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Insurer information for referring a worker

What to include in a referral

Only an insurer can refer a worker for a medical assessment tribunal (tribunal).

Insurers are responsible for completing the referral form and sending all relevant documentation to Tribunal Services. A referral can only be sent once all medical reports are finalised and received by the insurer.

Insurers should advise the worker that a referral is being made and why. They should also advise it is essential that the worker brings to the tribunal all their radiology for any physical injury being referred.

The insurer will need to specify what type of tribunal the matter is being referred for. To assist insurers identify the most appropriate tribunal for particular injuries, the Office of Industrial Relations has prepared a list of injuries and illnesses by tribunal (PDF, 0.55 MB).

Insurers should refer to the tribunal referral checklist (PDF, 0.18 MB) to ensure that all required information has been included in the referral. Insurers should also include any information relating to previous or similar injuries that the worker has experienced so that:

  • The medical assessment tribunal is aware of these previous injuries
  • The assessment for the worker's current injury can be assigned appropriately.

A referral made by an insurer is an official register of documents being submitted to a tribunal. If the claim has been to a previous tribunal, you only need to list and attach documents received since that tribunal.

As the tribunal is only assessing the medical aspects of the worker's injury, insurers do not need to include any of the following in the referral documentation:

  • Accounts information
  • Claim payments
  • Travel itineraries
  • Internal emails or memos
  • General correspondence between the worker, insurer or doctor
  • Witness statements or investigation reports (unless the referral is for determination of injury).

Insurers can submit all referrals by emailing MAT@qcomp.com.au.

Workers may feel anxious and intimidated attending a medical assessment tribunal. To ensure that the experience is as simple and comfortable as possible for a worker, the tribunal members rely on the insurer to provide comprehensive background reports. These reports help provide critical information to the tribunal members so that they do not have to ask the worker to repeat all this information. A tribunal appointment does not allow enough time for a detailed background to be obtained.

Comprehensive reports

Comprehensive reports regarding a worker and their injury should include:

  • a medical summary of the case – time sequences are very important
  • detailed medical history – including previous similar or related injuries
  • clinical findings
  • For physical injuries involving surgery a post-operative report must be provided
  • For psychiatric reports a full family history, educational history  and a personal history must also be included
  • diagnosis
  • results of investigations – x-rays, CT Scans, pathology
  • prognosis
  • details of treatment – including worker's attitude to treatment and compliance
  • opinion of capacity for work – either original job or alternative work
  • future management of the case.

Other important points to remember before sending the referral documentation to Tribunal Services include:

  • Reports should be up-to-date – they should be obtained at appropriate stages of injury management.
  • Specialist reports are required for accurate diagnosis and appropriate treatment options. A specialist report no more than 6 months old is a requirement.
  • All medical reports are required by the tribunal – the tribunal is responsible for determining the relevance of reports.
  • For psychiatric referrals there must be one comprehensive report provided as detailed above. An independent medical examination report is preferred. If there is any doubt as to the content of a comprehensive report, advice will be sought from a chairperson of the tribunal before an appointment can be booked.
  • Comprehensive reports from the treating practitioner are important for details of treatment provided – this ensures the information is accurate and reliable.
  • Telephone contacts, case conferences, completed forms, phone fax reports and progress reports are useful to the tribunal but are additional information and are not a substitute for comprehensive reports.