Edition No.12

Certain Medical Disputes May Now be Determined via Paper Assessment

As I mentioned in Personal Injury Commission News Edition No.11, the Commission is implementing multi-faceted strategies to manage and mitigate the unavoidable in-person medical assessment delays caused by the COVID-19 pandemic.

Each week that lockdown continues, the Commission has around 150 scheduled medical assessments that either need to be moved to audio-visual platforms or rescheduled to a point later in time when we hope restrictions will be lifted.

Although around 90% of psychiatric assessments are proceeding via audio-visual platforms, a significant number of in-person examinations are accumulating that will need to be rescheduled at a later time. As a result, the Commission expects to have a significant backlog which will probably take at least 12 months to clear.

The Commission has worked with its Medical Assessor Reference Group, Stakeholder Reference Group and CTP Insurer Reference Group to identify strategies that will assist in reaching timely outcomes for people with certain types of medical proceedings.

The Medical Assessor Reference Group has identified multiple injury types across the categories of Permanent Impairment, General Medical Damages, Medical Expenses, Minor Injury and Treatment disputes that may be suitable for assessment on the papers or combined with a video assessment/teleconference (paper assessments), instead of an in-person medical assessment. This is based on the Medical Assessors’ expert advice. In these circumstances Medical Assessors can provide a robust decision, provided the necessary documentation is available to be reviewed in the decision-making process.

These types of disputes may be able to proceed to decision without an in-person medical assessment provided that:

• All parties to the dispute, including the Medical Assessor, agree that the assessment can proceed in this way, and
• The documentation required for the dispute type, as indicated below, is provided for the on the papers assessment.

The list of applicable dispute and injury types is available here.

Over the coming weeks the Commission will consider applications from you for assessment on the papers when:

• the dispute and injury type fits the required criteria outlined, and
• the matter is currently scheduled for an appointment with a medical assessor, and
• you have agreement from all parties to proceed on the papers.

Such matters will be considered by the Commission and if they meet the criteria will be referred to the Medical Assessor to determine whether the matter can be assessed on the papers. If the Medical Assessor is unable to assess the matter, the in-person assessment will be scheduled once Public Health Orders allow.

How to advise the Commission that you have identified a matter that may be suitable for assessment on the papers:

You can make submissions via the Workers Compensation and Motor Accidents Portals. You must have the consent of both parties to be considered for inclusion in this initiative. Applications without consent will be declined.

Submissions must include:

• how the injury meets the criteria
• evidence of agreement or consent of both parties to submit the matter for inclusion in this process
• the worker’s/claimant’s e-mail address and telephone number
• assurance that they will be able to independently participate in a video-conference or teleconference in accordance with Public Health Orders.

The Medical Assessor will consider the matter and confirm whether assessment on the papers is suitable including whether or not a video-conference or teleconference is required, and the parties will be advised of the outcome.

Personal Injury Commission staff are not able to provide advice about whether a matter is suitable for this process.