The number of injured workers involved in disputes with icare and their employer regarding payment of medical treatment is on the increase.

Medical and related treatment includes treatment by a medical practitioner, dentist, physiotherapist, chiropractor, osteopath, masseur and speech therapist.  It is also defined to include the provision of crutches, glasses and other artificial aids (such as joint replacements), medications, domestic assistance and modification to an injured worker’s home or vehicle.

An employer must pay for any treatment if “it is reasonably necessary”. 

Icare guidelines state that the following are to be taken into account in determining whether medical treatment is “reasonably necessary”:

• the appropriateness of the particular treatment
• the availability of alternative treatment
• the cost of the treatment
• the actual or potential effectiveness of the treatment
• the acceptance of the treatment by medical experts.

An injured worker’s treating medical practitioner will normally provide a report commenting on these factors.  For example, a treating Neurosurgeon, who has recommended an injured worker undergo back surgery, may be able to comment that the surgery is appropriate given the other treatment options the injured worker has explored to date, that he / she is willing to perform the surgery, provide a quote, provide an opinion as to the likelihood the surgery will be effective, and comment broadly on the surgery’s acceptance by medical experts as a suitable treatment for the injury.

If icare and the employer continue to dispute that treatment is “reasonably necessary”, proceedings can be commenced in the Personal Injury Commission.  It has been determined that the following five factors are relevant to the determination of whether medical treatment is reasonably necessary:

1. Prima facie, if the treatment falls within the definition of medical treatment it is relevant medical treatment.  Broadly then, treatment is given by, or at the direction of, a medical practitioner and is such treatment;
2. However, though falling within that ambit and thereby presumed reasonable, that presumption is rebuttable if it be shown that particular treatment afforded is not appropriate, is not competent to alleviate the effects of injury, then it is not relevant treatment for the purposes of the act;
3. Any necessity for relevant treatment results from the injury where its purpose and potential effect is to alleviate the consequences of the injury;
4. It is reasonably necessary that such treatment be afforded a worker if the Commission concludes, exercising prudence, sound judgment and good sense, that it is so.  That involves the Commission in deciding, on the facts as it shows them, that the particular treatment is essential to, should be afforded to, and should not before born, by the worker;
5. In so doing the Commission will have regard to the medical opinion as to the relevance and appropriateness of the particular treatment, any available alternative treatment, the cost factor, the actual or potential effect of this of the treatment and its place in the usual medical armoury of treatments for the particular condition.

Commencing proceedings in the Personal Injury Commission is required when Insurer’s decline to pay for physiotherapy, medication, surgery, or other medical or related treatment.  Although unfortunate, this often occurs, despite evidence that an injured worker’s treating medical practitioner has recommended the treatment to achieve the best outcome for the worker.

As an injured worker you are entitled to be advised by Toby Tancred.  The Independent Review Office (IRO) can assist by providing funding for this legal advice.  IRO provides funding to approved Solicitors to investigate claims, provide advice to you as an injured worker, and deal with employers and insurers on your behalf.  Toby is an IRO Approved Lawyer.  Toby Tancred is a Law Society Personal Injury Accredited Specialist and has been recognised by Doyle’s Guide as a Recommended Work Injury Compensation Lawyer for two years running.  Doyle’s Guide has also named Toby Tancred Solicitor as a Recommended Asbestos & Dust Diseases Compensation Law Firm.  Toby Tancred has the experience, knowledge and ability to help all injured workers in difficult times.

 Many of our clients have recently received a letter from icare informing them that their weekly Workers Compensation payments may be incorrect.  This is an unsettling letter to receive.

icare has found instances where Workers Compensation Insurers have calculated weekly payments incorrectly as early as October 2012.  The potential underpayments have been uncovered as part of an Independent Review Report into icare that was handed down in April 2021.  Injured workers could be owed thousands, or even hundreds of thousands of dollars in arrears of payments.

If you receive this letter, it is important you obtain legal advice to determine whether you should apply for a reassessment of your weekly benefits.  If an assessment takes place and icare determine you have not been underpaid, your weekly payments will not change.  However, if an assessment takes place and icare determine you have been overpaid, your ongoing weekly payments could be reduced to the correct, lesser, amount.

An icare spokesperson has said “As at 30 July 2021, icare has reassessed some 8604 eligible claims from across NSW.  A total of 281 workers have found to have been underpaid a total of just over $3 million in weekly benefits.”  It may, literally, pay to take action.

As an injured worker you are entitled to be advised by Toby Tancred or Melissa Arndell.  The Independent Review Office (IRO) can assist by providing funding for this legal advice.  IRO provides funding to approved Solicitors to investigate claims, provide advice to you as an injured worker, and deal with employers and insurers on your behalf.  Toby Tancred and Melissa Arndell are IRO Approved Lawyers.  Toby Tancred is a Law Society Personal Injury Accredited Specialist and has been recognised by Doyle’s Guide as a Recommended Work Injury Compensation Lawyer for two years running.  Doyle’s Guide has also named Toby Tancred Solicitor as a Recommended Asbestos & Dust Diseases Compensation Law Firm.  Toby Tancred and his team have the experience, knowledge and ability to help all injured workers in difficult times.

A Council owes pedestrians walking in public spaces a duty. The standard of that duty acknowledges that people walking outdoors should keep a proper lookout to detect and avoid imperfections in a surface. The standard of care acknowledges that it is in the nature of walking outdoors that the ground may not be as even, flat or smooth as other surfaces. Pedestrians are ordinarily required to exercise sufficient care by looking where they are going and perceiving and avoiding obvious hazards such as uneven paving, stones, tree roots or holes.

The New South Wales Court of Appeal recently heard an Appeal in a claim for damages brought by a pedestrian against a large Council. The injured person was employed as a disability support worker. He was with one of his clients who wanted to use a public toilet. He fell on the first of three steps on a stepped pathway that lead down to the public toilet building. The trial Judge found that the risk of injury posed by the stepped pathway was not one that would have been obvious to a reasonable person. The trial judge had regard to the fact that the pathway led to a toilet block that included a disabled toilet and a reasonable person would not expect such a pathway to involve steps that were not otherwise clearly delineated. The trial Judge also had regard to shading that was present over the steps, and the absence of indicators that were present in other areas of the park to alert a person to the presence of the steps.

The Council appealed. On appeal, Council argued that the injured person was negligent because, rather than looking down as he approached the step, he made an assumption that the path had no steps. Council argued that the injured person looked at the path, kept walking towards it and then began to look at the public toilet building. He didn’t look at the pavers once he got close enough to discern the steps. It was argued by Council on that basis that the injured person’s own evidence demonstrated that he did not do what a reasonable person would do, which was “to continue to monitor, not look at your feet only, not stare fixedly at the ground, but as you’re moving off the asphalt on to the pavers, to continue looking”.

The Court of Appeal rejected Council’s arguments and determined that while the steps were not invisible, they were sufficiently conspicuous in the overall circumstances to generate a high probability of them not being seen by people who were not aware of them and not actively looking for them. The Court of Appeal accepted that once the steps were brought to the attention of a person, they were obvious, but until then, particularly on a downward sloping path leading to a disabled public toilet, they were not.

If you have sustained an injury, Toby Tancred and Melissa Arndell can help. They can provide you with legal advice, investigate your matter and represent you if you need to commence legal proceedings. Toby Tancred is a Law Society Personal Injury Accredited Specialist and has been recognised by Doyle’s Guide as a Recommended Work Injury Compensation Lawyer for two years running. Doyle’s Guide has also named Toby Tancred Solicitor as a Recommended Asbestos & Dust Diseases Compensation Law Firm. Toby Tancred and Melissa Arndell have the experience, knowledge and ability to help all injured people in difficult times.

A recent decision of the Workers Compensation Division of the Personal Injury Commission determined whether an injured worker had to attend a medical examination arranged by their employer.

The worker sustained psychological injury in her employment. The employer accepted liability for her claim while it conducted further investigations that included a request that the worker be assessed by a Psychiatrist. The worker objected to the medical examination in circumstances where her General Practitioner was prepared to promptly provide her treatment records.

When the worker’s solicitor confirmed she would not be attending the “unreasonable” examination, the employer suspended the worker’s weekly payments. It was quite clear from an objective view that the employer had ignored the Workers Compensation Guidelines 2021 at this point. This was despite the worker’s solicitor drawing the relevant part of the guidelines to the attention of the employer. That part of the Guidelines states:

“7.7 Unreasonable request
If the worker considers the requirement to attend an IME unreasonable, they are to advise the insurer of the reasons for their objection.

The insurer must consider this objection and advise the worker of their decision. This advice must include contact information for the Workers Compensation Independent Review Office (WIRO). Benefits are not to be affected prior to adequate written notice being received by the worker.

Any decision to suspend payment of weekly compensation can only be made after the worker has had an opportunity to comply with a reasonable request. This decision must be made on the basis of sound evidence, and the worker must be advised in writing of the reasons for the suspension and what they must do for weekly payments to be reinstated.”

The worker lodged an application in the Workers Compensation Commission, and it was heard by Arbitrator Batchelor, who delivered a decision on 15 September 2020. Arbitrator Batchelor referred to the Guidelines and noted that referral for an independent medical examination is only appropriate “when information from the treating medical practitioner(s) is inadequate, unavailable or inconsistent, and the referrer is unable to resolve the problem directly with the practitioners”. Arbitrator Batchelor held it was open to the employer to simply pay the General Practitioner’s invoice and then obtain the treatment records. On this ground alone the medical examination did not comply with the Guidelines. He found the worker was not obliged to undergo the medical examination and the employer could not suspend her weekly benefits.

The employer appealed Arbitrator Batchelor’s decision in the newly established Workers Compensation Division of the Personal Injury Commission. The employer argued that Arbitrator Batchelor erred by determining it did not comply with the Guidelines.

However, Deputy President Snell agreed with the original decision of Arbitrator Batchelor. He did not find any merit in the argument advanced by the employer that the Guidelines represent “a non-binding indication of policy” and instead determined Arbitrator Batchelor was bound to rely on the Guidelines. Deputy President Snell rejected the employer’s argument that it was prevented from making pre-payment of the General Practitioner’s invoice on the basis of a document titled “Workers compensation guide for medical practitioners”. Deputy President Snell held this submission was “plainly wrong” given the document did not possess “any regulatory authority at all”. The employer’s appeal was dismissed and Arbitrator Batchelor’s decision was confirmed.

This decision serves to highlight that quite often workers compensation insurers make requests of injured workers that are unreasonable and often unlawful. Do not hesitate to seek legal advice if you think something is unreasonable.

As an injured worker you are entitled to be advised by Toby Tancred. The Independent Review Office (IRO) can assist by providing funding for this legal advice. IRO provides funding to approved Solicitors to investigate claims, provide advice to you as an injured worker, and deal with employers and insurers on your behalf. Toby Tancred is an IRO Approved Lawyer, a Law Society Personal Injury Accredited Specialist and has been recognised by Doyle’s Guide as a Recommended Work Injury Compensation Lawyer for two years running. Doyle’s Guide has also named Toby Tancred Solicitor as a Recommended Asbestos & Dust Diseases Compensation Law Firm. Toby Tancred and his team have the experience, knowledge and ability to help all injured workers in difficult times.

If you are injured and unable to return to work you may be entitled to bring a Total & Permanent Disablement (“TPD”) claim through your superannuation fund. Depending on various factors including the amount of the premiums paid, you may have access to a TPD benefit ranging from the tens to hundreds of thousands of dollars.

To access this benefit, you must have suffered injury and be unable to return to work.  There are two types of Total & Permanent Disability policies; “own occupation” and “any occupation”.  “Own occupation” policies entitle an individual to a benefit if he or she cannot return to the usual occupation they were performing prior to their injury, or an occupation they have the skills, training and experience to undertake.  “Any occupation” policies entitle an individual to a benefit if he or she cannot return to any occupation whatsoever.

If you hold TPD insurance and meet the policy definitions of your superannuation fund, you are eligible to make a claim.  The claims process requires completion of a large number of documents and can be complex and, unfortunately, time consuming.  Your treating doctors will be required to certify that you are not capable of returning to your pre-injury occupation and your superannuation fund will request your medical records and information from your Employer.  If your superannuation fund recommends that your TPD benefit is paid, it will then go to the Trustee of the superannuation fund for final approval.  If your TPD claim is successful, you will also be able to obtain access to your superannuation balance, should you wish to do so.

Consideration should also be given to whether you hold any other insurance in your superannuation fund, such as income protection or death benefits, that you or your legal personal representative are eligible to claim.

It is helpful to seek legal advice when considering whether to lodge a TPD claim.  A Solicitor with expertise in this area can assist you through the claims process and increase the chance that your TPD claim is approved.  This year alone, Melissa Arndell of Toby Tancred Solicitor has assisted many people with their TPD claims and recovered millions of dollars of benefit for people unable to work.

If you have sustained an injury in the workplace Toby Tancred can help.  He can provide you with legal advice, investigate your matter and represent you if you need to commence legal proceedings.  Toby Tancred is a Law Society Personal Injury Accredited Specialist and has been recognised by Doyle’s Guide as a Recommended Work Injury Compensation Lawyer for two years running.  Doyle’s Guide has also named Toby Tancred Solicitor as a Recommended Asbestos & Dust Diseases Compensation Law Firm.  Toby Tancred and his team have the experience, knowledge and ability to help all injured people in difficult times.