Worker’s Weekly Compensation Benefits Reinstated by Workers Compensation Insurer

Published 05 Mar 2018

Our client was employed as a factory/process worker for over ten years. Her duties involved repetitive heavy lifting and repetitive overhead work. As a result of the nature and conditions of her employment, our client sustained injuries to both shoulders.

Our client made a Workers Compensation Claim. It was initially accepted and she was paid weekly compensation benefits and reasonable and necessary medical expenses.

Some months later, the Workers Compensation issuer denied the claim and issued a Section 74 notice. The Section 74 notice alleged the injury did not occur during the course of employment, rather it was as a result of an underlying degenerative disease or condition which was not work related.

Our client was certified totally unfit for any form of employment by her Nominated Treating Doctor. Her treating specialist also requested approval for major shoulder surgery.  As our client’s claim was declined, the insurer did not pay our client any weekly compensation. The insurer also declined to pay for the costs of the proposed surgery.

Although it is true, our client had a degenerative disease or condition, we were able to obtain expert evidence to support the disease or condition was caused as a result of the nature and conditions of her employment.

We also obtained reports from her treating doctors to support employment was the main contributing factor to our client’s bilateral shoulder injury and that our client was not able to return to any form of employment since the injury occurred. We also obtained a report from her treating specialist supporting the proposed surgery was reasonably necessary.

We subsequently filed an Application to Resolve a Dispute in the Workers Compensation Commission.  We successfully reinstated weekly compensation benefits for our client. Our client was paid back to her first day of incapacity. As our evidence was very supportive, the insurer also approved the costs of the proposed surgery and reimbursed any past out of pocket expenses. Her claim is now fully accepted by the insurer and continues to receive her workers compensation benefits.

Have you suffered a work place injury? Or do you know someone who has?

Contact Gerard Malouf and Partners on 1800-004-878 for a complementary free consultation to assess your legal rights and to provide you with free advice.