If the workers compensation insurer disputes liability for your claim, it does not mean that you do not have a valid claim. This is only the insurer’s decision based on the available evidence, and you can still try challenging the decision if you truly believe that you have a valid claim. You will need specialist legal advice and a personal injury lawyer is the best person to assist you with challenging the workers compensation insurer’s decision by commencing the dispute resolution process at the Personal Injury Commission on your behalf.
Our client is a gentleman who was in his late 40s when he suffered an injury to his right ankle and lower back during the course of his employment with a hoist and scaffolding company as a rigger. On the day of the subject accident, our client had a significant fall from approximately two metres’ height landing on his right ankle, which was wedged between two pieces of machinery while working on a building site. As a result of the fall, he suffered a serious right ankle injury, liability for which was accepted by the workers compensation insurer. In addition to that, he also suffered an injury to his lumbar spine, however, liability for which was disputed by the insurer on the basis it did not arise out of his employment and his employment was not a substantial contributing factor to it.
The insurer pointed out that the first entry on a workers compensation certificate referred to lower back problems was many months after the date of injury, and also referred to his GP records which revealed the onset of back pain many months after the date of injury. They argued that there was absence of complaint to his general practitioner regarding his back in the immediate aftermath of the fall and thus rejected the client’s lower back symptoms as relating to the fall. The insurer queried why the notes would reflect that history if our client had in fact told the doctor he has suffered back pain since the time of the fall in their dispute notice to our client.
When all of the treatment requests for our client’s lumbar spine injury including a request for a spinal surgery from his treating specialist were rejected by the insurer, he came to us seeking help and legal advice. As an IRO approved lawyer, we obtained funding from IRO in order to collate evidence and assist the client with resolving the dispute in the Personal Injury Commission (the Commission) at no cost to him. With IRO funding, we arranged for him to see an Independent Medical Examiner (IME) and obtained a medico-legal report. We also obtained medical records and reports from his treating doctors including his GP, and the surgeon who recommended the spinal surgery.
After all reports and evidence including an extensive statement we prepared for the client were ready, we then filed proceedings in the Commission. A telephone conference was held by the Commission between the parties in an attempt to have the matter resolved. However, a resolution was not successfully achieved at the first instance at the teleconference, despite our best endeavours to negotiate with the insurer and bring the dispute to a settlement.
The matter was then referred to a conciliation conference and went through an arbitration hearing. With Counsel’s assistance, we were able to put our best submissions and successfully argued that the client suffered a frank injury to his lumbar spine in the incident at issue.
We presented six years’ worth of clinical records prior to the subject incident in which no mention of any back pain and any complaint regarding back pain. We put forward extensive evidence, submissions and arguments to bear out that our client had back pain since the date of injury, however, his treatment in the immediate aftermath of the fall centred on his more serious right ankle symptoms until such time as the back pain evolved to the point where it required medical attention.
At the end of arbitration, the arbitrator made an award, and it was determined in our favour. The Arbitrator accepted our submissions and evidence that our client had no significant back issues pre-injury and the client’s primary focus and that of his treaters was the right ankle in the immediate aftermath of the fall. Though there was absence of records of complaint to his treating doctor regarding his back in the immediate aftermath of the fall, having considered all evidence presented, the arbitrator accepted on the balance of probabilities that the client’s lower back symptoms are relating to the fall at issue.
If you also have any aspect of your claim for workers compensation disputed by the insurer or want to ask a question about how we can help you in file proceedings in the Personal Injury Commission to challenge the insurer’s dispute decisions, please contact us.
Your Compensation is Our Reputation, one of our clients entrusted Alliance with their Workers Compensation Claim. We will be with you every step of the way to help you gain the maximum compensation you are entitled too..
