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WIRO Wire | Medical Reports

Medical report fees where gazetted fees order exceeded

In response to a request made to SIRA from WIRO for guidance for lawyers about maximum gazetted fees for medical reports, please find below a message from Darren Parker, Executive Director, SIRA:

Maximum fees for medical practitioners
 
The State Insurance Regulatory Authority (SIRA) sets the maximum fees that may be charged by medical practitioners in the NSW workers compensation system.
 
Please note payments must be made in accordance with the relevant fees order and cannot exceed those amounts.
 
If a medical practitioner asks to be paid more than the prescribed amount and you have been unable to resolve the dispute directly with the practitioner, you should notify SIRA via email at contact@sira.nsw.gov.au or telephone on 13 10 50.
 
SIRA will inform the medical practitioner they have charged an excessive fee and ask them to comply with the legislated fees. SIRA will also advise you of the action it has taken and ask you to contact them if the medical practitioner fails to comply.
 
Payment disputes can often be avoided by clearly stating the correct item code for the requested service, the dollar value of the requested service, and where relevant, the appropriate level of complexity of the service requested.
 
For more information, refer to paragraph 7 of the Procedure for Requesting & Paying for Schedules 1 & 2 Services of the Workplace Injury Management and Workers Compensation (Medical Examinations and Reports Fees) Order 2019.

Reliance on clinical notes and health records

WIRO draws to the attention of Lawyers the potential for over-reliance on medical records to prove injury as discussed in the decision of Arbitrator Paul Sweeney in Octavian Cruceanu v Vix Technology (Aust) Ltd [2019] NSWWCC 235.
 
In that case, the applicant gave evidence by way of statement in circumstances where there were a number of medical records and reports available from a number of treating medical practitioners and specialists.
 
Arbitrator Sweeney found it difficult to reconcile the Applicant’s evidence with medical records which were completely devoid of complaint of injury to the disputed body part over a period of 18 months during which the applicant had multiple consultations with his general practitioner about a variety of problems including other body parts.
 
At paragraph 67, arbitrator Sweeney states:
 
“On several occasions in recent years, the Court of Appeal has cautioned against the use of medical records and the histories contained in medical reports to undermine the credibility of a witness. See Davis v Council of the City of Wagga Wagga [2004] NSWCA 34 (26 February 2004), [2003] NSWCA 294 (3 December 2003) (Fitzgibbon) and Mason v Demasi [2009] NSWCA 227 (31 July 2009). These cases suggest that a tribunal would be wary of preferring entries in clinical records to the sworn evidence of witnesses. They also emphasise that the primary function of medical records is to facilitate treatment and not as an unerring record of the medical history.”
 
Kim Garling
Workers Compensation Independent Review Officer