Workers Compensation Commission

Sian LeathemRegistrar29 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 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 211 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

President

Deputy PresidentRegistrar

Director InformationServices

Deputy RegistrarOperations

Deputy RegistrarLegal

ProfessionalStandards Officer

ManagerAppeals Team

Manager DisputeServices Team

Senior DisputeManagement

Officer

DisputeAssessment

Officer

DisputeManagement

Officer

AssistantOperations

Officer

Manger RegistryServices Team

RegistryOfficer

AssistantOperations

Officer

AppealsManagement

Officer

AppealsAdmin Officer

LegalAdministrative

Officer

Information &Research Officer

ExpeditedAssessment

Officer

Project Officer(Records &

Administration)

Assistant OperationsOfficer

Senior ProjectOfficer (Business

Support)

Research Associateto the President

AdministrationOfficer

Dispute Services Teams x4 Registry Services Team

Executive Officer

Executive Assistant

Administrative Associateto the President

Research Associateto the Deputy Presidents

Administrative Associateto the Deputy Presidents

LEGAL UNIT APPEALS UNIT

INFORMATION SERVICESUNIT

PRESIDENTIAL UNIT

OPERATIONS

REGISTRAR’S UNIT

Workers Compensation CommissionOrganisation Chart 13/09/06

Senior ProjectOfficer (Information

Systems)

Senior RegistryManagement

Officer

Project Officer(Information

Support)

Senior ProjectOfficer (Statistics)

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 objectivesThe 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 complaintsWCC 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).

ReconsiderationsFactors 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.

SummaryThe 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.

Thank you