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It was recently reported (SMH 23 February 2020) that the NSW State Government is considering changes to the workers compensation scheme which will provide for injured workers having to pay a “gap fee” for some medical treatment.
Apparently the State Insurance Regulatory Authority is considering the proposed changes and submissions made by Icare. Icare is the insurer responsible for about 75% of all claims made by injured workers and therefore submissions made by Icare would appear to carry a significant amount of weight with the government.
The Chief Medical Officer for Icare, Chris Colqhuon referenced what he says are significant increases in costs for hospitals, surgical intervention and associated anaesthetics. To reduce this burden on the insurer the gap fee for treatment has been proposed but Dr Colqhuon has not stipulated how big the gap will be.
Dr Colqhuon is reported as saying that people would be less likely to claim for procedures they didn’t strictly need if there was a fee attached. He went on to say “if someone is potentially out-of-pocket for an intervention, they are more likely to do the research to see whether or not that intervention is the best possible treatment for them”
Genius.
How clever of Dr Colqhuon to recognise that if people were put to the expense of having to pay medical treatment themselves, usually in situations where they did not have the money to do so, then they were less likely to claim for the procedure.
Also, since when did it become the obligation of the injured worker to “do the research” to see whether or not the proposed treatment was the best possible treatment for them.
Is this not the role of the treating doctor?
Dr Colqhuon seems to assume that the moment a worker is injured and lodges a claim for compensation they are somehow endowed with medical expertise.
The Australian Medical Association’s NSW branch is, quite appropriately, “disappointed and concerned” about what they have regarded to be the “unfounded and inappropriate attacks on the medical profession by Icare”.
All of these proposed reforms should of course be read in the light of the Independent Reviewer Report on the Nominal Insurer of the NSW Workers Compensation Scheme prepared by Janet Dore in December 2019 which found that the Icare claims model “led to a significant deterioration… poor return to work rates, underwriting losses, no competition and therefore, a concentration of risk”.
If there is indeed a significant escalation in the costs of medical treatment then the insurers, the government and the medical profession should work together to resolve that issue. There should be absolutely no compromise on the extent and quality of the medical treatment that an injured worker requires. Nor should the injured worker be obligated to undertake “research” to determine what is the best treatment option for themselves.
This is the role of the medical profession.
The role of Icare is to pay for it.
It seems that whenever issues or concerns are raised with respect to the economic viability of an insurance scheme, rising costs or whatever the concern might be, the easy out is to look to the injured worker to subsidise the scheme by way of a reduction in benefits.
It is not the obligation of the injured worker to prop up insurers who, without hesitation, accept the premium for the policy they issue but are constantly looking at ways of reducing the benefits payable.
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PERSONAL INJURY
ANONYMOUS QUESTION:
I was involved in a car accident where someone changed lanes and hit me. I was in the left lane and deemed not at fault. I have no insurance but the other at fault driver does. I contacted his insurance company and they said he needs to lodge the insurance claim himself. I contacted him and he refused to lodge a claim. What do I do in this case to ensure damage to my vehicle is compensated for by the at fault party?
BRYDENS LAWYERS ANSWER:
What you have raised is unfortunately a difficulty that is encountered quite regularly. That is, if the party at fault does not make a claim on their insurance then the claims process itself is not activated and the insurer will not respond to a claim as against its insured. It is of course open to you to try and encourage the other party to make a claim on their insurer. If they fail or refuse to do so then there would be no reason why you should not commence formal court proceedings to recover the damages to which you are entitled. Such proceedings would no doubt focus the attention of the other party who would be motivated to contact their insurer. Brydens Lawyers are available to assist and should you require legal representation please click here to contact us to speak with one of our experts.
FAMILY LAW
ANONYMOUS QUESTION:
My partner and I have separated and we wish to resolve our financial issues. We purchased a house and land package together although our relationship broke down soon after. We have separated now and the house is near completion. Do we need to go to court? I want to make sure I receive what I am entitled to, I am worried it is getting messy and unfair.
BRYDENS LAWYERS ANSWER:
The majority of property settlements occur outside the court system. It is indeed the preferable course. It is a much cheaper and quicker alternative to commencing proceedings in court. If the parties are able to resolve their differences and reach a resolution then the agreement can be formalised and lodged with the Family Court for appropriate orders to be made. No court attendance is required. An alternative is for the parties to enter into a binding financial agreement which does not need to be lodged with the court. There are however a number of specific legal requirements pertaining to a binding financial agreement which must be fully complied with in order to ensure that the agreement is valid.
SUPERANNUATION & TPD
ANONYMOUS QUESTION:
I used to work for a government agency from 1986 until November 1994. Due to a car accident on the way to work, I was injured and unable to work after this. I have been living on a disability pension ever since. Recently I have found out that I might be able to seek a lump sum payout and a pension from superannuation fund. Is this possible and can you assist with it?
BRYDENS LAWYERS ANSWER:
We assume that the insurer deemed you to be at fault in the accident and that no motor vehicle accident claim was made. It is correct that there may be rights available to you to claim lump sum benefits pursuant to your superannuation policy which would ordinarily contain provision for a total and permanent disablement claim. Given that you have been unable to work you would, ordinarily, qualify for payment of benefits in this regard. Brydens Lawyers has a specialised Superannuation and TPD Division which can assist. We would invite you to contact us to arrange an appointment with one of our expert lawyers.
COMMERCIAL LAW
ANONYMOUS QUESTION:
I want to understand my current obligations under my commercial lease agreement that is contingent on DA being approved. My DA is not yet approved but I have been told the council today that they are thinking of providing me with a deferred commencement date which means the DA is not operational until the conditions are met. The financial implications are too much for me to meet the condition and I would prefer not to continue with the both the DA and the lease but don’t want to lose my deposit. What are my rights?
BRYDENS LAWYERS ANSWER:
Of course, any arrangements or contract including the Commercial Lease to which you refer, can be altered, amended or terminated by agreement between the parties. It would be recommended that discussions be undertaken with the lessor to determine whether or not they would be agreeable to a Surrender of Lease and if so, on what terms. Otherwise it will be the terms of the Commercial Lease that will determine the rights and obligations of the parties. If, as you say, the Commercial Lease is contingent on a DA being approved then until such time as the DA is approved the Commercial Lease is not in force or has effect. Brydens Lawyers has a specialised commercial division which is available to assist. We would invite you to contact Brydens Lawyers to speak with one of our experts should you wish to engage expert legal advice and representation.
PROPERTY LAW
ANONYMOUS QUESTION:
We bought an investment property in QLD through a financial group in Sydney. They misrepresented the property, providing us with paperwork that states it was a brand new build. Upon settlement we found out that the property was in fact 5 years old. We want to claim compensation for loss of depreciation, extra strata costs, misrepresentation and mental anguish. Are we within our rights to do this?
BRYDENS LAWYERS ANSWER:
When buying any property the guiding principle for purchases is “buyer beware”. That is, as the purchaser you bear the onus of investigating and establishing exactly what it is that is being bought before Contracts are exchanged.
That being the case consideration may have to be given as to whether there is an available cause of action as against your solicitor or licensed conveyancer who acted on your behalf in whom was entrusted the obligation to ensure that what was being purchased was that which was being represented to you. Your legal representatives have an obligation to ensure that the contract and all the details of the property that are being purchased are explained to you fully and that you understand same.
Before advising further it would be necessary for us to undertake a complete review of your conveyancing file. The Contract and Disclosure Documents would establish the basis of the agreement that existed as between you and the vendor. Any other representations about the property, whether made verbally or in marketing material, generally cannot be relied upon unless they form part of the Contract. Therefore, your only recourse may be against those who were representing you on the purchase.
To consider the matter we would invite you to contact Brydens Lawyers on 1800 848 848 to speak with one of our experts.
WORKERS COMPENSATION
ANONYMOUS QUESTION:
I am a pharmacist in a small country NSW town. I had recently banned a woman with a drug problem from entry to the pharmacy. Last month, she attacked me, tore through the shop – destroying property and stock and stole medication. The police initially charged her on 7 counts but the courts dropped it to 2 and she was out on bail right away. I am in the process of putting in place an AVO against her and her partner. I have also required medical attention and time off work as a result of the injuries sustained during her attack. Can I sue her for compensation in addition to the criminal charges she is facing?
BRYDENS LAWYERS ANSWER:
Given that the injuries sustained by you occurred during the course of your employment, (and assuming that you are an employee), you are entitled to make a claim on your employer’s workers compensation insurer. The benefits to which you are entitled include weekly benefits of compensation (wages) for periods of absence as well as reimbursement of all reasonable and necessary medical treatment expenses.
In some cases, you would be also entitled to claim lump sum compensation commensurate with the degree of permanent impairment that results from the injuries. In addition to same, you would have a common law action in assault available as against the perpetrator. Of course, any compensation that you receive from the workers compensation insurer would have to be reimbursed to that insurer from any damages that you recover from the perpetrator. There is a prohibition on “double dipping”. However, what would be of more concern, is whether there would be any prospects of recovering any judgment monies from the perpetrator. That is, although the claim may be successful and you are awarded damages for the injuries which you have sustained a question then arises as to whether the perpetrator has any capacity to pay those judgment monies. One other alternative is to make a claim through the Victims Compensation Tribunal for the injuries which you have sustained. Again however it is not open to you to retain both benefits under the workers compensation scheme and compensation from the Victims Compensation Tribunal.
EMPLOYMENT DISPUTES
ANONYMOUS QUESTION:
My wife is pregnant and our baby is due later this year. My employer is saying I am not entitled for parental leave because I muts be employed for 12 months to be eligible. I will be employed for 11 months and 16 days when our baby is due. What are my rights in this situation?
BRYDENS LAWYERS ANSWER:
Section 67 of the Fair Work Act provides than an employee is not entitled to parental leave unless the employee has, or will have, completed at least 12 months of continuous service with the employer immediately before the date that the leave is taken. Leave can be taken within 12 months after the birth of the child. If:
a) The employee has a spouse or de facto partner who is not an employee; and
b) The spouse or de facto partner has a responsibility for the care of the child for the period between the date of the birth of the child and the start date of the leave.
Therefore, you will need to continue working until you have completed 12 months of continuous service for your employer before being entitled to take parental leave.
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LATEST NEWS FROM LEE
It was recently reported (SMH 23 February 2020) that the NSW State Government is considering changes to the workers compensation scheme which will provide for injured workers having to pay a "gap fee" for some medical treatment.
Apparently the State Insurance Regulatory Authority is considering the proposed changes and submissions made by Icare. Icare is the insurer responsible for about 75% of all claims made by injured workers and therefore submissions made by Icare would appear to carry a significant amount of weight with the government.
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