Union assistance critical to overturning WorkCover claim rejection

19 September, 2020

The advice and support of our union has proved critical in having a member’s WorkCover claim rejection overturned.

IEUA-QNT Industrial Officer Danielle Wilson said the recent case served as a reminder that even if employers are unopposed to or supportive of an employee’s WorkCover claim, insurers do make wrongful decisions and our union can hold them to account.

Injured at work

The case involved a member working as a music teacher across multiple school sites who was physically injured over the course of several months performing their job.

As part of their role, our member was required to lift and rearrange heavy items and equipment including amplifiers, large instruments and stacks of furniture in order to hold lessons.

Consequently, the member sustained severe shoulder injuries and suffered pain over a period of time due to the repetitive movements and constant heavy lifting.

Following examination by an orthopaedic specialist (Dr A) – that doctor’s opinion was that the member’s injuries were not caused by their work duties, rather diagnosing ‘normal levels of degeneration’ seen in a person of that age.

However, Dr A confessed to not being entirely sure of this and referred the member to another orthopaedic surgeon who specialised in shoulder injuries (Dr B), who had expertise with shoulder injuries.

Dr B’s opinion contradicted that of Dr A; the second opinion found the shoulder injuries were directly caused by the member’s work.

WorkCover claim

Following these conflicting diagnoses, our member lodged a claim with WorkCover, who used evidence from both Dr A and Dr B to come to a decision.

WorkCover chose to accept the evidence of Dr A and ignored that provided by Dr B – rejecting our member’s compensation claim.

Despite the rejection from WorkCover, the member required surgery on one shoulder, which was performed by Dr B.

Our member paid for this surgery and took four weeks leave (including some unpaid) from work to rest and recover before returning to work.

It was at this point the member contacted our union for advice and assistance.

With our support and encouragement, the member applied for a review of WorkCover’s decision.

WorkCover rejection overturned

Our team of industrial experts immediately recognised WorkCover had made several procedural errors during the initial decision, which found ‘…that there has been no significant link made to the duties [the Applicant is] required to perform during employment to the nominated injury’.

Our union noted WorkCover decision-maker’s conclusion was factually inaccurate, flawed and that it gave greater weight to the uncertain evidence of Dr A over the clearer and more articulate opinion of Dr B.

Furthermore, WorkCover erred in failing to seek further medical assessment from another independent medical examiner (IME) or by failing to refer the matter to the Medical Assessment Tribunal (MAT) for determination, as is recommended under the Worker’s Compensation and Rehabilitation Act 2003.

IEUA-QNT wrote to the Workers’ Compensation Regulator submitting that the initial decision of WorkCover should be set aside and either;

  1. Substituted with a decision that the application for workers’ compensation be accepted; or
  2. Returned to WorkCover with directions that WorkCover either:
    a. Seek specific clarification from Dr A and/or Dr B in those areas where WorkCover believe the medical opinions are in conflict;
    b. Send the Applicant for the further IME with another orthopaedic surgeon; or
    c. Refer the matter to the MAT;

With our assistance, the member submitted additional evidence to the Regulator to support their position with the application for review.

Fortunately, the review rejected the initial WorkCover decision and our member was able to be financially reimbursed for the costs of surgery and recredited with all the leave they had taken for recovery.

Membership matters

Danielle said the member was extremely grateful for our union’s assistance and added they would not have pursued the review of WorkCover’s decision without our union’s encouragement.

“Our union was able to provide assistance to the member who was going through a really difficult time and called out WorkCover for the poor decision,” Danielle said.

Danielle said members should always contact our union immediately if they are injured at the workplace or during their work, either physically or psychologically.

“We are here for the members and are fully equipped to assist them, answer any questions and provide professional advice.

“It’s better to be safe than sorry,” she said.

IEUA-QNT members who have been injured at work or have questions regarding workplace health and safety matters should contact our union.

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