Workers Compensation Changes to Payment of Workers Treatment Expenses.

01-08-2016    |    Resource   |   Arthur Fogarty

It is now some time since the Premier of this State announced on 19 June 2012 that his Government intended to make significant changes to the New South Wales Workers Compensation scheme.

The changes that eventually were passed by the New South Wales Legislature are in fact retrospective in effect and apply to all injured workers whether those workers suffered an injury prior to 19 June 2012 or after that date.  All workers injured prior to the 19 June 2012 are required to be transitioned into the new workers compensation scheme by the end of June this year.

Of major concern to injured workers and their treatment providers are the significant restrictions that have been imposed upon injured workers receiving treatment.    These changes include the requirement for a worker to receive pre-approval from the insurer prior to any treatment being undertaken.  If this approval has not been granted then a worker or his/her treatment provider is not entitled to recover, or be paid, for any treatment provided prior to the approval.

There are limited exceptions to this requirement that apply when an insurer has only accepted provisional liability.  A practitioner would be very wary of taking on an injured worker in this instance without discussing the treatment with the insurer prior to undertaking any treatment.

Any prudent treatment provider would only undertake the treatment if payment is made at the time of the consultation by the injured worker or proof of the approval by the insurer for the specific treatment is shown to the provider prior to any treatment being undertaken.

It had been always taken for granted that a worker who was injured in the course of his or her employment would have his or her reasonable treatment paid by the insurer for the rest of his or her life.  Unfortunately, the Government has decided that injured workers will now only be entitled to have their reasonable treatment for the injury paid by the insurer for 12 months after the last date the worker receives weekly payments of compensation.

A worker's entitled to weekly compensation has in most instances been restricted to a maximum of 130 weeks which can sometimes be extended for up to another 130 weeks.   These restrictions do not apply to seriously injured workers.

These time limits also apply to workers injured prior to the 19 June 2012 and as a result any such worker who had returned to work but was still receiving treatment has now had his or her entitlement to treatment cut off.  The 12 months period allowed for treatment for those workers commenced on 1 January 2013 and finished on 31 December 2013.  These changes have caught a number of workers unawares and they now find themselves out of the WorkCover system and reliant on our already over crowded public health system for treatment.  This is inherently unfair on those workers.  The media is now picking up on the more serious cases that have been thrown up by this inequity.

The Government indicated that it would review the scheme within two years of its commencement.  The Minister responsible for WorkCover has indicated that review will take place before the end of June 2014.

If you have any patients who have had their treatment declined by the insurer for any reason then you should recommend those patients contact the WorkCover Independent Review Office (WIRO) at WorkCover to lodge a complaint about the insurer's decision. WIRO's contact number is 139476.

In addition those workers should obtain advice from a solicitor specialising in Workers Compensation matters.   Prior to the changes to the scheme, a worker could obtain free advice from a solicitor about any workers compensation entitlements.  The legal fees were paid by the insurer.  Unfortunately, the Government, at the time it passed the legislation to change the scheme, decided that an injured worker would have to pay for his or her own legal advice rather than the insurer, virtually ensuring that workers did not receive any advice about their entitlements to challenge decisions of the insurers.

The WorkCover Independent Review Officer has stepped in and created a panel of solicitors specializing in Workers Compensations matters to provide advice to injured workers without any costs to the worker.  Both Steve Groves and Arthur Fogarty from this office have been appointed to that panel to provide advice to injured workers'.

If any of your patients are unsure of their entitlement to weekly compensation then please ask them to speak to an appropriate solicitor for advice.  If they attend our office we can see them without incurring any fees.

If there are any matters in relation to providing treatment to the workers or any matter relating to procedures under the new Workers Compensation Scheme that you wish to discuss please telephone Arthur Fogarty or Steve Groves.

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