The early weeks after a soft tissue injury are a critical time. Evidence suggests that most soft tissue injuries usually heal within six weeks. When an injured worker fails to progress as expected it may be appropriate to refer for a specialist opinion.

Medical practitioners may refer for a specialist opinion from health providers such as:

• occupational physicians
• orthopaedic or neurosurgeons
• rehabilitation physicians.

Other health providers can recommend to the medical practitioner the need for a specialist opinion. They can also seek second opinions from their peers in regard to the treatment of the injured worker.

If the injured worker is referred to another health provider for a second or specialist opinion, the referral should cover:

• the diagnosis
• the worker's personal medical history
• treatment to date eg, tests, reports (consider sending computerised case notes if available)
• any factors or barriers to return to safe and sustainable work eg, industrial or psychological barriers
• any concerns of the health provider eg, pain or treatment failure.

If treatment is not resulting in the desired effect, an independent clinical assessment with an appropriately qualified person in the same field where that opinion would be valuable to help review the management of the worker may be arranged.

An ICA may only be utlilised by:

• a claims agent or self-insured employer
• a worker or injured worker’s representative
• the treating medical expert ie, the physiotherapist, occupational therapist, chiropractor or psychologist.

Where an independent clinical assessment is requested by the treating medical expert, the claims agent or self-insured employer must give approval for the service prior to its provision.

An ICA may be requested in order to:

• assess and make recommendations regarding the appropriateness and necessity of current or proposed treatment
• propose a recommended course of management
• make recommendations for strategic planning to progress the case, relating to goals and steps to achieve goals for treatment, which will assist in the achievement of a safe and durable return to work or restoration to the community
• provide a differential diagnosis where this is unclear from the current treatment program or, where required, determine prognosis for return to work (in relation to the injury)
• provide an opinion and/or recommendation on other criteria requested by the claims manager.

More information about ICA can be found in the WorkCover fee schedule and guidelines.

An independent medical examination can only be utilised by:

• a claims agent or self-insured employer
• a worker or injured worker's representative.

The information received (in the form of a report) may help the claims manager determine the nature, extend or likely duration of the injury, or provide an independent opinion regarding treatment or capacity for work.

Medical treatment remains the responsibility of the treating doctor and other treating health professionals.