Frequently Asked Questions

• Injured Workers

  Questions and Answers

  What should an injured worker discuss with their nominated treating doctor during the initial consultation?

  It is important that injured workers communicate with the nominated treating doctor exactly how the injury occurred. All injuries sustained in the accident should be recorded even if they appear to be minor at the time as it is often the case that minor injuries turn out to be more significant than first thought and it is difficult to add additional injuries later. All of these injuries should then be recorded not only in the clinical notes but also on the certificate of capacity which should be issued by the nominated treating doctor and provided to the employer and insurer.

  Injured workers should always check that the doctor has recorded all information on the certificate of capacity and that all information is correct, prior to leaving the consultation. Any incorrect information should be corrected immediately.

  What should the nominated doctor consider when determining an injured workers capacity to work?

  Nominated treating doctors are constantly under pressure to return injured workers to work as soon as possible.

  Whilst the goal of the scheme is to return workers to work, doctors have a responsibility to ensure that a worker has the capacity to return to work in a safe and durable manner. In order to do this the doctor not only needs to be aware of the workers injury but must also have an understanding of the workers work environment and what their job entailed and what suitable duties will be provided if the worker is unable to return to their pre-injury duties.

  If a doctor is unaware of the duties the worker will be required to perform there is a risk that the worker will return to work too soon and will sustain further injuries. For example there is a big difference between the duties a worker who has an office job will be required to perform compared to a retail worker or construction worker. The availability of suitable duties will also differ vastly within these positions. It is therefore important that the doctor is fully aware of the situation they are putting the worker in. The injured worker must clearly communicate with their doctor about their role and the nature of their work and the availability of suitable duties.

  What is a secondary injury?

  A secondary injury is an injury that arises after the initial injury and because of the initial injury. For example a worker may have a right shoulder injury but then their left shoulder is injured as a result of relying on it more to compensate for the original right shoulder injury. Another common secondary injury is the development of a psychological injury such as depression or anxiety as the injured worker struggles to come to terms with their injury and the impact it has on their life.

  It is important that any secondary injuries be listed on the certificate of capacity and reported to the insurer. An injured worker should also seek a determination on liability for the secondary injury to ensure that they will be able to claim compensation for all injuries.

  A secondary injury is not an injury that was sustained at the time of the accident but not detected until later.

  Can a worker be compensated for a secondary injury?

  A worker is entitled to receive weekly compensation and medical treatment for secondary injuries provided the insurer accepts liability for these injuries.

  In respect to receiving a lump sum, a worker can be compensated for secondary physical injuries but not for a secondary psychological injury.

• Medical Expenses & Treatment

  Questions and Answers

  Who do I speak to first when I have been injured at work?

  If you have been injured at work it is advisable to speak to a qualified workers compensation lawyer as soon as possible to make sure that you are receiving appropriate workers compensation benefits and to maximise potential claim outcomes. You should also inform your employer so they can contact their insurer. If your worker’s compensation claim is disputed, Taylor & Scott can communicate with the insurer and negotiate on your behalf, with the weight of the law on your side.

  What could count as a workplace injury?

  Workplace injuries can occur in any workplace situation although they are more common in dangerous and physically demanding jobs, although they can occur due to wide-ranging harmful, unplanned or critical situations that arise. Risks and hazards in the workplace include falling from heights, heavy lifting, repetitive strain, unsafe and slippery floors, poorly maintained equipment, falling debris and many more. Employers and business owners are obliged to create a safe and healthy environment for employees and visitors, with any negligence or breach of duty of care potentially causing injuries that can result in workers compensation and work injury damages claims.

  What is included in medical expenses?

  If you are injured in a work injury a range of medical expenses may be paid by the worker’s compensation insurer.

  Medically related treatments

  Any treatment by a doctor, physiotherapist, osteopath, chiropractor, psychologist, an exercise psychologist, remedial massage therapist, counsellor or other allied health practitioners can be covered. You are also eligible to claim for nursing care and medical supplies outside of the hospital, along with the provision of artificial aids. Domestic assistance is available provided you have sustained more than 15% diminished physical capacity as a result of the injury.

  Hospital treatments

  This includes treatment received at both public and private hospitals and accredited rehabilitation centres.

  Ambulance services

  These services include emergency services, non-emergency services and hospital transfers overseen by the Ambulance Service of NSW.

  Workplace rehabilitation services

  A range of assistance is available, including return to work programs, vocational assistance, job or workplace modification and other return-to-work programs.

  Travel expenses

  This includes travel by taxi, bus, train or ferry for attending treatment centres for your injury. You can also claim the cost of petrol for travel to appointments, and if you are unable to travel alone, the insurer is obliged to pay for travel assistance.

  Are there time limits on my medical expenses claim?

  If you have been injured at work, the worker’s compensation insurer will be liable to pay all medical and hospital expenses provided they have been preapproved by the insurer (this does not apply to expenses incurred in the first 48 hours after an injury) while ever weekly compensation payments are paid. If no weekly compensation payments are paid the insurer will be liable to pay medical, hospital and related expenses for up to 2 years from the date of injury. If weekly payments of compensation are paid, the insurer will be liable to pay medical, hospital and related expenses for up to 2 years from the date of the first cessation of payments. If you have sustained at least 11% whole person impairment the 2-year time limit becomes a five-year time limit. If you have sustained at least 21% whole person impairment, there is no time limit to claim for medical expenses. Your Taylor & Scott Lawyer will guide you through the claims process.

   

  How long does the insurer have to make a decision on medical treatment?

  The insurer has 21 days to determine a claim for medical expenses.

  What is domestic assistance?

  Domestic assistance can include a lot of tasks around the home that you are no longer able to carry out due to pain or injuries. This includes household cleaning, laundry, lawn and garden care, plus transport needs not covered by medical, hospital and rehabilitation expenses.

  Can I claim for domestic assistance?

  In order to claim for domestic assistance an injured worker must:

  • Be certified by a medical practitioner that domestic assistance is reasonably necessary based on a functional assessment and that the need for domestic assistance arises from the injury;
  • Establish that the worker performed the domestic task prior to the injury;
  • Have 15% whole person impairment or more.

  In some situations, temporary assistance may be available for up to three months.

  What is secondary surgery?

  Secondary surgery is surgery that is a direct consequence of an earlier surgery and affects a part of the body affected by the earlier surgery and that is approved within two years from the date the original surgery was approved.

  The actual surgery, however, does not need to occur within this two-year time frame; it just needs to be approved.

  What information do I need to make a medical expenses claim?

  In order to make a legal claim for medical expenses, you will need to provide receipts related to your claim. These can include receipts related to medical and hospital treatments, ambulance services, rehabilitation services and travel expenses. Your claim number should be attached to all documents. If an employer or insurer disputes your medical expenses claim, Taylor & Scott will examine the documents and support your claim wherever possible for best possible outcomes. For legal advice related to your medical expenses claim, medical negligence, lump sum payments and other important matters, contact us today.

  At Taylor & Scott, We Care For You.