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Motor accidents medical assessor terms of appointment

Your appointment as a medical assessor (for motor accidents) for SIRA is subject to these terms.

1 April 2017 to 30 June 2018

1 Appointment

1.1 Your appointment as a Medical Assessor for the State Insurance Regulatory Authority (the Authority) is subject to these Medical Assessor Terms of Appointment (the Terms).

1.2 Your appointment commences and terminates on the dates set out in your “Instrument of Appointment”, unless it is terminated earlier in accordance with these Terms.

1.3 Your appointment is in accordance with the laws of New South Wales, and Part 3.4 of the Motor Accidents Compensation Act 1999 (the Act).

1.4 Your appointment as a Medical Assessor is subject to your agreement to be bound by the Medical Assessor Code of Conduct (the Code) and these Terms.

1.5 Your appointment as a Medical Assessor is for a period up to and including 30 June 2018 subject to your compliance with these Terms, the Code and satisfactory performance according to standards set by the Motor Accidents Medical Assessment Service (MAS).

1.6 Your appointment as a Medical Assessor does not constitute you as an agent, partner or employee of the Authority, and does not preclude you from employment elsewhere except as otherwise specified in these Terms.

1.7 You are not to represent yourself as authorised to act on behalf of the Authority, except in your capacity, and in the discharge of your duties, as a Medical Assessor. You are also to direct your employees not to represent themselves as authorised to act on behalf of the Authority.

1.8 Your appointment as a Medical Assessor for the Authority entitles you to use the reference “State Insurance Regulatory Authority Medical Assessor” in your correspondence. You must, however, remove any such reference as soon as your appointment as a Medical Assessor for the Authority ceases.

1.9 It is your responsibility to ensure there are no conflicts or other impediments related to your professional work outside the Authority that may restrict your ability to conduct assessments as requested by the Authority.

1.10 All Medical Assessors who indicate a willingness to assess children will be required to provide MAS with a current Working with Children Check Number.

2 Medical assessment

2.1 The Authority makes no guarantee or representation regarding the allocation of work to any Medical Assessor. The allocation of matters to Medical Assessors is entirely at the discretion of the Authority and may not necessarily result in regular work or any work.

2.2 Relevant contact details are to be provided to the Authority for yourself, your agent or your staff, with whom the Authority can make immediate appointments. You must ensure that you update your contact details whenever necessary using the relevant forms accessible on the MAS Extranet.

2.3 You are to have availability for a minimum of 3 appointments per month in which to conduct assessments for the Authority and to provide an appointment time within 3-4 weeks of the date of contact.

2.4 If the Authority has block booking arrangements with you for appointments and has not utilised the appointments 3 weeks before the date of the block booking, you may use the appointment time for other matters.

2.5 You are to undertake medical assessments in accordance with the referral by the Authority and must allocate sufficient time to allow a fair and comprehensive examination of the claimant. Extra time may need to be allocated where an interpreter is required to attend the examination.

2.6 You are to consider all of the information provided to you by the Authority and ensure that all documentation has been read and, if applicable, any surveillance imaging has been viewed, at least 2 working days prior to the assessment.

2.7 You are not to consider any additional documents brought to the examination by the claimant, with the exception of radiology and accompanying reports.

2.8 If you will be unavailable for 4 weeks or more, you are to advise an Officer of MAS as soon as practicable.

2.9 Any medical assessments referred to you by the Authority are to be performed by you personally. You cannot assign or sub-contract the task, in whole or in part, with the exception of routine administrative duties such as:

  • booking of appointments
  • sorting of paperwork
  • preparing invoices and/or
  • typing.

2.10 Routine administrative duties do not include such things as history taking or summarising documents forwarded to the Medical Assessor by the Authority.

2.11 Medical Assessors whose assessment for the Authority requires the administration of testing such as hearing, respiratory or visual testing, may have that testing performed by a suitably qualified technician in accordance with current clinical practice standards. However, the Medical Assessor must interpret the test results for the purpose of the medical assessment.

2.12 You must treat all parties to the assessment process with respect and dignity and assist the claimant to understand the assessment process by explaining:

  • your role as a Medical Assessor
  • the purpose of the medical assessment examination and
  • how the claimant will be examined, ensuring that a gown or covering is always offered if the claimant is required to undress for the examination.

2.13 At no time are you permitted to treat or provide medical advice to the claimant during or after the medical assessment.

2.14 You are to conduct assessments of disputes referred to you by the Authority and issue Certificates including reasons in accordance with the Act, the current Medical Assessment Guidelines, the Code, these Terms, the current Permanent Impairment Guidelines, the American Medical Association Guides to the Evaluation of Permanent Impairment, 4th Edition (AMA 4 Guides) and any Guidance Notes issued by the Authority.

2.15 Your appointment as a Medical Assessor may require you to assess one or more of the following types of disputes:

  • whether the treatment provided or to be provided to the injured person was or is reasonable and necessary in the circumstances
  • whether any such treatment relates to the injury caused by the motor accident
  • whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%.

2.16 You are to provide a Certificate including reasons, in the format prescribed by the Authority ensuring that you:

  • address all disputes referred to you by the Authority for assessment
  • record all clinical findings
  • provide reasons for each aspect of the medical dispute referred for assessment.

2.17 You are to email your (electronically signed) Certificate including reasons to masreports@sira.nsw.gov.au within 15 working days, unless an extension of time has been granted by an Officer of MAS.

2.18 If the Certificate including reasons is not received within 10 working days after the due date (2 weeks late), the Director, Medical Reviews and Assessors (the Director) may suspend allocation of matters to you until such time as all overdue Certificates are submitted.

2.19 If the Certificate including reasons is not received within 15 working days after the due date (3 weeks late), the Director may deem the assessment abandoned and decline to pay you for any work undertaken on that matter.

2.20 If you become aware during an assessment of a serious and/or imminent threat to the life, health or safety of the claimant or another person, or a serious threat to public health or safety, you should take whatever action is appropriate to lessen the threat. You should also advise an Officer of MAS.

3 Facilities

3.1 You are required to maintain appropriate premises for undertaking all work in relation to conducting medical assessments referred by the Authority, and ensure that the premises are a safe working environment and meet all Workplace Health and Safety Standards.

3.2 You must maintain, in an operable and effective condition, all equipment used in providing assessments and where possible, premises should also have disabled access.

3.3 You must have access to current copies of the Motor Accidents Medical Assessment Guidelines the Permanent Impairment Guidelines, the AMA 4 Guides and any Guidance Notes issued by the Authority.

4 Potential conflict of interest or apprehension of bias

4.1 Assessments conducted by Medical Assessors must be fair to all parties. The amount of medico-legal work a Medical Assessor does for Insurers, claimants or any NSW CTP insurer must not give rise to a perceived or potential conflict of interest or apprehension of bias in the work they do for the Authority. To adhere to this principal, a Medical Assessor’s medico-legal work should not exceed:

  • 10% for any CTP insurer or any legal practice
  • A substantial proportion for CTP Insurers, or for claimants.

4.2 You must provide MAS with an update of the composition of your practice workload annually.

4.3 You must notify the Director immediately if the composition of your practice workload exceeds the levels outlined in 4.1.

4.4 You must contact an Officer of MAS if you have, or suspect you have, a conflict of interest in relation to a matter referred to you for assessment.

5 Performance evaluation

5.1 Your performance as a Medical Assessor will be monitored during the course of your appointment and will be evaluated in the following areas:

  • Accessibility – ability to accept and undertake work from the Authority
  • Timeliness – ability to comply with timeframes set by the Act and the Medical Assessment Guidelines
  • Obvious Errors and Incomplete Certificates - the nature, frequency and outcome of any incomplete Certificates and/or obvious error applications
  • Training – attendance at any training sessions arranged by the Authority
  • Complaints – the nature, frequency and outcome of any complaints made to the Authority by any stakeholder regarding Medical Assessor conduct and/or behaviour
  • Reviews – the nature, frequency and outcome of any review applications lodged
  • Code of Conduct – the nature and extent of any breaches of the Code
  • Terms of Appointment – the nature and extent of any breaches of these Terms
  • Professional Development – confirmation of continuing professional development
  • Appointment Rescheduling – the frequency of rescheduled appointments and the reasons for this, and your participation in the
  • MAS Quality Assurance Program – including peer review, self-review and meeting minimum quality benchmarks set by MAS.

5.2 Your past performance data will be a consideration in any application for appointment for future terms.

5.3 The Director will notify you of any concern regarding your performance in order to provide you and the Authority with the opportunity to address it, and may cease allocating matters to you if warranted.

6 Professional registration status and complaints

6.1 You are to notify the Director immediately if:

  • there is any change to your professional registration status such as practice conditions, suspensions, and/or deregistration
  • you are the subject of a complaint to the Health Care Complaints Commission, or any registration or professional body
  • you are under investigation for, or convicted of, an offence in NSW or elsewhere, or
  • there is any other reason or occurrence that could affect your ability to perform your responsibilities as a Medical Assessor for the Authority.

6.2 You authorise the Authority to seek information regarding your registration or membership status from any professional or registration body.

7 Training

7.1 You are to attend any training that MAS advises is mandatory. You are also encouraged to attend all training sessions organised by the Authority for Medical Assessors.

7.2 You may be requested to participate and assist in a Medical Assessor mentoring program.

7.3 There are no fees payable for training organised by the Authority. The Authority will reimburse reasonable travel and accommodation expenses incurred in attending any training event in accordance with the current SIRA Medical Assessors and Review Panel Assessors Travel Expenses Policy.

8 Remuneration

8.1 The Authority will pay you in accordance with the current Medical Assessors Fee Schedule for Medical and Review Panel Assessments.

8.2 You are to provide a tax invoice to the Authority in accordance with the allocated fee:

  • at the time you submit your Certificate including reasons
  • when you have been advised by MAS that a matter has been settled or withdrawn
  • when you are advised that an appointment has been cancelled with less than one week’s notice (5 working days), or
  • when you advise the Authority that a claimant has failed to attend an appointment.

8.3 The Authority is required to make superannuation guarantee payments under the Commonwealth Superannuation Guarantee (Administration) Act 1992. You are to provide the Authority with the name and details of your approved superannuation fund.

8.4 The Authority will pay you by electronic funds transfer (EFT) within 30 days of receipt of your tax invoice. You are to provide your ABN, Australian bank account and any other necessary details.

8.5 If an account is paid incorrectly any underpayment or overpayment is recoverable.

8.6 The Authority is not liable for any of your employee ‘on-costs’ such as wages, salaries, typing, holiday pay, allowances and insurance.

8.7 You are required to maintain accurate accounting practices and records relating to all of your assessment work for the Authority.

8.8 You are to adhere to any guidelines or policies relating to the claiming of expenditure from the Authority.

8.9 You must honestly represent actual expenses incurred when claiming any travel expenses and submit in a timely manner a completed claim form.

8.10 Medical Assessors are not to seek or accept frequent flyer points or similar loyalty programs from any airline or travel provider.

9 Insurance

9.1 You are required to have current insurance with a general insurance company licensed by the Australian Prudential Regulatory Authority including:

  • a broad form public liability policy of insurance in respect of all premises used by you to conduct medical assessments
  • workers compensation insurance in accordance with applicable legislation in the state(s) or country in which you practice in respect of all your employees, and
  • a professional indemnity policy of insurance in respect of each and every occurrence and unlimited in the number of such occurrences over any one period of cover.

9.2 You must provide evidence of the necessary insurance policies on request by the Authority.

9.3 The Authority does not provide income protection or workers compensation insurance for Medical Assessors or their staff.

The Motor Accidents Compensation Act 1999 provides statutory protection for Medical Assessors as follows:

59A Protection of medical assessors

(1) A matter or thing done or omitted to be done by a medical assessor under this Part in the exercise of the assessor’s functions does not, if the matter or thing was done or omitted in good faith, subject the assessor personally to any action, liability, claim or demand.

(2) A medical assessor is, in any legal proceedings, competent but not compellable to give evidence or produce documents in respect of any matter in which he or she was involved in the course of the exercise of his or her functions as a medical assessor.

(3) Any liability that would attach to a person were it not for the operation of subsection (1) attaches instead to the Crown.

10 Electronic operating environment

10.1 You must have access to a personal computer or laptop with internet access.

10.2 You must be able to open Microsoft Word files, Adobe Acrobat PDF files and other files as required.

11 Record Keeping, confidentiality and disclosure of information

11.1 Information provided by the Authority in relation to a medical assessment, including your Certificates, is confidential and remains the property of the Authority. You must take all reasonable steps to ensure all records in relation to assessments are stored in a secure place.

  • You are to take all reasonable steps to ensure you do not disclose, copy, reproduce, or supply this information to any person or organisation other than the Authority, except as required to do so by law.
  • You are to take all reasonable steps to ensure this information is to be used solely for the purposes of the service being provided to the Authority, and is protected against unauthorised use and access.
  • If you are required to disclose this information to your employees to allow them to carry out their duties, you must ensure that the employee is aware of the confidential nature the information provided and the requirements in handling this information.

11.2 Electronic records sent by the Authority or created by you in relation to a medical assessment must be stored securely and within your control. The Authority’s information should never be stored on flash/USB drives unless they are password protected and/or encrypted. Medical Assessors are required to have a high level of protection of electronic records including robust firewalls, up to date anti-virus software and secure passwords.

12 Disposal of documentation

12.1 An Officer of the Authority will advise you when a matter is finalised and all records can be disposed of in a manner that ensures confidentiality.

12.2 If you do not have facilities to dispose of records securely, you must forward the documents, either personally or at your own expense, to the Case Manager, who will arrange for their secure disposal.

13 Disputes

13.1 In the event of any dispute arising from the Code, these Terms, or any other matter in connection with an assessment, you are to contact the Director as soon as practicable and endeavour to resolve the dispute in good faith.

13.2 In the event that the matter cannot be resolved, the matter will be referred to the Executive Director, Dispute Resolution Services.

14 Termination

14.1 The Authority may at any time, with or without notice, cease allocating matters to you or terminate your appointment as a Medical Assessor, in the event of:

  • A breach of these Terms or the Code
  • A relevant change in your professional registration status
  • You being convicted of a criminal offence
  • Your failure to satisfy the minimum benchmarks set by MAS
  • Receipt of multiple complaints about your conduct and/or performance
  • A physical or mental injury/illness that detrimentally affects, or is likely to detrimentally affect, your capacity to perform medical assessments
  • A decrease in, or other change to, the need for Medical Assessors by the Authority, or
  • Any other matter that adversely impacts the Authority or your appointment as a Medical Assessor.

14.2 You may terminate your appointment as a Medical Assessor for the Authority by giving notice in writing to the Director.

14.3 If you cease to provide services to the Authority you must ensure that all materials relating to any assessment are returned promptly to the Authority.

15 General

15.1 These Terms may be reviewed and varied from time to time by the Director. The Authority reserves the right to amend these Terms at any time, particularly in relation to significant changes in legislation, the Authority’s electronic operating environment and/or the mode of remuneration. Medical Assessors will be informed of any changes.

16 Acknowledgment and Acceptance

16.1 Receipt by MAS of your Acceptance of Offer Form constitutes acknowledgment and acceptance of these Medical Assessor Terms of Appointment.