Appeal Personal Injury Claim. In workers compensation claims, insurers do at the best of times reject treatment for secondary injuries, consequential injuries or injuries that are not the main injury.
For one of our clients who was in his early 30’s and was in his working prime this very issue arose. He had sustained a very serious leg injury several years ago but in addition to that, he also suffered other injuries including spinal injuries. Though the spinal injuries were problematic from the beginning, the medical treatment for the spinal injuries took a ‘backseat’ as he had to undergo various surgical procedures for his fracture leg, which were on each occasion followed by extensive rehabilitation. The injuries were sustained during the course of his employment that had resulted from a fall of a considerable height.
Without any dispute, the workers compensation insurer had never rejected treatment for the fractured leg though other treatment of a lesser nature were not given similar support.
As the other injuries became more problematic, the extent of the treatment and other requirements increased. Due to the spinal injuries, our client then required surgery and certain home modifications. The spinal surgery obviously was costly, and the home modification was something that the insurer thought would not be worthy for this individual. They argued these were not reasonably necessary and therefore not covered under the provisions of the Workers Compensation Act, 1987.
As with any dispute, the Personal Injury Commission (the Commission) had to deal with the dispute and hence our requirement to collate our evidence and file proceedings in the Commission. The proceedings went through an Arbitration hearing and most unfortunately the Member of the Commission had agreed with the insurer’s view on the matter. A determination was made that both the surgical procedure and the home modification were not reasonably necessary and with that determination, the insurer was not required to meet the associated expense.
The whole process was lengthy and arduous. It involved the collation of many medical records and an extensive statement in order for us to put our best submissions forward on behalf of this injured worker. However, despite the extensive work, the claim was not successful at the first instance with the Member’s determination.
Following the unsuccessful Arbitration, this worker had two options. One of the options was to give up and the other option was to fight on and lodge an Appeal against this decision. With our support and encouragement, our client instructed us to lodge an Appeal. With Counsel’s assistance, a very detailed Appeal was prepared and submitted in the Commission. The Deputy President was to determine our Appeal and we felt confident in succeeding considering the extensive submissions and arguments put forth in support of the Appea
When the Appeal was finally determined, it was determined in our favour. When our client was notified of the successful Appeal, he was simply overwhelmed with emotion. Throughout this lengthy process his symptoms were increasingly becoming worse, but he now sees a brighter future. He says that he now feels some hope for his future.
Our client was overwhelmingly thankful for our efforts and for “fighting” for him. He found true support and help from us at Alliance Compensation Lawyers.
The fight that we put up for this client is the same fight we put up for each and every client. We are firm with our advice to our clients and along with our firmness, we also support each of our clients to achieve and attain the goal that they rightly deserve. As we say here at Alliance Compensation Lawyers, “We fight the fight, that we have to fight, in order to win the fight”.
If you want a fighting law office on your side, contact us at Alliance Compensation and Litigation Lawyers on (02) 8764 1776.
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