If you have a dispute with your workers’ compensation insurer that you have been unable to settle, your lawyer can file an application at the Personal Injury Commission (the PIC) to begin the legal process of resolving the dispute.
The PIC is an independent tribunal which resolves disputes about workers’ compensation claims and motor vehicle accidents which happen in New South Wales. On the workers’ compensation side, the PIC took over the functions of the old NSW Workers’ Compensation Commission (WCC) and its procedures are similar.
The PIC’s goal is to resolve disputes between workers and their workers’ compensation insurers justly, quickly, and cost effectively, with as little formality as possible.
What kind of workers’ compensation disputes go the PIC?
Depending on what kind of dispute you have, your application will be placed on one of the following dispute resolution pathways:
Legal Disputes are disputes about your workers’ compensation entitlements such as weekly compensation benefits, medical and treatment expenses, lump sum compensation for permanent impairment and claims for death benefits. Matters like this usually go to teleconference first, to see if the dispute can be resolved. If it can’t, they are allocated a date for a conciliation/arbitration before a Member of the PIC.
The Member will encourage the parties to resolve their dispute at every opportunity, but if the parties cannot reach an agreement, the Member hears the case and then makes a decision which is binding on you, the insurer and your employer.
Medical Disputes are disputes about the level of permanent impairment you have suffered because of your work-related injury. You may need to have your Whole Person Impairment (WPI) assessed if the insurer disputes your claim for lump sum compensation, or if you need to meet a threshold for ongoing workers’ compensation benefits.
Medical Disputes are referred to a Medical Assessor who is an independent medical specialist appointed by the PIC. The Medical Assessor will examine or assess your WPI. The decisions of Medical Assessors are final. There are limited grounds to appeal a Medical Assessor’s decision.
Expedited Assessments are a quick pathway for resolving disputes about smaller claims for weekly compensation and medical expenses, work capacity decisions that you don’t agree with, or issues with injury management plans and return to work. The goal of an expedited assessment is to resolve these smaller disputes quickly and efficiently.
Damages Disputes are Work Injury Damages disputes, which require you to participate in a mandatory Mediation before they can proceed to Court. A Mediator is appointed by the PIC to help the parties negotiate and to see if the claim can be resolved without the need to file the case in Court.
Miscellaneous Applications are for smaller issues that need to be resolved but that don’t fit in the above categories. These include making awards of weekly compensation payments and medical expenses to a worker living outside Australia, making interim awards of compensation, reviews of weekly payments and recovery proceedings for overpayments of weekly payments.
As you can see, the PIC deals with many different types of disputes and you will need the assistance of a well experienced lawyer to navigate the system and maximise your chances of success.
Who makes the decisions at the PIC?
If you have a dispute and your lawyer has filed an application, a Member will be assigned to your claim. Members are decision makers appointed by the Commission to assist the parties to resolve their dispute. They will encourage each party to find a solution to the dispute between themselves and, if the parties cannot agree, the Member will conduct a hearing and make a decision which is final and binding.
If you are unhappy with the decision of a Member and your lawyer advises that there are grounds for appeal, you can file an application to appeal the decision of the Member within 28 days of the decision. There must be an error of law, discretion or material finding for an appeal to be successful. The appeal is usually decided by a Presidential Member of the PIC. If your appeal is successful, your dispute may be sent back to be reheard by a different Member.
In rare circumstances, a presidential decision may be referred to the Supreme Court of NSW for judicial review.
If you are unhappy with a Medical Assessment Certificate issued by a Medical Assessor and your lawyer advises that there is an appealable error in the assessment, you can file an application to appeal. If your appeal is accepted, a decision will be made by a panel made up of two approved Medical Assessors and a Member.
Where can I find PIC decisions?
The PIC’s decisions are published on the Australian Legal Information Institute’s website at: http://www.austlii.edu.au
Decisions made by the former Workers’ Compensation Commission can be found on the PIC website at: https://pi.nsw.gov.au/decisions
How do I find a lawyer to take my dispute to the PIC?
Legal representation is vital if you wish to achieve a successful outcome in the PIC.
Most importantly, you will not need to pay for a lawyer to help you. Your legal costs and disbursements are funded by the Independent Review Office (IRO), however, you need to find an IRO Approved Lawyer to apply for a grant of funding and to represent you.