Medical Expenses The 2015 Amendments to the NSW Workers Compensation Act 1987

Presentation summary Introduction What is medical expenses compensation? The Limits on payment of medical expenses compensation The Transitional Regulation of 4 December 2015 How does it work

Introduction Part 3: Compensation - Benefits, Division 3: Compensation for medical, hospital and rehabilitation expenses of the 1987 Act  Sections 59 to 64A

An employer is liable to pay the cost of ‘ reasonably necessary’ medical or related treatment and services in addition to any other compensation under the Act. The employer is not liable to pay the cost of reasonably necessary medical treatment if: a)The treatment is provided without prior approval of the insurer [this does not include treatment provided within 48 hours of the injury happening or treatments and services exempted under the Workers Compensation Guidelines] b)the treatment is provided by a person who is not appropriately qualified to give that treatment or service c)the treatment is not in accordance with the Workers Compensation Guidelines. Medical expenses compensation

Let’s just tease that apart for a moment… Reasonably necessary Pre-approval Treatment and services exempted from pre-approval The WorkCover Guidelines

Disputes about medical treatment Section 60(5) (Amended: assented to 16 October 2015): (5) The jurisdiction of the Commission with respect to a dispute about compensation payable under this section extends to a dispute concerning any proposed treatment or service and the compensation that will be payable under this section in respect of any such proposed treatment or service. Any such dispute may be referred by the Registrar for assessment under Part 7 (Medical assessment) of Chapter 7 of the 1998 Act.

The limits on payment of medical expenses compensation Section 59A  The genesis of section 59A  From 1 October 2012 to 20 August 2015  The 2015 amendments to section 59A  first stage amendment made by the 2015 amending Act.  The second stage amendment  The current limits on receiving medical expenses compensation  The exemptions to the limits  Application of the amended section to claims and/or injuries