The Return to Work legislation became operational in July 2015 and has significantly impacted the entitlements of injured workers across South Australia. For workers who have injured themselves since the law became operational, their entitlements to income maintenance (weekly wages), medical expenses and other potential compensation are discussed in detail in other blogs.
"But many workers [...] have been subjected to complex and often unfair ‘transitional arrangements’."
But many workers who injured themselves before July 2015 (when the repealed Workers Rehabilitation and Compensation Act 1986 existed) have been subjected to complex and often unfair ‘transitional arrangements’. In other words, these workers have transitioned into the new Return to Work scheme, and this will have an impact on their workers compensation entitlements.
What will happen with my medical treatment after 30 June 2016?
If a worker injured themselves before July 2015 but was not in receipt of income maintenance at the time of the transition into the Return to Work scheme, their entitlement to receive reimbursement or compensation for medical treatment associated with their injury will cease on 30 June 2016. This rule exists for both physical and psychological injuries.
For example, if a worker injured their lower back in January 2014 but they had returned to work before July 2015 and therefore they were not receiving income support payments at the time of the transition into the Return to Work scheme, they were provided with a further 12 months of medical treatment which will expire on 30 June 2016.
"The new law is much harsher in relation to many entitlements compared to the previous scheme."
Their entitlement to medical treatment reimbursement will expire even if they still require regular physiotherapy, pain killers, etc. Under the old law, there was no specific end date regarding the entitlement to medical expenses; as long as the worker could prove that the treatment was reasonable and related to their workplace injury, they were entitled to seek reimbursement for treatment for their entire life. The new law is much harsher in relation to many entitlements compared to the previous scheme.
What are the exceptions in relation to ongoing medical treatment after 30 June 2016?
There are a few exceptions to the expiration of medical expenses detailed above.
For example, if the worker is deemed ‘seriously injured’ because of the severity of their physical or psychological injury, they are not affected by the 30 June 2016 cut-off date. Seriously injured workers can continue to receive their entitlement to medical treatment for the rest of their lives.
Also, a worker can seek an exception to the 30 June 2016 cut-off date for certain surgeries and therapeutic appliances. For example, if a worker suffers from a left knee injury and they have been coping with conservative treatment including physiotherapy and pain killers, those entitlements will expire on 30 June 2016. But if a doctor confirms that the worker will likely require a knee replacement over the coming years, the worker can seek pre-approval of that surgery, even though the surgery will clearly take place beyond 30 June 2016.
At Andersons, we have been working closely with clients to fight for the pre-approval of potential surgery before 30 June 2016. It is important to note that the pre-approval of surgery cannot be sought once their entitlement expires on 30 June 2016. In other words, if a worker only seeks the pre-approval after their entitlement to medical treatment ceases, the insurance company will have no obligation/liability to consider the approval of the surgery.
If you are presently not in receipt of income maintenance payments, but continue to suffer from a work-related injury, and you believe you might require surgery in the future, you should urgently contact us to discuss your matter further.
At Andersons, we’re concerned for many of our clients whose medical expenses will cease from June this year
At Andersons, we are extremely concerned for the welfare of many clients who will suddenly find themselves without the ability to seek compensation/reimbursement for medical treatment beyond 30 June 2016. Many workers who rely on their chiropractic sessions, physiotherapy, etc, will be personally liable for this treatment beyond 30 June 2016.
"...we are extremely concerned for the welfare of many clients who will suddenly find themselves without the ability to seek [compensation] for medical treatment beyond 30 June 2016. "
Many workers who cannot afford these treatments will simply go without, which will likely lead to undue pain and the deterioration of their injury. Many workers who suffer psychologically and require anti-depressant medication and regular counselling sessions may stop seeking this important treatment once they are no longer financially protected by the workers compensation scheme.
We are particularly worried about workers who have been taking medication (including analgesic and psychotropic medication) for some time who may need to stop taking the medication because they cannot afford it. Ceasing medication ‘cold turkey’ can often result in horrendous side-effects and withdrawal symptoms, but many workers will simply be unable to afford the medication without the support of the workers compensation system.
What will happen to my opportunity to claim lump sum compensation after 30 June 2016?
Another matter for injured workers to keep in mind before 30 June 2016 concerns their claim to ‘whole person impairment’ compensation; lump sum compensation. If a worker injured themselves before Return to Work became operational and has already been assessed for lump-sum compensation for their permanent impairment, the new law generally precludes them from undergoing a further assessment to potentially obtain further compensation.
However, under the RTW scheme, those workers have another chance for assessments of additional physical injuries that resulted from the initial injury, but that opportunity expires on 30 June 2016. This is a complex area of law, but the following example explores the key point.
Let’s say a worker injured their left knee in January 2010 and underwent a permanent impairment assessment in late 2013. That assessment resulted in a lump sum pay-out of $20,000. However, in the subsequent years they developed pain in their right knee due to overcompensating; that is using the right knee more often or more awkwardly to alleviate pain in the left knee. Their entitlement to be assessed for further lump sum compensation arising out of this overcompensation injury will expire on 30 June 2016. Workers should seek urgent legal advice if they are suffering from overcompensation type injuries.
If you are experiencing any problems at all regarding the management of your workers compensation claim, or if you are worried about your entitlements to compensation, please contact today’s blog writer Michael Irvine.
But many workers who injured themselves before July 2015 (when the repealed Workers Rehabilitation and Compensation Act 1986 existed) have been subjected to complex and often unfair ‘transitional arrangements’.