I wanted to talk today about a few tips for people who are experiencing being on workers compensation. I know it’s a really difficult and confusing process. It’s hard for people who are struggling with pain physically or mentally, to also at the same time try to process and make sense of what your new obligations are under the workers compensation scheme. So hopefully the tips that I’m about to relay are going to assist you if you’re in this situation.
So my first tip is your nominated treating doctor is very important and your nominated treating doctor is usually your general practitioner. I cannot emphasise enough how vital it is to have a trusting relationship with your doctor. Your doctor is going to be the gateway to your path to recovery. So you need to be able to speak openly and honestly with your doctor about the issues that you’re facing with your return to work because everybody’s situation is different. But the main reason for that is because your doctor is going to be completing your certificate of capacity for the insurer. And that is a very important document, which I’ll get to in a minute.
So your nominated treating doctor is normally going to be your general practitioner. However, if you have suffered a psychological or a psychiatric injury, you might want to consider asking your treating psychiatrist to be nominated treating doctor rather than your general practitioner. And this is because psychological or psychiatric injuries are really specific and your recovery can be complicated. And in those circumstances, when you are having a certificate of capacity completed, your doctor is needing to assess the treatment that’s required, make recommendations, and also assess your capacity for work.
And that is something that might actually be best to be completed by your treating psychiatrist. So if you’re in that situation, definitely give that some thought. Talk to your GP about it. Your GP may be happy to hand over that role to your treating psychiatrist.
So getting over to the certificate of capacity, this is my tip number two.
Be really careful about how that certificate is completed. It’s a really important document. It’s three pages long. Not only is it going to be confirming what your treating doctor’s view is about, whether your injury is actually work-related in the first place, it’s also telling the workers compensation insurer what treatment is required. And it also tells the insurer what your capacity for work is and what your capacity for work is is linked to how much you can be paid for weekly benefits.
So even if you are at some point in the future fit for full-time work, the certificate is still going to be telling the insurer what treatment you might still need and also any restrictions. So you might be fit for full-time hours, but you might still have some restrictions in terms of perhaps lifting or driving or the type of work that you can actually be doing.
When you are asking your doctor to complete a certificate of capacity, if you suspect that perhaps your doctor doesn’t understand the requirements of the job, that you do, get a job description from your employer, or you may have a job description within your contract of employment and give that document to your doctor before he or she assesses your capacity for work. If you don’t have a job description and you can’t find it anywhere, you can get one from your employer. Just write down all of your work, everything that you can think of, and give back to your doctor because he or she is going to appreciate understanding what you will be required to do when you return to work.
And in turn, that means that the doctor can properly assess your capacity for work and complete that certificate accordingly. And most importantly, with a job description. That means that your doctor will have a proper understanding of what pre-injury duties mean.
And that brings me to my tip number three. At some point during your workers compensation claim, you might reach full pre-injury hours, but you still need to observe some restrictions in relation to your injury.
It’s not uncommon for doctors at this stage to suggest to you that you might be now fit for pre-injury duties, and accordingly suggest that you should tick that box on your certificate of capacity. Before you think about doing that, or before your doctor does that, it is very important that you and your doctor understand what being fit for pre-injury duties actually means.
Being fit for pre-injury duties means that you can return to your pre-injury job with no restrictions whatsoever, now and in the future. It means you are fully recovered. I’ve seen time and time again clients who are upset and distressed because their doctor has ticked the pre-injury duties box on their certificate, perhaps noted a few restrictions, but has still ticked that box and then the insurer has stopped their payments.
It often turns out that what the doctor actually meant to do was to give the client a permanently modified duty certificate.
So just to give a sort of quick example of what this might look like, say you’re a carpenter and you have an injury to your shoulder at work, you have some surgery, you get a bit of physio and eventually your shoulder stabilises. The surgeon says, “Look, your shoulder is never going to be 100%, but you can go back to work.” Your GP says this is your restrictions. Perhaps the GP gets some help in this regard from your physiotherapist and your surgeon writes you a certificate that says you’re permanently restricted to working 8 hours a day, four days a week, with a rest day in between, and a restriction which is permanent to not lift any weight of more than ten kilogrammes with the injured arm.
So while you’re able to go back to work as a carpenter, You’re not, and you never will be fit for pre-injury duties because of your injury. You’re going to need a certificate that confirms you have permanent restrictions and that you need permanently modified duties from your employer. And so your nominated treating doctor should be writing that on your certificate rather than ticking the pre–injured duties box.
I want to point out here, getting back to work is a really important stepping stone in your recovery from a work-related injury, not just physically, but mentally.
Having a purpose for your day is important to you. It’s helpful for your rehabilitation. It’s helpful for lots of things. Just make sure that you don’t let that be derailed by not understanding what pre-injury duties means.
Sticking with the certificate of Capacity, don’t ever let that lapse is tip number four.
A certificate of capacity is usually only able to be provided for a maximum of 28 days, and the only exception to this is if you have a long-term chronic injury and the insurer has agreed that your doctor can provide a certificate for longer intervals, maybe three, six, or even 12 months, depending on the type of injury that you’ve got.
A really important part of the certificate of capacity is that it tells the insurer what your capacity for work is for the period it covers, and then the insurer pays your weekly benefit accordingly. If you don’t provide a certificate of capacity, then the insurer will not pay you. If you provide a certificate late or it’s backdated, then you might find yourself in a complicated argument about whether or not you can be paid your benefit, and this is at a time where you just really don’t need that drama. You can avoid all of this when you’re leaving your doctor’s surgery, after obtaining your certificate, just stop at the receptionist desk and book your next appointment for the day before your certificate expires.
When you have a certificate, send it straight to the insurer and by email is usually best because you have a record of it being sent by you and you have a copy in your email account in case there’s any problem down the line.
Now, my final tip, tip number five is still on this kind of process, but it’s more geared towards rehabilitation. If you are in the workers compensation scheme at the moment, then you have no doubt been in contact with rehabilitation advisors who are appointed by the insurer to help manage your injury and your claim.
Generally, I hear a lot from clients that the rehabilitation adviser has been attending absolutely every one of my client’s appointments with their doctors. And some of those stories that I hear from my clients are about rehabilitation advisors arguing with treating doctors, including treating surgeons, about those doctors recommendations for treatment, assessments of capacity for work. I’ve heard of rehabilitation advisors arranging treatment appointments for my clients, changing my clients’ appointment dates and times with their doctors to suit the advisor or attending appointments and aggressively insisting on changes to the certificate of capacity.
Now you should know now that this is outrageous and really unfortunate behaviour that you just don’t have to put up with. Your consults with your treating doctors are private and sometimes depending on the type of injury that you’ve got, you might have to remove your clothing for an examination. Sometimes you want to discuss matters in a full and frank manner one-on-one with your treating doctor and that is your right. The only appointments that a rehabilitation advisor is entitled to attend are appointments that are case conferences.
A case conference is a conference in which you, your doctor, sometimes more than one of your doctors, the rehabilitation advisor and the insurer attend and those appointments take place on a regular basis to discuss your claim discuss the progress that’s it case conferences only if you want the rehabilitation advisor to attend any other appointments with you. You can allow that. But what I’m telling you is that if you don’t want to, all you have to do is say so. Don’t let that become an issue that you let go of because you think that you have to allow it. You don’t.
And those are the five tips that I have for people who are dealing with the workers compensation scheme in New South Wales. And if this podcast has brought up any questions for you and you want to speak to someone about it, you’re welcome to contact us at Bourke Legal. Our phone number is 1300 026 875. We have offices at Kingscliff and Ballina.