Wednesday 28 January 2009
The WorkCover Ombudsman has released a short statistical report on investigations by his office from 1 July 2008 to 31 December 2008.
The data includes a comparison of section 36(15) suspension decisions on self insured and Employers Mutual claims. 19% of self insurer section 36 decisions were suspended compared to 37% for the rest of the scheme. The Ombudsman was asked to comment on whether he sees any common factors in suspension cases that might assist self insured case managers to improve the robustness of their decisions. His response was as follows:
The main cause of suspensions is in connection with whether medical evidence is sufficient to support a discontinuance based on section 36(1)(b). Sometimes the case manager has misread or misinterpreted the medical report, sometimes the incapacitating effects of sequelae or deconditioning have not been addressed, sometimes it seems that the case manager has not properly understood what "ceased to be incapacitated for work" means and has wrongly relied upon a medical opinion thinking that it supports a conclusion that the worker has ceased to be incapacitated for work when it clearly doesn't.