Medical Examinations and Medical Expenses
Medical panels may be used to determine medical disputes (s50, Workers Compensation and Rehabilitation Act 1988 (Tas)). If a dispute goes to a medical panel, the determination of that panel (where 2 or more members are in agreement) will be conclusive. If there is no agreement the question is to be returned to the Tribunal. Normally representatives of a worker will not appear before a medical panel although the worker is entitled to have someone accompany them (s53). Medical panels are rarely used.
Workers and employers are entitled to chose a medical examiner. An employer can only chose an independent medical examiner in circumstances where they have discussed the reasons for doing so with the worker’s primary treating medical practitioner, and have also informed the worker in writing of their reasons for reviewing the medical condition of the worker (s90A). An independent medical review cannot be conducted more than once every three months (s90A(5)). This does not apply where there are multiple injuries and a medical pracitioner specialises in a different field or different aspect of the injury than a previous examiner (s90A(6)).
A report of the independent medical examination requested by an employer must be provided by the independent examiner to the primary medical practitioner of the worker. There does not appear to be a time limit on this, however, once a report is provided to the employer, and the worker’s primary medical treatment practitioner, the primary practitioner must provide a copy to the worker within 7 days of receiving the report (s90B). In practice, insurance company doctors do not provide reports to the worker’s GP, but to the insurance company lawyer.
Recoverable medical expenses must be reasonable, and necessarily incurred by the worker as a result of his injury (s75(1)(a)). The Act determines that:
- an employer is required to pay the costs of any medical, hospital, nursing, and ambulance services reasonably incurred by a worker by reason of the injury, or the disease;
- where a worker dies from the injury or disease, the employer has to pay the reasonable burial or cremation costs;
- the costs of repair or replacement of crutches; artificial limbs; legs; teeth; glasses or hearing aids destroyed as a result of an accident must be paid by the employer.
Hospital and medical services paid under the Acts include:—
- treatment at any hospital;
- costs of any fares or travelling expenses reasonably necessary in obtaining any hospital service;
- treatment by a medical practitioner, dentist, masseur, chiropodist, psychologist or optometrist;
- the provision of crutches or artificial members, eyes, teeth, spectacles or hearing aids;
- surgical aids to rehabilitation;
- pharmaceutical provisions;
- travelling expenses and maintenance necessarily and reasonably incurred in obtaining any medical service.
The Act emphasises rehabilitation of injured workers, and an employer is required to pay the cost of rehabilitating an injured worker.
Where a worker has been incapacitated for a period exceeding 12 weeks, or suffers an incapacity of a permanent nature which is likely to prevent them from returning to their pre-accident employment, the employer is required to set up a rehabilitation program to be undertaken by the worker and to keep the worker’s job open for the worker for a period of 12 months.
In the event that the proposed rehabilitation program is not suitable, the Workplace Safety Board may direct the employer to take such action or adopt or provide such rehabilitation programs as it considers necessary.
Reasonable medical expenses are only payable for 52 weeks after the worker’s entitlement to weekly payments in respect of any injury ceases (s75(2)).
If the worker’s treating doctor recommends a medical procedure and the insurance company refuses to pay, the Tribunal has jurisdiction to order the insurance company to pay (s77).