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Standard 13 - additional or consequential medical conditions

It is important that prompt and proactive consideration is given to the development of additional or consequential medical conditions to ensure workers continue to receive appropriate compensation and support.

Additional or consequential medical conditions

Principle: Prompt action will be taken to assess and address any additional or consequential medical condition identified on a certificate of capacity.

 ExpectationBenchmarks
S13.1When an insurer receives a certificate of capacity that identifies an additional or consequential medical condition not previously diagnosed or reported, the insurer must seek advice from the treating doctor to establish the reason for inclusion on the certificate of the additional or consequential condition.Advice sought within five working days after receipt of certificate.
S13.2If the treating doctor considers that the additional or consequential medical condition may result from the compensable injury, the insurer must contact the worker to establish whether they intend to make a claim for reasonably necessary treatment for the condition.Contact with the worker attempted within five working days after receipt of certificate.
S13.3If the worker makes a claim for treatment or weekly benefits for the additional or consequential medical condition, the insurer must make a liability decision.Liability decision made within 21 days of lodgement of the claim.
S13.4If the worker is not making a claim for treatment or weekly benefits for the additional or consequential medical condition, this is to be documented on the claim file.Evidence on claim file.