Some of the ins & outs of Workers Compensation (including returning to work after an Injury)
Written by Craig Martin and Catherine O’Halloran
The NSW Workers’ Compensation system is complex and often confusing, involving several stakeholders who have different functions, purposes, and goals. These commonly include:
- your treating doctor
- Return to work coordinator employed by your workplace
- Insurance case manager
- Treating practitioners/providers such as physiotherapists, exercise physiologists, and psychologists
- Rehabilitation providers
- Treating specialist
- Personal Injury lawyer if you are disputing the insurer’s decision or you wish to explore a section 66 Lump sum claim
Here are a few things that you might not know about the Workers Compensation process:
- If you intend to report a workplace injury, report it to your employer as soon as possible.
- You have the right to choose your treating doctor, who is usually your regular GP.
- You have the right to choose your own treatment providers (GP, Specialists, rehabilitation providers). The WC insurer usually appoint the rehabilitation provider; however you can elect to choose your own rehabilitation provider to assist in your return to work. You can also change the rehabilitation provider during the life of your claim if for any reason you are not satisfied with the work done by the rehabilitation provider appointed to your case.
- You can claim travel expenses for travelling to and from treatment appointments, so keep a record of the dates, distances travelled and treatment providers for the purpose of lodging a claim to your insurer.
- You have a right to have a say in the return-to-work plan devised by your employer and the Injury Management Plan devised by the insurer.
- If you have any questions about your return to work, your payments or your workers compensation claim you can contact your employer’s return to work coordinator, the insurance case manager, or the rehabilitation provider. If you are unable to get appropriated assistance, seek independent legal advice. For example, If the insurer or employer forms the opinion that you have not returned to work in a timely manner, you may be pressured by stakeholders in a way that hinders your recovery, and a safe and sustainable return to work.
- Dealing with an insurance company can be frustrating, particularly when you are already experiencing stress. Try to develop a good relationship with your insurance case manager, if possible and endeavour to resolve any issues or concerns you may have about your claim with them. Remember: you can catch more flies with honey than with vinegar! However if you can’t resolve an issue, speak to a lawyer who specialises in workers compensation claims as you may be entitled to seek a review via the Personal Injury Commission of the WC insurer’s decision in relation to your claim, if you don’t agree with that decision. Your legal fees for seeking the review will be covered by a grant the lawyer can obtain from IRO.
- Your employer pays a workers’ compensation insurance premium to an insurer. That premium may increase depending on the type and number of workers compensation claims. One factor influencing premiums is the duration of a worker’s compensation claim. The goal of Workers’ Compensation is to return you to your full pre-injury duties as certified by a final fit for pre-injury duties Certificate of capacity / certificate of fitness.
- Your treating doctor will review your treatment and recovery progress on a regular basis and write regular Certificate of capacity / certificate of fitness documents for the insurer. These certificates are very important documents, and the insurer often uses them to make significant decisions based on their information. It is important that the certificate is completed in detail. It is also important that your injury diagnosis, work restrictions and fitness for work is accurate and specific. As a rule of thumb, ask your treating doctor to fill in every space on the certificate if possible. The “Other” and “Comments” section can be useful for further explanation. Check that the information is correct before signing and dating the certificate of Certificate of capacity / certificate of fitness.
- In our experience we have found that the insurer, employer or workplace rehabilitation provider are likely to want your treating doctor to upgrade your certificate in terms of what you are able to do or to increase the hours you are able to work. Your doctor needs to be sure that you are genuinely able to manage those changes.
- We have encountered rehabilitation providers who have persuaded treating doctors to change a “nil capacity” to “some capacity” on a certificate of capacity claiming that it is necessary for the worker’s rehabilitation to commence, which may not be the case.
- If the treating doctor is being “encouraged” to certify you fit for pre-injury duties, discuss the option with your treating doctor of trialling pre-injury duties before completing a final fit for pre-injury duties certificate. Liability for your claim is likely to end with a fit for pre-injury duties certificate.
- If your treating doctor is being encouraged to upgrade your certificate for job seeking, consider upgrading your certificate when you receive a job offer.