You have received a Section 78 Notice. What do I do?
EML has sent you a letter telling you they are disputing your claim or a part of your claim. This letter is called a Section 78 Notice. But what are you supposed to do when you get one? Read on further as we discuss what to do when you get one of these notices.
What is a Section 78 Notice?
Whenever EML makes a decision to dispute liability of your claim or part of your claim, they are required to give you notice of the decision in writing.
This notice will set out what it is they are disputing; the reasons they are disputing the claim and what documents they rely on when making the decision such as a medical report from your treating doctor or a specialist medico-legal report from an Independent Medical Examiner.
What types of decisions are EML required to notify me of in writing?
The types of decisions that EML is required to notify you of in writing, include but are not limited to, the following:
- that the injury arose out of or from your employment
- that you meet the threshold for a permanent impairment lump sum compensation claim
- that the treatment you requested is ‘reasonably necessary’
- that you have not suffered a total or partial loss of work capacity
- You are able to earn a certain amount in suitable employment. This is also known as a Work Capacity Decision and you can read about these types of decisions in one of our previous blogs by clicking on the link.
What do I do if I disagree with the decision?
If you disagree with the decision, you should contact a personal injury lawyer to discuss whether you have a good chance of challenging the decision with either an internal review or filing an application in the Personal Injury Commission.
The Independent Review Office (IRO) can provide funding for you to get assistance from an ILARS Approved Lawyer to challenge a section 78 Notice.
The Lawyers at Bourke Legal are all ILARS Approved and can assist you (including exempt workers) with a workers compensation claim and a dispute about a Section 78 Notice.
If you have good prospects of challenging the decision, your personal injury lawyer can help you with preparing and requesting an internal review directly from the insurer or preparing and filing an Application in the Personal Injury Commission.
Requesting an Internal Review
If you request an internal review from EML, then they have 14 days to review the decision and respond to you. The outcome may be that they change the decision, or they maintain it.
If they maintain the decision, you may be able to file an Application with the Personal Injury Commission.
Filing an Application in the Personal Injury Commission
You don’t have to request an internal review or wait for the outcome of the internal review before filing an Application in the Personal Injury Commission. However, if you need additional material such as reports from treatment providers or medicolegal doctors or updated radiology scans, then you will need these documents before you file.
Knowing what documents you should include in your application or whether you need to obtain further documents depends on what type of dispute the Section 78 Notice is about and what evidence you already have.
The process once an application is filed also varies depending on what type of application it is. For instance, you may need to attend a medical assessment, teleconference or conciliation conference/arbitration hearing. Having a lawyer who understands the workers compensation system and the Personal Injury Commission dispute system, can help guide you through this process and assist you with resolving any disputes for your claim.
What should you do?
If you receive a Section 78 Notice from EML, you should contact a personal injury lawyer as soon as possible so they have plenty of time to review the notice and any material served with the decision, discuss your circumstances, and provide you with advice on whether you can challenge the decision.
If you get one of these notices or have any queries regarding a workers compensation claim or dispute with the Insurer, give us a call on 1300 026 875 or contact us via our website – www.bourkelegal.com.