ACCIDENT COMPENSATION ACT 1985 - SECT 104 Claims for compensation under sections 98 and 98A
ACCIDENT COMPENSATION ACT 1985 - SECT 104
Claims for compensation under sections 98 and 98A(1) In addition to the requirements under section 103, a claim for compensation under section 98 or 98A must be given, served or lodged with a copy of all the medical reports—
(a) which the claimant intends to tender in any proceedings relating to the claim; or
(b) the substance of which the claimant intends to adduce in evidence in support of the entitlement of the claimant to compensation or as evidence of the extent of any relevant loss, impairment, disfigurement or pain and suffering in any proceedings relating to the claim.
S. 104(2) amended by Nos 107/1997
s. 35(1), 81/1998 s. 23(a).
(2) The Authority or self-insurer must within 90 days of receiving the claim—
(a) accept or reject the claim; and
(b) advise the claimant of the decision; and
(c) if the decision is to accept the claim, advise the claimant of its offer based on its determination of the worker's entitlement to compensation; and
(d) give the claimant a copy of all the medical reports—
S. 104(2)(d)(i) amended by No. 81/1998 s. 23(a).
(i) which the Authority or self-insurer intends to tender in any proceedings relating to the claim; or
S. 104(2)(d)(ii) amended by No. 81/1998 s. 23(a).
(ii) the substance of which the Authority or self-insurer intends to adduce in evidence in any proceedings relating to the claim.
(3) If the claimant disputes the decision in respect of the claim, the claimant must not commence proceedings unless the claimant first refers the dispute for conciliation by a Conciliation Officer in accordance with Division 2 of Part III and the Conciliation Officer has issued a certificate under subsection (8).
(4) If the Conciliation Officer considers that it is necessary for the purpose of settling the dispute, the Conciliation Officer may—
(a) obtain a medical report in relation to the worker from a medical practitioner appointed under section 63(2);
(b) request the worker to submit to a medical examination conducted by that medical practitioner.
S. 104(5) amended by No. 81/1998 s. 23(a).
(5) The costs of any medical report and medical examination under subsection (4) are to be paid by the Authority or self-insurer.
(6) The Conciliation Officer must serve a copy of a medical report obtained under subsection (4) with the certificate under subsection (8).
(7) If the Conciliation Officer is satisfied that all reasonable steps have been taken by the claimant to settle the dispute, the Conciliation Officer must issue a certificate under subsection (8).
(8) The certificate must—
(a) certify that all reasonable steps have been taken by the claimant to settle the dispute; and
(b) identify all copies of medical reports provided in accordance with subsections (1) and (2) and any medical report obtained under subsection (4); and
(c) if any medical question has been referred by the Conciliation Officer under section 56(6) for an opinion by a Medical Panel, specify that opinion; and
(d) be served by post on all the parties to the dispute.
S. 104(9) amended by Nos 107/1997
s. 35(2), 81/1998 s. 23(a).
(9) The Authority or self-insurer must within 14 days after the certificate has been served on the Authority or self-insurer make a statutory offer in writing in settlement or compromise of the claim.
S. 104(10) amended by No. 107/1997
s. 35(2).
(10) If any medical question has been referred by the Conciliation Officer under section 56(6) for an opinion by a Medical Panel, the statutory offer must be consistent with that opinion.
S. 104(11) amended by Nos 107/1997
s. 35(2), 81/1998 s. 23(a).
(11) If the Authority or self-insurer fails to comply with subsection (9), the Authority or self-insurer is deemed to have made a statutory offer of nothing.
S. 104(11A) inserted by No. 107/1997
s. 35(3), amended by No. 81/1998
s. 23(a).
(11A) The claimant must within 21 days after the making by the Authority or self-insurer of a statutory offer—
(a) accept the statutory offer in writing; or
(b) make a counter statutory offer in writing which is to remain open for 21 days.
S. 104(11B) inserted by No. 107/1997
s. 35(3).
(11B) If at the expiry of the first period specified in subsection (11A), the claimant—
(a) has not accepted the statutory offer; and
(b) has not made a counter statutory offer—
the claimant is deemed to have made a counter statutory offer of an amount equal to the total of the maximum amounts that can be claimed for the relevant injury or injuries under section 98 and, where applicable, under section 98A.
(12) A party to any proceedings relating to a claim for compensation under section 98 or 98A cannot in evidence submit any medical evidence or tender a medical report or adduce evidence dependent on a medical report unless that evidence is disclosed by a medical report a copy of which has been provided to the other party in accordance with subsection (1) or (2) or a copy of which has been provided in accordance with subsection (8).
(13) Subsection (12) does not affect the admissibility of the opinion of the Medical Panel.
(14) For the purposes of this section if a medical report was oral, a copy of the medical report is to be taken to have been provided to the other party in accordance with subsection (1) or (2) if notice in writing of the substance of the medical report is provided to the other party in accordance with subsection (1) or (2).
(15) In this section—
"medical report"—
(a) means a statement on medical matters concerning the worker whether in writing or oral made by a medical practitioner; and
(b) includes any document which the medical practitioner intends should be read with a statement whether the document was in existence at the time the statement was made or was a document which he or she obtained or caused to be brought into existence subsequently.
S. 104AA inserted by No. 82/2001 s. 18.