Medical Panels and WorkCover – What you need to know
Published on Posted onPlease note that this post was written for Victorian audiences and the information within may not apply to other regions.
Functions of Medical Panels in WorkCover Claims
Throughout the WorkCover claim process, disputes may arise regarding medical questions critical to your claim. These questions can significantly impact whether your claim is successful and the extent of your entitlements.
Medical Panels serve as independent tribunals responsible for resolving disputes related to medical questions under the WorkCover legislation. Their role is to provide a binding determination on matters such as the nature and severity of an injury. A common question posed to medical panels is whether an injury should be classified as “significant”.
What to expect from an Assessment?
The medical panel is comprised of a group of specialist doctors with expertise relevant to the medical question at hand. Typically, two doctors will conduct the assessment, but additional specialists may be involved depending on the complexity of the dispute.
During the examination, which usually lasts around an hour, the doctors will ask relevant questions and conduct a physical assessment. However, they cannot provide medical advice or guidance on your WorkCover claim.
To assist the panel in making an informed decision, it is advisable to bring any relevant medical scans, such as MRIs, CTs or X-rays.
In Victoria, most medical panel assessments take place at their office in the CBD, though alternative arrangements may be made in special circumstances. Referrals to a medical panel typically arise from conciliation, mediation, or court proceedings.
The Significance of a Medical Panel’s Decision
A medical panel’s role is strictly to resolve the medical question presented to them. They do not determine liability for an injury or recommend treatment options.
Given their predominant role is to answer the medical question they have been tasked, their decision will act as the leading authority for which the disagreement arose. For example, determining that an injury results in a 20% impairment, that decision is final and binding and must be adopted by all parties, including courts and WorkCover authorities. The vast majority of medical panel decisions are conclusive, though in rare cases, the panel may require further examination by another specialist before making a final determination.
Given the significant impact a medical panel opinion may have on your claim, it is essential to seek legal advice when facing a medical dispute, or possible medical panel referral.
After the Medical Panel Examination
Once the examination is complete, the panel has up to 60 days to issue a written decision, including a written statement of ‘reasons’ supporting their opinion.
As medical panel decisions are final and binding, they cannot be appealed solely on the basis of disagreement with the outcome. However, legal avenues may be available to challenge a decision in limited circumstances.
Possible grounds of appeal can include:
- Jurisdictional error
- Rising in situations where the panel has misidentified key issues, ignored relevant material, or relied on irrelevant evidence and made erroneous findings. For example, a medical panel may fall into jurisdictional error if they disregard crucial ultrasound results without proper justification.
- Procedural fairness
- Revolves around any opinions that are found to be formed or influenced by any source of bias. If you believe that during your examination, you felt any potential source of an undue process directed from bias, this can be a possible way to overturn a decision you believe was unfairly influenced by prejudice.
- Unreasonableness
- If the decision is so unreasonable that no reasonable decision-maker could have reached it.
- Inadequacy of reasons
- If the panel fails to provide sufficient reasoning to support it’s conclusion.
At Zaparas lawyers, we understand that appearing before a medical panel can be a stressful and complex experience. Our team works diligently to strengthen your case by ensuring all relevant facts are properly presented and agreed upon before the assessment. Our goal is to help you navigate the process with confidence and achieve the best possible outcome.
