Employers

Return To Work: Why You Need To Cover ALL Injuries

You need to know in advance that all potential work-related injuries will be considered, explains TGB's Dimitra Bouras and Alexandra Harris.

Since the Return to Work Act came into effect on 1 July 2015, more than ever before, workers have needed to be aware of what injuries have been accepted by the compensating authority in relation to their claim. This can have an impact on a workers entitlements generally.

As an injured worker, one of the main things to be aware of after submitting a claim form and having your injury accepted is being aware of what has actually been accepted. When a determination is issued, if the claim is accepted it is important that the claim accepts all injuries the worker has sustained (i.e., incorporate all body parts that may be affected).

What is (or isn’t) accepted can have future implications on the following:

  1. Medical treatment that will be covered;
  2. Weekly payments for time off work;
  3. Whole Person Impairment Assessment (as per sections 22 and 58 of the Return to Work Act).

The incapacity for work needs to arise from the accepted work injury. For example, if your lower back is accepted but your middle back or neck is what is causing problems, it is important to submit a further claim in order to have this injury accepted. If it isn’t, the compensating authority may not pay for medical treatment or weekly payments for time off work (if the unaccepted injury is causing you to lose time off work).

Another key reason why it is important to have ALL injuries accepted becomes crucial at a later stage after injuries have stabilised and a section 58 Whole Person Impairment assessment is undertaken.

A section 58 Whole Person Impairment assessment is a process whereby once injuries are stable (i.e., the workers injuries have reached a state of maximum improvement), an accredited doctor (of the workers choosing) assesses the worker’s injuries using the American Medical Association 5th edition Guidelines and attributes a Whole Person Impairment percentage.

This is a separate entitlement under the Return to Work Act which is offered to all injured workers, with no time restrictions or limits. It will not impact on a workers employment in any way.

A whole person impairment percentage of 5% or higher entitles the worker to a one off, tax free lump sum payment by way of compensation to the worker for their permanent impairment as a result of their accepted work injury/injuries.

The accredited doctor is only able to take into account injuries that have been accepted by the compensating authority. This is why it is crucial that all injuries are submitted and accepted, as if not, they will not be considered during the assessment which could in turn affect the whole person impairment percentage.

It is also worth noting that workers are only entitled to make one application pursuant to section 58 of the Act for injuries arising out of the same trauma. Based on this, it is crucial that all injuries are taken into account and all injuries are considered stable at the time of the assessment.

If a worker finalises their entitlements pursuant to section 58 of the Act based on an assessment they will be precluded from pursuing any further claim pursuant to section 58 of the Act for a permanent impairment in the future.

This is relevant to workers who have reached stability and are ready to undergo an assessment however are contemplating undergoing potential surgery at a later date. If they do undergo surgery after having a section 58 whole person impairment assessment performed, and their injuries become worse (leading to a higher permanent impairment) they will not be entitled to undergo a further assessment and have further compensation payable to them.

The benefit of having a lawyer assist in this process is not only ensuring that all injuries are accepted by the compensating authority, and assisting in doing so, but helping the worker choose a suitable doctor who will be able to assess their work injuries fairly, and at the right time.

If you need help with your claim, arrange a free initial interview with one of our experienced workers compensation lawyers. Contact your nearest TGB office.