Part 1 examined how assessment processes can create delays, foster mistrust and shift the focus from function to verification. The research evidence shows clear associations between claim experience and outcomes. Workers reporting positive experiences have 2.5 times higher odds of returning to work, while those with negative experiences face substantially longer disability.

But numbers alone don't capture the full picture. How assessments feel — whether workers experience them as collaborative or adversarial, whether they feel heard or questioned — shapes outcomes as much as how many occur. 

Part 2 examines these relational dimensions alongside the transparency gap that prevents us from understanding current patterns of use.

How common is this issue? An opportunity for transparency

Australian workers' compensation schemes and Safe Work Australia publish many types of data about scheme systems and outcomes. Common examples include claim numbers, duration, RTW rates, industry breakdowns and costs. We do not have publicly available data on how often independent medical examinations occur per claim, though this information likely exists in internal claims management systems.

Basic frequency and cost data would be a starting point. But understanding value requires going further: documenting why IMEs are requested and how often the results actually change management decisions. Without tracking whether assessments resolve genuine clinical uncertainty, guide treatment modifications or clarify work capacity — versus simply confirming existing opinions or adding procedural steps — we cannot assess whether current utilisation patterns serve their intended purpose.

Individual assessments cost $800 to $6,000+, but the larger question is their clinical utility. When treating practitioners provide clear, timely information and maintain good communication with claims managers, the need for independent assessment should be lower. International experience suggests that health systems with strong occupational health integration — where workplace physicians are involved from injury onset — have fewer disputes requiring independent assessment. Preventive and coordinated care models appear to reduce the need for adversarial medical opinions, though direct comparisons are complicated by different system designs and reporting practices.

Australian primary care operates under different constraints — 15-minute consultations managing both clinical care and compensation paperwork, with many experienced GPs now avoiding compensable cases due to administrative burden. This fragmentation likely drives higher IME use, though without frequency data or research into outcomes, the true scale and value remain unknown.

Assessment costs

Direct costs per assessment typically range from:

Standard independent medical examination: $800–$1,500
Specialist independent medical examination: $1,500–$3,000
Functional capacity evaluation: $2,000–$4,000
Neuropsychological assessment: $3,000–$6,000

These figures don’t include worker time off work, travel costs or the downstream costs of treatment delays while awaiting reports and decisions.

How and why the harm occurs

How the process feels: procedural justice

Beyond the clinical content, people react to how they are assessed. When workers feel they are being questioned rather than heard, or when an assessment feels rushed or unempathic, they are more likely to judge the process as unfair. Perceived fairness is shaped by 4 cues:

• Voice: being able to tell their story and have it reflected back accurately.
• Respectful treatment: empathy, attentive listening, and dignity in the interaction.
• Neutrality/consistency: transparent criteria applied the same way across cases.
• Explanation: clear reasons for conclusions and how the report will be used.

When these elements are missing, trust drops, distress rises and cooperation with rehabilitation can falter. Disputes and complaints become more likely, and time away from work tends to lengthen, even when the clinical picture has not worsened. 

Administrative load and tone

Language that frames capacity in absolutes (‘fit’/’unfit’) and emphasises deficits can harden beliefs, increase fear avoidance and shift identity toward ‘injured worker’. Adversarial tones — however unintended — undermine trust and increase the likelihood of disengagement.

Secondary effects

Delays and repeated scrutiny correlate with higher distress, demoralisation and sleep disruption. Over weeks and months, this increases the risk of secondary mental ill health and makes sustained time away from work more likely — even when the original injury is unchanged.

Opportunity cost and duplication

Each additional assessment consumes time (worker, employer, clinician), introduces travel and scheduling overhead and may incur legal and administrative effort. These resources could otherwise support timely graded activity, workplace modification and problem solving with the treating team. Where assessments do not change the care plan, the opportunity cost is significant.

Selection effects and referral patterns

Assessment providers operate in a market where repeat referrals can depend on insurer satisfaction. The 2019 Victorian Ombudsman (1) investigation into WorkSafe documented ‘doctor shopping’ — instances where insurers sought opinions from preferred examiners, favouring decisions to reject or terminate claims.

The system experiences this as ‘duelling doctors’ — where each party seeks opinions that support their position. This pattern increases disputes, erodes trust in the assessment process and extends time to resolution.

Case examples from scheme experience

Teacher with shoulder injury: early assessments agreed on a rotator cuff injury and surgical planning. Subsequent reports questioned the diagnosis, introduced alternative explanations (for example, somatisation) and paused definitive care. Over multiple rounds, confidence eroded and functional capacity declined while decisions were pending.

Hospital orderly with knee injury: the treating team proposed early physiotherapy and modified duties. An IME to ‘confirm capacity’ deferred the work trial. The IME recommended orthopaedic review. Each step added 2 to 4 weeks. While waiting, function and confidence declined and analgesic use rose. Final consensus: non operative management with graded activity.

What we've known — and what we overlook

We recognise that procedural fairness matters in principle. In practice, assessment pathways are rarely designed with voice, respect, neutrality and explanation as explicit goals. We measure throughput (reports completed, days to decision) but rarely track how workers experience the process. Without visibility of perceived fairness, we miss a key driver of engagement, trust and recovery.

Why this matters for schemes

The assessment burden is not rare. Data from one jurisdiction shows more than one in 3 claims involve 10 or more assessments, and some reach nearly 50. Each assessment is an intervention that can help or harm depending on its necessity, timing and delivery. When assessments feel adversarial or dismissive, the harm compounds — even when the clinical content is sound. Schemes that track only costs and timeframes miss the relational harm that drives disputes, disengagement and prolonged disability.

Questions for discussion

• One and done: what does the evidence say from schemes that use single shared reports (recognised across agents or insurers) to prevent duplication?
• Procedural justice: how could assessment pathways guarantee voice, respectful treatment, neutrality and clear explanations — and how would we measure perceived fairness after each assessment?
• Metrics: how do we track the assessment burden (counts, days in queue, days of treatment on hold) and link it to function and return to work at 3, 6 and 12 months. 

Independent medical examinations occupy a unique position in workers' compensation — positioned as neutral clinical opinions, yet questions persist about how effectively they're serving workers and schemes. Our next article examines what information we need about IME practices to understand whether current approaches are working as intended.

References

1. Victorian Ombudsman. WorkSafe 2: Follow-up investigation into the management of complex workers compensation claims. Melbourne: Victorian Ombudsman; 2019.