If you and your insurer cannot resolve a dispute about the percentage of permanent impairment for your physical or psychological injury, your lawyer can file an application in the Personal Injury Commission (PIC) requesting an assessment by a Medical Assessor.
Medical Assessors are highly qualified and experienced medical specialists who assess the level of permanent impairment arising from your work injury. You will be examined by a Medical Assessor who specialises in your type of injury, for example, if you have a back injury, you will be examined by an orthopaedic surgeon.
What is the Process?
Once your lawyer files an application in the Commission seeking a Medical Assessment, the Commission engages a Medical Assessor to examine you. Medical Assessors are independent and are not appointed by the insurer.
Appointments can either be face-to-face or via telehealth, depending on whether your injury is a physical injury or a psychological one. Physical injuries normally require a face-to-face examination, however, psychologically injuries can be assessed by telehealth where appropriate.
Your lawyer will notify you of the appointment date and time, and where the Medical Assessment will take place.
You should notify your lawyer immediately if you cannot attend your Medical Assessment. If you fail to attend your Medical Assessment two times, your claim may be dismissed by the Commission.
Attending a Medical Assessment in Person
Where will the examination take place?
If you are attending the examination in person and live outside the Sydney Metropolitan area, the Commission will most likely arrange for you to be examined at the closest regional centre such as Ballina, Tweed Heads, Orange, Coffs Harbour, Port Macquarie or Tamworth. Medical Assessors also examine at other regional centres.
Preparing for the Examination
Before you attend your Medical Assessment, dress modestly in comfortable clothing and footwear which is easy to move around in, for example, a t-shirt with leggings/shorts and trainers is suitable.
Make sure that you factor in enough travel time to arrive at least 15 minutes before your appointment.
You may wish to review your witness statement and your medical report prior to the appointment to refresh your memory about the history of your injury and treatment.
What do I bring to the examination?
You are not required to bring any anything to the examination other than your COVID-19 vaccination certificate or exemption certificate (if you have one).
If you have original radiographic films which are listed in the Application to Resolve a Dispute or the insurer’s Reply, you can bring those along with you and ask the Medical Assessor if they require them. The Medical Assessor cannot review any other material.
You cannot bring a support person into the examination room unless exceptional circumstances exist, and the President or Principal Registrar of the Commission has approved it beforehand. Exceptional circumstances may exist where a carer must accompany a person with a physical or cognitive disability.
As a result of the COVID-19 pandemic, the Commission usually requires you to:
- Arrive at least 15 minutes prior to your appointment and participate in a Rapid Antigen Testing (RAT);
- Confirm that you have had at least two doses of COVID-19 vaccine, or disclose that you are unvaccinated or partially vaccinated;
- Comply with any pre-screening required by the Medical Assessor and/or staff and show your vaccination status or exemption certificates;
- Agree to wear a mask in the waiting area and during the examination;
- Advise immediately if you:
- Are COVID-19 positive;
- Are required to isolate or quarantine due to being a household/close contact with someone with COVID-19; or
- If you have COVID-19 symptoms.
If your RAT test is positive or you do not comply with the COVID-19 requirements, the Medical Assessor may not proceed with the examination.
Attending a Medical Assessment by Telehealth
If the Commission has arranged a telehealth assessment for you, there is some groundwork that you need to do before your telehealth assessment.
The Commission requires that you ensure that you:
- Have an acceptable device such as a PC, Laptop, Tablet or Smartphone capable of video chat;
- Have downloaded and logged in to the Microsoft Teams (MS Teams) application;
- Have tested the Teams application with your lawyer if you are having issues;
- Ensure that you have the email with the link to the assessment;
- Ensure that you log on via the link at least 5 minutes prior to the assessment.
If you do not have the equipment or resources to complete the Medical Assessment at home, you should discuss this with your lawyer well in advance of the appointment so that alternative arrangements can be made.
What happens after the examination?
Once you have been examined/assessed, the Medical Assessor will issue a Medical Assessment Certificate (MAC) with their findings and permanent impairment assessment.
The Medical Assessment Certificate is binding on both you and the insurer and there are limited grounds of appeal. If you believe that there are grounds for appealing the MAC, you should discuss this with your lawyer as an appeal must be filed within 28 days of the MAC.
If you wish to claim lump sum compensation for permanent impairment or have a threshold dispute restricting your workers’ compensation entitlements, you should seek advice from an experienced workers’ compensation lawyer.
At Bourke Legal, all of our lawyers are IRO Approved Lawyers which means that we can apply for IRO funding to pay your legal costs and disbursements. One less thing for you to worry about. Contact us at www.bourkelegal.com or call 1300 026 875.