Practice Direction No 14 - Workplace injury management disputes

The purpose of this Practice Direction is to provide procedural information in respect of a dispute that concerns a failure by a party to comply with an obligation imposed under Ch 3 of the 1998 Act.

30 October 2018

Commencement

1. This Practice Direction is issued pursuant to r 18.1 of the Workers Compensation Commission Rules 2011 (2011 Rules) and commences on 30 October 2018.

Application

2. This Practice Direction applies to proceedings commenced under Div 3 of Pt 5 of Ch 7 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act). Rule 9.7 of the 2011 Rules applies to the commencement and resolution of these proceedings.

Purpose

3. The purpose of this Practice Direction is to provide procedural information in respect of a dispute that concerns a failure by a party to comply with an obligation imposed under Ch 3 of the 1998 Act.

Obligations

4. Chapter 3 of the 1998 Act imposes obligations on employers, insurers and workers. The object of the chapter is to establish a system that seeks to achieve optimum results in terms of the timely, safe and durable return to work for workers following a workplace injury (s 41 of the 1998 Act).

5. The obligations under Ch 3 apply even where there is a dispute as to liability (s 41A of the 1998 Act).

6. Any action taken by an employer or insurer under an injury management plan, or for the purpose of rehabilitation of the worker, does not constitute an admission of liability (s 58 of the 1998 Act).

Types of disputes

7. Disputes resolved under Div 3 of Pt 5 of the 1998 Act generally concern the following issues:

(a) there is no injury management plan, the injury management plan has not been followed, or is disputed;

(b) there is no return to work plan, the return to work plan has not been followed, or is disputed;

(d) whether the worker is making reasonable efforts to return to work in suitable employment;

(e) the worker’s request for vocational retraining has not been provided, and

(f) issues concerning the nominated treating doctor (including a failure to nominate a treating doctor, changing the nominated treating doctor, disputed cost of treatment by nominated treating doctor, and the provision of relevant information by the nominated treating doctor at the worker’s authorisation).

Commencement proceedings

8. Proceedings are commenced by lodging in the Commission an Application to Resolve a Workplace Injury Management Dispute (Form 6). These proceedings may be commenced by a worker, an insurer, or an employer. The applicant must serve a copy of the unsealed application on the respondent (and where the respondent is an employer, the insurer) the same day it is lodged in the Commission.

9. Each party may be legally represented in the proceedings.

10. In the application, the applicant must outline the nature of the dispute and whether any attempts have been made to resolve the dispute prior to the commencement of the proceedings. The applicant must also identify, in the application, the specific obligation under Ch 3 of the 1998 Act that has been breached.

11. The applicant should attach to the application all relevant supporting documentation. That documentation must be indexed and paginated. Documents attached should assist the resolution of the dispute and provide evidentiary support for the application. Relevant documents may include:

(a) injury management plan(s);

(b) return to work plan(s);

(d) clinical notes from the worker’s nominated treating doctor;

(e) medical report(s) from an independent medical expert;

(f) statement(s) addressing the circumstances and consequences of the injury, as well as the injury management issues in dispute;

(g) evidence about suitable employment (such as position descriptions, responsibilities of the role, or tasks required);

(h) investigation report(s);

(i) treatment plan(s) provided by healthcare provider, and

(j) any other relevant information.

Responding to an application

12. The respondent to the dispute may respond to the application by lodging a Reply to Application to Resolve a Workplace Injury Management Dispute (Form 6).

13. An unsealed copy of the reply must be served on the applicant and all other parties, no later than three working days before the date of the telephone conference.

14. All relevant documentation that provides evidentiary support must be attached to the reply, and must be indexed and paginated. Relevant documents may include:

(a) any statements in relation to the issues in dispute;

(b) evidence concerning why suitable employment is not available, and

15. It is not necessary to attach documents provided by the applicant in the application.

16. Disputes will be listed for telephone conference, usually 14 days from the date of lodgment of the application. The Registrar will delegate the dispute proceedings to a member of the Commission or a member of staff for resolution, who will exercise powers under Div 3 of Pt 5 of the 1998 Act to resolve the dispute.

17. The Commission will inform the parties of the date and time of the teleconference after the application is registered. It is expected that the following parties will be available for and will participate in the teleconference:

(a) the worker;

(b) the worker’s legal or union representative (where appointed);

(d) the insurer’s legal representative (where appointed).

18. The employer is entitled to separate representation to the insurer at the telephone conference. Employer representatives, such as HR personnel or rehabilitation providers may be joined as parties to the telephone conference. Employer representatives may assist in the resolution of the dispute by bringing internal policy and operational knowledge of the employer’s organisation. This may be of assistance, particularly in disputes concerning suitable employment. If an employer representative seeks to participate in the proceedings, the employer should make a request in writing to the Commission prior to the telephone conference to ensure that all parties are joined and proceedings are not delayed.

19. It is expected that parties will have had preliminary discussions with each other regarding resolution of the dispute prior to the teleconference.

20. Teleconferences are not sound recorded, except where the worker is not legally represented.

21. At the teleconference, the Registrar will attempt to bring the parties to an agreed resolution of the dispute. The teleconference is an opportunity for the parties to canvass all relevant issues and clarify the scope of the dispute. Parties should be prepared to enter into genuine settlement discussions during the teleconference.

Finalising the dispute

22. The Registrar may deal with the dispute:

(a) by conciliating the dispute and bringing the parties to agreement, following which the Registrar will issue a formal outcome document;

(b) by directing an injury management consultant or other suitably qualified person to conduct a workplace assessment;

(d) by making a recommendation.

23. If the dispute cannot be resolved by agreement, the parties will be given an opportunity to provide submissions with reference to relevant evidence in support of their respective positions. The Registrar will then determine the appropriate way to resolve the dispute.

24. The Registrar can recommend:

(a) that a party to the dispute take specified action, necessary or desirable to remedy the failure to comply with an obligation with which the dispute is concerned;

(b) compliance with an injury management plan, subject to modifications considered appropriate, and/or

25. Before making a recommendation, the Registrar may:

(a) consider the information contained in the application and reply;

(b) consider the views of all parties;

(d) require further documents to be served and lodged, or

(e) refer the matter to an injury management consultant or other suitably qualified person to conduct a workplace assessment.

26. The Registrar may issue recommendations orally at a teleconference, or in writing at a later date. An oral decision may also be produced in written form to the parties following the teleconference.

The role of the injury management consultant

27. The WorkCover Guidelines on Injury Management Consultants dated 27 September 2012 provide further guidance in relation to injury management consultants. The parties may agree on an injury management consultant or the Registrar will an appoint an appropriate person.

28. Injury management consultants are doctors experienced in occupational injury and workplace based rehabilitation. They are approved by the Authority. Their role is to assist insurers, employers, workers, doctors, and the Commission overcome complex return to work and injury management barriers. The employer is obliged to pay for the cost of the injury management consultant.

29. Issues considered by an injury management consultant include:

(a) aspects of treatment (if required);

(b) appropriate recovery or return to work goals;

(d) clarifying communication issues between insurer, employer and/or nominated treating doctor;

(e) perceived conflict between the nominated treating doctor's recommendations and the workplace requirements;

(f) unexplained changes in work capacity, and

(g) disagreement regarding the suitable work offered to a worker.

30. An injury management consultant does not comment on:

(a) the appropriateness of treatment;

(b) diagnostic procedures, or

31. The parties may agree on, or the Registrar may determine, the scope of the issues to be referred to the injury management consultant. The injury management consultant will liaise with relevant parties in preparing a workplace assessment report. The injury management consultant may interview the worker in conference with the employer (or alone), discuss the matter with the worker’s nominated treating doctor and visit the worksite.

32. The injury management consultant will provide a workplace assessment report to the parties and the Registrar. If the report does not resolve the issues in dispute, a party may seek to have the matter relisted by notifying the Commission of any outstanding disputes.

Compliance with recommendations of the Registrar

33. A party to the dispute must comply with the Registrar’s recommendation within 14 days (or other period specified by the Registrar), or request that the Registrar refer the dispute to the Commission for determination.

34. Pursuant to r 9.8 of the 2011 Rules, if a party requests that a matter be referred to the Commission for determination, that party must provide reasons for seeking that the dispute be referred and reasons for not complying with the recommendation. The Commission may make orders with respect to any matter that can be the subject of a recommendation by the Registrar under Div 3 of Pt 5 of the 1998 Act.

His Hon Judge Greg Keating

President

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