Workers Compensation Commission Sian Leathem Registrar 29 September 2008

Overview Who are we? Our role Our objectives How the process works How we manage complaints Appeals Summary

Who are we? We are an independent statutory tribunal within the justice system in New South Wales. Our dispute resolution model implements the objectives of the Commission as set out in section 367(1) of the Workplace Injury Management and Workers Compensation Act Workplace Injury Management and Workers Compensation Act 1998 The Commission is committed to providing a fair and independent forum for the efficient and just resolution of workers compensation disputes in New South Wales. The Commission consists of approximately 110 staff, 60 contracted Arbitrators and Mediators and 120 Approved Medical Specialists. We are located at: Levels 19, 20, and 21 1 Oxford Street DARLINGHURST NSW

Who are we? The Commission consists of: Presidential Unit – determination of appeals from Arbitrators, questions of law, Practice Directions Registrar’s Unit – oversees the work carried out by the Commission Appeals Unit – manages all medical appeals Professional Standards Unit – supports and manages the Arbitrators, Mediators and Approved Medical Specialists Operations Unit – consists of two units: The Registry which is the first point of contact for the Commission; and Dispute Services which case manages all applications Legal Unit – undertakes assessments of costs, and provides legal advice and information to internal and external providers Information Services Unit – provides business services, information technology, records, administration and information management support to the Commission

Our role The Workers Compensation Commission resolves workers compensation disputes between injured workers and employers. We resolve and determine disputes about workers compensation claims, for example, weekly compensation for loss of income, payment of medical expenses and compensation for permanent impairment/pain and suffering. We encourage parties (workers, employers and insurers) to discuss ways of resolving the dispute at all stages of the process.

Our objectives The objectives of the Commission are: to provide a fair and cost effective resolution service for disputed workers compensation claims to provide an independent dispute resolution service that leads to durable agreements between the parties in accordance with the Workers Compensation Act to provide a timely service ensuring that workers entitlements are paid promptly to provide service that is accessible, approachable and professional to communicate effectively with our stakeholders to reduce administrative costs to the workers compensation scheme

How the process works A worker is injured and submits a claim for compensation. The claim, or part of the claim, is declined by the employer’s insurance company. The employee seeks advice by contacting WorkCover’s Claims Assistance Service (CAS - part of the Workers Compensation Division of WorkCover). If the dispute is not resolved, then the worker may choose to lodge an Application with the Workers Compensation Commission.

Once an Application is lodged with the Workers Compensation Commission, a simple guide to the process is:

How we manage complaints Complaints can be received against: Commission staff, including the Registrar Commission Member, including Presidential Member Arbitrator, Mediator, or Approved Medical Specialist The Commission’s practices and procedures The behaviour of an Insurer The behaviour of a legal representative

How we manage complaints WCC Access and Equity Service Charter Section 5 – Complaints and Appeals Complaint Procedure: All complaints are received by the Registrar Complaints must be in writing and must be signed Verbal complaints will be considered but not formally responded to Every complaint will be investigated in an appropriate manner All written complaints will be responded to by the Registrar

How we manage complaints All complaints received from an Arbitrator about the behaviour of an Insurer are forwarded by the Registrar to WorkCover Authority. An Arbitrator may request that the Registrar lodge a complaint against a legal representative with the Legal Services Commissioner.

Appeals Appeals can be lodged against: A medical assessment The decision of an Arbitrator There must be good reasons, or grounds, for either type of appeal.

Appeals Medical assessment: Reasons: deterioration of the worker’s condition, additional information; incorrect criteria (28 day limit); error in the Medical Assessment Certificate (28 day limit) Complete Form 10 Other parties respond with Form 10A Appeal referred to either an Appeal Panel (2 Approved Medical Specialists and 1 Arbitrator) or an Approved Medical Specialist The decision is by a majority of the Medical Appeal Panel

Appeals Appeal against the decision of an Arbitrator: Criteria for Appeal: must be lodged within 28 days of the decision date; amount of compensation is at least $5,000 and 20% awarded in the decision Complete Form 9 Other parties respond within 14 days by way of Form 9A Decided by a Presidential Member of the Commission and is final (subject to legal right of appeal grounds)

Reconsiderations Reconsiderations available under sections 329(1A), 350(3) and 378 of the Workplace Injury Management and Workers Compensation Act 1998 (“the 1998 Act”): Section 329(1a) – confined to medical assessments. May be referred for further assessment by AMS as an alternative to an appeal. Section 350(3) – Commission may rescind, alter or amend any decision it has previously made. Applies to decisions by a Presidential Member, an Arbitrator, or the Registrar exercising the functions of an Arbitrator. Section 378 authorises the Registrar, an approved medical specialist (AMS) or an Appeal Panel to rescind,alter or amend any decision they have previously made. Not the preferred provision to correct errors of fact, law or discretion made by an AMS (should be via an appeal).

Reconsiderations Factors in considering reconsideration applications: (1) The sections confer a wide discretion to reconsider previous decisions; (2) Reason for and extent of any delay in bringing the application; (3) Public interest that litigation should not proceed indefinitely; (4) May be allowed if new evidence is later obtained that would have been likely to lead to a different result; (5) A party may be prevented from pursuing a claim or defence in later reconsideration proceedings if it unreasonably refrained from pursuing that claim or defence in the original proceedings; (6) A mistake or oversight by a legal representative or agent will generally not give rise to a ground for reconsideration; and (7) Duty to do justice between the parties according to the substantial merits of the case.

Summary The Workers Compensation Commission is: an independent statutory tribunal within the justice system in New South Wales comprising of 7 Units with approximately 110 staff located at 1 Oxford Street, Darlinghurst that engages Arbitrators, Mediators and Approved Medical Specialists to assist in resolving workers compensation disputes between injured workers and employers in a fair and independent forum for the efficient and just resolution of workers compensation disputes in New South Wales.

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