Appendix 1: Context and relevant provisions - 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.

As claims progress, it is not uncommon for additional medical conditions or consequential conditions to be added to a certificate of capacity. This may have an impact on the management of a claim including the need for treatment, and the worker’s degree of permanent impairment. Insurers should be proactive in their review of certificates of capacity.

If the additional medical condition or consequential condition is accompanied by a request for treatment, the insurer must make a liability decision within 21 calendar days to determine if the employer is liable for costs and expenses related to the condition.

Insurers need to be aware of any medical condition which may impact a worker’s recovery at/return to work, whether work-related or not.

Properly responding to additional information on the certificate of capacity confirms to the worker and nominated treating doctor that requests for reasonably necessary treatment will be considered without delay.

If the additional or consequential medical condition is not work-related, prompt action by the insurer enables the treating doctor to appropriately manage the non-work-related medical condition.