Important Changes to NSW Workers Compensation laws

* Information especially relevant to Workers Compensation recipients and treatment providers.

Recent changes to the Workers Compensation Act 1987 have closed a significant flaw in the scheme and will commence from 01 February 2011.

One of the best aspects of the workers compensation scheme in New South Wales is the medical and rehabilitation treatment provided to injured workers. The scheme basically provides that injured workers are entitled to the payment of all reasonably necessary medical and rehabilitation treatment for the rest of their lives. This entails surgery in private hospitals and Doctors of the injured worker's choice. However until recently a major flaw in the scheme existed. 

Flaw with Workers Compensation law:
If treatment was proposed by the injured worker's GP for example, but the workers compensation insurer refused to approve it - there was no way for the injured worker to force the insurer to approve and pay for the treatment.

The only remedy available for the injured worker was to go ahead with treatment and pay for it themselves. Once the treatment was provided the worker could then approach the Workers Compensation Commission seeking an order that the cost of the treatment be reimbursed. This was unsatisfactory in two respects:

• Firstly, the worker had to incur the cost with no certainty that the Workers Compensation Commission would approve the treatment and reimbursement the money spent by the injured worker; and
• Secondly, some treatment such as day surgery is prohibitively expensive without some form of insurance cover. The only way for most workers to get such treatment was to put their name down onto public hospital waiting lists.

Flaw addressed through amendments to Workers Compensation law:
The flaw referred to above has now been addressed. The Workers Compensation Act 1987 has now been amended so that the Workers Compensation Commission can now resolve disputes concerning proposed treatment. This means that if an injured worker's treating Doctor proposes a treatment which the insurer refuses to approve, the worker can now approach the Workers Compensation Commission for a resolution of the dispute. This is a much better outcome. This should help to relieve the burden on the public health system and enable workers to better access reasonably necessary treatment to assist in their recovery.

There is also a similar existing provision with respect to people injured in motor vehicle accidents. As medical practitioners, you should be aware of your patient's entitlements especially when there are insurance companies involved! We are here to help your patients with their entitlements under the current legislation.

For any further information please contact Ben Carroll, Allan Cowley or Jessica Riddell: toll free 1300 277 000 or jess.riddell@splawyers.com.au