IME Appointments for Coal Miners in NSW: What Happens If You Don’t Agree with the Insurer’s Doctor?

You’re working underground or at the surface in a coal mine in New South Wales. You’ve been injured, maybe a back strain from shifting heavy machinery, a slip in the wash-bay, or even a hearing issue or respiratory problem from years of underground work. You report the injury, your employer and insurer get involved, and now you’re told you must attend an IME (Independent Medical Examination) organised by the insurer.

You’re thinking: Do I really have to go? What if I don’t agree with the doctor’s report they get from that IME? Will that mess up my claim?

These are big, stressful questions. You’re already dealing with pain, lost hours, maybe uncertainty about returning to work, and the injury is disrupting your life.

What you don’t need is extra legal confusion. That’s where we come in. At Shaw & Bunner Legal, we specialise in helping coal miners and workers in mining in NSW navigate these exact issues. We’ll walk you through, in plain English, what the IME is, why you must attend it, what happens if you refuse, how to prepare, and what you can do if you disagree with the report.

What is an IME and Why the Insurer Can Make You Attend

When you’ve made a claim for injury working in or about a coal mine in NSW, the insurer has a right to investigate your injury, how it’s affecting you, and whether the treatment or ongoing benefits you’re asking for are reasonable and supported. One of the ways they do this is by arranging an IME - an Independent Medical Examination.

This IME is usually a doctor (or another suitably qualified medical practitioner) chosen by the insurer. They assess your injury, look at your medical history, your treatment, your capacity to work, and then provide a report to the insurer. The insurer uses that report as part of deciding whether your claim is accepted, whether you continue to receive weekly benefits, medical treatment expenses, or whether certain treatment (for example surgery) is “reasonably necessary.”

In coal-mining claims in NSW, things can be more complex because of the specific scheme which applies to workers injured “in or about” a coal mine.

So in short: yes - you are obliged to attend an IME when the insurer requests it.

Obligations: Must You Attend the IME? What Happens If You Don’t?

You must attend

If you’ve made a claim and the insurer arranges the IME, you have an obligation to show up. The scheme (in your case the coal mining workers’ compensation scheme) expects that when a legitimate claim is made, and the insurer exercises their rights to investigation, you cooperate. Refusing to attend the IME without a reasonable excuse may jeopardise your ongoing entitlements.

What counts as a “reasonable excuse”?

A “reasonable excuse” might include genuine illness that prevents you from attending, or lack of adequate notice, or perhaps travelling difficulties (especially relevant if you live in a remote area). If you do have a valid reason, you should let the insurer know, provide documentation (medical certificate etc) and ask to reschedule or attend remotely if appropriate.

The insurer can often assist with travel arrangements if required, whether that be arranging a hire car or paying for a night’s accommodation if you are travel a long distance to attend.

If you refuse without a reasonable excuse

If you simply decline to attend the IME, the insurer may interpret that as non-compliance and that you are refusing to cooperate. Consequences may include:

• Suspension of your weekly benefits (or refusal to pay until you attend).

• Delay in treatment approval or medical expenses being paid.

• The claim may be flagged as non-compliant, giving the insurer grounds to dispute further payments or benefits.

In other words: non-attendance can seriously impact your claim and your ongoing support.

Why it matters especially for coal mining injuries

For workers injured in or about coal mines in NSW, the scheme provides substantial entitlements (weekly payments, treatment, lump sum for impairment, etc) if the claim is accepted. Because there are significant supports in place, the insurers are entitled and motivated to properly assess the claim (which is why IMEs play a big role). So, attending the IME is a key part of ensuring your rights are preserved.

Tips on Attending the IME: Getting Prepared, What to Expect

When you head into the IME, you want to make sure you go in confidently, prepared, and with a clear head. The report from that IME could influence how payments and treatment continue. Here are some practical tips (and yes, we made a short video to help: click here):

• Bring all your medical records and history. Have your treating doctor’s notes, specialists’ reports, medication list, the history of how the injury occurred, what treatment you’ve had so far.

• Be honest and consistent. If you exaggerate or minimise your symptoms you risk credibility issues. The IME doctor investigates - inconsistent statements harm you.

• Explain your symptoms clearly and how the injury affects your day to day work and home life. Don’t try to use legal jargon, just say what it is, how it hurts or limits you.

• Ask questions if you don’t understand something. The IME should explain their process to you (they’re professionals and must act ethically).

• Make sure you understand your rights. The IME doctor must act under an expert code of conduct - you’re not their “client” in the usual sense, they’re an independent examiner engaged by the insurer.

• After the IME: note any minutes / observations. Some people like to write down key points immediately after the IME so they recall what was discussed.

Attending the IME well prepared improves your credibility, helps ensure the report is accurate and fair, and gives you a stronger basis if you later challenge the report.

What If You Don’t Agree With the Insurer’s IME Report? Your Options:

Let’s assume you attend the IME, the insurer receives the doctor’s report, and then the insurer makes a decision you disagree with. Maybe they say your injury isn’t work related, or that you don’t need surgery (despite your specialist recommending it), or they reduce or suspend weekly payments. Here’s what you need to know:

Yes, you can challenge it

Just because the insurer used an IME and got a report doesn’t mean the decision is final. You still have rights. For example:

• If the insurer disputes liability (saying your injury didn’t arise out of or in the course of employment) and denies your claim entirely, you can gather evidence to dispute that conclusion.

• If the insurer accepts the claim but disagrees with a particular treatment (for example surgery) or denies that your injury has reached a given impairment threshold, you can challenge that too.

How we help you challenge it

At Shaw & Bunner Legal we assist injured workers by:

• Obtaining independent medical evidence of our choosing. We’ll get you to attend an IME selected by us (or on your behalf) and get treating specialist reports.

• Reviewing the insurer’s IME report and identifying any flaws or inconsistencies. Maybe the doctor didn’t see certain records, didn’t properly consider the view of your treating specialist, or misunderstood the nature of your work and injury.

• Where necessary, filings Court proceedings to challenge the decision of the insurer.

• Presenting the evidence and advocating for you. If necessary, we prepare for dispute resolution processes, negotiations, or even court steps if needed.

• Ensuring your rights under the coal mining compensation scheme are properly protected (for example the statutory weekly payments, treatment, lump sum for impairment or common law if eligible).

Two common scenarios

1. Liability disputed entirely: The insurer says “we don’t accept your injury is work related”. We’d help you obtain evidence to show the incident’s history, medical records, worksite evidence, witness statements, specialist evidence to overturn this decision.

2. Treatment or surgery denied: The insurer says “the IME considers surgery is not necessary, so we will not pay for it”. But your treating doctor says surgery is required for you to recover and perform work safely and you want to have the surgery. We would obtain supporting specialist reports, may arrange our own IME, and argue the surgery is reasonably necessary for treatment of your work injury.

In short: disagreeing with an insurer’s IME report is not the end of the road - it’s a milestone in the process, and you still have options.

Case Studies: Real-World Successes (We’ve Helped Others Like You)
Case Study 1: “John, underground multi skilled mineworker, NSW Hunter Valley”

John was an underground multi-skilled mine worker in the Hunter Valley. He suffered a shoulder injury when performing rib bolting duties. The insurer arranged an IME which concluded that John’s injuries were “minor” and he could return to full underground duties. John’s treating specialist disagreed. He said John had a torn rotator cuff requiring surgery, and that he should not return to underground duties until he had been operated on.

We got involved. We arranged for John to see a second IME (of our choosing), gathered the specialist’s report, worksite incident report (machinery shift), John’s witness statements. We negotiated with the insurer, showing that the initial IME failed to review the MRI scan and misunderstood the mechanism of the injury. We filed Court proceedings to challenge the decision. The insurer eventually accepted the surgery as reasonable, approved it, and John had the surgery paid for. He received weekly payments whilst off work and then in due course, he will also be entitled to a lump sum payment for permanent impairment and pain & suffering.

Case Study 2: “Sarah, haul truck operator, Gunnedah Basin”

Sarah was a haul truck operator on an open cut coal mine site. She slipped whilst stepping down off a haul truck and sustained a knee injury. The insurer arranged an IME which concluded the injury was “pre-existing arthritic change” and refused personalised rehabilitation and surgery funding. Sarah could not return to her pre-injury role and was worried about her income and her future. We assisted by retrieving prior medical records, evidence of her work history, and arranged a specialist in orthopaedic surgery to confirm the link between the accident and the knee injury. The specialist report challenged the IME’s interpretation of arthritic change as “unrelated”. We then negotiated successfully with the insurer to fund the surgery, ongoing rehab, and weekly payments until she was fit for light duties.

These cases reflect our strong experience in working for miners and those in or about coal mines in New South Wales.

Some Pitfalls to Watch Out For

• Don’t ignore the IME request: failing to act is worse than attending and disagreeing.

• Don’t assume the IME will side with you: it’s organised by the insurer; the doctor is independent, but the insurer chooses them. Prepare as if it matters (because it does).

• Don’t accept a “no surgery” result without getting a second opinion if your treating specialist recommends surgery.

• Don’t wait too long to get legal advice. Early involvement gives you more control.

Key Takeaways

• If you’re injured working in or about a coal mine in NSW and have made a compensation claim, you must attend the insurer’s IME when requested.

• Refusing to attend without a reasonable excuse can jeopardise your ongoing benefits, treatment, and claim progress.

• An IME is an examination conducted by a doctor engaged by the insurer, who must act professionally and under a code of conduct - but their report is not the final word.

• If you disagree with the report (liability is denied, treatment refused, surgery off the table), you still have options: obtaining your own expert evidence, specialist reports, arranging your own IME of our choosing, and challenging the insurer’s decision.

• Having experienced legal representation (especially in the NSW coal mining compensation context) improves your chances of getting fair treatment, especially when negotiating treatment, lump sums or continuing weekly payments.

Next Steps

If you are a coal mine worker (or contractor, or someone working in or about a coal mine) in New South Wales and you’ve been injured, then:

1. Book your free consultation with our specialist team at Shaw & Bunner Legal so we can assess your situation, explain your rights, and outline what you should do next.

2. Gather and send us your medical records, treatment history, incident reports, employment details and any correspondence with the insurer.

3. If you have been asked to attend an IME, let us know - we’ll help you prepare for it and we’ll monitor the report and insurer’s decision.

4. If you’ve received a report you disagree with, contact us asap: we’ll review the report with you, compare with your treating specialist’s views, and assess whether we should challenge the decision.

5. Stay on top of your treatment, keep good records of what you’re experiencing, how the injury affects you in work and home life, and stay in touch with your employer and insurer as required - you’ll strengthen your position.

Injuries in the coal mining industry are tough. You deserve an ally who understands your world, your worksite, and the challenges you face. We’re here to help. Book your free consultation today and let us make the process as clear and fair as possible.

Frequently Asked Questions (FAQs)

• Do I have to attend the insurer’s IME if I’m making a coal mining workers compensation claim in NSW?

  Yes. When you make a claim and the insurer requests an IME, you are obligated to attend. Failure to attend without a valid reason can impact your entitlement to weekly payments and treatment.

• What happens if I attend the IME and the doctor’s report says my injury isn’t work related or treatment isn’t necessary?

  The insurer may rely on that report to reduce, suspend or deny benefits. But you are not locked out - you can challenge the decision by obtaining your own specialist evidence, possibly arranging an IME of your own choosing, and seeking legal advice to dispute the insurer’s position.

• Am I dealing with a different scheme if I work in coal mining compared to other workplaces?

  Yes. In NSW, workers injured “in or about” a coal mine have a specific compensation scheme and claims are generally made upon Coal Mines Insurance (CMI), the monopoly insurer. The scheme offers more generous entitlements and specialised rules. It’s important you get legal advice from someone experienced in that scheme.

• If I don’t agree with the IME report, how long do I have to act?

  You should act as soon as possible. Disputes can delay treatment and payments; the sooner you gather your own evidence and seek legal help, the better. In any claim, time limits matter (including for negligence/common law claims).

• Will attending an IME help or damage my claim?

  Attending, and attending well prepared, can help your claim. It shows cooperation and gives you a chance to present your side. A poorly attended IME (late, unprepared, vague about your symptoms) may give the insurer’s doctor a weaker or less credible view of your injury.

Written by the
Shaw & Bunner Legal Team

At Shaw & Bunner Legal, we’re highly experienced personal injury lawyers proudly serving clients across regional NSW. With over a decade working in national firms and deep personal ties to the coal mining industry, we’re uniquely positioned to help injured workers—especially miners—navigate complex claims with confidence.

Since our start in 2018, we’ve committed to providing clear, compassionate, and solution-focused legal advice that delivers real results. When you read our content, you’re getting insights from a team that truly understands what you’re going through—because we’ve lived it, worked in it, and helped hundreds of people through it.

Disclaimer: This article is general information only and cannot be regarded as legal advice as it does not take into account your personal circumstances. For tailored advice, please call us on (02) 4046 1805 or email us at admin@shawbunner.com.au.