WorkCover and offers of settlement (Vic)

There are a number of occasions during a WorkCover claim where WorkCover may offer you a settlement.

This article will explore those occasions and will discuss what you need to know in relation to each.

Medical and like expenses offers

Once you have an accepted WorkCover claim, you are entitled to the payment of reasonable medical and like expenses.

At some point however, the WorkCover insurer may make a decision to either reduce or terminate your entitlement to a particular type of medical expense – or to your entitlement to the payment of  medical expenses altogether.

If you disagree with the decision of the insurer, then you can pursue the matter to conciliation.

It is common at conciliation for the insurer to make an offer at conciliation.

Typically, the offer can be to pay for a particular type of medical treatment for a certain period of time, with your entitlement to cease thereafter.

For example, say that you are claiming payment for physiotherapy treatment. The insurer may say that they will pay any outstanding physio therapy sessions to date and then pay for a further eight sessions to be used at your discretion, with no entitlement to further sessions after that.

If you were to accept an offer like this then in most cases your entitlement to physiotherapy treatment would end after the eight sessions. For this reason you need to be careful accepting an offer like this.

If you were to require further treatment into the future on a regular basis, that is a significant amount of treatment that will not be covered by the insurer that you would need to pay for yourself (or get it paid via other means, such as through health insurance).

Weekly payments offers

As with medical and like expenses, the WorkCover insurer may make a decision to reduce or terminate your entitlement to weekly payments.

And if you want to contest this again you should go to conciliation.

Technically you can request that the insurer perform an internal review, however it’s not something that we generally recommend to people. We instead recommend conciliation as the first port of call.

At the conciliation, the insurer may make an offer to pay weekly payments for a limited period of time with payments to cease thereafter.

So say for example it’s been 10 weeks since your payments have been terminated, the WorkCover insurer may say that they will pay you for that 10 weeks and thereafter weekly payments will cease.

Again, you should be careful accepting offers like this particular one if you’re not sure how much time you may need off work into the future.

If you need an extended period of time off work and you don’t have weekly payments to cover you, there are other options but if you have a WorkCover claim on foot the best option is in our opinion, in most cases, is to obtain weekly payments.

Another time when you may receive an offer of settlement is after the conciliation if process your matter does not resolve, and you then issue proceedings in the Magistrates Court.

Before the matter proceeds to hearing you (in most cases via your lawyers) can negotiate with the lawyers representing WorkCover and potentially an an offer or offers may be made by the other side to you (this also applies to medical expenses).

Impairment benefit offers

There are two stages during an impairment benefit lump sum claim where you may receive an offer from WorkCover.

The first is after you have lodged the claim and gone through the IME process.

The WorkCover insurer will then provide you with what’s called a notice of entitlement which outlines their offer to resolve your impairment benefit claim.

You can read about the impairment claim process in detail here.

If you accept the insurers offer, then your impairment claim is finalised. It cannot be reopened in the future.

You might not want to accept their offer and instead proceed to the medical panel.

You can read about the medical panel here.

The medical panel in a nutshell is a process where you get assessed by two or more doctors in the one sitting.

They would be required to review the impairment assessment completed by the previous doctor that assessed you and then form their own opinion.

Following this they will provide a written opinion which will be sent to the WorkCover Insurer.

If you reach the relevant threshold level of impairment, then the insurer will issue you with a new notice and offer.

Generally speaking the opinion of a medical panel is final and binding but there are limited instances in which an opinion of the medical panel can be appealed.

When considering whether to accept an offer relating to an impairment claim, you need to take into account:

1. Have all relevant injuries been assessed? This includes any consequential injuries. An example of a consequential injury is if you had to take medication to treat an injury, and the medication caused gastrointestinal damage.
2. Has the IME assessed your injury/injuries appropriately?
3. Have the assessments been added up appropriately?
4. Has the insurer calculated your compensation amount appropriately?

Common-law claim offers

The final entitlement under a WorkCover claim is a common-law claim.

You can really receive an offer to settle a common-law claim at any time once you have lodged a serious injury application.

You can read about the serious injury process here.

So once you have lodged the serious injury application, the lawyers acting on behalf of WorkCover have 120 days to make a decision in relation to your claim.

What normally happens is that they either say yes or no to the question of whether you have a serious injury during this period.

What can happen however is that they offer you a monetary lump sum to finalise your matter at an early stage.

If this doesn’t happen, then if you obtain a serious injury certificate you’ll go to a conference whereby offers to settle the matter may be made by the other side.

If the matter doesn’t resolve at the conference then you’ll need to go through the process whereby the other side will need to provide a written offer to you called a statutory offer.

If you do not accept their offer then you are required to make a statutory counter offer. You can read about statutory counter offers here.

If the matter then doesn’t resolve you need to issue what’s called a writ and have the matter set down for hearing.

At any time once you have done this the other side can make you an offer.

And they can keep making offers.

If the matter doesn’t resolve by way of negotiation between the parties, then the next step is to go to a mediation where the parties will discuss the matter with the assistance of a mediator.

You can read about mediations here.

The other side may offer you make an offer to you during the mediation and the matter may resolve.

If not your WorkCover matter will need to proceed to hearing.

Any time during the hearing the other side is able to make offers to you. This includes just before the hearing and any time during the hearing.

Conclusion

You can see that there are many instances during a WorkCover matter where WorkCover can make an offer to you.

Offers can be made to resolve your medical and like expenses, your weekly payments, your impairment benefit and your common-law claim.

Keep in mind that acceptance of any offer made by the WorkCover insurer will likely windup the relevant entitlement.