If you have a WorkCover claim, and the WorkCover insurer has made a decision that you don’t agree with, it is important that you know that you are allowed to challenge this decision. This can include denial of medical and like treatment, even denial of requested surgery. In this article you will find some useful resources to help speed up the decision-making process, as well as dispute and complaints avenues.
Unfortunately, and despite the fairly recent Ombudsman’s findings and recommendations about WorkCover VIC, we know first hand that people with longer-lasting injuries are still often forced to battle doctors hand-picked by insurance companies to get medical treatment. In other words: injured workers are still waiting in pain!
We have recently been contacted by a couple of seriously injured workers regarding their workcover injury permanent impairment claim. Most are confused about the process and many are quite shocked at the low monetary value put on their case/injury. Some don’t know whether they should accept the lump sum, or take their case to conciliation (and/or a medical panel). Perhaps it’s time we summarised the permanent impairment claim process in order for injured workers to better understand the process and what to expect.
Last week, NSW launched an inquiry into the possibility and feasability of a consolidated personal injury tribunal to resolve workcover disputes as well as CTP disputes. This was recommended by last year’s massive review of the NSW workers compensation system.
We receive a lot of questions re Comcare, particularly on how decisions can be disputed. Many Comcare decisions can be disputed, such as rejection of the claim, decisions to cease your benefits or a decision not to pay for certain medical treatment and/or pay you lump sum compensation for your permanent impairment, and even unreasonable decisions re your RTW.
The aim of conciliation in Victoria is to resolve disputes and avoid litigation. The injured worker can request conciliation if there is a dispute between the injured worker and the agent (insurer) and/or employer about the injured worker’s claim. What’s more, if your WorkCover insurer fails to respond to a request within 28 days you can also lodge a Conciliation.
In Victoria, if your WorkCover insurer makes a decision in writing that you disagree with you can appeal the decision at Conciliation. However, what many injured workers don’t know is that if your WorkCover insurer fails to respond to a request within 28 days, you can also lodge a request for Conciliation!
In a fairly recent (August 2013) scorching judgment related to a medical panel process, the Victorian Supreme Court has found an injured workers’ compensation dispute could have been easily resolved if the medical panel examination of the injured worker had been tape recorded.
The Supreme Court recently (March 2014) found that a Victorian Medical Panel for a workcover matter acted unreasonably by failing to let an injured worker explain alleged inconsistencies between the surveillance footage obtained from the worker and the worker’s reported medical history, symptoms and presentation. The famous ‘gotcha’ video showed the injured worker “moving freely”, and as a consequence the injured worker’s condition was no longer deemed “serious”. Again, this case, reinforces that our Medical Panels are also flawed and that they too can be prejudiced.
With the recent rise in workcover, common law and civil claims involving alleged psychiatric injury, knowledge of how psychiatric impairment is assessed is critical to determining whether an injured worker is entitled to a lumpsum or general damages.