Handy Abbreviations / Terminology
Handy Abbreviations / Terminology:
- ACA – Accident Compensation Act 1985
- ACCS – Accident Compensation Conciliation Service
- Agent – Insurer managing claim and authorised representative of VWA – QBE, Allianz, CGU, Gallagher Bassett and Xchanging (were Cambridge Integrated Services)
- Circs – Circumstance / Factual Investigation
- Comp – Weekly compensation
- CWC – Current Work Capacity
- DOI – Date of Injury
- Emp – Employer
- Employer Liability – Threshold which the employer is required to pay – First 10 days of weekly compensation and/or first $660 of medical and like expenses (amount indexed 1st July every year)
- GP – General Practitioner / doctor
- IMA – Injury Management Advisor
- IME / Section 112/S27 – Independent Medical Examination
- IB – Impairment Benefit – lump sum compensation claim for permanent impairment
- MP – Medical Panel
- Med Rep – Medical report
- NCC – No current capacity / incapacity
- OHS – Occupational Health & Safety
- OR – Occupational Rehabilitation
- PIAWE – Pre-Injury Average Weekly Earnings
- RTW – Return to Work
- Section 93CD/Section 165 – application for reinstatement of weekly compensation after payments terminated at 104/130 weeks
- Self-Insurers – organisations authorised by the VWA to manage their own WorkCover claims eg. Toll, Coles, Ford, Qantas, Crown Casino, Westfarmers
- Termo – Termination of entitlement
- VWA – Victorian WorkCover Authority / WorkSafe / WorkCover
- WIRCA – Workplace Injury Rehabilitation and Compensation Act 2013
- Wkr – injured worker
- 13 week review – End of “first entitlement period” where weekly compensation rate reduces to 75% of PIAWE (from 05/04/2010 it will reduce to 80% of PIAWE)
- 104 / 130 week termination – end of “second entitlement period” where weekly compensation ceases if worker has a current work capacity or the incapacity is not indefinite
Types of Outcomes
Level 18, 460 Lonsdale Street, Melbourne
Opinion is final and binding on parties
The questions that the panel can be asked are from the Accident Compensation Act (1985) and are therefore not written by the insurer, employer, worker or conciliation officer. The conciliation officer will determine which questions are appropriate for the dispute before them. The parties will receive a draft referral to make sure the information contained in this is correct and the questions asked are appropriate.
The Convenor of Medical Panels arranges the number of panel members and the date/time for the appointment. You will generally see the “panel” of doctors at the one time although sometimes when there are both physical and psychological issues the psychiatrist will see you at a separate time to the physical doctors.
The Medical Panel will ask you a series of questions as well as undertake a thorough examination. They will form their opinion and answer the questions asked by the Conciliation officer. They normally have 60 days from the date they see you to form their opinion and provide this, in writing, to the conciliation officer. The conciliation officer will then forward this to the parties and the matter will end up being resolved either with payments being reinstated, payments for a limited period or will be unresolved (if not found in the workers favour). The matter cannot be taken any further i.e. to Court if not found in favour of a particular party.
This means that the matter has been resolved, often on a limited basis or the parties have agreed to do something i.e. formulate a RTW plan. This resolution is done with “no admission of liability”.
It is important that prior to agreeing to anything being finalised in a recommendation that you have advised your Union Assist advisor of any other issues which may arise so that they can be considered.
It is also important that you seek legal advice if you are unsure whether you should resolve your dispute under a recommendation.
Sometimes a matter may resolve under an agreement between the parties to pay for a particular service or period of compensation. This differs from a recommendation as it can be done with admission of liability or without admission of liability.
It is important to note that if your dispute resolves under an “agreement with no admission of liability” there are no return to work obligations imposed on the employer/self-insurer.
If there is a proposal to resolve your dispute by this way, you should seek some independent legal advice
Genuine Dispute (GD)
If the matter cannot be resolved and a medical panel is not an option then the conciliation officer will issue a GD. This means that there is an arguable case for the insurer. You will need to seek legal advice/assistance to take this to Court.
If you already have solicitors assisting you with other WorkCover legal action they may suggest / request a GD in the new dispute so that the matters can be joined.
If the conciliation officer believes that there is no arguable case (the threshold for an arguable case is very low) then they may, in some instances, issue a direction. This directs the insurer to make payments of either weekly compensation, medical and like expenses or both.
There are limits to the direction that the conciliation officer can make:
- Weekly Compensation = 12 weeks in the past and 26 weeks into the future
- If medical and like are to be paid as well as weekly compensation then there is no $ limit to the amount payable. The medical and like services are payable for the same period as the weekly compensation
- Medical and Like services only = $5000 for disputes after 05/04/2010 ($2000 for disputes before 05/04/2010)
If a direction is going to be issued it is important for you to seek legal advice straight away as they will need to attend court on your behalf, if the insurer seeks a revocation of the direction. The cost of attending court will be paid by the WorkCover scheme.
If the direction is revoked within 7 days from the date it’s issued then no payments are required to be made and a GD will be issued.
If the direction is revoked outside of 7 days from the date it’s issued then payments are to be made up to the date of the revocation.
Important things to know about Medical Expenses
Here are some important things to know about medical expenses following changes to the WorkCover law
If you are seeking any of the following services, you will now require a medical practitioner’s referral and prior approval before the initial service:
- aids and appliances
- attendant care
- community access
- elective surgery
- external case management
- gym / swimming programs
- hearing devices
- home exercise equipment
- implantable pain therapy
- MRI scans (where requested by a GP)
- Network occupational therapy
- Network pain mgt program
- Network psychology
- Occupational rehabilitation
- Pain mgt programs
- Pharmacy medications (specific ones)
- Private hospital expenses
- Removalist costs
- Respite care
If you are unsure whether the insurer will pay for a particular type of treatment / service, you should contact your case manager to find out what you need to do to obtain approval.
The following services require prior approval before subsequent services will be paid:
- acupuncture – after 2nd medical practitioner referral
- dietician – after 2nd medical practitioner referral
- district nursing services – after initial 4 services
- exercise physiology – after 2nd medical practitioner referral
- grief and loss counseling – after 2nd medical practitioner referral
- household help – after initial 12 week program
- naturopathy – after 2nd medical practitioner referral
- occupational therapy – after 2nd medical practitioner referral
- remedial massage – after 2nd medical practitioner referral
- social work – after 2nd medical practitioner referral
- speech pathology – after 2nd medical practitioner referral
The following are considered “treating health practitioners” for the purpose of getting a report. They need to be registered as a provider with WorkSafe (Victorian WorkCover Authority):