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Motor accidents medical assessor code of conduct

The medical assessor code of conduct governs how we expect people appointed by us as medical assessors (for motor accidents) to behave.

1 April 2017 to 30 June 2018

1. Introduction

1.1 This Medical Assessor Code of Conduct (the Code) governs the conduct of persons appointed by the State Insurance Regulatory Authority (the Authority) as Medical Assessors pursuant to Part 3.4 of the Motor Accidents Compensation Act 1999 (the Act).

1.2 This Code should be read in conjunction with the Medical Assessor Terms of Appointment (the Terms). Compliance with this Code is a requirement of the Terms.

1.3 This Code provides guidance to Medical Assessors in the performance of their statutory functions as Medical Assessors. While many of the standards set in this Code are in general terms, this Code is intended to provide practical assistance to Medical Assessors in relation to performing their duties in a manner that is consistent with the Objects of the Act and standards, including behavioural standards, as set by the Motor Accidents Medical Assessment Service (MAS).

1.4 This Code is based to a large extent on the work of the Administrative Review Council publication - A Guide to Standards of Conduct for Tribunal Members (available at www.coat.gov.au). Medical Assessors may consult the Director, Medical Reviews and Assessors (the Director) for assistance or guidance in applying the principles of this Code.

1.5 Medical Assessors must act in accordance with the Objects of MAS as set out in the Medical Assessment Guidelines 2008:

  • 1.14.1 to provide a timely, fair and cost effective system for the assessment of medical disputes under the Motor Accidents Compensation Act 1999 that is accessible, transparent, independent and professional;
  • 1.14.2 to assess medical disputes fairly and according to the substantial merits of the application with as little formality and technicality as is practicable and minimising the cost to the parties;
  • 1.14.3 to ensure the quality and consistency of MAS decision making;
  • 1.14.4 to make appropriate use of the knowledge and experience of MAS Assessors; and
  • 1.14.5 to establish and maintain effective communication and liaison with stakeholders concerning the role of MAS.

2. General Principles

2.1 In the performance of their duties, Medical Assessors must uphold the highest standards of integrity and honesty and act ethically and in accordance with the law. This requires Medical Assessors to demonstrate fairness, diligence, impartiality, expertise and timeliness.

2.2 Medical Assessors must demonstrate a respect of the NSW Motor Accidents CTP scheme in the conduct of their professional life and have regard to the potential impact of activities, interests and associations on the impartial and effective performance of their duties as a Medical Assessor.

2.3 In the conduct of their assessments, Medical Assessors are required to abide by the principles of natural justice and procedural fairness.

3. Fairness

A Medical Assessor must:

  • 3.1 abide by the principles of procedural fairness
  • 3.2 ensure that their decisions are made in accordance with the law, with due regard to fairness and equity, and based on relevant and logically probative information
  • 3.3 ensure that assessments are conducted in a transparent manner and are fair, providing each party to an assessment an opportunity to put their case and
  • 3.4 ensure that they act without bias and in a way that does not give rise to a reasonable apprehension of bias while undertaking assessments.

4. Accountability and Transparency

A Medical Assessor:

  • 4.1 is accountable for their decisions and actions and is subject to legislative and administrative scrutiny and
  • 4.2 must be transparent in their decisions and actions, including any lack of action.

5. Independence

5.1 A Medical Assessor must perform their assessment responsibilities independently and free from external influences.

6. Diligence and Timeliness

A Medical Assessor must:

  • 6.1 conduct assessments and make decisions with due rigour, diligence, intellectual honesty and
  • 6.2 be timely in the performance of their assessment responsibilities.

7. Integrity

A Medical Assessor must:

  • 7.1 act honestly and truthfully whilst performing their assessment responsibilities
  • 7.2 not knowingly take advantage of, or benefit from, information not generally available to the public obtained in the course of the performance of their assessment responsibilities
  • 7.3 not use their position as a Medical Assessor to improperly obtain, or seek to obtain for themselves or others, benefits, preferential treatment or advantage
  • 7.4 be scrupulous in the use of the Authority’s resources
  • 7.5 behave in a way that upholds the integrity and good reputation of the Authority in their professional and private life
  • 7.6 not accept gifts or benefits of any kind where this could reasonably be perceived to compromise the impartiality of the Medical Assessor or the Authority. If a gift or benefit is offered to the Medical Assessor, and it is more than of a token nature, the Medical Assessor should decline the gift and notify the Director immediately and
  • 7.7 not offer gifts or benefits of any kind to improperly obtain, or seek to obtain, benefits, preferential treatment or advantage for the Medical Assessor or for any other person or body.

8. Respect for Persons and Privacy

A Medical Assessor must:

  • 8.1 demonstrate patience, dignity and courtesy to all persons involved in a medical dispute
  • 8.2 be aware of, and sensitive to, the needs of claimants involved in the medical assessment process, and take into consideration the claimant’s language abilities, cultural background, literacy and any disability
  • 8.3 be respectful and courteous when discussing or commenting on the opinion of other medical professionals
  • 8.4 maintain professional relationships within the Medical Assessor group and the Authority’s staff
  • 8.5 respect the confidentiality of the matters that are referred for assessment. This requires compliance with the Information Protection Principles in Part 2, Division 1 of the Privacy and Personal Information Protection Act 1998 and Health Privacy Principles in Schedule 1 of the Health Records and Information Privacy Act 2002 and
  • 8.6 advise their staff to respect the confidentiality of the matters that are referred for assessment.

9. Potential Conflicts of Interest

9.1 A Medical Assessor must:

  • immediately disclose to the Director any potential conflict that may affect their ability to carry out their medical assessment responsibilities in accordance with this Code and
  • not accept a referral from the Authority to assess any claimant with whom they may have a conflict of interest and
  • notify an Officer of MAS immediately where an actual or perceived conflict of interest occurs.

9.2 A Medical Assessor should:

  • have regard to the potential impact of any activities, interests and associations on the impartial and efficient performance of their assessment responsibilities and
  • generally decline an invitation extended by legal firms or insurance companies who have an interest in the NSW Motor Accidents CTP scheme.

9.3 A Medical Assessor must not:

  • provide medical advice or treatment to a claimant whom they have previously assessed for the Authority
  • provide a medico-legal assessment or an assessment for some other jurisdiction of a claimant whom they have previously assessed for the Authority
  • assess a claimant for the Authority for whom they have previously provided medical advice or treatment
  • assess a claimant for the Authority if that claimant or a member of their immediate family is known personally to the Medical Assessor or
  • assess a claimant for the Authority whom they have previously assessed, unless the previous assessment was a referral from the Authority.

10. Suspect Corrupt Conduct

10.1 If a Medical Assessor becomes aware of an instance of corrupt conduct, maladministration or criminal conduct relating to the Authority, they must notify the Director immediately.

11. Media and Public Comment

A Medical Assessor:

  • 11.1 must not provide comment to the media on Authority matters that are, or have been, before them
  • 11.2 should not identify themselves as a Medical Assessor when involved in providing comment to the media on a matter unrelated to their responsibilities as a Medical Assessor
  • 11.3 should refrain from engaging in activities or expressing opinions that have the potential to compromise their ability to deal with specific cases, or diminish the standing of the Authority, MAS or the NSW Motor Accidents CTP Scheme, and
  • 11.4 must consult with the Director before accepting the invitation to speak at a public forum such as a conference, seminar or the like in their role as a Medical Assessor, and provide a copy of their paper prior to the presentation.

12. Professional Standards

A Medical Assessor:

  • 12.1 should take reasonable steps to maintain and enhance the knowledge, skills and personal attributes necessary for the effective performance of their professional responsibilities.

13. Responsibilities of the Director, Medical Reviews and Assessors

The Director:

  • 13.1 will assist Medical Assessors to comply with this Code, and to perform their assessment responsibilities, through the provision of appropriate leadership, training and support, and
  • 13.2 must report to the Executive Director, Dispute Resolutions Services, any instance of corrupt conduct, maladministration or criminal conduct relating to the Authority of which they become aware.

14. Acknowledgment and Acceptance

14.1 Receipt by MAS of your Acceptance of Offer Form constitutes acknowledgment and acceptance of this Code.