Big Mac Last Resort for Compensation Claimants
Now more than ever, proper consideration needs to be given when deciding whether to commence proceedings in the Workers Compensation Commission to have an injured worker’s level of permanent impairment determined.
After a workplace injury, an injured worker may be required to undergo an assessment of their level of permanent impairment. This process involves a suitably qualified Independent Medical Examiner (IME) conducting an assessment, reviewing the medical evidence and providing their opinion on the worker’s injuries.
The IME will attribute a percentage to any permanent impairment suffered by an injured worker. These assessments may be at the request of the worker’s compensation insurer or the worker’s legal representative.
An injured worker’s level of permanent impairment not only determines their entitlement to claim lump sum compensation for their injuries, but also determines how long they will be entitled to claim statutory benefits from the workers compensation insurer including medical and treatment related expenses as well as weekly payments when an injured worker is partially or totally incapacitated for work.
When disputes arise in relation to a worker’s level of impairment, often the avenue is to lodge proceedings in the Workers Compensation Commission. The Commission then allocates an Approved Medical Specialist (AMS) to assess the worker’s injuries and provide a Medical Assessment Certificate (MAC) setting out a binding assessment of the injured worker’s level of impairment.
The Commission has recently confirmed that injured workers are only entitled to one MAC in their lifetime.
Obtaining a binding MAC early in the life of a claim may be detrimental to an injured worker and their ongoing entitlements so it is important that injured workers are aware that if they have their level of impairment determined by an AMS early on, this avenue for dispute resolution will never be available to them again in the future.
In circumstances where an injured worker has obtained a MAC and the workers compensation insurer later decides to dispute the worker’s level of impairment, the injured worker will have limited avenues available to dispute the insurer’s decision.
Therefore significant consideration needs to be given to the ramifications a binding decision can have on a worker and their ongoing entitlements under the scheme.
It is impossible to know how the life of a claim will unfold for an injured worker but proceeding to an AMS should be the last resort after all other avenues have been considered and exhausted.