What happens when my claim is referred to an Approved Medical Specialist?

Disputes regarding the degree of permanent impairment or whether medical expenses are reasonable and necessary will be referred directly to an Approval Medical Specialist by the Registrar of the Workers Compensation Commission.

An Approved Medical Specialist (AMS) is a doctor who is a medical specialist with suitable experience and training by WorkCover. They are to provide an independent and unbiased assessment about the injuries. There is a panel of doctors that the Workers Compensation Commission uses for these examinations and one will be appointed to determine your claim for permanent impairment or medical expenses.

The Approved Medical Specialist is not appointed by the workers compensation insurer or by your Lawyer.

The Workers Compensation Commission arranges the medical examination and will let your lawyer know the date and time of the assessment and the name of the approved medical specialist. The examination will take place at the doctor’s practice and a report will then be provided directly to the Workers Compensation Commission, usually within 21 days. The report is then checked for errors by the Commission and if satisfied that it is correct, the report is then provided to your Lawyers.

The report will outline your level of whole person impairment and the reasons for deciding the percentage WPI in accordance with the WorkCover Medical Assessment Guidelines and/or will outline whether medical treatment is reasonable and necessary.

Can I appeal the decision of the approved medical specialist?

Yes, an appeal can be made against the approved medical specialist but must be made within 28 days of receipt of the medical assessment. You can only lodge an appeal on the following basis:-

  • The medical assessment was made on the basis of some incorrect criteria
  • •The medical assessment contained a demonstrable error
  • Your condition has deteriorated and there is an increase in the permanent impairment since you were last examined
  • You have additional relevant information that was not available to the approved medical specialist; or
  • A combination of the above.

Once an appeal is lodged with the Workers Compensation Commission the matter is referred to an appeal panel consisting of 2 approved medical specialists and one Arbitrator. The medical appeal panel reviews the documents and decides whether the matter can be:-

  • Determined on the papers
  • Whether new evidence should be allowed
  • Whether a further medical examination should take place