*The contents in this blog relates to legislation in South Australia.
Lodging a workers compensation claim can be a scary thing, especially if you have not previously made a claim. This blog provides a quick guide to some of the important preliminary considerations for claims made under the Return to Work Act 2014 (SA).
Work capacity certificate
A claim made under the Return to Work Act must be accompanied by a medical certificate in prescribed form (section 30). The prescribed medical certificate is a ReturnToWorkSA Work Capacity Certificate completed by a recognised health practitioner, which includes a medical practitioner. ReturnToWork SA is the state compensating authority, and was previously called WorkCover SA.
A Work Capacity Certificate includes important details including the nature and extent of your work injuries, how the injuries arose, medical certification of your capacity for work, your treatment plan and whether you have any functions limitations or restrictions, including mental health functions.
It is important that the details in your Work Capacity Certificate are correct and up to date. Your entitlement to make a claim for entitlements including for weekly payments and medical expenses (including surgery and rehabilitation expenses) may depend on the contents of your certificate.
Importantly, an ordinary medical or sick certificate is not a prescribed medical certificate.
Interim benefits
If your claim is not determined by the claims agent within 10 business days after it receives your claim, then it must make an offer to pay your weekly payments and/or medical expenses on an interim basis (section 32).
Depending on what entitlement you have claimed, the offer of interim benefits means that the claims agent can pay you weekly payments of income maintenance and/or medical expenses until it has determined your claim. An offer of interim benefits should be made to you in writing and explain that if your claim is rejected, then the claims agent can recover from you the amount it has paid in weekly payments and/or medical expenses.
You do not have to accept an offer of interim benefits.
It is important that you carefully consider whether to accept an offer of interim benefits. The investigation and determination of a claim can take several weeks to several months (or more) and depends on factors including the availability of appropriately qualified specialists and whether additional medical and factual information is required such as hospital and general practice notes, and records of interviews. Your income (including any leave or other industrial entitlements) and the urgency of any treatment for your work injuries should be considered in deciding whether you require interim benefits.
If payments have been made by the claims agent on an interim basis and then your claim is rejected, you are entitled to dispute the determination in the South Australian Employment Tribunal. Recovery of your debt will be suspended and the outcome of the dispute will determine whether you have any amount to repay.
Independent medical assessment
Your claims agent can arrange for you to be examined by a specialist of their choice. The purpose of these assessments is to determine the nature, extent or probable duration of your injuries.
It is important to note that if you fail or refuse to attend a medical assessment arranged by a claims agent that your claim can be rejected (section 31). If you are not able to attend an examination arranged by the claims agent it is important that you notify them as soon as possible and the reason why you cannot attend. Depending on your circumstances, it may be possible to request that alternate arrangements be made, including an assessment with a different Doctor or at a different location. For example, if you cannot travel long distances because of your work injury, or because the medical rooms require a certain degree of mobility.
You can also claim the cost of your expenses travelling to and from the assessment.
Turner Freeman assists workers at every stage of a claim, from lodgement through to disputes in the South Australian Employment Tribunal. We have acted for workers with all manner of injuries, including complex physical and mental harm injuries. Our first consultation is provided at no cost to you and after that, we act on a “no win, no fee” basis.
