Motor accidents disputes - 1999 scheme

If a medical dispute is referred to a medical assessor, a dispute resolution officer will arrange an appointment at the earliest possible time with a specialist who is accredited in the assessment of the injuries that are the subject of the dispute.

Medical assessments are conducted throughout NSW, at a location suitable to the claimant where possible. This includes at the Commission’s Medical Suites at 1 Oxford Street, Darlinghurst. The assessment may be conducted by video when that is appropriate.

Claimants and legal representatives will be notified in writing by the Commission of the name of the approved medical specialist and the date, time and place of the assessment.

The insurer is required to meet the reasonable costs of  the claimant attending this assessment.

The appointed medical assessor will review the information provided by both parties, including the medical reports from the doctors who have examined the claimant at the request of their own lawyers or at the request of the insurer, and the medical reports from the doctors who have provided treatment. They will also review any other relevant documents, including the claimant’s statement and investigations such as X-rays, MRIs, ultrasounds and CT scans, to help to get a full picture of the claimant’s injury and its effects.

To understand more about the claimant’s injury, the medical assessor will ask about the circumstances that caused the injury, the effects of the injury, the treatment the claimant has had to date, and his or her medical history, including previous injuries.

The medical assessor will usually carry out an independent examination of the claimant at the assessor’s practice.

The Commission will arrange for an interpreter to attend the assessment and/or provide assistance for any disability needs, if the claimant requests this.

A claimant may have a support person attend with them at the assessment if the medical assessor agrees. However, the support person cannot take an active part in the assessment.

The medical assessor will prepare a Medical Assessment Certificate that sets out their decision and reasons in relation to the medical dispute.

Medical Assessment Certificates are usually issued within 14 days  after the medical assessment.

If there are multiple physical medical assessments, a lead medical assessor is appointed and all non-lead certificates are forwarded to the lead assessor who then issues a Combined Certificate.  The non-lead certificates will be forwarded to the parties with the Combined Certificate.

Medical assessors are highly experienced medical practitioners who have worked in a range of medical specialties. The role of the medical assessor is to examine the claimant and provide an independent assessment to the Commission.

Medical assessors do not to give advice or recommend treatment for the claimant.

Medical assessors are engaged directly by the Commission and are independent of claimants and insurers. The Commission will choose the next available medical assessor with the appropriate expertise to assess the claimant’s injury.

Medical assessors may also sit on medical appeal panels.

Applications for a panel review should be lodged via the Commission’s online portal.

If a self-represented claimant is unable to use the portal to lodge their application, they may contact the Commission to obtain a PDF copy of the form or have an application mailed to them. These applications may be lodged via email or post, or in person at the Commission.

The reply to an application for a panel review should be lodged via the Commission’s online portal.

A reply must be lodged within 20 working days of receiving the application for review.

If a self-represented respondent is unable to use the portal to lodge their reply, they may contact the Commission to obtain a PDF copy of the form or have an application mailed to them. These applications may be lodged via email or post, or in person at the Commission at the direction of the President.

The respondent should provide a reply to the application for further medical assessment as soon as practicable. The reply should include any response to the submissions made by the applicant and any documents the respondent wishes to have considered as part of the review of the medical assessment.

If the review is allowed to proceed, it will be referred to a medical review panel, made up of a Commission Member and two Medical Assessors. The Medical Assessor who did the assessment being reviewed cannot be on the panel.

The members of the panel will meet, usually by telephone, to review the application and the information provided by the parties. The panel will also review the assessment and all the information previously available to the Medical Assessor who conducted the original assessment.

The panel may conduct a formal hearing if that is deemed necessary. One of the Medical Assessors on the panel may need to re-examine the claimant.

Once the panel has finished its review, it will issue a detailed decision which confirms the assessment and certificate of the original Medical Assessor or they will issue a new certificate to replace the original certificate.

Applications for a further medical assessment should be lodged via the Commission’s online portal.

If a self-represented claimant is unable to use the portal to lodge their application, they may contact the Commission to obtain a PDF copy of the form or have an application mailed to them. These applications may be lodged via email or post, or in person at the Commission.

Applications for further medical assessments should include submissions as to the nature of the deterioration of the injury or the additional relevant information that is relied on. Any information supporting the application should be listed and attached at the time the application is made.

All relevant information must be attached to the application. An application should not be lodged until all relevant material is available because it may not be possible to include further information later in the dispute resolution process.

A response to an application for further medical assessment should be lodged via the Commission’s online portal.

If a self-represented respondent is unable to use the portal to lodge their response, they may contact the Commission to obtain a PDF copy of the form or have an application mailed to them. These applications may be lodged via email or post, or in person at the Commission.

The respondent should provide a reply to the application for further medical assessment as soon as practicable. The reply should include any response to the submissions made by the applicant and any documents the respondent wishes to have considered as part of the further medical assessment.