S5. Recurrence or aggravation of a previous workplace injury
Commencement date: 21 October 2019
Clarity and certainty regarding the distinction between the recurrence of an injury and a new injury is important for workers and employers because of the potential impact on a worker’s benefits and an employer’s premium.
Principle
All available evidence will be considered to determine whether an injury is the recurrence of a previous injury or a new injury, and all reasonable support will be provided to the worker in either case.
Expectations
Benchmarks
S5.1
If the insurer determines that an injury is a recurrence of a previous injury or a new injury to a previously injured body part, the insurer is to contact the worker and employer to advise of the reasons for that decision and its implications.
Advice provided to the worker and employer within two working days after decision
Insurers must have regard to the facts and medical evidence to properly determine whether an injury is a recurrence of a previously accepted workplace injury, or a new injury to a body part previously injured at work.
The distinction between a recurrence of an injury and a new injury can be significant for workers and employers. The insurer’s decision will impact the calculation of a worker’s benefits and may be significant for an employer’s premium. Determining whether the claim should be treated as a recurrence or a new injury requires a common-sense evaluation of the evidence.
A recurrence occurs where, after a worker suffers a work-related injury, there is a later increase in symptoms or a re-emergence of symptoms needing treatment or causing incapacity. An example is a worker who is symptom-free for a period of time and then symptoms start again, whether or not this occurs at work. Provided the work-related injury caused or materially contributed to the further incapacity or need for treatment, liability should be accepted for a recurrence of the injury and the insurer should reactivate the original claim made by the worker.
If a worker suffers a new work-related injury to a body part that has previously been injured at work, the insurer should decide which of the two injuries caused or materially contributed to the incapacity or need for treatment. For example, a worker may have had a work-related knee injury that has resolved. If the worker suffers a further injury to the knee at work and the medical evidence supports that the further injury was the cause of the incapacity or need for treatment, this should be accepted as a new claim.
If both injuries contribute, it is preferable that the injury that was the most material of the contributors should be accepted. However, if acceptance of an injury as the main contributor would result in the worker not being entitled to compensation (for example, because of the expiry of a compensation period such as provided by section 39 or section 59A), careful consideration should be given to accepting the other injury if it also materially contributed to the incapacity or need for treatment.
