Common Law Unassessed Injuries
This process may be applied where a claimant has already received a Notice of Assessment for at least one injury and the Notice of Claim for Damages (NOC) identifies additional unassessed injuries. The onus of proof remains with the claimant to demonstrate that additional injuries claimed in the NOC are as a result of the original event.
The aim of this process is to work with the claimant’s solicitor to:
- Avoid delays in resolution of claims caused by waiting on medical evidence for the determination of unassessed injuries.
- Avoid costs in obtaining medical reports where they are not required.
- Set clear timeframes that will help expedite the unassessed injuries process.
When does this process apply?
Where possible we would prefer to expedite the resolution of claims utilising the unassessed injuries process. This process only applies if:
- The claimant already has a Notice of Assessment for injuries from the same event
- The claimant is prepared to use the unassessed injuries process and does not require us to make a formal decision
- The employer agrees to us applying the unassessed injuries process to the claim
- The unassessed injuries will not have a significant impact on the quantum or settlement amount
- The unassessed injuries are not part of a common law only statutory claim
- The unassessed injuries are not considered to be the dominant or primary injury
What happens if we apply this process?
If we apply the unassessed injuries process to the claim:
- We will make no formal decision about whether or not to accept the additional injuries.
- Permanent impairment cannot legislatively be assessed, therefore no Notice of Assessment for the additional injuries will be issued.
- We will only make an allowance during settlement for the additional injuries if the claimant produces evidence to support the additional injuries.
- We will settle the claim for all injuries from the event (both assessed and unassessed).
- If the matter doesn’t settle, WorkCover undertakes to make all reasonable efforts to determine the injury during the 60 days following the conference.
Unassessed Injuries Process
On receipt of a NOC claiming additional injuries we will review existing medical reports and records on file to determine if any of the unassessed injuries' omission from the notice of assessment was an oversight or if those medical reports and records demonstrate sufficient evidence of an "injury" for the purposes of s32 of the WCRA. If there is unequivocal evidence of the injury and its link to the event, we will make a determination and accept the injury.
If there is insufficient evidence to support the acceptability of the unassessed injury we will issue a compliance response that details:
- The unassessed injuries process may be appropriate in this particular claim
- The decision regarding whether the unassessed injuries process will be applied will depend on whether the claimant provides supporting information within 30 days of the date of the compliance response
- The responsibility lies with the claimant’s solicitors to provide, within 30 days of the date of the compliance response, medical evidence in relation to the unassessed injuries, or if that is not possible, a clear response as to how and when the claimant will proceed and provide medical evidence
- If no evidence is supplied within 30 days of the date of the compliance response, the unassessed injury will be rejected and the claimant will be provided with Reasons for the Decision.
If we have received little to no evidence within the 30 days however the claimant has submitted a clear response as to what undertakings they will be conducting and a solid timeframe for when this will be occurring, WorkCover may be prepared to schedule the compulsory conference.
However, should we still not have the evidence we require to make a decision after the claimant’s response timeframe has expired, we will continue onto compulsory conference but on the basis that all injuries (assessed and unassessed) will be included in the settlement and in the discharge.
These unsubstantiated unassessed injuries will not be taken into consideration for quantum and offer purposes. In the event the matter does not resolve at compulsory conference we would make every effort to determine the additional injuries within 60 days.
Additional injuries added after receipt of NOC
If the claimant requests the addition of an unassessed injury after the Notice of Claim has been served, we will request the claimant submit a statutory declaration containing further information on the unassessed injury including:
(a) date of onset of symptoms
(b) nature of symptoms
(c) severity of symptoms in comparison to those arising from the assessed injury
(d) name and address of practitioners consulted.
We will also request the claimant provide within 30 days of the date of receipt of the statutory declaration, medical evidence in relation to the unassessed injury; or a clear response as to how and when the claimant will proceed to obtain and provide that medical evidence.
- Last updated
- 29 June 2015