Gaius Whiffin featured on 2GB discussing personal injury claims - 11 September 2021
Gaius Whiffin providing Q & A on the 2GB Chris Smith Show discussing Personal Injury 11 September 2021
CS – Chris Smith/GW –Gaius Whiffin /C1,2,3, etc – Callers
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Read the transcript below:
CS Now we’ve got an email here from James, one of our listeners, who has sent this in this week, he says he injured his back whilst lifting at work, he’s been put off work by his doctor, he’s receiving his wages but is frustrated by the insurer’s delay in approving his medical costs. Does he have to wait for this approval and if so what can he do to speed the process up?
GW Yeah, look this is a common problem Chris, the situation is you do have to wait, with the amendments that were made to the Workers Compensation Act in 2012, the insurer needs to pre-approve all medical, virtually all medical treatment. There is a body called the IRO, the Independent Review Office which you can access by email that deals with complaints against insurers for things like failing to provide approvals within reasonable timeframes and they’re pretty good at investigating these sorts of complaints and they will contact the insurer and generally come up with a solution without the need to go through any legal proceedings which of course will take a lot of time when treatment is needed a lot quicker than that.
CS Okay, so if and when they come back to James and he gets a notice from the insurer denying approval what can he do then, is there another body or is it the same body he should refer to if he wants to appeal that decision.
GW Yeah, look if they have actually then denied the treatment, and issue what’s called a Section 78 Notice, then he only has one choice which is to go to the Personal Injury Commission and get them to determine whether the treatment is reasonably necessary for treatment of his injuries and that’s the test, so reasonably necessary is the test that the Commission will use. Things that are relevant there are whether the treatment would improve functioning, the cost of the treatment, whether there are any alternatives, say if James has gone through other sorts of treatment first and hasn’t worked, whether it’s acceptable practice, obviously there’s some forms of treatment that aren’t recognised in the medical community and there’s others that are clearly recognised, that can relevant too. Perhaps is James, if he receives the notice can then go ahead and have the treatment if he can afford it and then claim the cost back from the insurer in the Commission and of course if he then can have the treatment and he finds it very effective, then it will be very helpful for the case when it gets to the Commission.
CS And just quickly will his legal costs outweigh the medical costs he’s claiming?
GW No, legal costs will be paid by the IRO, the same organisation.
CS Great, good on you Gaius, thank you very much for all that advice.
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