*The contents in this blog relates to legislation in New South Wales.
Under the Motor Accident Injuries Act 2017, Medical Assessors appointed by the Personal Injury Commission play a very significant role in determining the outcome of a CTP claim.
There is very often a dispute with the insurer about whether an injured person has a minor injury, whether a particular treatment is reasonable and necessary or whether WPI is over 10% (enabling a claim for non-economic loss or pain and suffering)
In these instances, the Medical Assessor is tasked with having the final say. Except for the avenues discussed below, their decision is final and binding.
If an injured person or the insurer wishes to challenge the outcome of a medical assessment, this can be done via either an application to a review panel, or by applying for a further assessment.
On one occasion only, either a claimant or insurer can apply for the referral of a medical assessment to a review panel under Section 7.24 of the Motor Accident Injuries Act.
This application can only be made on the grounds that the assessment was incorrect in a material respect. Such an error might be misapplying the Motor Accident Guidelines or overlooking an important piece of evidence.
If President of the Personal Injury Commission accepts there is reasonable cause to suspect the medical assessment was incorrect in a material respect, the application then proceeds to a review panel.
Unlike previously where the review panel consisted of three medical assessors, the panel now comprises of two medical assessors and one member of the Motor Accidents Division of the Personal Injury Commission. The review panel may or may not request a re-examination of the injured person. The review panel has the power to confirm or revoke the original certificate issued by the medical assessor.
For example, a certificate determining 5% whole person impairment might be revoked in favour of a new certificate of 11%.
There is another avenue to challenge a medical assessor’s certificate, being an application for a further medical assessment under Section 7.25 of the Motor Accident Injuries Act. This application is made on the basis of deterioration of the injury or additional relevant information on the injury.
This application can be made on one occasion only, so it is important that an injured person not bring this application prematurely.
As an example, if a medical assessor may certify that an injured person has a “minor injury”. If this injury then requires surgery, bringing an application for a further medical assessment post-surgery may see the “minor injury” decision overturned.
An injured person should be aware that opportunities for a further assessment cut both ways. For example, if a medical assessor finds whole person impairment to exceed 10%, you can expect the insurer to be on the hunt for new evidence (such as surveillance) which might see this decision overturned.
It is not always possible to have the outcome of a medical assessment changed. However, the medical assessor can be judge and jury for the outcome of a CTP claim. It is important to leave no stone unturned in looking at ways to challenge a decision which is adverse to the injured person.
Get in touch with us
If your claim has been rejected or if you want to challenge the outcome of your medical assessment, get in touch with us our personal injury lawyers today. You can reach us via calling 13 43 63 or filling out the online form below.