Under NSW workers compensation law medical expenses are stopped after certain periods depending on the severity of the injury. For all accepted injuries there is a minimum of two years from the date of the injury or the date of the last weekly payment that reasonably necessary medical expenses will be covered by the workers compensation insurer. If the worker is assessed between 11% and 20% whole person impairment the worker’s medical expenses are then covered for five years from the date of injury or from the date of the last weekly payment. If the worker is assessed at greater than 20% whole person impairment the worker’s medical expenses are covered for life.
There is an exception to this rule if the worker is outside of the above time limitations, under section 59A(6) of the Workers Compensation Act 1987 (NSW). This exception only applies for claiming compensation in respect to the following kinds of medical or related treatment:
- The provision of crutches, artificial members, eyes or teeth and other artificial aids or spectacles (including hearing aids and hearing aid batteries);
- The modification of a worker’s home or vehicle;
- And, secondary surgery.
This exception is important as it provides workers with assurance that future medical expenses will be covered by the insurer, particularly for items or aids that will be used indefinitely. Additionally, many people choose to delay having surgery, such as knee replacements, under medical opinion or otherwise, and require protection that the insurer will cover the cost of the surgery when the time comes to proceed with the surgery.
In a recent case of Pacific National Pty Limited v Baldacchino & SIRA it determined that a total knee replacement was an ‘artificial aid’ for the purposes of S59A (6)(a) of the Act therefore ensuring that protection is there for workers. However the insurer has commenced proceedings to appeal against the decision and we await whether knee replacements will continue to be covered as an ‘artificial aid’ under the protection of s59A (6)(a) of the Act.
If you have a query in relation to medical expenses under the workers compensation scheme, even though the insurer may deny the claim, please contact the experienced team at Everingham Solomons because Helping You is Our Business.
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