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Procedural Justice and the Use of Independent Medical Evaluations in Workers’ Compensation

Psychological Injury and Law volume 8, pages 153–168 (2015)Cite this article

Abstract

Workers’ compensation systems aim to service both employer and worker needs following workplace accidents; however, there is increasing debate about the influence of the compensation system itself on recovery of the injured worker. Independent medical examinations (IMEs) are one of the processes within workers’ compensation systems that have been reported as distressing for injured workers. The aim of this study was to understand how workers’ compensation systems influence the work of psychologists who see clients with compensation claims, and their clients’ recovery. Semi-structured interviews were conducted with 19 psychologists. Interviews were transcribed verbatim, and data were analysed according to thematic analysis principles. In this manuscript, we focus specifically on the issue of IMEs—a component of the workers’ compensation process that was often raised in interviews with psychologists. Five main themes were identified: how IMEs complicate psychological therapy; how psychologists’ consider IMEs can exacerbate injury; disincentives for psychologists to practice within the workers’ compensation system; the limitations of independent opinions and suggestions for alternatives to the current IME process. Psychologists’ views of the impact of IMEs are discussed in relation to procedural, interactional, informational and distributive justice principles. Redesign of the IME process to meet procedural justice principles would likely reduce the negative and adversarial attitudes that injured workers and psychologists have towards insurers and workers’ compensation systems.

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Notes

  1. As enshrined in article 6 of the European Convention on Human Rights and developed in the case law of the European Court of Human Rights. The influence of the fair procedure requirement is omnipresent, but the details of feedback arrangements on IMEs vary greatly between European jurisdictions.

  2. Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data establishes the right for individuals to have access to their personal data concerning their health, for example the data in their medical records containing such information as diagnosis, examination results, assessments by treating physicians and any treatment or interventions provided. Details of the operationalization of this right vary greatly between EU member states.

  3. Individuals are legally entitled to receive any medical examination report, at least simultaneously and sometimes even prior to its submission (article 7:464 sub 2 under b Civil Code), and enjoy the right to correct any error in facts in all personal data (article 36 Data Protection Act), also in IMEs (e.g. the ‘I have no brother’ comment mentioned in one of the interviews).

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Acknowledgments

The authors would like to thank the psychologists who took time out from their busy practices to participate in this research. This project No FS-M-11-029 was funded by WorkSafe Victoria (WSV) and the Transport Accident Commission (TAC), Victoria, Australia, through the Institute for Safety, Compensation and Recovery Research (ISCRR) and Monash University. ISCRR is a joint initiative of TAC, WSV and Monash University.

Conflict of Interest

Two authors, Elizabeth Kilgour and Prof Alex Collie, receive funding from some or all of WorkSafe Victoria, the Transport Accident Commission, Victoria, the Institute for Safety, Compensation and Recovery Research and Monash University, Australia. The other two authors, Dr Agnieszka Kosny and Prof Arno Akkermans, declare that they have no conflict of interest.

Informed Consent and Compliance with Ethical Standards

The project was approved by Monash University Human Research Ethics Committee. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual subjects participating in the study.

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Authors and Affiliations

  1. Institute for Safety, Compensation and Recovery Research, Monash University, Level 11, 499 St Kilda Rd, Melbourne, Victoria, 3004, Australia

    Elizabeth Kilgour & Alex Collie

  2. Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario, M5G 2E9, Canada

    Agnieszka Kosny

  3. Department of Epidemiology and Preventive Medicine, Monash University, Commercial Rd, Melbourne, Victoria, 3004, Australia

    Elizabeth Kilgour, Agnieszka Kosny & Alex Collie

  4. Amsterdam Centre for Comprehensive Law, Faculty of Law, VU University, Amsterdam, Netherlands

    Arno Akkermans

Authors
  1. Elizabeth Kilgour
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  2. Agnieszka Kosny
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  3. Arno Akkermans
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  4. Alex Collie
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Corresponding author

Correspondence to Elizabeth Kilgour.

Appendix 1

Appendix 1

Table 1 Participant demographics
Full size table

Interview Questions

Context statement:

The Victorian WorkCover system requires that some injured workers’ participate in IMEs for service approval or assessment of degree of impairment.

  1. Q1.

    How would you describe WorkCover clients’ experience of the IME process?

  2. Q2.

    Do you think the IME process has an influence on the client’s recovery? In what ways?

  3. Q3.

    How do IMEs impact on you and your practice?

  4. Q4.

    Can you suggest an alternative to this system?

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Kilgour, E., Kosny, A., Akkermans, A. et al. Procedural Justice and the Use of Independent Medical Evaluations in Workers’ Compensation. Psychol. Inj. and Law 8, 153–168 (2015). https://doi.org/10.1007/s12207-015-9222-6

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