Don’t forget to check the doctor’s qualifications

Key Points

• Before you think about how much a worker has claimed, be sure to check whether their doctor is properly accredited.

• Ensure they are not only accredited, but are accredited for the relevant body part/system.

• This will ensure that the worker’s claim is legitimate, but also avoid insurers incorrectly accepting a WPI assessment that contravenes the Guides.

A quick and valuable preliminary step for all impairment claims is to check if the doctor is accredited to assess the impairment of the body system(s) being claimed.

The WorkCover Guides for Claiming Compensation Benefits (“The Guides”), require that for a claim for impairment for injuries sustained after 1 January 2002 the claim must be supported by “a medical report concluded in accordance with the WorkCover Guides for evaluation of permanent impairment by a medical specialist with qualification and training relevant to the body system being assessed who is being trained in the WorkCover Guides”.  This requirement in the Guides is enforced by the worker compensation legislation.

In a recent matter, Hicksons noted the applicant was making a claim for impairment of the spine and also gastrointestinal impairment based upon a report from an orthopaedic surgeon.

A check of the WorkCover list of accredited permanent impairment assessors (www.workcover.nsw.gov.au/information-search/permanent-impairment-assessors) failed to find that doctor’s name anywhere on the list.  An enquiry of WorkCover indicated that doctor had been previously approved to provide assessments of the spine and limbs up to 31/03/2016, but had never been approved to assess the digestive body system at any time. It would appear this doctor, and possibly other doctors, have not been reaccredited under the Fourth Edition Guides that came into effect on 1 April 2016.

This matter shows that for any impairment claim it is important to check the qualifications of the applicant’s doctor using that website, to see if they are still accredited generally and, in particular, accredited for the body systems they purport to assess.  This will not only ensure that applicant’s claims are based on proper evidence, but will avoid insurers getting into the difficult position of accepting a WPI assessment that was never properly made to begin with.

Post by John Smidmore