Comcare medical examinations: your rights and obligations

If you’re injured at work and make a claim under the Commonwealth workers’ compensation scheme, Comcare or your employer (if they are a self-insurer) may ask you to attend an independent medical examination (“IME”). These assessments can affect liability decisions, treatment approvals and the nature and extent of your weekly payments.

This guide explains your rights and obligations so you can approach an exam with confidence and avoid unnecessary delays.

Who is covered by Comcare?

Comcare administers the national scheme for Australian Government employees and certain licensed corporations (self-insurers). If you work for a Commonwealth agency or a self-insurer, any claim you might make for workers’ compensation is managed under the Safety, Rehabilitation and Compensation Act 1988 (Cth) (“the SRC Act”). This Act sets out when medical exams can be required and what happens if you do not attend.

Why Comcare request medical examinations

Medical examinations can assist decision-makers answer key questions, including:

• diagnosis and whether it is related to work;
• capacity for work and suitable duties;
• reasonable treatment needs and duration;
• assessments for the purposes of determining lump sum payments  for permanent impairment.

Requests are common for psychological injuries and complex physical conditions, or where medical opinions conflict.

Your legal obligation to attend an IME

Under the SRC Act, you must attend a medical examination reasonably required by Comcare or a self-insurer to assess your claim. If you unreasonably refuse or fail to attend, your entitlements may be suspended until you comply. A genuine reason for rescheduling is usually acceptable, but ignoring a notice can put your entitlement to continued payments at risk.

Reasonable notice and practical arrangements to attend an IME

You should receive clear written notice that sets out the purpose of the exam, the doctor’s details and the time and place the examination is to occur. Arrangements must be reasonable. In practice, that means:

• location is within a reasonable distance, or travel is arranged;
• reasonable notice is given so you can attend;
• timing takes account of medical needs, caring responsibilities and rostered work;
• travel costs are covered. 

If you cannot attend the appointment, contact your claims manager promptly to request alternatives and suggest times that work for you.

Who can perform an IME?

Examinations are to be carried out by an appropriately qualified medical practitioner with relevant expertise. For specialist issues, Comcare may choose an occupational physician, orthopaedic surgeon, psychiatrist or another appropriately qualified specialist. You can raise concerns about cultural safety, gender preference or conflicts of interest and ask for a different examiner where reasonable.

What you must do at the examination

Your obligations on the day are straightforward:

• arrive on time and bring photo identification;
• provide an accurate and complete/relevant history of your injury and current symptoms;
• cooperate with reasonable physical or psychological testing that is clinically necessary;
• disclose medications, relevant past injuries and current restrictions.

What Comcare must do for you

You should expect:

• clear information about why the exam is needed;
• a clinically relevant choice of examiner;
• reimbursement of reasonable travel and accommodation costs;
• access to an interpreter if required;
• privacy and respectful treatment during the assessment.

If you need a support person, contact your claims manager and ask in advance so the doctor’s clinic can accommodate this.

Accessing the medical report from your exam

You are entitled to know the outcome. You can request a copy of the independent medical examiner’s report from your claims manager. If a decision relies on the report, it should be provided with the decision or upon request so you can properly understand why the decision was made and, if needed, respond to it (including by seeking a Request for Reconsideration, if that is what you need to do).

Managing multiple or repeated examinations

Sometimes, Comcare may arrange more than one exam, for example, where new issues arise or where the first report is unclear. Repeated exams should still be reasonable. If you feel the requests are excessive or overlapping:

• ask why a further report is needed and what questions it will answer;
• propose using the same specialist to ensure continuity;
• seek advice if the frequency of IMEs appears unfair.

Consequences of not attending an IME

Failure to attend without a reasonable excuse can lead to suspension of weekly payments and other entitlements until you comply. 

If you miss an appointment for a genuine reason - illness, carer duties, transport disruption - tell your claims manager as soon as possible, provide evidence if needed and ask to reschedule. Addressing the issue quickly will keep your claim on track.

Practical tips to prepare for a Comcare medical exam

A calm, organised approach reduces stress and improves the quality of the assessment:

• Confirm details early;
• List on a piece of paper/on your phone beforehand, your symptoms, flare triggers and work restrictions (if relevant);
• Bring key imaging (X-rays, etc) or letters if requested;
• Note how the injury affects sleep, concentration and daily tasks;
• Wear comfortable clothing for physical exams;
• Take the aids or braces you normally use;
• After the exam, write down what occurred while it is fresh in your mind (this can be an important reference if there is any dispute as to what the doctor asked you, or your responses to their questions).

Psychological injury examinations

Psychological injury claims often involve detailed history taking and validated questionnaires. To prepare:

• outline the specific work events and timeframe;
• explain current symptoms and treatment;
• be frank about pre-existing conditions or personal stressors;
• describe any return-to-work barriers and what support helps.

Candour is important. A full, accurate picture assists the examiner and can strengthen your claim.

Fit for work vs independent medical exams

Your employer may also arrange a fitness for duty or rehabilitation assessment to plan suitable duties. This is different to an independent medical examination obtained for the purposes of your compensation claim. If you are unsure which type of assessment you have been asked to attend, ask for clarification of the purpose and how the results will be used.

Disputes and second opinions

If a decision relies on a medical report that you believe is inaccurate, you can:

• request clarification from the examiner via your claims manager;
• provide Comcare/the self-insurer with a detailed response, including any views from your treating doctor;
• supply further evidence, such as updated imaging or specialist reports.

Act promptly, as review time limits can apply to certain decisions (e.g., a formal Request for Reconsideration of the decision you are not happy with).

FAQ: common questions about Comcare medical exams

Can I choose my own specialist for the Comcare exam?

You can express preferences and raise concerns about conflicts, culture or gender. The decision maker selects the examiner, but reasonable requests can be accommodated.

What if travel is difficult or the clinic is far away?

Tell your claims manager. Appointments should be reasonably convenient. Travel costs should be covered and, where needed, accommodation can be arranged.

Do I have to sign broad medical authorities?

You should only authorise access to records relevant to your claim. Ask for clarification if a form looks overly broad and seek advice before signing.

Will my treating doctor’s opinion be ignored?

No. Treating medical evidence is important. The decision maker weighs all evidence, including the independent report, treating doctors’ opinions and objective tests.

Can I get the report?

Yes. Always request a copy from your claims manager, especially if it informs a decision affecting your entitlements.

Key takeaways

• You must attend reasonable Comcare medical examinations.
• Comcare should give clear notice, use appropriately qualified examiners and cover reasonable costs.
• You can ask for adjustments for safety, culture, gender or accessibility.
• If you do not attend without a reasonable excuse, benefits may be suspended.
• Prepare well, be honest and complete all the information/answers to questions that you give to the doctor (and keep a record of what occurred).
• If a decision relies on a report you disagree with, respond with evidence and use the review pathways (but ensure you keep an eye on any relevant time limits!)

Get help from a Comcare lawyer

Being asked to attend a Comcare medical exam can affect your claim, treatment approvals and weekly payments. 

If you are unsure about anything to do with the IME, consider getting advice from a lawyer experienced in the Comcare scheme about what is reasonable, how to prepare and how to respond to the report. Early advice can help protect your entitlements and keep your claim on track.