Where a question in a worker’s compensation claim has both a medical and legal element, can the Tribunal refer the question to a medical panel? The power to do so may be broader than you originally thought!
- Whether certain questions before the Workers Rehabilitation and Compensation Tribunal (‘the Tribunal’) constituted a ‘medical question’.
The Tribunal dismissed an appeal under which the appellant sought a question be referred to a medical panel pursuant to s49(3)(b) of the Workers Rehabilitation and Compensation Act 1988 (Tas) (‘the Act’). The appeal was brought before the Tasmanian Supreme Court Full Court of Appeal pursuant to r 703(4) of the Supreme Court Rules 2000 (Tas). The case involved a worker who injured her lumbar spine in the course of her employment for the Tasmanian Department of Health at the Royal Hobart Hospital.
The decision of the Tribunal
The Tribunal found the two questions put forward by the appellant were not medical questions and, as such, could not be referred to an independent medical panel. The questions the appellant put forward were:
- What was the injury suffered by the worker on 26 February 2016?
- Was the surgery performed on 4 October 2018 (L4/5 and L5/S1 disc arthroplasty) a result of that injury of 26 February 2016?
Essentially, the worker submitted various claims for the reimbursement of medical expenses, which the employer disputed liability to pay on the basis that it was not liable to pay the expenses because they were not necessarily incurred by the employer ‘as a result of her injury’. The employer argued the surgery was required for underlying degenerative issues and not from the injury at work.
The decision on appeal
The Full Court of Appeal found the term ‘medical question’, as provided in the Act, was to be interpreted within its ordinary and grammatical meaning as there was no alternative contextual statutory intention or purpose. It was further reasoned that referral to ‘a medical panel constituted by appropriately qualified independent medical practitioners is a means of facilitating the fair, expeditious and efficient determination of medical questions’ and promotes the objects of the Act. The court distinguished between a medical panel deciding a medical question, and determining a disputed fact. The former being within the panel’s power and the latter being an adjudicative power beyond that held by the panel.
Determination of the nature of the worker’s injury, in answer to question (1), involved reference to the statutory definition of the term ‘injury’ and consideration of whether the worker’s employment was a ‘major or most significant contributing factor’ as defined under section 3. Whilst this involved an assessment of causation, liability had already been accepted by the appellant and the remainder of the question was purely medical in nature.
The nature of question (2) was argued by the respondent to require resolutions of disputed questions of fact. The Tribunal supported this argument. The Full Court of Appeal found the question involved a more thorough level of statutory interpretation to determine whether it was medical or not. The question was found in this instance to be solely concerned with the causal relationship between the compensable injury and the claimed expense. After examining historical development of the statutory regime and its purpose, and similarities with other jurisdictions throughout Australia, the Court found a broad interpretation of the term ‘medical question’ should be utilised. Again, this was reasoned to promote the overall purpose of the Act. Ultimately, it was reasoned that the wording of the Act ‘supports a construction that a question requiring determination of the causal relationship between an injury and a consequence, is a medical question’. The second question was indeed a ‘medical question’.
Implications for you
The decision establishes the view that, even though a medical question may go further than being purely medical in nature, the Act promotes a broad interpretation of the term ‘medical question’. And that such questions can indeed be answered by the medical panel, even though this may mean that they are answering questions that go to the nature of the dispute and are broader than strictly medical based questions. This means the Tribunal may be more inclined to refer questions of fact or issues in dispute to medical panels where their essence is medical in nature. This is certainly something to consider if your cases have a clear medical issue in dispute and whether the best option to resolve the dispute is to consider a medical panel.