take care of the communications and negotiations with the insurer, allowing you to focus on your recovery.
Our lawyers have decades of experience tackling big insurance companies and advocating for the rights our injured clients, ensuring that they are able to obtain the treatment and compensation they rightfully deserve.
If you have suffered an injury in a work related accident, car accident, or public liability accident and want to find out more about the claims process, please call our Compensation Law Department Manager, Tyra Hall, on direct line 07 5506 8261, email thall@attwoodmarshall.com.au or call our 24/7 phone line on 1800 621 071.
Our compensation lawyers are available for appointments at any of our conveniently located offices at Coolangatta, Robina Town Centre, Southport, Kingscliff, Brisbane, Sydney, and Melbourne.
