Joel Trigg is legal practice director at Stephen Browne Personal Injury Lawyers. I have asked Joel to provide some legal perspective on the term ‘reasonable medical expenses’ which appears in the Workers Compensation Act, and what an injured worker can do when approval for surgery is declined by the insurer. David: Joel, what happens if the insurer refuses to pay …
Confidentiality The normal doctor-patient relationship is one of strict confidentiality. This confidentiality is challenged when the patient’s injury is part of a workers’ compensation claim. When you lodge a workers’ compensation claim, you complete a Claim Form, which includes a “consent authority”. In doing so you agree that the insurer can collect and use your personal information for the purposes …
What you or I might think of as an “Injury“, and what legally constitutes an injury under the terms of the Workers’ Compensation Act, are two completely different things. I asked Peter Parker, an Independent Registered Agent with WorkCover WA to help explain some of the legalities around this complex issue. David: What is the definition of a workers compensation …
If you are involved in workers’ compensation, you need to know about ODG – The Official Disability Guidelines. “Big Data“ is the buzz word at the moment. For me it all sounds a bit too much like Big Brother – someone is using my personal information for who knows what. But it is not all bad. Big data has …
Over the years I have seen several patients who have been involved in a motor vehicle accident at work. I asked Peter Kakulas at Percy Kakulas Gleeson Injury Lawyers to help me understand what happens when the workers compensation scheme and the motor vehicle insurance scheme overlap. David: Can an injured worker claim under both schemes? Peter: It’s difficult, from …
Something I hear commonly in the workers’ compensation environment is “my boss said he had the same operation and was back at work after a week”. Apart from being highly inflammatory, the statement in itself is probably not true. “Knee arthroscopy” is a very generic term for any operation that is done with keyhole cuts on the knee. Under this …
For many people, flying is a critical part of their job. Here are some tips if you do have to fly after surgery. Do not take a long international flight for six weeks after lower limb surgery. This risk of deep vein thrombosis is substantially increased. Shorter domestic flights may be tolerated with simple precautions. Calf stockings. Short below knee inflight …
All workers’ compensation claims are ultimately finalized. Many patients are apprehensive about this process and some patients express a desire to keep their claim open indefinitely. Unfortunately, that is not practical or feasible. If the insurer was obliged to keep all claims open indefinitely, they would not have a viable business and we would therefore not have a workers’ compensation …
During the recovery period, the patient, doctor, employer, insurer and rehabilitation provider need to agree on a rehabilitation goal. That is, to determine whether the patient is likely to return to their previous occupation or whether, as a result of the injury, there may be some permanent restrictions, which would prevent them from returning to that occupation. In the setting …
Being fit to drive a motor vehicle is a critical milestone in the return to work process. The legal guidelines regarding fitness to drive are not as specific as we would like. Obviously safety for all those on the road is an overriding factor. With respect to shoulder surgery, you are not fit to drive while you are wearing a …
A secondary condition is a condition that arises indirectly from the original injury. The Workers’ Compensation Act in Western Australia specifically excludes secondary psychological, psychiatric or sexual conditions. That is to say, if as a result of your injuries you become depressed, that secondary psychological condition will not be covered by your workers’ compensation claim. I not infrequently see patients …
The meniscus is the rubber cartilage in the knee. We see meniscal tearing or torn cartilages in the knee in two settings. Firstly, everyone has heard about the young footy player who has a twisting injury, keyhole surgery to tidy up the torn cartilage and he is back on the field in a month or so. That is a tear …
One area of conflict in the workers’ compensation scheme is the return to work process. During the time you are being treated for your work injury, you will be issued with progress medical certificates. These certificates will indicate whether you are totally unfit for work, fit to return to work with modified duties, or fully fit to return to your …
Patients occasionally request follow up MRI scans in the recovery period. Often this is motivated by concern for their repair or reconstruction. They may have had a minor injury or aggravation and want the reassurance of knowing that everything is okay. Sometimes they want to see how things are healing. Unfortunately MRI scans do not always have the answers to …
There is no diagnosis in the area of workers’ compensation injuries that causes more confusion and outright disbelief than the diagnosis of “osteoarthritis”. How is it possible that I have never had a days knee pain in my life, I went to work, had an injury, now my knee is sore and you are telling me that it is osteoarthritis? …
Some orthopaedic conditions are painful due to inflammation of the tissues or joint. This includes osteoarthritis of the knee, frozen shoulder, rotator cuff tendonitis and subacromial bursitis. Successful recovery from orthopaedic surgery requires a structured progressive rehabilitation program. However, it is possible to have too much of a good thing. It certainly looks good on a progress report to have …
To the insurance company, a workers’ compensation claim is just another insurance claim, no different to a car accident. By its very nature, any insurance system is somewhat adversarial. Insurance companies always ask questions about the validity of a claim. I myself can clearly recall a rather unpleasant conversation with a motor vehicle damage assessor that occurred over twenty years …
About six months after you have lodged a workers’ compensation claim, you may receive a letter from your employer or insurer indicating that your termination date is about another six months away. The letter will state that if you wish to pursue a common law claim you must notify of your intention prior to that date. Unfortunately this letter usually …
One of the commonest things I hear from patients who are on a return to work program is that they feel that their colleagues think they are “bludging”. There is no way to change what other people are thinking but rest assured your work restrictions have been put in place by your treating doctors for good reasons. It is not …
The results of rotator cuff repair surgery in young people are generally very good and most people return to their previous occupation. That is not to say that everybody makes a full recovery, most people still have some slight reduction in their range of movement. The normal recovery after rotator cuff repair surgery requires a sling for four to six …
Successful pain management is critical to the recovery from any injury. Some patients struggle with pain management and are referred to pain specialists. This can be invaluable, but if we are needing their services, we are already facing an uphill battle. We should plan not to need their help. The workers’ compensation scheme places a heavy emphasis on early return …
Your workers’ compensation claim cannot be finalized until you have reached maximum medical improvement. That does not mean that you are fully recovered. Rather it means that you have made as good a recovery as you are going to make, and there is no prospect of further improvements over time or improvement with further treatment. Generally you are likely to …
Although it is not common, I occasionally see patients who have had a work related injury to their knee where the underlying arthritic changes are so severe that the only appropriate treatment would be a knee replacement. The question then arises as to whether the workers’ compensation insurer is liable for the cost of a knee replacement. The first issue …
This is a question I am asked frequently. Unfortunately if a work injury is severe enough to require surgical treatment, then it is highly unlikely that we will ever reach that gold standard 100% recovery. One of the problems we face in orthopaedics is that some human tissues have limited or no regenerative capacity. Muscles have very good blood supply …
The recovery from major reconstructive surgery is never a straightforward path. There are inevitable ups and downs and occasionally minor aggravations or re-injuries. These flare ups can occur anytime within the first twelve months after surgery and often come completely out of the blue. Sometimes it can be as simple as a change in the weather, or the way you …
