Workers Compensation: How to deal with WorkCover and TAC claims during COVID-19

15/04/2020

By Rachel Schutze, Principal Lawyer, Injury Law department, Gordon Legal

We all appreciate the sacrifices healthcare workers and their teams are making to treat those who are unwell during the current global pandemic. This includes the essential health services being provided to injured workers on WorkCover and Transport Accident Cover (TAC) by doctors, physios, therapists and social workers. 

Claims management has changed in light of COVID-19. Recipients and their families should know that: 

  • Many consultations are now available via Telehealth. 
  • The Medical Panel has temporarily ceased operation, so outstanding disputes or assessments, and new claims, will be placed on hold until further notice. 
  • Existing appointments are being assessed on a case by case basis. 

Below is a detailed personal injury lawyers’ guide to COVID-19 changes to WorkCover and TAC claims to ensure you get the compensation you deserve. 

Key changes to cover claims during Covid-19

Future WorkCover and TAC Claims - How do I get workers compensation insurance? 

  • The Medical Panel has temporarily ceased operation as of 23 March 2020. 
  • Any outstanding disputes or assessments which have been previously referred and granted an appointment date have now had their examination date cancelled until the Medical Panel recommences operation. 
  • Any matters which are now referred to the Medical Panel through conciliation and the courts will also be placed in a queue to obtain Medical Panel appointment dates. 

Current WorkCover and TAC Claims - Who qualifies for workers compensation? 

  • Workers currently receiving claims will be still required to attend appointments with independent medical examiners (IMEs) including through authorised insurers such as EML, CGU, Allianz and Gallagher Bassett. 
  • Telehealth can be utilised for treatment services that already have agent approval. These are virtual appointments conducted over the phone or video conferencing services like FaceTime, Zoom or WhatsApp. 
  • Telehealth consults aren't compulsory, but they may be preferred by some providers. 
  • Telehealth – WorkCover: The WorkSafe website will introduce temporary treatment services available on Telehealth. Read more here. 
  • A pilot program for all psychiatric examinations is being trialled using videoconferencing technologies. 
  • Telehealth – TAC: TAC will now fund temporary Telehealth items for services provided by medical specialists, such as GPs, consulting physicians and psychiatrists, however the TAC website should be checked regularly for updates. *The TAC expects its providers to only use Telehealth when it is clinically appropriate and relates to a client’s accident injuries. 

Recommendations

WorkCover: Honouring existing appointments 

At present, independent medical examiners (IME’s) are individually determining whether to accept new appointments or honour existing appointments. 

  • Appointments that require range of motion assessment are being cancelled: IMEs do not feel this can be undertaken successfully with the use of conferencing technologies. 
  • Psychiatric appointments are continuing in their current form via conferencing technologies such as Zoom. 
  • Most appointments involving back injuries with radiological reports available are proceeding with the use of conferencing technologies. 

WorkCover: Attending independent medical examinations (IMEs) 

Workers can advise their insurer in some instances that they are not willing to attend the appointment in person due to COVID-19 concerns. This is completely appropriate. 

We are seeing a large number of these appointments cancelled. If you or a family member are concerned that a joint medical examination (JME) or an independent medical examination (IME) has been cancelled, please contact your legal representative, or if you are not represented, please contact WorkSafe or the TAC and ask if alternate arrangements can be made. 

Alternatively, workers under WorkCover or TAC can obtain advice from a lawyer in relation to their claim and their concerns. 

The inability of the insurer to inform itself of a medical question will result in the delay of approval of requested treatment or the suspension of claims. 

Transport accident claims (TAC): Joint Medical Examinations (JMEs) & Independent Medical Examinations (IMEs)

For workers who are injured in transport accidents the TAC will, on occasion, organise medical appointments jointly with the injured person’s legal representatives and medical examiners. The aim of these appointments is to reduce the overall number of appointments for the injured person, and to reduce dispute in the assessment of injuries for the purposes of medical treatment or compensation. 

TAC patients who are not legally represented will often be referred to IMEs by the TAC. 

Court Hearings: What to expect going forward 

Each of the Victorian Courts is taking a different approach to matters listed for hearing in the WorkCover and Transport Accident jurisdictions. 

Matters for patients in Geelong and South West Victoria are heard on circuit. 

The Magistrates’ Court has advised it will not be holding any circuits in our region at present. 

Both the County Court and Supreme Court are still proceeding with some matters where the witnesses are limited, or matters where determination can proceed without witnesses via Zoom. 

What to do if this information applies to you 

Patients who are concerned should contact their legal representative for clarification. 

At Gordon Legal we understand that WorkCover or TAC claims, and how they are treated by the schemes, are a personal issue. 

We offer ourselves as a resource to you, your team or patients to assist with any concerns regarding claims and how they are affected by COVID-19. 

For personalised and individual advice, we offer consultations to discuss your matter. 

Please call Gordon Legal (Melbourne) on (03) 9603 3000 or our Geelong office on (03) 5202 2729 to speak with a member of our team.

Given the current environment, we are providing consultations over the phone, or using Zoom, WebEx or Skype. 

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