VWA New Fee Schedule for Victorian Psychiatrists for Independent Impairment Assessments (not to be confused with the IMEs Fee Schedule)
September 26, 2014
The VWA have produced a new fee shedule backdated to 1 July 2014 “due to an administrative oversight”. When in doubt between conspiracy and stuffup, stuffup generally wins. I became confused about the fee schedule as there appeared to be items missing. I sought clarification that arrived promptly. In fact there are two fee schedules. There is a fee schedule for IMEs and a fee schedule for IIA, that is independent impairment assessments. I have been dealing with the system for a long time and it just goes to show how confusing all this is when I was unaware of these two different schedules.
Independent Medical Examinations 1 July 2014
| Psychiatrist | |||
| PCT100 First Examination and Report– Inclusive of conducting the examination, report writing, reading lime and any incidentals (such as postage, photography and faxing services)
– Diagnostic tests (such as x-rays) carried out as a necessary part of the examination are not included in the first examination and report item code and will be reimbursed in accordance with WorkSafe policies, the relevant Medicare Benefit Schedule item code and the WorkSafe’s Reimbursement Rates for Medical Practitioners. |
$833.77 | $83.38 | $917.15 |
| PCT150 Subsequent Examination and Report– Applies where a WorkSafe Agent requests a report within 12 months of the first examination and report for the same claim | $500.26 | $50.03 | $550.29 |
| Loadings additional to examination and report fee are subject to Work Safe Agent prior written approval only | |||
| PCT200 Report reading | $45.88 | $4.59 | $50.47 |
| – Flat rate for reading of all reports that accumulatively are greater than 20 pages | |||
| – This fee is payable once only per claim per WorkSafe Agent report request | |||
| PCT250 Urgent Examination and Report– Urgent request by a WorkSafe Agent to complete initial or subsequent exam and provide the report to the Agent within two business days | $94.33 | $9.44 | $103.77 |
| PCT300 Worksite visit | $817.55 | $81.76 | $899.31 |
| – Request by a WorkSafe Agent to complete a worksite visit and provide a report to the Agent | |||
| – Inclusive of worksite visit, report writing, reading time and any incidentals | |||
| PCT350 Travel to and from assessment (at Agent’s request) per hour | $423.98 | $42.40 | $466.38 |
| – Calculated in 15 minutes blocks | |||
| – Travel only paid when travelling to a location other than IMEs nominated practice location/s | |||
| – Travel for multiple assessments in the one location should be charged on a pro-rata basis for each claim | |||
| PCT400 Audiovisual Viewing | $212.01 | $21.20 | $233.21 |
| – Flat rate for the viewing of all audiovisual material | |||
| – This fee is payable once only per claim per WorkSafe Agent report request | |||
| PCT450 Supplementary report– Applies where a WorkSafe Agent provides information additional to that initially provided or to answer additional questions not initially asked and the IME has previously examined an injured worker in the past 12 months
– An IME is not required to conduct a re-examination (or re-contact) the injured worker in order to provide the additional information. |
$271.42 | $27.14 | $298.56 |
| PCT500 Interim report | $56.64 | $5.67 | $62.31 |
| – Request by a WorkSafe Agent to provide information prior to receiving the IME final written report | |||
| – The advice from the IME may be provided verbally (i.e. by telephone) or in writing (i.e. fax). | |||
| PCT550 Non–attendance on day of appointment– Non–attendance fee is applicable where an IME appointment is cancelled by the WorkSafe Agent on the day of the appointment or where the injured worker does not attend | $282.74 | $28.27 | $311.01 |
| IEO400 Assessment of Impairment as requested by Agent using AMA2Guide** | $155.21 | $15.52 | $170.73 |
Fee Schedule 1 July 2014 regarding Independent Impairment Assessments
Note 1 A Dual Purpose Referral refers to those requests for an assessor’s opinion regarding BOTH liability AND impairment within the one referral, examination, assessment and report request. Dual Purpose Referrals will only be requested of those assessors who are both an Independent Impairment Assessor and WorkSafe approved Independent Medical Examiner. This loading only applies subject to Agent request at referral. |
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DSM IV TR or DSM 5?
September 23, 2014
The question has been raised about whether or not we should be using DSM 5. (See my blog from August 2013) In general psychiatry it is of little consequence but in the forensic area there are potential minefields. Recently a finding of the Victorian Medical Panels was challenged on the basis that the diagnosis made was a “somatisation disorder. On page 489 of DSM IV TR it states “by definition, all individuals with somatisation disorder have a history of pain symptoms, sexual symptoms and conversion or dissociative symptoms. Therefore if these symptoms occur exclusively during the course of somatisation disorder, this should not be an additional diagnosis of pain disorder et cetera.”
The diagnosis was challenged on the basis that it was a DSM IV TR diagnosis and should have been a DSM 5 diagnosis.
My own view is that the DSM 5 deals poorly with pain. It is interesting to note that the word “pain” does not appear in the index! Somatisation disorder, hypochondriasis, pain disorder and undifferentiated somatoform disorder had been removed from DSM 5. They are merged under the term “somatic symptom disorder. “Some individuals with chronic pain would be appropriately diagnosed as having somatic symptom disorder, with predominant pain.” (My emphasis).
I prefer the DSM IV TR term of Pain Disorder, and you will notice that it is actually in the index.
This is a significant issue for us and leaves us open to challenge, I can imagine the dialogue “so doctor did you use DSM IV TR or DSM 5 for your diagnosis. Could you explain why you chose to use DSM IV TR when it has been superseded by DSM 5? What would your response be?
I have commented on DSM 5 previously. The other areas where I believe the changes are significant include changing the term dysthymia to persistent depressive disorder that I think is a plus. I was once asked in court “Dr Epstein, you have diagnosis man with dysthymia that he would have to agree that there is no evidence that he has any problems with his thymus gland.”
Panic disorder has been separated from agoraphobia, this seems to be not a big issue. There have been changes to the qualifiers with regard to acute stress disorder that are now explicit as to whether the stressor was expressed directly, witnessed or experienced indirectly. Criterion A2 has been eliminated (the one related to experiencing “fear, helplessness, or horror”.)
Adjustment disorders have been rejigged as stress response syndromes rather than a residual category for those who have clinically significant distress but whose symptoms do not meet the criteria for a more discreet disorder.
DSM 5 criteria for PTSD are said to differ significantly from the DSM IV TR criteria with criterion A being more explicit with regard to events that qualify as “traumatic” experiences”. I am pleased about that as too often I read that somebody has PTSD because they have had a negative assessment or because they have fallen over a chair or some other relatively minor trauma. You will note that criterion A2 had been eliminated as described above. There are now 4 symptom clusters clusters, re-experiencing, avoidance, persisted negative alterations in cognition and mood, alteration in arousal and reactivity including behavioural changes such as angry outbursts and reckless or self destructive behaviour. All these are of some value. I am not sure if any other changes are of great significance.
I would be interested if you can see any other DSM 5 diagnoses that are of value in terms of the work we do.
Nevertheless the initial point raised was whether or not we should be using DSM 5 or DSM IV TR and who decides. We have had no guidance from the College. DSM 5 does not make it explicit that it replaces DSM IV TR but by implication it must do so, the question is when does it do so, when it was published?
Which one do you prefer?
Is a national WorkCover system feasible?
August 10, 2014
There are obvious advantages to having a uniform WorkCover system, interstate companies not having to deal with nine different systems(think about it, Western Australia, South Australia, Northern Territory, Queensland, New South Wales, ACT, Victoria, Tasmania and Comcare!), unions with workers in different states, the amount of bureaucracy, duplication and cost shifting is mind-boggling. It is also a nightmare for IMEs assessing people who have been injured in different jurisdictions.. Like much that we have I often think it would be best if we scrapped the whole thing and started afresh but of course that’s not going to happen.The question of a uniform WorkCover system raises further questions. Why should there be a uniform system for people who are injured at work but totally different system so people injured in transport accidents and loosely no system for people who are injured in other situations. Maybe we should go the New Zealand route and have a uniform accident compensation system for all accidents. One of the advantages of a non- federal system. The political and financial implications however are mind-boggling. Nevertheless the various WorkCover authority’s in each state and territory do have an organisation looking at doing precisely this..
I think there are 4 major problems with a uniform system.
1.The situation is complicated by a number of factors. Most states have moved to AMA 5 except Victoria and the Northern Territory. There is general satisfaction with AMA 4 in Victoria and a large amount of money has been spent in training IMEs. The feedback I have received suggest there will be no change in the near future.
2.The second point is that WorkCover schemes as opposed to motor accident schemes, have powerful constituencies especially unions and employers but also lawyers. This adds to the general unwillingness for either side to sponsor change that may disadvantage their clients.
3. The third issue is a specific issue with regard to psychiatry There are three systems of measuring psychiatric impairment that are incompatible with each other. Comcare uses a rudimentary table, most states use the Psychiatric Impairment Rating Scale about which I’ve written scathingly and Victoria uses the GEPIC (see article). Does this matter? Well, in fact it has great significance because the various thresholds for claiming permanent injury are different according to the method of psychiatric impairment used. For example in New South Wales it is 15% and in Victoria it is 30%. Bearing in mind that the psychiatric impairment has to be impairment that does not result from physical injury. AMA 6, from a psychiatric point of view is a disaster although it is used in the Northern Territory for motor accident claims.
One of the reasons we don’t want change in Victoria is that the GEPIC is used for WorkCover claims, transport accident claims and civil liability claims. This makes impairment assessment much easier and more understandable, it would bring a system into disrepute if a person had both WorkCover claim and a transport accident claim and the impairment assessment produced startling different figures.
There is an answer although not for the foreseeable future. The answer is that the authors of the chapter on mental and behavioural disorders in the American Medical Association Guide produce something worthwhile instead of what has been produced since AMA 2.
4.The unwillingness of individual states and to give up their own power and potential source of income to embrace a national model
some websites to think about.
A new member of the website, an occupational physician has started a blogging site called ‘Insult & Injury’ www.workcoverobservertas.wordpress.com with a focus on the damage that can result to claimants from the claims management system. He has some very interesting thoughts. In particular he is a proponent of a uniform system throughout Australia (see my thoughts). He like most of us has seen claimants regarding claims in other states and it can be something of a nightmare navigating the system. This is especially so with regard to doing impairment assessments. I urge you to have a look at the site. It gives you a different perspective on the damage to claimants when you see comments on various websites. There are two websites that you might be interested in checking. The first called WorkCover Victims Diary is very much about how people have been done over. The second, based in New South Wales Injured Workers Support Network seems to me a little more evenhanded.It will do you good to see how much we can be hated!
Parsing bureaucracy
August 7, 2014
I have had an interesting correspondence with the Victorian Transport Accident Commission. It has been a salutary lesson in teasing out the meanings of bureaucratic jargon as you will see. I have posted all correspondence in the Resources Section. The background to this were the amendments that were made to the Victorian Transport Accident Act in 2013. One of the amendments (when translated) was:
The commission will only pay for medicolegal reports if the report is requested jointly by the commission and the plaintiff solicitor and the report is provided to both parties.
This was to take effect from 1 July 2014. There was a form of consultation with regard to an appropriate fee schedule and we were arbitrarily informed that the fee set would be 30% above the usual TAC fee with no extras. I and others complained about this as it was significantly lower than our usual fee. I received several cryptic letters from the TAC that I interpreted, apparently correctly. The first was agreeing to pay additional costs for particular cases where there was some complexity or excessive reading and so forth and subsequently the second appeared to agree to me charging my usual fee.
I have since done so. The message is keep hammering away at these authorities, they have no idea about the type of work we do, the complexity of the work, the responsibility we have and we seem to be regarded as a necessary evil.
Using Technology to Enhance Your Reports
July 31, 2014
I have been experimenting with improving the quality of my reports in a variety of ways.
Example, if I come across a reference to a physical condition that appears unusual in the documentation I go to some for a total saw such as WikiLeaks (don’t laugh) and cut-and-paste a sentence or two about the condition. I do that in part because it is very embarrassing when you have made reference to the condition in court and you are asked about it and you plead ignorance.
I have also been making use of the Internet when illustrating surgical appliances that people have have to use e.g. a Philadelphia collar. I think it gives a much more graphic sense of what the claimant has had to endure when you can show the type of apparatus they may have had to wear.
Some of these appliances look like instruments of torture. For example look at this illustration of an external fixateur.
I have also found it very useful to understand the use and misuse of equipment that might have led to workers suffering work injuries.
Often workers talk about different sorts of machines and I have no real picture of them in my mind. I saw a roof tiler recently who had complained that safety rails had not been fitted around the house he was working on and he had fallen, landing heavily and was severely disabled. I got this image from Google images and put it in the report.
I find it especially valuable when writing reports about transport accidents. You are usually given the location of the accident although sometimes that is incorrect but you have little sense of what actually occurred. This is an extract from a recent report.
The accident that led to this claim occurred at 7.50 pm on Thursday 7 February 2013 at the intersection of Miller Street and St George’s Road, Fitzroy North. She was planning to meet friends for dinner in Preston. She had intended getting a train but was running late and chose to go by taxi instead.
She was a back seat passenger seated behind the driver wearing a seatbelt in a taxi travelling along St George’s Road at approximately fifty kilometres per hour. She was leaning forward to send a text message and her seatbelt was loose when another vehicle pulled out from Miller Street (where the white vehicle is visible in the photograph) and collided with the taxi on the left front door (the taxi was located near the “keep clear” sign on the road). She said she looked up and saw the car coming at them. According to the ambulance report there was no cabin intrusion.
I think this gave me extra understanding of what had happened in the accident. I encourage you to be more creative in your use of these type of images to enhance your reports.
The Techo’s will know how to do this. Somebody showed me step-by-step.
Step 1 open Google Earth, type in the location. step 2 Then go to ground view and get the best picture you can of the same. step 3 Press Alt and Print Screen together. step 4 Then use Microsoft paint (you find this by clicking the Microsoft button on your screen, go to All programs–to Accessories where you will see Paint. Open that. step 5 Click paste where you will see the screenshot of Google Earth. step 6 Then use Crop in the Paint program to select the Image you need, step 7 then press copy, step 8 Open a word document and position your cursor on the page and then click paste.. You will then have the image in the word document as above. step 9 If you click on the image you will see arrows at each corner and you can use those to resize the photograph. Step 10 go to Page layout in Word, click the image and then click Wrap, to have the text flow around the picture. Good luck.
Humongous Files
July 10, 2014
I think my record was five boxes of documents totally more than 5000 pages. This was for a desk top report about a young man who committed suicide. Nowadays it is not uncommon to me to receive more than 400 pages of documentation. At face value this can seem a nightmare.
I have developed some strategies for managing this mountain of paper. Before I read anything I put everything in chronological order. I find that by doing this I can progressively worked my way through, pulling out relevant nuggets and, because the reports are in sequence I can fairly quickly move backwards and forwards through all the material to get an overall picture of what has happened.
Whilst I am reading this I am also dictating various items using DragonDictate so that gradually I build up a summary of what has happened. At this stage I don’t care about English or grammar I simply want to get the relevant material assembled in chronological order.
Once that phase is completed I leave aside the documents, making sure they are still in chronological order, and then work on the summary pages writing the assembled data as a narrative. During this process I sometimes have to refer back to the written material where the retained order is very helpful in locating documents.
Once I have written the report using all the data I can then form an opinion based on the questions I have been asked.
I then wait aday or two and reread the report to see whether or not the opinion is consistent with all the data and whether there are any other matters that I should have put in the opinion.
This process seems to work.
The other problem I have with these massive files is that I am usually asked to quote a fee before the file is sent. I can only do so based on the number of hours I will be working on the file. I always underestimate. Nowadays what I do is to give a range and to make sure that I both stay within that range and at times charge at the bottom end of the range if that is the number of hours that I have worked.
Latest bloopers from Dragon
June 26, 2014
DragonDictate has a mind of its own, this can lead to some interesting mistakes.
- As she was driving down the street she ran over a gardener. She was very upset by that.
- She appeared older than her stated age with a swallow complexion.
- He gave the neurology at the funeral.
- She was anxious, depressed, tearfull and felt disfigured by her disease and the weight gain associated with her courtesan usage.
- Following that examination a series of recommendations were made to the department of human soup.
- He reported that he imagined a hawk could be attached to his amputated forearm.
- He was tricked with a collar and calf.
- She has a friend who was a counsellor in hell.
- Her third husband is aged nine.
- She had tachycardia and had treasured that over the years.
- A new system was brought, in which she had to pick her own shit.
- He was depressed as he thought his wife was falling apart.
- The chicken had a rental car.
- Disorder came to Melbourne and stayed for several months.
- It was confirmed that Eureka had been torn from his bladder.
The Unknowable: The Unfathomable
June 14, 2014
Most of what George wants you to know about him is that he rides a Harley. George is the real deal, leather jacket, open face helmet, leather boots and gloves and belongs to a motorcycle club. George has had eight accident on his Harley, most involving his right leg and has spent years in rehab. His right leg is scarred from hip to toe, bowed with little ankle movement but some movement of his knee. He walks with a marked limp and will not use a crutch. His most recent accident involved him coming off his bike and skidding on the road surface on his face! More pain, more skin grafting and more time in rehab. When I saw him he was back riding his Harley and denied any fears about riding. After all, all his mates ride Harleys and if he didn’t get on the bike and go riding with them he would not have any friends. I asked him “after this last accident involving your face do you wear a full face helmet?” George looked at me in astonishment and said “of course not, I ride a Harley!” Go figure, as they say.
Have you interviewed individually members of a family about an accident involving a family member? It is the Rashomonon effect writ large. The Rashomon effect is contradictory interpretations of the same event by different people. The phrase derives from the movie Rashomon, where four witnesses’ accounts of a rape and murder are all different. According to Wikipedia ‘The idea of contradicting interpretations has been around for a long time and has implications for ethics in journalism. It is studied in the context of understanding the nature of truth(s) and truth-telling in journalism.” You could substitute psychiatry for journalism.
Every member of the family gives a different version of the same story. One remembers that an ambulance arrived, another remembers that the police arrived but no ambulance, another remembers what the family were told by the doctors, another has no memory of that. The wife remembers the meeting at which organ donation was discussed, the parents have no memory of that and deny it occurred.
I was 18 years old and staying with my family at a holiday house down the coast. My father had just bought a Mercedes of which he was inordinately proud. My sister, then aged 21 had borrowed the car to go for a drive with her boyfriend. At about 1 o’clock in the morning I awoke to hear screaming and rushed out to see my sister being carried into the house. The story that emerged was that they were parked on a clifftop “talking” when the handbrake was inadvertently released and the car rolled forward and down part of the cliff.
The next morning my father and I went in a tow truck to retrieve the car. Fortunately it was undamaged, it was about 3 m from the precipitous edge of the cliff on a sloping grass verge.
My sister has been living in Los Angeles for many years. When I was last there I mentioned this incident. She said “what are you talking about? That never happened!” So, either I made up the whole story or she had “repressed it” or, for whatever reason she did not want to even acknowledge that it occurred. I have no idea about her motivation but I am still certain that the incident occurred. What was going on?
I have always been interested in people’s stories and motivations. I look back on some reports I wrote 20 years ago and I am surprised at how lacking in substance they are. Over the years I seem to accumulate more and more information, my interviews have become longer and longer and yet I never feel I get to the heart of the matter.
I was reading a comment made by Agnes Varda, a French film director now 86 years old. She said “I have the feeling that whatever in life, whatever we are trying to capture, whatever we are trying to understand – including another person – we face the fact that pieces of the puzzle are missing.” I guess I have to accept that.
Federalism gone mad-a multiplicity of motor accident schemes in Australia
May 30, 2014
In the process of doing some research for the training seminar on 31 May and 1 June 2014 I revisited some of the State motor accident schemes. The diversity of schemes is extraordinary.
In broad terms there are two different types of schemes, Compulsory Third Party Insurance Schemes that require fault to be determined and No Fault Schemes, however over the years hybrid schemes have developed.
The Compulsory Third-Party Schemes include:
New South Wales – (however small payment is made to those who are at fault and there is also a Lifetime Care and Support Authority for accident victims with specific injuries: spinal injury, moderate to severe brain injury, multiple amputations, major burns and blindness. This scheme is no fault.
South Australia – however recent legislation has partially converted this into a no fault scheme so this is a real hybrid. There is also a Lifetime Support Scheme. The LSS, likely New South Wales Lifetime Care and Support Scheme will include people who suffer very serious spinal or brain injury, amputations, burns or blindness, regardless of who was at fault for the accident. The care will be provided from the time of the accident.
No Fault Schemes include:
Tasmania This scheme is No Fault but is also a hybrid with the opportunity to make personal injury claims if fault can be shown.
Victoria – this is also a hybrid scheme that is mainly No Fault but also allows for personal injury claims when fault becomes an issue.
Fortunately, most of us only work in one jurisdiction but even then we are often unaware of the complexities. This post gives you an opportunity to look at the situation in your state and, if need be compare that with the situation elsewhere.
Do bureaucracies ever listen?
May 27, 2014
A very silly question, not even the right question, of course they listen. The problem is not that they don’t listen, the problem is that they don’t take any notice of what they hear.
For some years I have been a member of the Victorian AMA subcommittee that deals with workers compensation and transport accident matters. It has been the most frustrating experience. Dealing with the Victorian WorkCover authority and the Transport Accident Commission has been an exercise in futility. We have raised many issues and have had heard how important our input is, how important it is that we be consulted, what a vital cog in the system we are etc etc. The reality is that consultation takes place at the end of the process, to say it has occurred, our comments and warnings are disregarded and the bureaucracy does what it had always intended to do. Sometimes our involvement leads to perverse outcomes. We raised the issue of dangerousness regarding independent medical examiners. The Victorian WorkCover authority operates behind a fortress to protect themselves from angry injured workers. Similar problems have occurred with transport accident victims. We suggested that the authorities consider their responsibilities to independent medical examiners ( IMEs) in terms of warning IMEs about possible dangerousness, providing a secure location for assessing some people and even providing security guards. Oddly, after some delay, the response we received was a lengthy document about our liability to provide a safe environment for claimants! The original issue we raised was ignored and has remained forgotten.
The most recent episodes of futility involve the Transport Accident Amendment Act 2013. I have already written about the consultation process and what a fiasco it was. One of my concerns was that the plaintiff lawyers would not be compensated for IME reports unless the claim was successful. However if the plaintiff lawyers agreed to a joint medical examination for both the plaintiff lawyer and the TAC, those costs would automatically be met. At the time I raised the issue that this effectively provided the TAC with a veto over who did the work. Those claims were pooh-poohed.
In early April this year I received a lengthy document stating that I must become a member of the TAC medical panel if I wanted to become a joint medical examiner (JME). This arrived on a Friday and had to be submitted the following Monday week giving me effectively five working days to complete the 40 page document including arranging for two referees. I was annoyed both by the absurdly short timeframe and by the fact that I did not want to become a member of the TAC medical panel. I am well known to the TAC and indeed have had frequent requests for supplementary reports from them. Why should I jump through all these hoops? I was further irritated because the document stated what I had to do but did not include any information about what the TAC would do such as provide a schedule of fees. It appeared I was providing them with a blank cheque.
I rang the TAC and spoke to a senior manager who made comments like “I understand your concerns”. I told her I did not care whether she understood my concerns I wanted her to do something about them. I said the timeframe was absurd, I was being asked to sign a blank cheque and why should I have to join the TAC medical panel with what seemed to me excessive demands to attend training sessions, peer review processes and so forth.
Subsequently I recalled that I was an accredited IME examiner with the Victorian WorkCover authority and contacted this person again who told me that accreditation had nothing to do with the TAC. I told her that the letterhead I had received was headed Victorian WorkCover authority and TAC and that most of the documentation provided to me was labelled Victorian WorkCover Authority! She said she would get back to me. I received a phone call the following day saying that if I signed a document and send it back that would be satisfactory. I was also told I would be informed about the fee structure at the end of the day.
I understand that 90 such applications were sent out of which 13 were returned!
In the meantime I heard nothing about fees. There was a meeting with a representative of our forensic psychiatry group in Victoria who spoke to several of us and as a result had compiled a lengthy document indicating the various costs involved in doing this work especially as a joint medical examiner with all the additional responsibilities involved. There were at least two meetings with representatives of the TAC. At the first meeting the TAC representatives stated they were prepared to pay 30% above the usual rate for these examinations and would not pay for any extra such as excessive reading, use of interpreters, complex claims and so forth. Our representative stated that this was inappropriate for a variety of reasons citing fee schedules in other states. The outcome? No change from 30% above the usual fee. In other words more consultation that was meaningless. Our representative feels quite disgusted and used by the whole process.
What a waste of time, we had numerous meetings and subsequent consultations about the Act itself. We pointed out the flaws in the Act. The response of the TAC when the Act was passed in its original form was to issue a series of policy advice papers telling us how the Act was to be interpreted. I had the naive idea that it was the role of the courts to interpret the Act and not the TAC. I envisage being an expert witness and stating that although the Act may say black, the TAC has told us to interpret this as meaning white. imagine the response of the judge. Similarly a great deal of time and effort was put into compiling a realistic fee schedule, bearing in mind the extra responsibilities the costs and the issues involved in dealing with complex claims and so forth. No notice was taken of this at all, another total waste of time.
I think that the only way to operate is by means of a type of guerrilla warfare. I will accept their fee schedule then demand extras for excessive reading, use of interpreters and so forth and see how I go. I will keep you informed.
Chalk and Cheese – the faculty of forensic psychiatry
May 8, 2014
I have always had some concerns about the concept of the Faculty of Forensic Psychiatry as it brings together two fundamentally different groups, those who do civil forensic psychiatry and those who work in the criminal field. We have virtually nothing to say to each other and apart from our involvement with courts we have fundamentally different tasks. Even with court appearances we attend different courts. Nevertheless the move to a Faculty seemed to serve a useful function as it gave us a greater voice within the College and I was prepared to paper over the obvious fissures between as long as we acknowledged each other and gave the other group some respect.
The Victorian Branch committee has representatives from both the civil and criminal area and we have run a state seminar and a national conference and have made sure that both sides had fairly equal representation. At the Darwin meeting in July 2013 I was surprised to hear that the only training contemplated with regard to civil forensic psychiatry is that given to trainees in the criminal area and there was no thought given to training those who do or planning to do civil forensic psychiatry. I wrote about this previously, see my post dated 3 May 2013.
Apart from training provided by Nigel Strauss on myself (a reminder that the next training weekend is on 31 May and 1 June 2014) there are no other options for training in civil forensic psychiatry that I am aware of.
I was aware that the next binational conference was to be in Hong Kong in August 2014 (incidentally a terrible time to be in Hong Kong from the point of view of climate) and was planning to go. The theme “Is There Anything Forensic Psychiatrists Don’t Know about Sex?” lead me to to assuming that there would be some sessions with regard to assessing victims of sexual abuse especially in light of the Royal commission and issues with regard to allegations of sexual abuse in the Family Court area. I have just seen the program however. I invite you to look at the program yourself. I was annoyed to see that there is no part of the program involved with civil forensic psychiatry. We have been shut out, I don’t think this has been malicious I think they just forgot that we exist.
It is clear that the term Forensic Psychiatrist in the theme refers to psychiatrists working in the criminal area.
Since psychiatrist working in the civil forensic area constitute a significant number of members of the faculty I’m astonished by this slap in the face. I feel this has been a complete takeover and that we have been treated with contempt.
Maybe we need to stop messing around with the notion of united Faculty and make a clear distinction between civil forensic psychiatry and criminal forensic psychiatry in the Faculty and go our separate ways.
I would be interested in your thoughts, possibly I am overreacting.
Bullying-a forensic psychiatry perspective
March 31, 2014
You will have noticed that bullying claims are becoming increasingly frequent. There are some bullying claims that seem very clear-cut, for example kids being bullied at school; but others are sometimes very challenging. I have noted three particular groups who seem predominant. The first group are those who have had a WorkCover claim for a physical injury and had come back to work and it is clear they are not wanted, for a variety of reasons, usually because it is a small workplace and as far as the owner is concerned, either the worker does the usual work or there is no place for them and the owner tries to hound the person out of the workplace. The second group are those claimants whose performance has been problematic and who claim bullying after a performance review. The third group are those claimants who have had issues with work colleagues sometimes because others resented the claimant being promoted or being given special treatment and sometimes because the claimant had had a social relationship with the alleged bully and problems arose in their social relationship that spilled over into the workplace. My experience is that victims of bullying or alleged bullying arising in the workplace are difficult to interview and want to recount every instance of injustice.
I have been trying to sort out some sort of taxonomy of bullying as there are a number of other categories that I think should be included.
I would be interested to hear of your own experiences as I am writing a paper for conference later this year.
PhD project to use workers’ compensation data to examine primary prevention of work related injury and illness in Victoria
March 27, 2014
The Institute for Safety, Compensation and Recover Research (ISCRR) has produced another newsletter. There is an interesting PhD Scholarship Opportunity focused on preventing work‐related injury and illness in Victoria with the Monash Centre For Occupational & Environmental Health part of the School of Public Health and Preventive Medicine,
Monash University, Melbourne. This is funded by the Institute for Safety, Compensation and Recover Research (ISCRR) .
The main objectives of this PhD project are to use workers’ compensation data to answer questions related to the primary prevention of work related injury and illness in Victoria; and to develop methods to integrate workers’ compensation data with other data sources (e.g. labour market survey information or emergency department data) and to examine questions concerning the use of workers’ compensation data for surveillance purposes. There is also said to be scope to conduct analyses comparing primary prevention performance across different jurisdictions.
The ISCRR, about which I have written previously, is a disappointment to me. I had expected that there might be some research looking at the neglected area (in academia) of impairment assessment. To my knowledge there have been no worthwhile studies on this enormous and vastly expensive area.
My Experience with Medical Panels Victoria – Michael Epstein
March 25, 2014
I have been a member of the Medical Panels system in Victoria since soon after its inception. I thought you might be interested to see how it started, how it works and the pleasures and pain of being a member. I have found it has sharpened my report writing skills more generally. I have been more aware of how to deal with other opinions and the collegiate discussion has broadened my mind. Have a look at my post in ‘Resources‘.
The South Australian CRASH Seminar 20 March 2014 (Motor accident claims)
March 23, 2014
I attended the CRASH Seminar in Adelaide as a guest speaker talking about the GEPIC, the system of psychiatric impairment we use in Victoria. As you may know the system has been adopted in South Australia for motor accident claims. South Australia has a compulsory third party scheme, a common-law scheme, with a no fault component bolted on. By contrast the system in Victoria is a no fault scheme with a common-law scheme bolted on.
South Australia is using AMA 5 but the percentages from AMA 5 have been grafted on to the system used in Queensland where there are INJURY SCALE VALUES. What that means is that depending on the nature of the injury a percentage impairment leads to a certain ISV number (or range of numbers) and on the basis of that a tribunal, quite separate from the medical profession determines the lump sum payment. For those familiar with the GEPIC, the person has to be in medium class III (25-50% leading to an ISV of 7 or more) to gain any benefits.
There was concern about disadvantage for those with psychiatric injury in the South Australia WorkCover system where there is no entitlement to lump sum payment. I mentioned that it would be useful if South Australia had the same method of psychiatric impairment for both motor accidents and WorkCover claims.
In general there were no negative comments about the GEPIC, probably because nobody knows how it will work. I think the underlying issue is the belief that the system has become much more Draconian and more people will be excluded from receiving benefits. This is not the fault of the GEPIC or indeed any other method of impairment assessment.
South Australia has a Lifetime Supporter Authority that is intended to cover people with catastrophic motor vehicle accidents in South Australia regardless of fault. There is a Lifetime Support Scheme Fund paid for by a levy on motorists.
It was very interesting to talk to people who have been trying to establish the system. Of course the devil is in the details and the details are in the regulations. A committee has been established to determine all these issues consisting of representatives of the law Institute, the AMA, the Motor Accident Commission and a representative of the responsible Minister, the Attorney General. It is interesting to see where this will all end up.
It appears that training for the GEPIC will take place in May or June.
I was surprised by the lively atmosphere of Adelaide. There seem to be so many restaurants and bars, a number of narrow streets like Melbourne’s laneways that were filled with customers. Many of the older buildings were built in that beautiful Adelaide sandstone. The weather was great, it was a pleasure to be there.
A summary of changes and potential changes to Workers’ Compensation in Qld, Vic, WA, SA and NSW
March 8, 2014
There have been significant changes or potential changes in workers compensation in 5 states, I have summarised the changes here.
Queensland: Injury threshold introduced and other changes. The Workers’ Compensation and Rehabilitation and Other Legislation Amendment Act 2013 (Qld) has been discussed in a previous blog.
Victoria’s new Act consolidates previous workers compensation Acts, as from 1 July 2014 WorkSafe goes, the new entity is , surprise, the Victorian WorkCover Authority!
In Western Australia feedback is being sought on a proposal to repeal Western Australia’s workers compensation laws and replace them with a more ‘user-friendly’ Act that includes a new ‘worker’ definition to help employers determine with greater ease whether a worker is covered by the scheme. According to WorkCover WA, a significant number of amendments to the Workers Compensation and Injury Management Act 1981 over the last three decades have resulted in a ‘complex and highly prescriptive statute which is difficult to understand and apply’.
A discussion paper has been released, based on an internal review of the Act and includes proposal to enhance readability and consistency in the legislation.
South Australia WorkCover has been decommissioned. The State Attorney-General and Industrial Relations Minister said, in relation to SA Workcover: ‘It’s been amended, patched over and fiddled with for years and in the process has become so disliked, the only thing to do is to rub it out and start again.’ Workcover SA has an unfunded liability of well over $1b.
New South Wales Lump sum law changes. NSW legislation has attempted to restrict lump sums, by imposing a 10 per cent whole-person-impairment threshold on claims, this will be decided by the High Court.
The sound you hear is my mind boggling – read on
March 7, 2014
Canberra’s Tax Office letter bomber has won a battle against the government over his right to continue receiving worker’s compensation for its mishandling of a workplace love affair.
Former public servant Colin George Dunstan sent 28 bombs in the post to colleagues and high-profile figures in 1998. One of Mr Dunstan’s bombs exploded in a mail centre and injured a postal worker. The rest were intercepted by police, but the letters had already caused mass evacuations and fear just before Christmas.
Mr Dunstan, now in his late 50s, spent nine years in prison over the notorious letter-bombing campaign, and was formally sacked from the public service in 2001. The crimes came after a turbulent romantic affair with a colleague, known as ”Ms X”, that took place over a number of years.
The former Australian Tax Office employee claimed he was left feeling suicidal and depressed after the woman sexually harassed and stalked him. He won a long-running compensation battle in 2012 when the Administrative Appeals Tribunal ruled the ATO had compounded his depression through its handling of the matter.
But, the year after Mr Dunstan’s win, federal government workplace insurer Comcare decided he should stop receiving compensation because he had become eligible for the superannuation pension at the age of 55. That pension, part of the generous Commonwealth Superannuation Scheme, was valued at about $1066 a week, or a $40,000, lump sum.
But Dunstan never formally elected to take the superannuation out, either as a lump sum or a weekly payment. The government insurer argued that Mr Dunstan, and others in his position, were ”double-dipping”, forcing the government to contribute to their super benefits while also paying them workers’ compensation.
But Comcare lost its fight in the tribunal last year, and was ordered to keep paying the former public servant compensation until he turned 65, died, or became permanently disabled. Comcare appealed in the Federal Court on Friday, arguing before the full bench that the tribunal’s decision was flawed.
It based the appeal on two grounds, alleging the tribunal had misdirected itself in interpreting the meanings of terms in relevant legislation. It argued that Mr Dunstan had the ability or right to take the superannuation pension at the age of 55, which could have meant he was taken to have received it. That could then have disqualified him from the compensation payments.
But the Federal Court ruled against Comcare without hearing submissions from Mr Dunstan’s barrister. It said no error had been made by the tribunal and dismissed the appeal.
Comcare was ordered to pay Mr Dunstan’s costs. Mr Dunstan still has two ongoing legal battles with authorities, in the ACT Supreme Court and at the Administrative Appeals Tribunal. He is arguing against his original suspension from the ATO in the Supreme Court.
There is no more to be said, I wonder how this claim can be accepted when so many others, with arguably more merit, are rejected.
Further news on the TAC Amendment Act 2013
Victorian TransportAccidentAmendmentBill 2013 further information
Slater and Gordon had an information session on 25 February 2014 after discussion s with the TAC. The relevant sections of the act for us are the following.
13 Amendment of section 46A (accident-related impairment)
After section 46A(1E) of the Principal Act insert—”(1F) When determining the degree of impairment under this section, section 47(7) or section 47(7A), the Commission must—
(a) not include impairments resulting from injuries or causes that are unrelated to the transport accident; and
(b) in the case of a person who has an injury that existed before the transport accident that is aggravated by an injury that was the result of a transport accident—
(i) in the case of a spinal injury, use the apportionment methodology set out in Chapter 3.3f of the A.M.A Guides;
(ii) in any other case, use the subtraction methodology set out in Chapter 2 of the A.M.A Guides.”.
21 Amendments relating to reimbursement of medical reports
The Commission is not liable to pay as compensation the reasonable costs of medical services that are the provision of a document obtained for medico-legal purposes, or related to medico-legal purposes for examinations made after 1 July 2014 unless the document—
(a) is requested jointly by the Commission and the person who is injured;
and
(b) is provided jointly to the Commission and the person who is injured;
(c) is provided by a registered health practitioner within the meaning of the Health Practitioner Regulation National Law.
document includes but is not limited to a medical report.
The Minister Second Reading Speech Commentary on Amendment 21
Currently, the TAC funds the reasonable cost of medical reports obtained by or on behalf of a client, in relation to injuries sustained in a transport accident.
On average, clients attend 8 medical examinations over the course of their claim, of which, only 2 are commissioned by the TAC. The remaining examinations are commissioned by the client’s legal representative in support of legal claims.
To address the need for a client to attend multiple examinations and to minimise the occurrence of a client attending duplicate examinations in relation to the same specialisation, this bill will enable the TAC to reimburse medico-legal report expenses if the medico-legal report is requested jointly by the TAC and the person who is injured.
It is intended that this provision come into operation on 1 July 2014 to inform and assist medical practitioners of this new policy change.
ISSUES: Potential for TAC to veto some IMEs. We have been assured that current arrangements will continue but the future is uncertain. Solicitors requiring other reports will have to pay for the reports themselves and will only be re-imbursed if the case is successful.
Clause 26 Amendments -Common law damages claims for mental injury due to injury or death
A person who is injured as a result of a transport accident may not recover damages from a person indemnified by the Commission if—
(a) the injury is nervous shock or other mental injury; and
(b) the person was not directly involved in the accident and did not witness the transport accident; and
(c) the mental injury or nervous shock was suffered as a result of the injury or death of another person who was directly involved in the transport accident; and
(d) the transport accident was caused—
(i) in the course of the other person referred to in paragraph
(c) committing, or intending to commit suicide; or
(ii) solely or predominantly by the negligence of the other person referred to in paragraph (c).”
The Minister Second Reading Speech Commentary on Amendment 26
The bill will clarify that the injury or death of a person through suicide, an intention to commit suicide or predominately through their own negligence does not give rise to an action by another person for damages in respect of mental injury (including nervous shock) where the other person was not directly involved in or witnessed the transport accident.
ISSUES: The TAC has assured us this does not exclude first responders and will be implemented flexibly. The usual benefits will be paid, this only refers to common law claims.
27 Amendments relating to serious injury applications
the definition of serious injury, a person has a severe long-term mental or severe long-term behavioural disturbance or disorder if that person, for a continuous period of at least 3 years—
(a) has a recognised mental illness or disorder (other than abnormal illness behaviour) as a result of a transport accident; and
(b) displays symptoms and consequent disability that have not responded, or have substantially failed to respond, to known effective clinical treatments provided by a registered mental health professional who is registered under the Health Practitioner Regulation National Law to practice (other than as a student); and
(c) has severely impaired function with symptoms causing clinically significant distress and severe impairment in relationships and social and vocational functioning.”
The Minister Second Reading Speech Commentary on Amendment 27
As a community we know much more about mental illness than we did when the TAC scheme was established in 1986 . The government understands that recovering from a transport accident can be a very emotional and challenging time.
This bill introduces clauses that set out clinical criteria of what constitutes a severe long-term mental or severe long-term behavioural disturbance or disorder for the purposes of serious injury. This provision has been developed in consultation with the Department of Health, including the chief psychiatrist. The clinical criteria will encourage people who were directly exposed to a transport accident and who have suffered a recognised mental illness or disorder to seek treatment by a registered mental health professional, to improve their chances of getting their life back on track as soon as possible.
ISSUES: We have been assured that the retired, those out of the workforce and others will not be disadvantaged. It has been recognized the no-one is a ‘qualified mental health practitioner’ but the explanatory notes from the TAC state that all but GPs and social workers will be included as treaters. This begs the question of the status of GPs with mental health specialist qualifications. We have also been advised that it is recognized that symptoms will fluctuate and this will not disadvantage claimants. We will see!
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A compilation of discrimination against people with psychiatric injuries in the various schemes in Australia and new Zealand
February 6, 2014
Discrimination against people with psychiatric injuries in various schemes used in Australia and New Zealand.
This is going to be in the nature of a running blog as there are frequent changes leading to further discrimination.
In South Australia there is no lump sum payment for any permanent psychiatric injury in their WorkCover scheme.
In Queensland following a review significant changes were made effective from 29 October 2013.
Employment is to be ‘the major significant contributing factor’ for psychological or psychiatric claims. For physical injuries the definition remains unchanged stating ‘Employment to be ‘a major significant contributing factor’ for psychological or psychiatric claims’. Note the term ‘ the major significant contributing factor’, this is a much more stringemt test than a major significant contributing factor.
In Victoria in the WorkCover system the threshold for a permanent injury is 10% but 30% for any psychiatric injury. Similarly for a civil injury claim (Wrongs Act) claim to proceed it must exceed the threshold of 5% for a physical injury but more than 10% for a psychiatric injury and the psychiatric injury cannot be secondary to a physical injury.
In New Zealand by contrast with the system in all the Australian states a person only has cover for a mental injury (defined as a clinically significant behavioural, cognitive, or psychological dysfunction):
because of physical injuries such as death of a person, physical injuries suffered by a person including those arising from an accident, treatment, treatment for another physical injury and under certain circumstances gradual process, disease or infection or from cardiovascular or cerebral vascular event.
Crimes involving sexual assault that lead to a mental injury are compensable. Suicide is excluded suicide unless the suicide was the result of a mental injury arising from a physical injury.
I will keep adding to this as I further examples of discrimination
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