A health worker successfully appealed a WorkCover insurer’s decision not to fund surgery or any further medical expenses for his work-related knee injury.
Previously recovered from a meniscal tear to his knee, the worker was working full time as chef at the time of the work-related aggravation of the tear to his knee.
The initial WorkCover claim was accepted, however when the treating surgeon recommended surgery the insurer rejected requests for funding. This was done on the basis that an independent medical examiner had concluded that the pre-existing tear was in fact the reason surgery was required. The insurer also terminated all ongoing medical expenses on the basis of the same opinion.
Due to the significant level of pain and restriction suffered by the employee following his work injury, he chose to proceed with the surgery without WorkCover funding. Following his recovery from the surgery, he referred the insurer’s decision to the Accident Compensation Conciliation Service and from there, a referral to the Medical Panel was made.
With the assistance of Lauren Freeman, Special Counsel at Adviceline Injury Lawyers, submissions were made to the Medical Panel.
Lauren said that the submission highlighted the discrepancies between the independent medical examiner’s opinion and that of the employee’s treating general practitioner and surgeon.
“The GP and surgeon, having the benefit of examining and treating our client’s knee both before and after the work-related aggravation, understood the significant difference in his pain levels, restrictions in movement and the fact that he was unfit for all work following the work-related aggravation.”
The Medical Panel found that although his pre-existing meniscus injury may have warranted surgery in its own right, the work-related aggravation of that injury sped up the need for surgical treatment. The Panel concluded that the need for surgery and the post-surgical condition of the knee contributed to the work injury.
“We are very pleased to have achieved this result for our client, as the worker can now recover the reasonable costs of the surgery to his knee and further necessary post-operative treatment.
“It also opens the door to potential lump sum compensation for any permanent impairment he suffers as a result of the work aggravation of his knee injury.”
Injured employees commonly feel they have no choice but to fund their own treatment when it is rejected under their WorkCover claim. It is important for any injured employee to be aware that it is never too late to seek legal advice about disputing an insurer’s decision not to pay your medical expenses or weekly payments of compensation.
To speak directly to a lawyer about your injury, call our free Adviceline on (03) 9321 9988.Go Back