Emerging Issues - WIRO · 5/31/2019 · Reviews, reconsiderations of Not MMI Certificates for s39 threshold. EMERGING ISSUES | 31 May 2019 >The first wave of cessation of medical

EMERGING ISSUES | 31 May 2019

Director ILARS

2019 WIRO REGIONAL SEMINAR | ORANGE

Emerging IssuesRoshana May

31 May 2019


> SIRA review of icare> Section 39 | Backpayments of weekly payments: Hochbaum> Section 39 | Insurer reconsiderations of ‘NOT MMI MACs’> Section 59A Limitations on medical and treatment expenses post

section 39 cessation> WCD reviews and the Commission process | Allott, Grima> Recovery of compensation payments > Heise – implications for insurers> Trends

Subjects


> Compliance audit and performance review of icare commenced February 2019

> Terms of reference, discussion paper and public consultation announced 16 May 2019

> Power:> State Insurance and Care Governance Act 2015

> Section 23, Section 24

> Workplace Injury Management and Workers Compensation Act 1998> Section 22, Section 23

SIRA review of icare


> Rationale> Largest insurer in the scheme (65% of active claims)

> Regulator to ‘hold insurers accountable for the services, experiences and outcomes’

> Outcome and reports> Public Consultation on Discussion Paper now open - submissions close 14

June 2019

> Report expected August 2019

> icare will be given the opportunity to consider and respond to the draft report

SIRA review of icare


> Kennewell v ISS Facility Services Australia Limited t/as Sontic Pty Limited [2018] NSWWCC 216 (Kennewell)

> RSM Building Services Pty Ltd v Hochbaum [2019] NSWWCCPD 15 (Hochbaum) 18 April 2019

> Is Kennewell now wrong?

Section 39 and the decision in Hochbaum


> Insurers are applying to the Commission to have a further assessment of whether the worker has reached MMI (by way of reconsideration), but are also seeking that the worker undergo an assessment of permanent impairment

> The original referral was to answer the question “whether the degree of permanent impairment of the injured worker is fully ascertainable” and NOT “the degree of permanent impairment of the worker as a result of an injury”

> Model procedure developed by icare, WIRO, SIRA and WCC with hallmarks of notice, time to consider, attendance at IME and/or AMS

> Consequences for failure of worker to attend IME or AMS?

> Can an insurer lodge a Form 7 and seek a s319(g) and/or a s319(c) question?

Reviews, reconsiderations of Not MMI Certificates for s39 threshold


> The first wave of cessation of medical expenses post 2017 section 39 impact is about to happen

> Medical treatment must be ‘given’ or ‘provided’ within period

> Is assessment permitted unaffected by section 322A?

> First effective cut off: 26 September 2019

> Greatest impact of cut off on 25 December 2019

Section 59A limitation periods post section 39 cessation of weekly payments


> What happens when…> The original work capacity decision (WCD) is the subject of an

internal review and > A new decision is made after 31 December 2018 which is

different and> The worker wishes to dispute the new decision?

WCD reviews and the Commission


> Labourpower Recruitment Services Pty Ltd v Nolland [2019] NSWSC 512 (6/5/2019)

> Section 235 Workplace Injury Management and Workers Compensation Act 1998

> Does the employer have standing in circumstances where it acted as conduit for compensation payments?

> On appeal…

Recovery of Compensation payments


Employers Mutual Limited v Julie Ann Heise and the Local Court of New South Wales [2018] NSWSC 1842> The worker claimed a s.66 lump sum on 11 April 2017

> EML failed to determine the claim

> The worker filed an ARD in WCC on 25 July 2018

> The worker sought Local Court issue a Court Attendance Notice (CAN) for breach of s.283 1998 Act (penalty for failing to determine a claim)

Heise


Medical Appeals and Judicial Review of Medical Appeal Panel decisions> These are increasing > Not surprising in view of the importance of assessments of

permanent impairment> WIRO Funding is availableWCC > Observation that matters are being scrutinised for being fully

prepared in order to proceed | Thadsanamoorthy

Trends


> Section 41 1987 Act claims – is this a re-entry point for continuance of weekly payments?

> Upper House (Standing Committee on Law and Justice) bi-annual review of the State Insurance and Care Governance Act 2015> Last review 2017

> Budget Estimates | Change of procedure and process in Upper House

> Independent Tribunal for statutory insurance scheme claims | The PIT?

What’s coming our way? Watch this space


EMERGING ISSUES31 MAY 2019

Director ILARS

[email protected]

2019 WIRO REGIONAL SEMINAR | ORANGE

Roshana May

Documents

Emerging Issues - WIRO · 5/31/2019 · Reviews, reconsiderations of Not MMI Certificates for s39 threshold. EMERGING ISSUES | 31 May 2019 >The first wave of cessation of medical