So Your Medical Assessment Doesn't Add Up? Here's What You Can Do About It

Got a medical assessment certificate that makes you wonder if the doctor examined someone else entirely? Yeah, that happens more often than you'd think. These assessments can make or break your compensation claim, affect your work status, or determine what support you're entitled to. Let's talk about what you can actually do when the official paperwork doesn't match your reality.

What Are These Assessments Anyway?

Medical assessment certificates aren't just random paperwork. They're official documents where doctors (often ones you've never met before) make calls about:

• Whether you can work and what you can do

• How much your injury is "worth" in compensation terms

• What kind of support you need

• Whether your condition is permanent

• If your treatment should continue

The thing is, these assessments don't always get it right. Maybe the doctor spent all of 10 minutes with you. Maybe they didn't read your full medical history. Or maybe they just have a different view than the specialist who's been treating you for months.

A quick example? A nurse with a back injury got assessed as having "full capacity to return to nursing duties" despite the fact she couldn't even lift her toddler at home. The assessing doctor completely missed the point that nursing involves regular lifting and positioning of patients.

When Can You Fight Back?

Not every assessment you disagree with can be appealed. But there are definitely situations where you've got solid grounds to challenge what's been written about you:

• The doctor got facts about your medical history completely wrong

• They ignored test results or specialist reports

• Your condition has gotten significantly worse since the assessment

• The examination was rushed or procedures weren't followed properly

• The conclusions make zero sense given the evidence

This isn't about not liking the outcome. It's about the assessment being objectively wrong or unfair.

Don't Snooze on Deadlines

Here's where loads of people trip up. Those appeal deadlines? They're not suggestions.

For workers comp, you're typically looking at:

• QLD: 28 days

• NSW: 30 days

• VIC: 60 days

• WA: 21 days

• SA: 30 days

Motor accident injury assessment appeals have similar timeframes, usually 14-30 days depending on your state.

Disability support pension reviews? Usually 13 weeks for standard reviews, but only 28 days if you're challenging a specific medical assessment.

These clocks usually start ticking from when you receive the assessment document. And no, "the dog ate my mail" typically doesn't cut it as an excuse for missing these deadlines.

OK, So You Want to Appeal - Now What?

Appealing isn't just firing off an angry email saying "This is rubbish!" There's a bit more to it than that.

First Up: Get Your Hands on Everything

You need:

• The actual assessment (obviously)

• Any notes or reports it was based on

• Your full medical file

• The rules for whatever scheme you're dealing with

Don't have these? Request them immediately. Like, today. Most places have to give you access to your records, though some might charge a small fee.

Chat With Your Regular Doctors

Your GP or specialist who's been managing your condition should review this assessment. They'll often spot issues that you might miss.

A factory worker with chronic shoulder pain had an assessment claiming he had "normal range of motion." His physiotherapist was able to demonstrate with detailed treatment notes that his external rotation was limited to 60% of normal, with objective measurements taken over six months of treatment. That's the kind of specific contradiction that can help overturn a dodgy assessment.

Maybe Get Another Opinion

Sometimes bringing in a specialist who hasn't treated you before can strengthen your case. They're seen as more "objective" than your regular doctors (whether that's fair or not).

This isn't cheap - medical reports for legal purposes can set you back anywhere from $400 to over $2000 depending on the specialist and complexity. But if there's a lot at stake, it might be worth it.

Write Your Appeal (And Make It Count)

When writing your appeal, stick to the facts. Seriously. Emotions are totally understandable, but they don't help your case.

So instead of: "The doctor was horrible and didn't listen to anything I said!"

Try: "The assessment states I can sit for 4 hours continuously, but my treating doctor has documented that I cannot sit for more than 30 minutes without severe pain requiring position changes, as noted in my treatment records from March through June."

Be super clear about what you're asking for:

• A fresh assessment with a different doctor?

• Changes to specific parts of the report?

• Recognition of conditions that were ignored?

Send It to the Right Place (Sounds Obvious, But...)

Different systems have different appeal bodies:

• WorkCover claims usually go through state workers' comp authorities

• Motor accident appeals go to specific state bodies like SIRA in NSW

• NDIS decisions get appealed to the AAT

• Centrelink stuff goes through their internal review process first

Double-check where yours needs to go. Sending it to the wrong place is a waste of those precious appeal days.

When to Get Help From the Professionals

Some appeals are straightforward enough to handle yourself. Others? You'd be mad not to get some legal help, especially when:

• There's a lot of money involved

• Your injuries are complicated or disputed

• The insurer has rejected liability entirely

• You've already tried appealing and failed

• The insurer has lawyers all over it (and they almost always do)

Compensation lawyers who deal with medical assessment appeals know the system inside out. They know which arguments work and which are wastes of time. Yeah, it costs money, but most offer no-win-no-fee arrangements for valid claims.

Classic Stuff-Ups to Avoid

Plenty of valid appeals crash and burn because of these common mistakes:

• Missing those deadlines: Once they're gone, they're usually gone for good.

• Getting caught up in emotions: The doctor might have been a complete jerk, but that's rarely grounds for appeal by itself.

• Vague medical support: "My doctor agrees with me" isn't enough. You need specific medical evidence that contradicts specific points in the assessment.

• Not addressing the actual criteria: Each scheme has its own weird and wonderful criteria. Your appeal needs to speak to these directly.

• DIY-ing a complex case: Some appeals need expertise. Period.

A warehouse worker with a complicated back injury tried appealing his 8% impairment rating himself. His appeal was basically "I'm in pain all the time, this isn't fair." When he eventually spoke to a lawyer, they pointed out the assessor had completely failed to account for his documented nerve damage according to the AMA guidelines. His DIY appeal was rejected, but a properly prepared second appeal succeeded.

After You Lodge the Appeal - What Happens?

The process isn't exactly speedy, but it usually follows this sort of pattern:

1. Someone reviews your paperwork: The relevant authority looks over your appeal and the original assessment.

2. You might need to provide more stuff: They might ask for additional evidence or records.

3. Sometimes there's a panel review: Some systems use medical panels rather than individual doctors.

4. You get an outcome: Either:

• "Sorry, original assessment stands"

• "We're changing some bits of the assessment"

• "You'll need a complete reassessment"

• "We've made a new decision entirely"

5. Still not happy?: There might be further appeal options to tribunals or courts, but these get increasingly formal and complex.

Looking After Yourself Through This Mess

Let's be real - dealing with this stuff while you're already sick or injured is rough. While you're fighting the bureaucratic battle:

• Keep seeing your doctors and following treatment advice

• Document your symptoms and limitations (a simple diary can help)

• Consider a chat with a psychologist if it's all getting too much

• Stay organised with your paperwork - create a simple folder system

Bottom Line: Worth the Hassle?

Appeals take time, energy, and sometimes money. But when a medical assessment gets it wrong, the impact can be huge - the difference between getting support or not, between appropriate work duties or injuring yourself further, between fair compensation and being short-changed.

A retail worker with a shoulder injury was initially assessed at just below the threshold for lump sum compensation. After appeal, the correct assessment put him just over the threshold - resulting in a $30,000 payment he would have missed completely.

Understanding your rights, getting proper medical evidence, meeting those deadlines, and knowing when to call in the experts - that's what gives you the best shot at getting an assessment that actually reflects your real situation.

Dan Toombs is the Director of Practice Proof, a legal marketing agency helping law firms grow through smart Seo and content strategies.