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Discrimination against work and accident claimants with a mental health injury

June 4, 2019

For some time I have been interested in the various tactics used by governments to reduce the number of mental health claims in workers compensation and motor accident schemes. It is ironic that there is so much focus now on preventing discrimination against people with mental health problems, including, in Victoria, a Minister for Mental Health but, at the same time, there is fear and trembling that people with mental health injuries arising from work or motor accident will send the state bankrupt. In South Australia, for example an impairment benefit can only be paid for a person with “pure mental harm”, a person with a physical injury has to meet the threshold of 5% impairment for it to be considered a serious injury and to then receive a lump sum payment. A worker with a mental injury has to reach the threshold of 30% impairment and there is no lump sum payment!

I have found a table listing the exclusionary provisions for people with work-related mental health conditions in the states, territories and in New Zealand. It makes for interesting reading.

It is interesting to note that this is an international phenomena. For example the Purple Heart, awarded in the United States for injuries received in various circumstances is not awarded for people suffering from post traumatic stress disorder or from battle fatigue!

Have a look at this Guide to Concurrent Evidence in New South Wales

May 30, 2019

Henry Chen has written an informative guide about concurrent evidence in New South Wales that has applicability to other jurisdictions. In Victoria concurrent evidence appears to have had a limited effect although of course it is permitted as a court procedure. Concurrent evidence also is a procedure in the Administrative Appeals Tribunal. It does appear however that Sydney Is the hot tubbing centre of Australia!

More discrimination against claimants with psychological injuries

May 6, 2019

 

The Canberra Times (5 April 2019) reported that Canberrans injured in a motor vehicle accident will not be able to claim any insurance for anxiety or depression caused by the crash, under proposed changes to the compulsory insurance scheme.

The Barr government Motor Accident Injury Bill passed in principle on Thursday, with the details to be debated when the Assembly resumes sitting next month.

The ACT government is ditching its common-law compulsory third party insurance scheme in favour of a hybrid, no-fault model. But there are significant concerns about some of the exclusions proposed. Photo: Rohan Thomson

But the ACT Law Society and ACT Bar Association have written to all parliamentarians highlighting fundamental problems with the proposed scheme.

Claimants will have choose between getting compensation for pyschological or physical injuries, meaning they cannot combine the physical and psychological injuries they suffer from the accident.

Their insurer only has to pay for one whole person impairment assessment as well, so if the injured person wants to be assessed for both physical and psychological injuries, they will have to foot the bill.

The definition of psychological injury also excludes psychiatric disorders such as depression and anxiety, meaning people can only get compensation for conditions like post-traumatic stress disorder or “mental shocks”.

In a speech that drew heavily from the Law Society and Bar Association letter, Canberra Liberals leader Alistair Coe described the exclusions as “appalling”.

“I cannot overstate the effect these changes would have,” Mr Coe said.

“The government has not addressed the significant issues raised by stakeholders and the Assembly inquiry. The Canberra Liberals believe Canberrans should continue to have access to a comprehensive CTP scheme that supports the rights of motor vehicle accident victims.”

The Law Society and Bar Association also said provisions that would allow children still getting treatment for their injuries four and a half years after their accident to pursue more benefits were easily circumvented.

“There is nothing to stop an insurer ceasing treatment and care after four years and five months and effectively avoiding the automatic consequences,” they said.

However Chief Minister Andrew Barr said insurers could lose their licence if they did not follow the rules set out in the scheme which state they must provide people with reasonable access to treatment and care.

“Now of course there is no such thing as a perfect accident insurance scheme and as we’ve said from the start of this reform project, we’re aiming to deliver a scheme that best reflects the prioirties and the values of this community,” Mr Barr said.

“We have been upfront in acknowledging there will always be trade-offs and competing views when emarking on an overhaul this significant.”

Mr Barr said of the 1500 people injured a year on Canberra’s roads, only about 900 could access the existing, fault-based system.

“The changes we are making would mean around 600 more Canberrans would be covered,” Mr Barr said.

However Mr Coe said this was only achieved by slashing the rights of not-at-fault drivers.

“Quality of life payments would be cut by 80 per cent. There’d be a 31 per cent reduction in loss of earning compensation, a 26 per cent decrease in care costs and reimbursement of private medical costs and public hosptial costs would drop 17 per cent and 6 per cent respectively,” Mr Coe said.

Do pre-existing health problems effect recovery from accidents? Have a guess at the answer.

December 18, 2018

The TAC has provided us with the results of a new study.

Before I tell you about the study I want you to guess the answer to this question.

Do a person’s previous health issues (especially involving mental illness or drug or alcohol use) reduce their chances of a good recovery from an accident?  If you answered yes you are on the money.  Here is another blinding glimpse of the obvious.

This new study has shown how pre-accident health can impact a person’s recovery from a transport accident. By linking pre- and post-accident data, researchers at the Monash University Accident Research Centre have revealed fascinating insights into the factors that contribute to a person’s recovery.

Led by Dr Janneke Berecki-Gisolf and Dr Trevor Allen, the project looked at TAC clients’ physical and mental health service use and health service needs before and after their transport accident.

“A better understanding of what’s going on with someone’s health before the crash [will] help to understand why some people recover more quickly than others,” said Dr Berecki-Gisolf. “So to find out about someone’s health before the crash, rather than ask them, we did a data linkage study which actually shows patterns of health before and how that relates to recovery.”

In one section of the project, the researchers looked at hospital admissions data to discover how someone’s pre-accident health might affect recovery outcomes. This showed that pre-existing chronic pain was common and associated with a range of adverse post-accident outcomes. Those TAC clients who then had a delayed recovery experienced a subsequent onset of chronic conditions such as hypertension and depression.

The researchers also analysed Victorian records of mental health service and alcohol and drug treatment. They looked at the overall use of these services before and after the transport injury, as well as associations between mental health and drug and alcohol related issues and claim outcomes. This showed that pre-accident use of these services was significantly associated with more complex claims and delayed return to work.

Sponsored by the TAC through the Institute for Safety, Compensation and Recovery Research, the project will help the TAC more effectively identify clients who may be at risk and provide additional services to achieve better outcomes.

Expert Witnesses, some changes to immunity from negligence suits

September 16, 2018

In the context of revising my book,’The DIY’ Guide to Civil Forensic Psychiatry’ I came across a paper by Tina Cockburn And Bill Madden entitled

Expert Witness Immunity In Australia after Attwells V Jackson Lalic Lawyers: A Smaller and Less Predictable Shield?

This paper gives a comprehensive overview of the current situation regarding expert witnesses and liability in Australia.  By contrast with the UK, New Zealand and Canada where expert witnesses are not immune for negligence suits, in Australia we are still immune from negligence suit in relation to court work, and work done out of court which is intimately connected with the work in court. The latter is of particular significance in medical negligence litigation given that such claims most often resolve without a court hearing. However the the High Court of Australia in Attwells v Jackson Lalic Lawyers Pty Ltd upheld the advocates’ immunity from suit in negligence. Crucially however, the majority took a narrower approach as to the scope of the immunity by holding that it does not usually extend to negligent advice which leads to the settlement of a case by agreement between the parties. It is worth reading the article.

During the recent Forensic faculty Conference there was a paper given about the situation in the UK where it appears some expert witnesses have suffered draconian consequences! Let us hope the situation here remains unchanged.

 

Pre-existing psychiatric impairment- problems with assessment

July 26, 2018

The issue of pre-existing psychiatric impairment is always difficult for examiners. The usual situation is that a person who has had problems with anxiety or depression and has had or has continued to have a course of psychiatric or psychological treatment or counselling.

In my view there are a number of matters that need to be considered including the following has there been a diagnosable psychiatric disorder?

Has the diagnosable psychiatric disorder required treatment?

Has the diagnosed psychiatric disorder lead to any area of impairment? The examiner has to look to see has there been any problems with regard to employment, relationships, recreational activity, drug or alcohol abuse or other significant behavioural issues such as gambling, aggression, withdrawal and unexplained physical illness.

It is not sufficient for the examiner to say that on the basis of how this person was after the accident it is likely that they had a pre-existing impairment. The examiner has to demonstrate that prior to the accident the pre-existing impairment was manifested by a reduction in level of function or had been diagnosed by a competent clinician.

The task of the examiner is to determine all these factors in the period prior to the accident or incident that led to the claim.

The examiner is then required to determine whether there has been any change with regard to this pre-existing psychiatric disorder. Is factors indicating any change would be a deterioration in function such as ability to work, relationship difficulties, the development of drug or alcohol-related problems that seems to be arising from this pre-existing condition and any changes in treatment for the pre-existing condition such as an increase in medication, an altered frequency of treatment, hospitalisation and so forth.

The examiner can only determine these matters at the time of the examination. It should be a critical part of the examination for the examiner to closely question the claimant’s level of function in the period prior to the incident or accident.

When examining the claimant the stamina has to separate out that impairment arising from the work or transport accident injury as opposed to that impairment arising from the pre-existing condition or an unrelated subsequent condition. This relies on data such as the matters described above. The examiner should be able to provide sufficient data to make a convincing case to a layperson for the presence absence of any pre-existing psychiatric disorder bearing in mind that the presence of a disorder does not necessarily mean any level of impairment. The examiner has to bear in mind that there is a difference between having a psychiatric diagnosis and having a level of impairment.

For example a person who has had a significant depressive disorder but has been appropriately treated and has been on maintenance medication for some years with no reduction in their quality of life including their work capacity, their relationships and their recreational enjoyment cannot be regarded as having any level of impairment. It may be that if that person stopped taking medication their condition would deteriorate and what they would then have some level of impairment but this is a matter of conjecture. The critical issue is that even if they are taking medication is there any pre-existing level of impairment?

 

In terms of assessing the level of impairment arising from the pre-existing condition at the time of the examination the examiner should look at those symptoms due to the pre-existing impairment and attempt to relate them to the descriptors and the GEPIC and on that basis form an opinion as to what class and to what level in that class this pre-existing impairment now rates.

The examiner is then required to subtract that from the whole person impairment (bearing in mind that the whole person impairment relates to pure mental harm as consequential mental harm will have been removed.

eReports response to my Blog

February 27, 2018

In a blog written on 31 August, 2017 I noted ‘I have been reliably told that eReports were unhappy about my reference to them in a previous blog and were contemplating legal action!!’

I received an email from Ruth Hogarth, the chief operating officer of eReports dated 19 January 2018 stating that she was unaware of the Blog until recently and had never contemplated taking legal action. She wrote “I was very surprised that without contacting us, or verifying with us the authenticity of such claims that you were published what is very much untrue“. I am happy to accept that, although my informant remains adamant that the information provided was correct.  The underlying issue was that eReports had claimed they had been provided with appointment blocks by WorkSafe who sent out a letter refuting that. Since eReports have been called out as deceptive (at the least) it is a question of who is more credible, my informant or eReports.

Safe Work Australia – a useful guide to nationwide trends

October 12, 2017

I try to look at the website of Safe Work Australia because it is full of information about nationwide issues and issues in particular states. There is a comparison of the various workers compensation schemes in the different states and a plethora  of statistical information. It is well worth a look.

For example they are attempting to develop a nationwide system of impairment assessment (including the PIRS)

Permanent impairment

When someone sustains an injury it may result in a permanent impairment.

A prerequisite to determining the level of permanent impairment is the understanding that it shouldn’t be decided until the claimant has improved as much as is possible; that is when their impairment has become stable or isn’t likely to improve despite medical treatment.

  • In addition to the assessment principles laid out in the AMA Guides, scheme legislation also provides substantial guidance on how to determine whether or not impairment is permanent.

In 2013, we made recommendations to the Ministerial Council on nationally consistent arrangements to assess permanent impairment, which were agreed to by the majority of jurisdictions in early-2014.

As a result we are now developing a national permanent impairment guide and a system for updating it, as well as developing a training package for medical practitioners who want to become permanent impairment assessors.

 

WorkSafe Victoria- dialogue with psychiatrists

June 15, 2017

A small group of psychiatrist (including myself) in Victoria are negotiating with WorkSafe with regard to a number of issues including remuneration. Incidentally go to ‘Resources” to have a look at the current fee schedules around the country. This groupare also looking at issues such as suitability to become an IME. My own view is that people should have at least five years postgraduate clinical experience before they are ready to do this type of work. Some of my colleagues disagree and say that people who have done the forensic training program should be able to work as IMEs immediately. I am totally opposed to this.I’m also concerned that people do not seem to understand that we have an essentially adversarial relationship with the WorkCover authority. There have been all sorts of suggestions about accreditation, there was even one suggestion that only those who see at least one IME per month every year should have continuing accreditation. The mind boggles. I hope that a dash of sanity will creep into these discussions. My concerns are with regard to providing appropriate training for IMEs, appropriate remuneration, appropriate mechanisms for dealing with substandard reports, continuing training opportunities and a recognition of the very special nature of the work that we do.

Harmonised Expert Witness Code of Conduct

March 8, 2017

 

 

As outlined in our November 2016 blog, Sweeping Changes for Federal Court Practice Notes, the Federal Court, in late 2016, issued 26 updated practice notes for use in federal litigation. The previously used Practice Note CM7 Expert Witnesses in Proceedings in the Federal Court of Australia was replaced with the considerably lengthier Expert Evidence Practice Note (GNP-EXPT) which included 2 annexures, the Harmonised Expert Witness Code of Conduct in Annexure A and the Concurrent Expert Evidence Guidelines in Annexure B.

In this blog, we consider the approach taken in the Harmonised Expert Witness Code of Conduct and the adoption of this Code by a number of states.

Content of the Harmonised Code

The Harmonised Expert Witness Code of Conduct covers issues which are commonly covered by the state based expert witness codes of conduct including:

  • The application of the code;
  • An expert witnesses’ duties to the court;
  • Requirements concerning the content of the report;
  • Protocol for when an expert changes their opinion;
  • Duty to comply with the court’s directions; and
  • Expert requirements when participating in expert witness conferences.

Adoption by the states

Currently, 4 states and territories have adopted the Harmonised Expert Witness Code of Conduct: ACT, NSW, Tasmania, and Victoria. As a result, these states

have a uniform approach to expert witness conduct when compared with the approach in the Federal Courts.

Advisory firm KordaMentha have provided the following summary of the approach taken by each state with respect to their expert witness codes of conduct[1]:

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The benefits of a uniform approach to expert witness conduct are widespread.

From the perspective of the expert witness, a uniform standard of expert witness obligations

creates a greater level of consistency across jurisdictions, which will in turn reduce

the complexity for experts operating in different jurisdictions.

It will also enable experts to produce reports more efficiently, with less time spent complying with

state-specific rules and more time focusing on the content of the report.

From the perspective of legal counsel and the client, a uniform system of expert witness guidelines

reduces the need for state-specific guidance for expert witnesses,

which should reduce time spent providing guidance to expert witnesses

who give testimony in multiple jurisdictions. Less time spent by legal counsel on any one task translates to lower fees for the client

and as such, a harmonisation of expert witness codes of conduct should lead to lower fees in relation to preparing expert witnesses for trial.

Non-Adopting States

While the expert witness codes of conduct utilised in the 4 states which have not adopted the Harmonised Expert Witness Code of Conduct

are fairly similar to the harmonised code, differences do exist which add to the requirements with which expert witnesses must comply.

For example, the South Australian code of conduct includes a requirement that an expert witness report ‘identify the differences (if any)

in assumptions made and opinions expressed compared to those made and expressed by a prior expert (if any)’. Such a requirement is not present in the harmonised code of conduct.

Conclusion

The harmonisation of expert witness codes of conducts reflects an exciting step forward for both expert witnesses and

legal counsel responsible for ensuring that the witnesses are aware of the requirements to which they must adhere

in the jurisdiction in which they are testifying. A uniform approach across the nation’s jurisdictions increases efficiency and productivity

in the legal industry and is, without a doubt, a positive step forward for expert witnesses and the legal industry.

[1] Ben Mahler, Expert Matters: Only some experts in harmony, KordaMentha,

http://kordamentha.com/publications/expert-matters-only-some-experts-in-harmony?utm_source=Mondaq&utm_medium=syndication&utm_campaign=View-Original