What can I do if an IME report is inaccurate or unfair?

Ask the insurer for the complete IME report and the documents supplied to the examiner. The current Guidelines require the appointment notice to explain that the worker can request both. If the report is relevant to a decision disputing liability or reducing compensation, legislation also gives the worker or a nominee report-access rights.

Next identify what has actually happened. The insurer may still be gathering information, or it may have issued a section 78 liability notice, a treatment decision, a work capacity decision, a permanent impairment response or another formal notice. The correct response and timing depend on the decision, not simply on the date of the examination.

A factual error can often be proved directly. A clinical disagreement usually requires a reasoned medical response. A legal or procedural problem is addressed through the applicable review or dispute process. Keeping those categories separate produces a more useful response.

Ask the treating practitioner a focused question. For example: whether the proposed duties are medically suitable and sustainable; why requested treatment is reasonably necessary; whether work materially contributed to the diagnosed condition; or which objective findings support the restriction. A letter that only says “the worker remains unfit” may not answer the insurer’s reasoning.

• A short chronology linking the incident, symptoms, diagnosis, treatment, work attempts and changes in capacity.
• The actual pre-injury duties, physical and cognitive demands, hours, travel and any proposed suitable duties.
• Treating notes, specialist reports, imaging, operative reports and certificates that address the disputed point.
• A treating response explaining why an error matters to causation, treatment, capacity or permanent impairment.
• Medication effects, fluctuating symptoms, failed return-to-work attempts and objective functional observations where relevant.
• Earlier records that show whether a condition was symptomatic and functionally significant before the work injury.

Liability and treatment disputes, work capacity decisions and permanent impairment disputes use different statutory processes. An insurer review may be available in some matters, and a dispute may be brought to the Personal Injury Commission where its jurisdiction and requirements are met. Do not assume that an internal review is mandatory before every PIC application or that one deadline applies to every notice.

Read the actual notice for the decision, reasons, evidence relied on, effective date and review information. If weekly payments, treatment or another entitlement is about to change, obtain advice promptly rather than waiting for the examiner or insurer to revise the report voluntarily.

Check whether the condition has reached maximum medical improvement, whether the assessor is listed for the relevant body system, whether the accepted injury and all relevant body systems were assessed, and whether the current NSW permanent impairment Guidelines were applied. Surgery or an imaging finding does not create an automatic WPI result.

During the interim period from 1 July 2026 until commencement of the new Part 6 Divisions 2 and 3 in mid-2027, separate worker and insurer examinations remain in place. A worker must obtain independent legal advice before being seen by a permanent impairment assessor. If the parties cannot agree after an interim assessment, the dispute may proceed to the PIC medical-dispute process with supporting medical evidence.

If the concern is discourtesy, unsafe conduct, discrimination, a privacy issue or professional conduct, the appointment letter should identify a complaint process. Depending on the issue, the insurer, SIRA, the Health Care Complaints Commission or Ahpra may have a role.

A complaint does not itself overturn the insurer decision, replace medical evidence, or preserve a claim-review deadline. Deal with the compensation decision and any conduct complaint as separate tasks.