Medical Assessments and Medical Appeals in the Workers Compensation Commission Sian Leathem, Registrar. Content. Medical disputes Approved Medical Specialists Medical referrals Examination by AMS Applications to appeal a medical assessment Role of the gatekeeper Medical Appeal Panels
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Section 326(1) of the 1998 Act:
(a) the degree of permanent impairment of the worker as a result of an injury
(b) whether any proportion of permanent impairment is due to a previous injury or pre-existing condition or abnormality
(c) whether impairment is permanent
(d) whether the degree of permanent impairment is fully ascertainable
What are the grounds of appeal? correct?
Section 327(3) of the 1998 Act
an increase in the degree of permanent impairment
(b) there is availability of additional relevant information (being
evidence that was not available to the appellant before the
medical assessment appealed against and that could not
reasonably have been obtained by the appellant before that
(c) the assessment was made on the basis of incorrect criteria
(d) the MAC contains a demonstrable error
When can a medical appeal be filed? correct?
- if ground of appeal is for incorrect
criteria and/or demonstrable error
- Rewitu Pty Ltd v The Registrar of the
WCC & Anor  NSWSC 441
- if ground of appeal is for deterioration
and/or additional relevant information
What are special circumstances that allow the extension of time to file a medical appeal?
Section 327(5) of the 1998 Act:
Who is the “gatekeeper”?
What is the role of the “gatekeeper”? time to file a medical appeal?
Section 327(4) of the 1998 Act:
- 4,379 MACs issued
- 566 medical appeals lodged
- 569 medical appeals finalised
- 69 medical appeals rejected by the gatekeeper
- 4,833 MACs issued
- 606 medical appeals lodged
- 685 medial appeals finalised
- 38 medical appeals rejected by the gatekeeper
What happens next after the Registrar is satisfied that a ground of appeal has been made out?
(1) Section 328(1) of the 1998 Act:
Medical appeal is by way of review but is limited to the grounds on which the appeal was made (section 328(2)).
(2) Section 329 of the 1998 Act:
Grounds of appeal under section 327(3) of the 1998 Act
a. Registrar’s Guideline on Medical Appeals
b. WorkCover Medical Assessment Guidelines (Chapter E)
Sian Leathem, Registrar
Workers Commission of NSW