Difficult assessments and use of Independent Medical Examinations
This resource describes how compensation assessments can vary in difficulty and the role that Independent Medical Examinations (IME) have in supporting DVA decision-making.
In most cases, DVA requests assessments from the veteran's treating doctor because they are familiar with the veteran's history and have access to relevant clinical information. The advice below assumes that the assessment is being completed by the treating doctor as this makes the process easier and quicker; naturally an assessment will take longer for a provider unfamiliar with the veteran.
Assessment difficulty
Most compensation assessments are not difficult. However, DVA recognises that some assessments require more time and effort than others. The time required to complete a compensation assessment is influenced by the:
- number of conditions or body systems being assessed
- complexity of the clinical questions being asked or examination required, and
- individual patient factors.
The number of conditions alone does not necessarily increase assessment complexity, although it may require additional time to complete the assessment. When the anticipated assessment time is significantly greater than DVA fee guidance covers, the provider can submit a request for a higher fee. Details on how to request fees above DVA’s published guidance are available from Provider remuneration for compensation assessments.
When DVA may refer a veteran for an IME
Some assessments are particularly complex and may require an independent examiner or other expert assessor requiring specialist knowledge to assess a veteran’s conditions. These include cases where there is a need for advanced specialist clinical knowledge (for example rare conditions that may be associated with occupational exposures), or an application of clinical knowledge in an unusual or nuanced way. Most assessments requiring significant knowledge of compensation concepts and legislation will need to be conducted by an IME.
DVA can also nominate an IME to conduct the medical examination when medical evidence is unavailable from existing DVA held files or Defence service records, where a veteran does not have a treating practitioner, or where a veteran’s claim involves multiple undifferentiated conditions.