WorkCover medical panels: what you need to know.
At some point during the life of your workers compensation matter in Victoria, you may be asked to attend a medical panel.
There are a number of reasons as to why you maybe asked to do so which will be explored below.
What is a medical panel?
The medical panel is made up of a panel of doctors that have been asked to resolve a medical question or questions.
Their job is to assess an injured worker, to consider any medical evidence and to provide a legally binding opinion backed by written reasons.
What happens at a medical panel?
The Medical panel will ask you about your injuries and any relevant history. Depending upon the nature of your injury or condition, the medical panel will also perform an examination.
The panel will consider any medical material, which includes reports from your treating doctors and other health practitioners, as well as any previous assessments performed by IME doctors.
The panel may ask you questions about your work duties and any medical treatment that you’ve been obtaining.
Why would I be asked to attend a panel assessment?
There are a number of reasons as to why you may be asked to attend a medical panel assessment.
- Because the insurer rejected your WorkCover claim (here’s what to do if that happens);
- To determine whether a particular medical expense is required to treat your injury;
- The insurer rejected an injury for the purposes of your impairment claim;
- To determine whether household help is required;
- To determine the impact of your injury and your ability to work;
- To determine the cause of your injuries;
- There is a dispute about the whole person impairment assessment.
Who decides to send me to the medical panel?
You may be referred to the medical panel from conciliation or from court.
If you are referred from conciliation it’s likely that either you or your lawyer have agreed to refer the matter there.
If you are referred from court, it’s likely the other side have requested to refer your matter to the panel.
In impairment claim lump sum matters, it’s likely that your lawyer has requested to refer your matter to the medical panel following the assessment or assessments of the IMEs.
How long do I have to wait before I see them?
From the time that you get referred to the panel, it can take a couple of months, sometimes more, before you get to see the panel.
There’s not a lot that you can do to speed this up unfortunately. This is because the medical panel usually has a backlog of matters that they need to deal with.
Wait times depend upon the type of injury and the questions that the panel needs to address. It also depends upon the availability of the doctors that are to assess you.
Usually it takes about 6 to 12 weeks from the time that the medical panel received your referral for you to see the panel.
How do I find out details of my appointment?
Once the medical panel receives a referral, correspondence is sent to all the parties involved in the matter.
This will mean you will receive details as well your lawyer if you have one. The opposing party which might be the insurance company or a law firm will also receive details.
Correspondence will detail the date time and location of the appointment (or appointments) as well as the names of any doctors that are on the medical panel, along with their specialities.
It is important to note that if you’ve seen any of the doctors previously, you can’t see them again.
So you need to let your lawyer know, if you have one, or alternatively if you do not have one to let the medical panel know if this is the case.
How long will the appointment go for?
This depends on the questions the panel needs to answer as well as the complexity of your injury or injuries.
Some appointments may be very quick, taking only half an hour or so while others could be 90 minutes or more.
Am I able to bring someone with me to the appointment?
You are able to bring a family member or a friend in to the appointment with you.
However, they are not able to speak on your behalf. They will be there to provide support only.
You can’t bring in a lawyer or any other person to represent you.
Insurers and employers cannot attend a medical panel appointment.
If you have an appointment with a psychiatrist, it’s unlikely that you will be able to bring in someone else with you as these appointments are private.
Where do the appointments occur?
Most of the appointments take place at the office of the medical panel which is located in the Melbourne CBD.
Sometimes you may need to attend appointments elsewhere if special equipment is required. For example, if your injury involves hearing loss and special equipment is needed.
Can I give the panel extra information?
In certain circumstances, yes you can give a medical panel further information like medical reports or material from a doctor or other treating practitioner.
It is best to provide this information prior to your appointment with the medical panel if possible.
You are not able to provide further information to the medical panel directly if you have been referred to the medical panel from court.
This is because the court needs to approve a Magistrate or Judge needs to approve the document or documents before it’s given to the medical panel. If you have any questions in relation to this it’s best to speak to your lawyer.
Should I bring copies of medical reports and other medical material that I have to give to them?
You should bring any scans (i.e. MRI, CT, x-rays) that you might have. Any test results that you think might be relevant should also be brought, along with a list of medications so you can answer the medical panel about this if they ask.
How many doctors will there be at the medical panel?
This depends upon your injuries and the nature of the questions that the panel is required to ask.
Generally speaking, a medical panel will be made up of somewhere between two and five doctors.
Medical panel questions – what are they likely to ask me?
The panel will perform an assessment and probably ask you questions that you’d assume would be asked.
For example, if you’re seeing the panel with a back injury, they’ll ask you about pain and restriction, and what you have trouble doing.
However, what they ask you will also depend upon why you’re seeing them.
For example, if you’re there because the insurer terminated your entitlement to weekly payments because they believe you have a work capacity – the panel will ask you questions that go to this issue.
They might, for example, want to know about how you go bending, or lifting, or questions relating to past jobs and your work experience.
If your matter concerns, for example, the rejection of an injury relating to an impairment claim, they’ll ask you about that injury and will also ask you questions that go to any connection the injury might have to your employment.
Can the they give me any advice?
The medical panel is not in a position to give you advice in relation to medical treatment or in relation to your WorkCover claim. Their role is to make a decision on certain questions that have been put to them.
Will I need more than one medical panel appointment?
Sometimes a medical panel may need you to attend another doctor or other medical professional in order to assist them to form a decision. This is not common but sometimes does happen.
Is the medical panel independent?
The medical panel is independent of the parties that are involved in the relevant dispute. The doctors that are on the panel are selected by the convenor of medical panels and are doctors that are considered to have the relevant expertise to answer the medical question or questions that are need to be determined.
What happens after the medical panel?
There are two medical panel outcomes – you’ll either succeed at the panel or you’ll lose.
After you’ve seen the medical panel, the panel will spend a bit of time drafting up a written opinion. This written opinion will be several pages long.
In their opinion, they will answer the questions that they have been tasked with answering.
Once they have completed their written opinion, they will send it off to the appropriate bodies.
This may mean that the insurance company may be provided with a copy, as well any lawyers that are involved in your matter.
If you have someone acting on your behalf such as a lawyer you will not receive a copy of the opinion directly. If you are representing yourself, then you may receive an opinion.
What happens next depends upon why you have gone to the medical panel.
If you are attending the panel for the purposes of an impairment assessment, then the insurance company will contact you or your lawyers to let them know of the outcome and to put a new offer to you regarding compensation.
(If this applies to you and you’d like to know what compensation you might be entitled to, you can visit this page).
If you do not reach the relevant threshold in order to be entitled to an impairment benefit, then they will advise of this in writing.
If you are attending the panel relation to a dispute concerning payment of a medical and like expenses, then the insurance company should contact you or your lawyers and let them know the outcome.
If the matter concerns a magistrates court matter, then the opinion will be sent to the lawyers involved and usually your matter will be listed for a mention before the magistrates Court. This is a short court proceeding where the medical panel opinion will be discussed and orders will be made.
Referred to later in this article, if you have issues with the medical panel opinion, it is possible in certain circumstances to appeal the opinion.
How long after I have seen the panel will I receive their decision?
After the examination, the panel have 60 days to finalise their opinion. Generally speaking however, you should receive notification of their opinion within about four weeks.
The panel is required to give written reasons for the decision.
Appealing a medical panel decision in Victoria:
The panels opinion is legally binding. However, if you disagree with their decision, in some cases you are able to appeal.
You have 60 days to file an appeal from the date that the medical panel signed off on their decision.
When it comes to appealing a medical panel decision in Victoria, it is not enough to simply disagree with the opinion. There must be grounds for appeal.
The following are grounds for appealing a medical panel decision;
This means that the panel might have ignored a relevant material consideration, relied on irrelevant material, or made a wrong finding or came to a mistaken conclusion.
One example is that the panel may have taken an incorrect history which impacted their opinion. If the reasons are not factually accurate and do not accord with the history that you have provided to the medical panel, you may be able to appeal the medical panel‘s opinion.
An example of not being accorded procedural fairness would be if surveillance footage of you was sent to the medical panel but you or your lawyer were not advised of this and you did not have an opportunity to address it.
This could be that the decision made by the medical panel was so unreasonable that no reasonable decision maker could have made it. That is, that the decision is not supported by logic as it is not possible to understand from the opinion and reasons as to how the medical panel reached its conclusion.
Inadequacy of reasons:
The medical panel needs to provide adequate reasons indicating how they reached a particular conclusion and if they do not do so, they maybe grounds for appeal.