Diagnostic Tests such as X-rays and MRIs are supposed to be extremely valuable pieces of evidence of a workplace injury and a workcover claim. Unfortunately, and not surprising, many of these tests are open to insurance doctors (IMEs) interpretation and as such routinely abused by the workcover insurance companies! After all some difference in “opinion” if a case is not as clear as a silver bullet, such as a massive herniated disc or a fractured shoulder, could actually be the “evidence” thy need to show what’s “wrong” (or not) and how (not) it relates to your workplace accident.
We received a shocking email overnight from an injured worker claiming he has evidence that certain Workcover insurers are going as far as to use “Medical Image Consultants”, IMEs as well as their own “insurance doctors” to blatantly falsify injured workers X-Ray and MRI results! In this sickening case, the injured worker has the insurer’s IME on record stating he reviewed his MRI 4 day’s before it was even made and signed off!
What is a Magnetic Resonance Imaging (MRI)?
Magnetic Resonance Imaging (MRI) is a radiological investigation to create cross- sectional images of the body. These detailed clear images are used by medical practitioners to diagnose and investigate a range of conditions.
An MRI service requires a referral and consists of imaging, reading and providing a written report by a radiologist.
Referral for an MRI from a surgeon, registered consultant physician or specialist
If your surgeon, consultant or specialists refers you for an MRI, you do not need prior approval from work cover (your case manager) for the MRI.
However, some Radiology facilities (i.e. Olympic Park Imaging) will require an approval letter from workcover for any MRI, even if it has been prescribed by your surgeon or specialist.
In this case, simply ask your work cover case manager to write you a letter addressed to the Radiology facility, stating that the MRI has been approved and will be paid for by work cover. Your case manager should be able to do this immediately. However, make sure you tell (or write/email) your case manager in “child language” what it is you are after (because they don’t understand plain English!)
Example (true story):
My surgeon referred me for an MRI. I sent the MRI request form (from my surgeon) through to my case manager and asked her for a letter of approval stating that the radiology department had requested one and will not undertake any MRIs without a letter from work cover, detailing that the MRI has been approved and will be paid for. After a few days I did not hear back from my case manager. My GP, whom I happened to visit a few days later, wrote a letter to my case manager, stating that my surgeon had requested an MRI and could she please ensure prompt approval as I was in great pain. This letter was faxed to my case manager, again with the request to provide me with a simple letter for the radiology department. Well, about 3 weeks (!!!) later I contacted my case manager and her Team Leader and told them that I was still waiting for that letter for the radiology department. They told me that the request for the MRI needed to be reviewed by their in-house doctor before making a decision whether or not they would approve the MRI (- which was requested by my surgeon, and made urgent by my GP-). A few days later (we’re now waiting 25 days) my GP tells me he had been contacted by the work cover insurance ‘house doctor’ to discuss the need for the MRI!
28 Days after having sent the urgent referral from my treating surgeon to my case manager, I finally obtained that 2 line letter for the radiology clinic, stating that the MRI had been approved and would be paid for by work cover.
My case manager insisted she had 28 days time… in-spite of me writing to her that I would hold her personally liable for any additional damage I would sustain and that I would rely on our correspondence in a court of law.
NO- she did not!!! An MRI requested by a surgeon does NOT need prior approval ! Needless to say how frustrated we (me and my surgeon) were. Imagine, you are in f***** agony, have done some serious damage to a body part, your treating surgeon and your GP feel that you need an urgent MRI, and they make you wait (inappropriately) for nearly 1 month before writing a 2-line letter! WTF!
What is wrong with these people? Are they illiterate? Are they just trying to wear you down until you give up? Or are they plain stupid?
Extract of WorkSafe’s policy regarding MRI’s
Is prior approval required for an MRI service? An injured worker may be referred for an MRI service by a consultant physician or specialist recognised for this purpose by the Commonwealth Health Insurance Act (1973). In these cases prior approval from a WorkSafe Agent is not required. It is recommended that the referring consultant physician or specialist contact the WorkSafe Agent to confirm that their patient has an accepted claim and that the region to be scanned correlates with the region of the accepted injury.
Request for an MRI by your treating GP
WorkSafe will consider a request for an MRI service by a treating medical practitioner other than a consultant physician or specialist, where access to consultant physicians or specialists is limited and provision of the service would be expedited by a referral from the treating medical practitioner. In these cases prior approval by the WorkSafe Agent is required. The treating medical practitioner should provide a written request that includes a working diagnosis, an outline of examination findings and a clinical rationale for the MRI service. A medical practitioner at the WorkSafe Agent will review these requests on a case by case basis.
I would love to hear about your stories!