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WorkCover disputes and whole person impairment assessment

In the workers’ compensation system in Perth WA, reaching an agreement to settle a workers compensation claim within the no fault workers compensation system can only be completed after the injured worker and employer both agree to settle the claim. There are several parts to most workers compensation settlement including money for any permanent disability, future weekly payments of compensation, expenses for medical costs into the future, vocational rehabilitation expenses and travel expenses.

Compensation Claim Concept

Assessments of Permanent Impairment

To obtain a whole person impairment the injured person should be reviewed by an approved medical practitioner. A full list of these doctors can be found on the WorkCover website.

It is common in workers compensation claims for the insurer to agree that an injured worker has a permanent disability (aslo called a whole person impairment) if the injured worker has been examined by an medical practitioner who is approved by WorkCover (AMS), and AMS after meeting with the injured worker has provided the worker with a whole person impairment assessment using the WorkCover WA forms that are required.

More than one assessment

It is relatively common for the injured worker to obtain an assessment which is different to that provided by the workers compensation insurer’s approved medical specialist. The usual way to reach a resolution of this discrepancy is for both parties to discuss the differences in the medical reports and to negotiate a position in the middle as to the worker’s permanent impairment.

Sometimes the whole person impairment provided by the workers compensation insurer will be radically different to that specified in the other reports. The reason for this is usually that the insurer’s doctor believes that the disability ‘in the injured person’s head’ or the condition that the injured person is suffering from is not due to the accident. In extreme situations the insurer is not willing to make any form of offer to settle the claim and relies completely on the report that they have obtained

If a worker comes across this rare, hard line approach to the resolution of a workers compensation claim they will be wondering what they can do next. The answer lies in the Workers Compensation and Injury Management Act 1981, the governing act for workers compensation in Western Australia.

Section 31D (5) of the Workers Compensation and Injury Management Act 1981 states that if a determination is made that the workers degree of permanent impairment arising from the injury concerned is not less than that alleged by the worker, the arbitrator may order the employer to pay all or any of the costs connected with the dispute, including any costs connected with referral to an approved medical specialist panel.

The procedure for putting this section into effect would usually be for the injured worker to write to the workers compensation insurer requesting that they agree to the level of wholepersom impairment. If the insurer does not agre or no response is received then the worker can apply to WorkCover W.A. For a determination in respect of the dispute, and if the worker has a workers compensation lawyer, and is successful, the worker will be able to claim their legal fees from the insurer.

This kind of dispute is relatively uncommon. In WorkCover Western Australia most disputes regarding workers compensation claims involve whether the worker is entitled to weekly payments of compensation from their employer, or whether the worker is entitled to medical expenses or a surgical procedure, which can be very expensive, for example for a spinal fusion operation the cost can be in the vicinity of $30,000-$60,000.

It is common for WorkCover W.A. disputes come into existence in respect of subsequent injuries from an original accident. For example, a worker who was injured his right knee may overcompensate using the left knee, and as a result suffer injuries to the left knee. WorkCover W.A. can determine liability to pay weekly payments of compensation as well as statutory expenses (medical expenses, rehabilitation expenses and travel expenses) in respect of such a claim.

The rules in respect of workers compensation in Western Australia result in WorkCover W.A. being a difficult and complicated court system. Workers who are seeking to bring proceedings in WorkCover W.A. should secure the services of a trained personal injury lawyer specialising in workers compensation.

Author Bio:

Foyle Legal specialises in the area of workers compensation law in Western Australia and takes on workers compensation claims on a no win no fee basis. Visit foylelegal.com to know more details.

About Aldger Heler

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