The Role of Medical Panels in Workers’ Compensation Claims

If you have made a Victorian workers’ compensation claim following an injury you sustained at work, you may have a Medical Panel involved at some point during your claim. This blog article will explore the role of a Medical Panel during WorkCover claims.

A Medical Panel is a group of independent specialist doctors who are brought together to answer specific questions about a medical dispute in workers’ compensation matters.

The panel members change for each dispute and are selected based on the issue they need to decide. For example, if the medical question is about a knee surgery, the members selected will be orthopaedic specialists. The members of the panel are truly independent. They cannot have treated the worker in the past and neither the worker nor the insurer can select them.

The panel functions like a tribunal. Its decision (known as its opinion) is final and binding on the parties involved.

A referral to a Medical Panel can be made by an insurer, a self-insured employer, a Conciliator from the Accident Compensation and Conciliation Service or a Court.  A worker can request that a referral be made to the Medical Panel, however the worker will not be the person who directly makes the referral.

A worker will have an opportunity to make submissions to the Medical Panel as part of the referral process.

A Medical Panel can only answer questions put to it that relate to a dispute about a medical issue which is relevant to your worker’s compensation claim. Generally, if the insurer disputes something that your treating doctors say about your claimed injury or treatment, then a Medical Panel may become involved to resolve the dispute.

For example, if your treating surgeon has requested you have surgery but the insurer rejects your request for surgery, the question as to whether the surgery request is reasonable and necessary can be decided by a Medical Panel. A Medical Panel can also be used to resolve a dispute about your level of whole person impairment in an impairment benefit claim.

A Medical Panel cannot make determinations about questions of fact.

For example, if there is a dispute about whether your injury was sustained at work or at home, this is not something that a Medical Panel could resolve as it involves a factual dispute. The questions put to a Medical Panel can only be about medical issues.

A Medical Panel can be used at any point there is a dispute about a medical question. It might be at the very beginning of your claim if the insurer rejects your claim for weekly payments of compensation or at any other time throughout your claim.

For example, if a decision is made to terminate your weekly payments on the basis that you have a medical capacity for employment but your treating doctors say you cannot work, a Medical Panel may be used to resolve this dispute. Similarly, if your entitlement to physiotherapy treatment is stopped, but your physiotherapist believes you would benefit from further sessions, a Medical Panel may resolve the issue.

A Medical Panel can also be used during your lump sum compensation claims. During a claim for an impairment benefit, a Medical Panel will be used if you dispute the percentage impairment assessed by the insurer. During a Serious Injury Application, a Medical Panel might be used to answer questions about the nature of your injury.

Serious injury is defined as either:

1. a permanent, serious impairment or loss of a body function;
2. a permanent serious disfigurement;
3. a permanent severe mental or behavioural disturbance or disorder;
4. loss of a foetus.

A question might also be referred to a Medical Panel during court proceedings. For example, if you litigate a decision to terminate your entitlement to weekly payments and the dispute involves medical questions, the Judge may refer those questions to a Medical Panel. The opinion would then be binding on the Court.

Typically, there are 2 doctors that assess you during your Medical Panel appointment. The appointment usually lasts about 1 hour and 15 minutes. Depending on the complexity of your injuries, there may be more or less doctors present and the time of the consultation could be longer or shorter.

You will be given an opportunity to tell the Medical Panel about your injuries and review any CCTV footage that has been sent to them. Generally, you are allowed to take one person with you for support, however they are not allowed to answer questions on your behalf.

If you require an interpreter, this can be arranged prior to your appointment. You should take along any scans or test results that you have had for your injuries. It is important to note that anything you give to the Medical Panel will be shared with the insurer.

The opinion of a Medical Panel is final and binding. You cannot appeal or review a decision of a Medical Panel because you disagree with it.

There are only limited circumstances where you can appeal a Medical Panel opinion to the Supreme Court if there has been an error of law; for example, if the Medical Panel has taken something into consideration that it was not legally allowed to.

There are strict time limits to appeal a Medical Panel decision (depending on the grounds for appeal it could be either 30 or 60 days from the date of the opinion) so it is imperative to seek urgent legal advice if you wish to appeal a Medical Panel opinion.

The opinion of a Medical Panel can significantly affect your claim. Its opinion is final and binding. Your entitlements can be terminated or the total amount of compensation you receive could be reduced based on the opinion of a Medical Panel.

Given the significant effect a Medical Panel opinion can have on your WorkCover entitlements, it is critical that you obtain legal advice about your medical dispute and any potential referrals to a Medical Panel, including the questions being referred to it and the submissions made on your behalf.

At Polaris, we are experts in WorkCover compensation claims. We’ve successfully represented many clients in relation to their workers’ compensation claims.

For advice or assistance with any aspect of your WorkCover claim, please get in touch directly with Polaris Lawyers. It doesn’t cost you anything to find out if you have a claim.