Published by Independent Med Management (IMM)  |  Reading time: 5 minutes

You have a claimant on a growing list of medications. The treating GP keeps adding scripts, the claim is dragging, and you are not sure if the medications are helping or hindering recovery. The question is obvious: who do you call?

This article walks through every pathway available to claims managers and case managers in Australian Workers’ Compensation, what each one is suited to, and why the right choice can make a meaningful difference to claim outcomes.

The Options at a Glance

There are four main pathways for arranging a medication review in a Workers’ Compensation claim. They vary significantly in scope, independence, and clinical depth.

1. Specialist Pharmacy Review Services

These are purpose-built for the insurance sector. Independent pharmacists review the full medication regime, including both claim-related and non-claim-related medications, to assess safety, appropriateness, and recovery alignment.

This is the most comprehensive and cost-effective option for the majority of WC claims involving complex medication use, polypharmacy, or long-term opioid or sedative prescribing.

2. Independent Medical Examination (IME)

An IME involves an independent specialist providing an opinion on the claimant’s medical condition and treatment. While IMEs can address medication appropriateness as part of a broader clinical assessment, they are typically more expensive, slower to arrange, and less focused on medication-specific analysis than a dedicated pharmacy review.

IMEs are best suited to complex medico-legal questions about diagnosis, causation, or treatment liability, rather than medication optimisation as a standalone exercise.

3. Nominated Treating Doctor (NTD) or GP

The treating GP is responsible for the claimant’s ongoing care and can review or adjust medications at any time. However, GPs are often time-poor, may have limited visibility of the full claims context, and may be reluctant to reduce or cease medications that another specialist has recommended.

An independent pharmacy review can provide the GP with a structured clinical report that makes it easier for them to act, supporting rather than bypassing the treating relationship.

4. Clinical Panels (Scheme-Specific)

In some schemes, such as Comcare, clinical panels made up of independent doctors and pharmacists can conduct medication reviews. This pathway is typically reserved for disputed or complex cases and involves a more formal process with longer timeframes.

When to Arrange an Independent Pharmacy Review

A pharmacy review is warranted when one or more of the following is present:

• The claimant is taking four or more concurrent medications (polypharmacy)
• Opioids, benzodiazepines, z-drugs, or antidepressants are part of the regime
• The claim is long-term and the medication list has expanded over time
• There are concerns about dependency, sedation, or impaired work capacity
• A return-to-work plan is stalling and medication effects may be a contributing factor
• The GP has not reviewed the medication regime for an extended period
• There is no clear evidence base for one or more of the prescribed medications

What to Expect from an IMM Pharmacy Review

IMM’s pharmacy review process is designed to be straightforward for claims managers to arrange and clinically rigorous in output.

Each review produces a clear written report that identifies risks, ranks recommendations by priority, and outlines a proposed medication management plan. Reports are written to be understood by claims managers and case managers, not just clinicians.

How Reviews Align with Australian WC Scheme Requirements

Medication reviews conducted by qualified pharmacists are consistent with SIRA NSW guidelines, the Return to Work Act obligations in various states, and the clinical governance frameworks of major insurers. IMM works within all major Australian WC schemes including icare NSW, WorkCover Queensland, WorkSafe Victoria, ReturnToWorkSA, and Comcare.

Next Steps

If you have a claimant where medication management is a concern, an independent pharmacy review is typically the fastest, most cost-effective, and most clinically focused option available.

IMM reviews can be arranged directly through the IMM referral portal or by contacting the team. Turnaround times are generally two to five business days from receipt of medical records.

Independent Med Management (IMM) provides pharmacy review and medication risk governance services to Workers’ Compensation and CTP insurers across Australia. This article is for general information purposes. Clinical decisions should be made in consultation with qualified health professionals.