PIC medical assessment guide

Start with the dispute issue, not the appointment. If the insurer says your injury is threshold, your treatment is not reasonable and necessary, your capacity has changed, or your WPI evidence is weak, the PIC material should answer that specific point. A clear issue map usually improves both preparation and the usefulness of the assessment certificate.

Useful next pages are the PIC filing step guide, the insurer IME guide, the threshold injury dispute guide, and the Medical Review Panel explainer if a certificate needs review.

PIC medical assessment questions commonly arise after the insurer maintains a decision about threshold injury, causation, treatment and care, work capacity, permanent impairment, or whether an injury has stabilised enough for assessment. The page you prepare should match the certificate you need. A threshold injury dispute needs current diagnosis and functional evidence; a treatment dispute needs reasoning about why the treatment is reasonable, necessary, and accident-related; a WPI dispute needs impairment material that uses the correct method and addresses any competing IME reasoning.

If you are still at the insurer stage, start with the internal review workflow. If the insurer has already issued review reasons and the issue is medical, compare this guide with the PIC filing workflow before lodging.

A lot of avoidable damage happens in the final 24–48 hours. Treat this as an execution phase, not an admin task.

• • Day before: re-read the insurer reason and your core dispute question (for example causation, threshold classification, treatment reasonableness, or WPI method issue).
• • Check consistency: your chronology, certificates, and treating reports should not conflict on mechanism, timeline, or restrictions.
• • Logistics lock: confirm location, time, identity requirements, and travel timing so attendance itself is not put in issue.
• • Medication/treatment record: keep a clean list of current medication, recent treatment changes, and any upcoming procedures.
• • On the day: answer questions directly and consistently with your documented history; avoid speculation or broad statements that do not match your records.

If fatigue, pain flares, or psychiatric symptoms affect your ability to present clearly, document that pattern in advance through treating records rather than trying to explain it for the first time in the room. For psychological injury or nervous shock issues, also check the nervous shock CTP guide so the medical material explains symptoms, diagnosis, treatment, and functional impact without overstating what the evidence can prove.

Do not respond with a generic objection. Start by identifying exactly what finding is adverse and what pathway that finding belongs to.

1. Extract the key finding: diagnosis, causation, threshold classification, treatment necessity, capacity, or impairment methodology.
2. Preserve deadlines: record the date of issue and all review or filing cutoffs immediately.
3. Match evidence to finding: one focused bundle per adverse finding beats a large mixed-file response.
4. Check stream fit: confirm whether the issue should move through medical review, merit review, or another PIC route.
5. Plan escalation in writing: set out what is disputed, what evidence answers it, and what outcome is sought.

For pathway selection and escalation structure, cross-check Merit Review vs Medical Assessment, Medical Review Panel, and internal review workflow.