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WIRO Wire | ILARS funding information and policy changes

2019 Gazetted Fees Orders

The following Fees Orders were gazetted on 14 December 2018 and are effective 1 January 2019 for services provided on and after this date. 

  • Workers Compensation (Medical Practitioners Fees) Order 2019
  • Workers Compensation (Orthopaedic Surgeon Fees) Order 2019
  • Workers Compensation (Surgeon Fees) Order 2019
  • Workplace Injury Management and Workers Compensation (Medical Examinations and Reports Fees) Order 2019
  • Workplace Injury Management and Workers Compensation (Injury Management Consultants Fees) Order 2019
  • Workplace Injury Management and Workers Compensation (Independent Consultants Fees) Order 2019
  • Workers Compensation (Physiotherapy, Chiropractic and Osteopathy Fees) Order 2019
  • Workers Compensation (Accredited Exercise Physiology Fees) Order 2019
  • Workers Compensation (Massage Therapy Fees) Order 2019
  • Workers Compensation (Psychology and Counselling Fees) Order 2019
  • Workers Compensation2019
  • Workers Compensation (Private Hospital Rates) Order 2019

The Gazetted Fee orders for 2019 of relevance are found on the WIRO website here or on the SIRA website.

What’s changed?

The Medical Examinations and Reports Fees Order 2019

Now refers to video consultations.

Now includes fees for reports based on complexity from treating General Practitioners (IMG 004, 005, 006 etc).

Has incorporated under the general practitioners’ and treating specialists’ rates WCO005 for clinical notes which now states “where medical records are maintained electronically by a medical practitioner/practice, a flat fee of $60 applies for provision of all requested clinical records held by the medical practice. When medical records are not maintained electronically, the maximum fee for providing hard copies of clinical records is $38 (for 33 pages or less) and an additional $1.40 per page if more than 33 pages. This fee includes postage and handling.”

Refers in paragraph 8 Requirement for invoices, that the invoice must be forwarded to "the insurer" within 30 calendar days of the service provided for payment.

[Note: WIRO requires invoices to be submitted with the final tax invoice in a grant matter or through an approved medical service provider.]

The Medical Practitioner Fees Order 2019

Now incorporates in subparagraph 5(5) the following concerning the provision of clinical notes “The maximum fee for providing hard copies of medical records (including Medical Specialists’ notes and reports) is $38 (for 33 pages or less) and an additional $1.40 per page if more than 33 pages. This fee includes postage and handling. Where medical records are maintained electronically by a medical practitioner/practice, a flat fee of $60 applies for provision of all requested clinical records held by the medical practice. Provision of electronic or hard copy medical records is to be billed under State Insurance Regulatory Authority payment classification code WCO005.

Where a medical practitioner has been requested to provide clinical notes and the doctor needs to review the records prior to provision (for example to redact non work related injury information), the time taken to review the records is to be billed under WCO002. The hourly rate is to be pro-rated into 5 minute blocks to reflect the time taken.”

Paragraph 11 provides that "all invoices should be submitted to the insurer within 30 calendar days of the service provided and must comply with the Authorities itemised invoicing requirements (refer to SIRA website…)”. [Note: See above for WIRO comment]

The Hearing Aid Fees Order 2019

This represents a departure from the previous Hearing Aid Fees Orders which incorporated material concerning the regulation of hearing service providers. That material has now been removed and will be placed into a “hearing service guideline” which is due to be gazetted. The guideline will be the subject of some consultation early in the New Year as it continues to refer to the requirement for a trained ENT to assess a worker for the provision of hearing aids.

The Private Hospital Rates Order 2019

Now includes a flat fee of $60 for the provision of health records under the code of WCO005​​

Compliance with Fees Orders

Approved Lawyers are reminded that the responsibility for setting the standard of complexity of medical reports and ensuring compliance with the Gazetted Fees Orders rests with the lawyer requesting the service and not with WIRO. Approved Lawyers should be cognisant of the Fees Orders and make appropriate requests for funding specifying the level of complexity and the appropriate code based on the standards of complexity in the Fees Orders.

WIRO may be required to exchange or share information and data with SIRA as required by section 40B of the 1998 Act.

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ILARS funding policy changes in force from 1 January 2019

Funding for Work Capacity Decisions

WIRO has now released its Guide for Lawyers and Funding Policy in relation to matters concerning Work Capacity Decisions dated on or after 1 January 2019. Please refer to the WIRO WIRE released on 18 December 2018.

The full Guide can be found here.

Hearing Aid Claims

From 1 January 2019 WIRO will no longer provide funding to pursue claims for the provision of hearing aids where the worker is eligible for hearing aids under the Australian Government Hearing Services Scheme. The full Policy change can be found here.

Counsel’s Fees to attend Conciliation and Arbitration hearings (Con/Arbs)

From 1 January 2019 Approved Lawyers are not required to seek pre-approval to brief counsel to appear at a ‘Con/Arb’. This is subject to the provision of information to assist WIRO to keep up to date with the progress of a matter in the WCC.

WIRO will consider paying full day hearing fees to Counsel where the WCC has set the matter down for a full day arbitration hearing and where Counsel is unable to take any other work as a consequence of the listing.

WIRO requires an extension of funding request for all advices from Counsel, Counsel refresher fees, for appearing at Teleconference, full day hearing fees and for the preparation of submissions or appearance in appeals in the WCC.

The full revised ILARS Policy on Counsel can be read here.

Clarification of Funding for Appeals

The policy concerning the funding of court appeals is now confirmed as the following:

An extension of funding for an appeal will be considered in the following circumstances:

Where the worker is named as a respondent to the appeal

WIRO will provide full funding for workers named as respondents in appeals in the WCC, Supreme Court and Court of Appeal.

Where the worker is named as the appellant in Court Appeals

Where the worker is the proposed appellant in appeals to the Supreme Court and Court of Appeal WIRO will provide conditional funding and will consider full funding on a case by case basis.

No indemnity

WIRO cannot and will not indemnify the worker against a costs order made against him or her by the Court.

WIRO expects that the Approved Lawyer will seek an assurance or undertaking from the insurer/employer that they will not seek a costs order in the event of their success or alternatively they will not seek to enforce a costs order made by the court.

Whilst this is not a condition of granting funding on any basis, WIRO has an expectation that efforts will be made by the Approved Lawyer to secure this arrangement.

In the event that such an arrangement is refused by the insurer, WIRO may make representations on behalf of the worker to such an effect.

Application to extend funding grant required

WIRO will only consider payment of costs for an Appeal where WIRO is notified prior to or at the time of the appeal being lodged or responded to. WIRO will not extend funding if first notice of the appeal is at or after finalisation.

Costs orders in Court matters

It is expected that on the basis that WIRO grants full funding no costs order will be sought against the insurer appellant or respondent regardless of the court outcome.

Costs Agreement

WIRO requires a copy of the Approved Lawyer’s cost agreement with the worker in respect of the court proceedings and counsel’s fee agreement in order that WIRO can consider and approve the proposed rates.

Funding of matters valued less than $3,000

The current ILARS Policy stipulates that an ILARS grant of funding will generally not be made where the amount in dispute is less than $3,000.

WIRO may however exercise its discretion to provide a grant of funding where it is considered that:

  1. an injured worker suffers financial hardship
  2. clarification of the law is required
  3. it is in the public interest for the dispute to be determined or
  4. there is an overriding interest of fairness that the injured worker has the dispute determined.

WIRO has recently observed employer and insurer practices which have led to workers being prevented from notifying injuries and claiming benefits (weekly payments and medical treatment) within the provisional liability period or the first 12 weeks of injury.

As a consequence, ILARS Principal Lawyers will now consider Applications for Grants of Funding where the value of the claim is less than $3,000 and arises within the first 12 weeks of injury.

Funding for Threshold Issues

WIRO will now provide funding for certain threshold matters.

The threshold issue should be clearly identified in the Grant Application Form.

Each application for a grant of funding will be considered by an ILARS Principal Lawyer and the terms of funding will be provided for in the grant approval letter.

The Grant Application Form will be amended and updated early in 2019 and a Threshold Funding Guide provided.

Clarification of ILARS Policy Changes

If you are in doubt about the application of a Policy change to your grant please email your query to ilarscontact@wiro.nsw.gov.au
 
Kim Garling
Workers Compensation Independent Review Officer
21 December 2018

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