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Weder v Workers' Compensation Regulator[2018] QIRC 22
Weder v Workers' Compensation Regulator[2018] QIRC 22
QUEENSLAND INDUSTRIAL RELATIONS COMMISSION
CITATION: | Weder v Workers' Compensation Regulator [2018] QIRC 022 |
PARTIES: | Weder, Anthony (Appellant) v Workers' Compensation Regulator (Respondent) |
CASE NO: | WC/2017/77 |
PROCEEDING: | Appeal against a decision of the Workers' Compensation Regulator |
DELIVERED ON: | 6 March 2018 |
HEARING DATES: | 15 February 2018 |
HEARD AT: | Brisbane |
MEMBER: | Industrial Commissioner Thompson |
ORDERS: |
|
CATCHWORDS: | WORKERS' COMPENSATION – APPEAL AGAINST DECISION – Decision of Workers' Compensation Regulator – Appellant bears onus of proof – Standard of proof – Balance of probabilities – Witness evidence – Time for applying – Legislative requirements – Doctor's assessment – Medical certificate – Entitlement to compensation – Ability to waive s 141(1) of the Act – Appeal dismissed – Decision of Regulator confirmed – Appellant to pay Regulator's costs of and incidental to the appeal to be agreed or failing agreement to be the subject of a further application to the Commission. |
CASES: | Workers' Compensation and Rehabilitation Act 2003 ss 131, 132, 141, 208, 209, 210 Workers' Compensation and Rehabilitation Regulation 2014 s 104 Simon Blackwood (Workers' Compensation Regulator) v Toward [2015] ICQ 8 Quinlivan v Portland Harbour Trust [1963] VR 25 Van Dongen v Northern Territory of Australia [205] NTCA 6 WorkCover Queensland v Downey (2001) 168 QGIG 381 Appo v Q-COMP (2003) 174 QGIG 1120 DeAlwis v Simon Blackwood (Workers' Compensation Regulator) [2016] ICQ 008 Black v City of South Melbourne [1963] VR 34 Augustynski v Simon Blackwood (Workers' Compensation Regulator) [2014] QIRC 207 Appo v Review Unit Q-COMP (unreported, Industrial Magistrates Court of Queensland, Barrett IM, 15 May 2003 Wiley v Q-COMP (unreported, Industrial Magistrates Court of Queensland, 30 May 2003) Cook v Q-COMP (2008) QGIG 220 Susan Marshall AND Q-COMP (WC/2011/386) -Decision http://www.qirc.qld.gov.au Telstra Corporation v Roycroft (1997) 77 FCR 358 Whitehead v Workers' Compensation Regulator [2012] QIRC 71 R v Workers' Compensation Board of Queensland ex parte Heffernan (1979) Qd R 563 Australia and New Zealand Banking Group Limited v Q-COMP (2004) 175 QGIG 1125 Churchill v Q-COMP (2009) 190 QGIG 247 Nuttall v Workers’ Compensation Regulator [2017] QIRC 069 |
APPEARANCES: | Mr R. Ivessa, Counsel instructed by Mr J. Wright of Colwell Wright Solicitors for the Appellant. Mr S. Gray, Counsel directly instructed by the Workers' Compensation Regulator, the Respondent. |
Decision
- [1]A notice of appeal was lodged with the Industrial Registrar on 4 May 2017 by Anthony Weder (Weder) pursuant to ss 548A and 549 of the Workers' Compensation and Rehabilitation Act 2003 (the Act) against a decision of the Workers' Compensation Regulator (Regulator) dated 31 March 2017.
- [2]The decision of the Regulator was to confirm the decision of WorkCover Queensland (WorkCover) not to waive the time for applying in accordance with s 131 of the Act.
Relevant Legislation
- [3]The legislation pertinent to this appeal are the provisions ss 131, 141, 208, 209 and 210 of the Act:
- "131Time for applying
- An application for compensation is valid and enforceable only if the application is lodged by the claimant within 6 months after the entitlement to compensation arises.
- If an application is lodged more than 20 business days after the entitlement to compensation arises, the extent of the insurer's liability to pay compensation is limited to a period starting no earlier than 20 business days before the day on which the valid application is lodged.
- Subsection (2) does not apply if death is, or results from, the injury.
- An insurer must waive subsection (1) for a particular application if it is satisfied that special circumstances of a medical nature, decided by a medical assessment tribunal, exist.
- An insurer may waive subsection (1) or (2) for a particular application if the insurer is satisfied that a claimant's failure to lodge the application was due to -
- mistake; or
- the claimant's absence from the State; or
- a reasonable cause."
- "141Time from which compensation payable
- The entitlement to compensation for an injury arises on the day the worker is assessed by -
- a doctor; or
- if the injury is a minor injury - a nurse practitioner acting in accordance with the workers' compensation certificate protocol; or
- if the injury is an oral injury and the worker attends a dentist - the dentist.
- However, any entitlement to weekly payment of compensation starts on -
- if a doctor, nurse practitioner or dentist assesses the injury as resulting in total or partial incapacity for work on the day the worker stops work because of the injury - the day after the worker stops work because of the injury; or
- if a doctor, nurse practitioner or dentist assesses the injury as resulting in total or partial incapacity for work on a day later than the day the worker stops work because of the injury - the day the doctor, nurse practitioner or dentist assesses the injury."
- "208Application and object of ch 4
- This chapter applies if a worker sustains an injury for which compensation under chapter 3 is payable.
- The object of this chapter is to provide for appropriate medical treatment, hospitalisation and rehabilitation of the worker.
- 209Application of pt 2
- This part applies if medical treatment or hospitalisation of a worker is required for the management of an injury sustained by the worker.
- However, this part, other than section 219, does not apply to medical treatment provided to, or hospitalisation of, a worker during a period for which the worker is entitled to compensation under chapter 4A for the injury, including any period for which the entitlement is suspended under section 232ZH.
- 210Insurer's liability for medical treatment, hospitalisation and expenses
- The insurer must pay the cost of the medical treatment or hospitalisation that the insurer considers reasonable, having regard to the worker's injury.
- Under the table of costs, WorkCover may impose conditions on the provision of the medical treatment.
- Before imposing a condition under subsection (2) WorkCover must consult with self-insurers."
Nature of Appeal
- [4]The appeal to the Commission are by way of a hearing de novo in which the onus of proof falls upon the appellant.
Standard of Proof
- [5]The standard of proof upon which appeals of this nature must be determined is that of "on the balance of probabilities".
Evidence
- [6]In the course of the proceedings, evidence was provided by two witnesses.
Witness List
- [7]The witnesses for the appellant were:
- Weder; and
- Dr Bradley Matthews (Dr Matthews).
- [8]The Regulator did not call any witness evidence.
- [9]The Commission, in deciding to précis the evidence of the witnesses, and submissions, notes that all the material has, for the purposes of this decision, been considered in its entirety.
Appellant
Weder
- [10]Weder commenced employment with the Queensland Investment Corporation (QIC) in 2006 having been "head hunted" for their global real estate division. The role was stressful and included the following tasks:
- procurement of debt;
- managing debt;
- managing cases; and
- managing financial risk.
- [11]On 9 September 2013 he sought treatment from Dr Matthews for a stress-related condition. Dr Matthews had been recommended by his [then] partner, as a practitioner that had WorkCover experience. A medical certificate was issued by Dr Matthews for the information of his employer that identified him as unfit for duty from 9 September 2013 until 24 September 2013. There had prior to the issue of the medical certificate been no discussions about his inability to work however Dr Matthews suggested he consider the following propositions:
- WorkCover claim;
- resignation; and
- changing jobs (working somewhere else).
Dr Matthews had not assessed on 9 September 2013 an injury resulting in total or partial incapacity for work or mentioned time limitations for a WorkCover claim.
- [12]In the period from the initial consultation with Dr Matthews and when he ceased employment with QIC on 13 March 2015 he was able to perform all his duties and managed a "lot of stress" with Dr Matthew's assistance. In terms of his remuneration package it contained a bonus element which at a minimum was 60 per cent if expectations were met in the performance of his duties.
- [13]Towards the end of 2014 whilst he had partial resolution of some work issues the undertakings given had not been delivered on which had increased his stressors, making it difficult to cope. He was being excluded from team meetings also at this time.
- [14]Weder attended upon Dr Matthews on 16 March 2015 where he outlined some of the things that were going on at QIC, how he was feeling and there being a lot of stress that he was not able to cope with. Dr Matthews suggested that he should not return to work and raised the issue of WorkCover. That was the first time he had been assessed as being either totally or partially incapable of work. He tendered his resignation on 20 March 2015 but had not worked in the intervening period between seeing Dr Matthews and the giving of notice
- [15]Under cross-examination Weder agreed that at the consultation with Dr Matthews on 16 March 2015 he had a belief that QIC were going to take steps to terminate his employment and at a meeting on 18 March 2015 there was mutual agreement reached that he would tender his resignation [Transcript p. 1-9] Weder had requested his general practitioner to provide a referral to Dr Matthews, specifically due to advice from his [then] partner who said he was a good doctor and not because he knew about WorkCover claims [Transcript p. 1-10]. However he later accepted the doctor's WorkCover experience was one of the reasons for wanting the referral [Transcript p. 1-11]. One of the considerations suggested by Dr Matthews at the initial consultation was that he could make a WorkCover claim [Transcript p. 1-11]. He denied that on 9 September 2013 he was considering a WorkCover claim because it was his intention to work [Transcript p. 1-12]. Dr Matthews had prescribed medication which was subsequently taken by Weder but he refused to concede it was treatment for a psychiatric condition but was for managing his health at work [Transcript p. 1-13]. Dr Matthews had given him a medical certificate which stated as at 9 September 2013 he was unfit for duty and recommended some time off [Transcript p. 1-14].
Dr Matthews
- [16]Dr Matthews a Psychiatrist, frequently worked with injured workers, and had been a member of the General Medical Assessment Tribunal for Psychiatry for the past three trimesters. Dr Matthews provided two reports (dated 1 August 2016 and 18 January 2017) that were tendered in the proceedings. In the report of 18 January 2017 it was confirmed that an assessment of total incapacity for work in respect of Weder had been made on 20 March 2015 and whilst a medical certificate had been offered on 9 September 2013 for the purposes of an attempt to arrest further deterioration in his emotional state there had been no previous assessment of partial or permanent incapacity.
- [17]At the time of issuing the medical certificate on 9 September 2013 he thought it would be useful for Weder to get some respite from his ongoing stressors and may have been useful in arresting his deteriorating mental state by taking him away from the stressful work environment. Weder had chosen not to take advantage of the medical certificate and according to Dr Matthews remained capable for work. In addition to the suggestion that he take two weeks away from work he also raised the possibility of Weder making a WorkCover claim.
- [18]Dr Matthews continued to treat Weder after the 9 September 2013 consultation with the extent of his distress, depressive and anxious symptoms varying in the period up to March 2015. In the same period Weder had a compromised mental state with a facet of his presentation being indecision and difficulty in making a firm decision as to which was the correct line of action.
- [19]Under cross-examination Dr Matthews confirmed that on 9 September 2013 he was concerned that Weder had either developed an adjustment disorder with depressed mood or indeed a major depressive episode secondary to his work pressures and considered he had a psychiatric injury of some description [Transcript p. 1-23]. He formed the view that it was caused by events occurring in his workplace which was the reason he suggested Weder consider a WorkCover claim [Transcript p. 1-24]. On the issuing of a general medical certificate on 9 September 2013 rather than a workers' compensation medical certificate it was the case Weder was unfit for duty, not incapacitated for work [Transcript p. 1-28]. Dr Matthews confirmed that as at 9 September 2013 in his opinion Weder had a psychiatric injury and that his employment was a significant contributing factor to the condition [Transcript p. 1-29] which was why he had discussed the lodging of the WorkCover claim [Transcript p. 1-30]. Weder in his opinion needed treatment for his injury and was prescribed medication with the option of lodging a WorkCover claim if he was unable to continue at work [Transcript p. 1-30]. Dr Matthews opined there was a causal connection with his employment [Transcript p. 1-31]. Finally he evidenced that he had formed the view on 9 September 2013 that Weder might benefit from an absence away from the workplace but not that he was necessarily unable to continue to work [Transcript p. 1-32].
Submissions
- [20]The parties provided written submissions which were addressed orally in the course of the proceedings.
Appellant
- [21]The appeal was against the original decision of WorkCover not to waive the time limit for the appellant to lodge an application for compensation under s 131(5) of the Act in respect of an application for compensation lodged on 4 August 2015.
Facts Relevant to Appeal
- [22]The appellant worked for QIC from 2006 until March 2015. After a series of stressful interactions with the QIC Chief Financial Officer (CFO) to whom he directly reported he sought treatment for stress symptoms in 2013 through a referral to Dr Matthews. In a report (dated 1 August 2016) Dr Matthews stated:
- initial consultation - 9 September 2013;
- Weder described symptoms of anxiety and depression;
- Weder was given a medical certificate for two weeks off work;
- Weder did not use the certificate and continued to perform work; and
- he suggested Weder consider a WorkCover claim and also a change of workplace.
- [23]Weder was not assessed as incapacitated for work on 9 September 2013 and continued to perform his role for 18 months until his last day of work on 13 March 2015. He continued to be treated by Dr Matthews exhibiting intermittent deterioration and improvements in his mental state although an overall slow deterioration. On 16 March 2015 following a consultation with Dr Matthews he was assessed as unable to work due to an "Adjustment Disorder with Mixed Anxious and Depressed Mood" with a workers' compensation medical certificate issued to that effect. The injury had developed "over a period of time" with the appellant first seeing Dr Matthews on 9 September 2013.
The Law
- [24]Relevant sections of the Act were identified as:
- Section 131(1) and (5) of the Act:
"131Time for applying
- An application for compensation is valid and enforceable only if the application is lodged by the claimant within 6 months after the entitlement to compensation arises.
…
- An insurer may waive subsection (1) or (2) for a particular application if the insurer is satisfied that a claimant's failure to lodge the application was due to -
- mistake; or
- the claimant's absence from the State; or
- a reasonable cause."
- Section 141(1) and (2) of the Act:
"141Time from which compensation payable
- The entitlement to compensation for an injury arises on the day the worker is assessed by -
- a doctor; or
- if the injury is a minor injury-a nurse practitioner acting in accordance with the workers' compensation certificate protocol; or
- if the injury is an oral injury and the worker attends a dentist - the dentist.
- However, any entitlement to weekly payment of compensation starts on -
- if a doctor, nurse practitioner or dentist assesses the injury as resulting in total or partial incapacity for work on the day the worker stops work because of the injury - the day after the worker stops work because of the injury; or
- if a doctor, nurse practitioner or dentist assesses the injury as resulting in total or partial incapacity for work on a day later than the day the worker stops work because of the injury - the day the doctor, nurse practitioner or dentist assesses the injury."
- [25]On 24 March 2015 the decision in Simon Blackwood (Workers' Compensation Regulator) v Toward[1] (Blackwood v Toward) was handed down with the effect that the law was changed in that the six month time limit for making a WorkCover claim runs from an assessment by a doctor that a person is suffering from an injury. Prior to that decision the assessment was that a person is suffering from an injury if it results in a total or partial incapacity to work.
- [26]In Quinlivan v Portland Harbour Trust[2] Sholl J had found the expression "reasonable cause" to mean:
"Which a reasonable man would regard as sufficient, a cause consistent with a reasonable standard of conduct, the kind of thing which might be expected to delay the giving of notice by a reasonable man."
Analysis
- [27]The Act differentiates between an entitlement to compensation and an entitlement to a weekly payment of compensation. An entitlement to compensation arises the day a doctor first assesses the injury. Such entitlement is a "technical entitlement" as there is no payment of compensation until a doctor assesses the injury as resulting in total or partial incapacity for work and the worker ceases work.
- [28]The time limit for making a claim for compensation runs for six months after the "technical entitlement" for compensation arises (whether or not an actual entitlement for payment has arisen).
- [29]It is not contested that the date Weder was first seen by Dr Matthews for the injury was 9 September 2013 with a "technical entitlement" to compensation arising on that day and the legislative time for a claim was six months from that day. However until March 2015 there was no claim that could be made for compensation as:
- Dr Matthews had not assessed Weder as incapacitated for work until March 2015; and
- Weder did not stop work until 13 March 2015.
- [30]In the matter of Van Dongen v Northern Territory of Australia[3] (Van Dongen) an appeal was heard by the Northern Territory Court of Appeal by a worker from a decision to refuse to waive compliance with a six month limitation period. In that case it was found:
- worker suffered a mental injury on 12 August 1996;
- within the next six months he was partially incapacitated although he nevertheless received increased entitlements for undertaking duties he could not perform;
- worker did not seek medical treatment in the six month limitation period hoping his symptoms would go away; and
- worker claimed compensation in 2000 - two years after he had resigned from the employment.
- [31]The Court unanimously dismissed the worker's appeal on the basis no payment could have been made in the six month period was not reasonable cause as:
- it was a result of the worker not seeking medical treatment and concealing from his employer the fact that he was partially incapacitated from performing his duties (and was not performing all of his duties); and
- the worker had knowledge of the relevant legislative requirement and chose not to claim.
- [32]In the decision, Mildren J said:
"However, on further reflection it seems to me that whilst the fact that there is nothing to claim in the relevant period will often, if not usually, amount to reasonable cause for the failure to make a claim, there can be no hard and fast rule, as the court is bound to consider all of the circumstances of the case in determining what is and what is not reasonable cause. If, as is the case here, the worker deliberately delayed seeking medical advice in circumstances which were not that which a reasonable person might do in looking after his own interests, and if, had he done so, a claim for compensation would probably have arisen, even if for no more than the cost of medical treatment, within the relevant period, thus enabling him to have made a claim, that might result in a finding that there was no 'reasonable cause'."
- [33]Further, Riley J (with whom Martin CJ agreed) said:
"Mere ignorance of the law alone will not be sufficient. However ignorance of the law when combined with other factors may amount to reasonable cause. For example in Melbourne & Metropolitan Tramways Board v Witton [1963] VR 417 the Full Court held that there may be reasonable cause for failure to give notice of an intended action where the proposed plaintiff was ignorant of the requirements of the relevant legislation and was reasonably waiting for her injuries to stabilise before consulting a solicitor and taking proceedings."
- [34]Riley J went on to state:
"It is clear that each case must be assessed upon its own facts and circumstances. Contrary to the submission of the appellant the whole of the circumstances of the case as they impact upon the reasonableness or otherwise of the conduct of the worker must be considered in order to determine whether reasonable cause is established."
- [35]Similarly to the worker in Van Dongen, Weder (despite having a technical entitlement to compensation) had no entitlement to payment of compensation until he had been assessed as incapacitated for work and ceased working.
- [36]The six month limitation period and the requirement that it can only be waived if there is a reasonable cause exists because for a vast majority of workers it is reasonable to expect them to bring a claim. That was not the case for Weder for the following reasons:
- Weder was not familiar with the Act and had never previously made a claim;
- no great blameworthiness can be attributed to Weder's ignorance of the law as there was nothing he could have practically done to correct his ignorance of the six months in September 2013 until March 2015 because had he sought advice from a lawyer the correct advice based on the binding authorities at the time would have been that the six month limitation period would not run until an assessment by a doctor that he was suffering from an injury resulting in a total or partial incapacity for work;
- the fact Weder had nothing to claim (except reimbursement of out-of-pocket medical expenses) in the six month limitation period was not due to his concealment from his employer but that he had not been assessed as incapacitated (totally or partially) from working in the limitation period and continued to work in that period until his later incapacity and resignation; and
- the nature of his injury likely contributed to his not applying for compensation until after he ceased employment.
- [37]The discretion in s 131(5) of the Act to waive the six month limitation period should be exercised in this case.
- [38]In the oral phase of his submission Counsel addressed the changes in law with respect to the decision in Blackwood v Toward (24 March 2015) which had the effect of the time limit running from the assessment by a doctor that a person was suffering an injury where the situation prior was that an assessment of total or partial incapacity for work was the requirement.
- [39]The appeal turns on whether Weder had a reasonable cause for not filing a workers' compensation claim within the time limitation period. The principle reason supporting his position was that claim for the payment of compensation could not be made until March 2015 when Dr Matthews assessed him as incapacitated for work.
- [40]Further comparisons were made with regards to the difference in circumstances in Van Dongen and the situation in which Weder had found himself with regards to the six month time period.
Regulator
- [41]The appeal requires the Commission to give consideration of whether Weder had lodged a valid and enforceable application for compensation in accordance with the provisions of s 131 of the Act with the date upon which an entitlement to compensation arises is provided for at s 141(1) of the Act.
- [42]The grounds for appeal were nominated as:
- Regulator erred by determining that Weder's entitlement to compensation arose on 9 September 2013 instead of 16 March 2015; and
- in the alternative the Regulator erred by failing to find that any failure by Weder to lodge his application for compensation within six months of the entitlement for compensation arising was due to a reasonable cause.
- [43]Those grounds were said to have been modified in the Statement of Facts and Contentions filed on Weder's behalf which accepted:
- entitlement to compensation arose on 9 September 2013;
- to be valid and enforceable his application for compensation had to be lodged within six months of that date; and
- application was not lodged within the six months from 9 September 2013.
- [44]The matters requiring determination were:
- had Weder proved a mistake, absence from the State or a reasonable cause for failing to lodge the application within six months of the date upon which the entitlement to compensation arose; and
- if Weder was able to prove a mistake or reasonable cause should the discretion at s 131(5) be exercised to waive s 131(1).
- [45]On consideration of the reasons relied upon by Weder, it is the Regulator's view:
- Weder's entitlement to compensation arose on 9 September 2013;
- Weder was assessed as being totally incapacitated for work on 9 September 2013;
- Weder required extensive treatment from Dr Matthews since 9 September 2013; and
- Weder had not demonstrated mistake or reasonable cause.
Date upon which the entitlement to compensation arose
- [46]
- [47]However in Blackwood v Toward, Martin P disagreed with the interpretation in Downey determining it should not be followed. The submission cited paragraphs 27, 28 and 29 of the decision as of relevance in the consideration of this matter:
- "[27]Section 141 is concerned with the time from which compensation is payable for an 'injury' as defined. The compensation may be in one or more of the types available under Chapter 3 or 4 of the Act. To confine the words 'assessed by ... a doctor' to an assessment relating only to total or partial incapacity for work as envisaged in s 141(2) is to ignore the other, possible, compensable sequelae of an injury.
- [28]In s 141(2) the assessment concerns the severity of the injury and not whether a worker has suffered an injury. Elsewhere in the Act, when the word 'assess' or 'assessment' is used about an injury it concerns the extent or effect of the injury.
- [29]Section 141(1) concerns the worker and whether, in the opinion of a doctor or other nominated medical professional, the worker has suffered a 'personal injury arising out of, or in the course of, employment if the employment is a significant contributing factor to the injury' as described in s 9. That is what is meant by 'the worker is assessed by … a doctor'. To confine it as the respondent suggests is to equate assessing a worker with assessing an injury."
- [48]Further cited in Blackwood v Toward were paragraphs 44 and 45 where Martin P said:
- "[44]…It has not been established that the doctors directed themselves to that issue until the time of the making of the claim. Each of them was concerned with the treatment of Mr Toward. They knew that he had suffered injuries at various times but they did not direct their minds to the question of which physical injury, if any, arose out of employment.
- [45]In this case, the Regulator has not demonstrated that such a conclusion or opinion was either formed or communicated outside the six months preceding the lodgement of the claim."
- [49]A further authority relied upon was DeAlwis v Simon Blackwood (Workers' Compensation Regulator)[6] (DeAlwis) where Martin P in dismissing the appeal wrote:
- "[12]The Commissioner recorded in his reasons that the appellant had consulted Dr Rodney Morris on 20 November 2010 about work-related stress. He had a consultation with Dr Craig Morris on 21 December 2010 in which a diagnosis of an adjustment disorder relating to work stressors was recorded and the appellant acknowledged that there were other occasions before 2014 in which he had sought medical treatment for stress-related conditions that were work-related.
- [13]The case conducted by the appellant was inconsistent. On the one hand, he said that all of the stressors contributed to his psychological/psychiatric injury while, on the other, he pressed the view that the only relevant stressor was the one concerning the meeting on 20 February 2014.
- [14]The question for the Commissioner was whether or not the appellant had been assessed as having an injury within the meaning of the Act at a time more than six months before he lodged his application for compensation. In order to answer that question, the Commissioner had regard to the medical records of the appellant, the evidence from the doctors, and the express purposes for which he was treated from 2008 until April 2014. The conclusion that the Commissioner reached was that the appellant was first diagnosed with an adjustment disorder attributable to work-related issues on 28 January 2010. There was evidence to support that conclusion."
- [50]In the case of Weder he was assessed by Dr Matthews as suffering from an injury by a doctor in accordance with the provisions of the Act and issued with a manuscript medical certificate by DR Matthews on 9 September 2013 which certified Weder as being incapacitated for work from 9 September 2013 until 24 September 2013.
- [51]The workers' compensation medical certificate issued by Dr Matthews on 16 March 2015 certified:
- a diagnosis of adjustment disorder with mixed anxiety and depressed mood;
- Weder first saw Dr Matthews for the injury on 9 September 2013;
- stated date of injury is "over a period of time";
- stated cause of injury was workplace stressors;
- injury is consistent with Weder's description of cause; and
- Weder was not able to work from 16 March 2015 to 16 April 2015.
- [52]The appellant's argument offered in support of the appeal cannot be accepted because:
- Dr Matthews offered a workers' compensation medical certificate on the day. The fact Weder chose not to lodge an application does not affect the assessment;
- Dr Matthews issued a manuscript medical certificate on 9 September 2013 certifying as being incapacitated from work from 9 September 2013 until 24 September 2013 which is no different to the workers' compensation certificate issued by Dr Matthews on 16 March 2015;
- as observed in Blackwood v Toward by Martin P Weder is entitled to other compensation in accordance with the Act:
"The respondent also argued that to construe s 141(1) as I have would create an anomaly because, in his situation, no medical treatment or rehabilitation was required. Thus, says the respondent, it would be anomalous to require the lodgement of an application for compensation 'at that time when no compensation would have been payable'. But that is incorrect. The respondent was entitled to compensation - for the treatment he received and for the medication he took. The issue here is entitlement - not its quantum."; and
- there is no merit in Weder's argument he was unfamiliar with the relevant law.
- [53]Dr Matthews' medical certificate issued on 9 September 2013 at a time when he held concerns that Weder had either an adjustment disorder with depressed mood or a major depressive episode secondary to work pressures. In the time period immediately following the 9 September 2013 consultation Weder continued to seek treatment on multiple occasions during which time he continued to raise issues of concern within the workplace.
- [54]There is no doubt that Weder's entitlement to compensation arose on 9 September 2013 and having regard for DeAlwis there were multiple occasions where Dr Matthews could have assessed an entitlement for compensation in accordance with the provisions of the Act.
Can Weder prove
- Mistake;
- Absence from the State; or
- Reasonable cause.
- [55]There was no evidence of any mistake operating to prevent him from lodging his application for compensation within the statutory time period. See:
- Black v City of South Melbourne[7] (Black); and
- Augustynski v Simon Blackwood (Workers' Compensation Regulator)[8].
Reasonable Cause
- [56]
"Which a reasonable man would regard as sufficient, a cause consistent with a reasonable standard of conduct, the kind of thing which might be expected to delay the giving of notice by a reasonable man."
- [57]In Black, the Full Court of the Supreme Court of Victoria considered that the enquiry in respect of "reasonable cause", when compared with the enquiry as to "mistake":
"…appears to be of a much wider kind justifying a more liberal attitude. The expression 'reasonable cause' appears to us to mean some act or omission which operated to prevent the giving of notice, and which was an act or omission which was in the circumstances reasonable. In Quinlivan v Portland Harbour Trust, [1963] VicRp 5; [1963] VR 25, at p. 28, Sholl, J, used these words:
'The sub-section means to refer to a cause which a reasonable man would regard as sufficient, a cause consistent with a reasonable standard of conduct, the kind of thing which might be expected to delay the giving of notice by a reasonable man'."
- [58]
"…Reasonable cause cannot and should not be defined. Each case turns on its own facts and circumstances in that regard.
I find, however, that the test to be applied to such facts and circumstances is objective and not subjective. To hold otherwise would result in an impossible situation as regards assessment of claims for compensation. The proven facts must be assessed, uncoloured by feelings or personal opinions. In my opinion, that is the true test to be applied to claims under this legislation".
- [59]Other authorities cited with regards to reasonable cause included:
- Wiley v Q-COMP[11];
- Cook v Q-COMP[12];
- Susan Marshall AND Q-COMP[13];
- Telstra Corporation v Roycroft[14]; and
- Whitehead v Workers' Compensation Regulator[15].
- [60]Having regard for all of the cited decisions, Weder had not demonstrated any reasonable cause for failing to lodge the application for compensation within the required time frames.
If mistake or reasonable cause was proved should discretion at s 131(5) of the Act be exercised to waive s 131(1)
- [61]In Black the Court held that it is a mistake or reasonable cause during the six month period that has to be shown. Delay after that period had expired is irrelevant to this purpose, though it may in some cases be relevant to the question of prejudice, or in the manner in which the Court discretion should be exercised.
- [62]In R v Workers' Compensation Board of Queensland ex parte Heffernan[16] where Kelly J, with whom Stable SPJ and Dunn J agreed, held that:
"The first matter for consideration is what was the duty of the Office in relation to an application filed after the expiration of the six months period prescribed by clause 4(2) of the Schedule. Firstly, it was required to consider whether the failure to make the application within the prescribed time was due to mistake, absence from Queensland, or other reasonable cause. If it was not satisfied that the failure was due to any of those matters then there is no power to waive the time provision and that would be the end of the matter. If, however, it was satisfied that the failure was due to any one of those matters the question arises whether the time provision must then be waived or whether the Office has a discretion whether or not to do so, and if there is such a discretion, what matters it may properly take into account in its exercise."
- [63]Other authorities cited in relation to the exercise of discretion included:
- Australia and New Zealand Banking Group Limited v Q-COMP[17];
- Cook v Q-COMP[18];
- Churchill v Q-COMP[19]; and
- Blackwood v Toward.
- [64]Weder had been constantly advised by Dr Matthews that he should lodge an application for compensation but chose not to do so and the condition deteriorated. There are no circumstances that would warrant discretion to exercise the extension of time.
Conclusion
- [65]The burden of proof had not been discharged by Weder with it being appropriate to make the following orders:
- appeal be dismissed;
- decision of the Review Unit be confirmed; and
- the appellant pay the Regulator's costs of the appeal to be agreed or failing agreement to be the subject of a further application to the Commission.
- [66]In further oral submissions references were made to ss 209 and 210 of the Act regarding the liability for medical treatment and expenses. The Act at s 209 states:
"This part applies if medical treatment or hospitalisation of a worker is required for the management of an injury sustained by the worker."
- [67]The assessment of Dr Matthews at the relevant time was that Weder required treatment for his condition which included the prescription of anti-depressant medication as well as continuing treatment. The application of s 141 of the Act does not fall solely on whether there is an assessment of total or partial incapacity for work.
- [68]Weder had been aware of workers' compensation benefits and had chosen Dr Matthews because of his involvement in WorkCover claims and for the purposes of treatment. Dr Matthews spoke to him at an early stage about lodging the WorkCover claim.
- [69]The Commission will need to make a determination as to whether or not there was a partial incapacity for work and whether that was assessed at the time by a doctor. The fact is that Dr Matthews certified Weder as being unfit for work for a two week period which is an incapacity for work. In the course of the oral submissions references were made to other authorities that included:
- [70]On the appellant's submission in terms of the Blackwood v Toward decision providing a different outcome that effected case law, this was said not to matter in these circumstances because Weder had simply taken no action to make any application for compensation.
Conclusion
- [71]The matter for determination was in respect of the decision by the insurer and subsequently confirmed by the Regulator not to waive the time limit pursuant to s 131(5) of the Act for an application made for compensation by Weder on 4 August 2015.
Legislation - relevant to time limitations
- [72]The legislation applicable to the lodgement of an application for compensation is that of s 131(1) of the Act:
"An application for compensation is valid and enforceable only if the application is lodged by the claimant within 6 months after the entitlement to compensation arises."
- [73]In circumstances where a claim for compensation has been lodged outside the six month period identified in s 131(1) of the Act there is an avenue available for the requirements of s 131(1) of the Act to be waived subject to considerations of s 131(5) of the Act:
"An insurer may waive subsection (1) or (2) for a particular application if the insurer is satisfied that a claimant's failure to lodge the application was due to -
- (a)mistake; or
- (b)the claimant's absence from the State; or
- (c)a reasonable cause."
Assessed by a doctor
- [74]The evidence of the appellant is that on 9 September 2013 as a consequence of a referral by a general practitioner he attended upon Dr Matthews a Psychiatrist seeking treatment for a stress related condition. In terms of the referral Weder had nominated Dr Matthews as his medical specialist of choice based upon a recommendation of his [then] partner who amongst other things had mentioned Dr Matthews had WorkCover experience.
- [75]At the 9 September 2013 consultation it was evident that Weder had provided to Dr Matthews a full history regarding factors relating to his then psychiatric health which indicated there were no significant issues in his life outside of work-related factors. Weder had described in some detail the work-related conduct of the CFO at QIC as the source of his concerns with work-related issues and the effect that had upon his health.
- [76]Dr Matthews was at this time concerned that Weder had either developed an adjustment disorder with depressed mood or a major depressive episode secondary to his work pressures. Dr Matthews on that day had suggested Weder:
- consider the lodgement of a WorkCover claim; and
- a change of workplace.
Dr Matthews issued a medical certificate (dated 9 September 2013) which stated having been examined Weder was "unfit for duty" from 9 September 2013 to 24 September 2013 (inclusive) due to a medical condition. Further he commenced treatment by prescribing a course of anti-depressant medication for the purposes of improving sleep and addressing his mood symptoms. Under cross-examination Dr Matthews accepted the proposition that:
"…you express there that you were concerned that Mr Weder had either developed an adjustment disorder with depressed mood or indeed a major depressive episode secondary to his work pressures." [Transcript p. 1-23]
- [77]It was not of contest that Weder disregarded the finding of Dr Matthews that he was unfit for duty in the period 9 to 24 September 2013 and continued to present for work undertaking his duties as usual.
- [78]In the time period between 9 September 2013 and 9 February 2014 it is factual that Weder presented to Dr Matthews for treatment on a further eight occasions. In the report of Dr Matthews (dated 1 August 2016) he identified those particular consultations as:
- 16 September 2013;
- 25 September 2013;
- 2 October 2013;
- 17 October 2013;
- 29 October 2013;
- 12 November 2013;
- 2 December 2013; and
- 29 January 2014.
- [79]A summation of these consultations indicated that:
- Weder continued to be prescribed anti-depressant medication;
- he continued to feel intimidated and agitated at work;
- remained depressed;
- refused to accept a medical certificate for time off work;
- continued to struggle with pressures at work;
- depressive symptoms improved at times;
- his biological mood symptoms were more settled but there were ongoing work-related stressors which needed to be resolved; and
- he was not ready to make a WorkCover claim.
On the face it is reasonable to accept that 9 September 2013 was the date an entitlement for compensation arose with the six month period available in which to lodge a claim ceasing on or around 9 February 2014.
Medical Certificate
- [80]The medical certificate issued on 9 September 2013 had been described as a manuscript or general certificate during the proceedings and was therefore not compliant with s 132(3)(a)(i) of the Act:
"The application must be accompanied by -
- (a)a certificate in the approved form given by -
- (i)a doctor who attended the claimant".
- [81]Dr Matthews in evidence drew a distinction between the medical certificate issued on 9 September 2013 and the workers' compensation medical certificate (dated 6 March 2015) in which Weder was diagnosed with an adjustment disorder with mixed anxiety and depressed mood. The distinction was that the general medical certificate was for Weder being unfit for duty not incapacitated for work.
- [82]The Workers' Compensation and Rehabilitation Regulation 2014 (Regulation) provides guidance in respect of certificates given by practitioners in circumstances where a worker has lodged a medical certificate not in the approved form:
- "104Certificate given by dentist, doctor or nurse practitioner
- (1)This section applies if—
- (a)a certificate in the approved form is not lodged with an application made under section 132, 132A or 132B of the Act in relation to a worker who sustains an injury; and
- (b)the worker sustained the injury in another State or country.
- (2)The insurer must accept a written certificate that is substantially to the effect of the approved form from the dentist, doctor or nurse practitioner who attended the worker.
- (3)The certificate is taken to be a certificate in the approved form for section 132 (3)(a), 132A(3)(c)(i) or 132B(3)(c)(i) of the Act."
- [83]The application of the regulation has limited effect in that s 104(1)(b) of the Regulation refers to a worker having "sustained the injury in another State or country" however of interest is that it declares at s 104(2) of the Regulation, the insurer "must" accept a written certificate that is substantially to the effect of the approved form which offers for certain workers the legitimacy of a certificate not issued on the approved form as established at s 104(3) of the Regulation.
- [84]The medical certificate issued on 9 September 2013 confirmed that Dr Matthews conducted an examination of Weder on that day and based upon the examination had issued a medical certificate in "keeping with the policy of the Medical Board of Queensland, July 2002" that opined Weder was unfit for duty from 9 September 2013 until 24 September 2013 (inclusive) due to a medical condition. Whilst the medical certificate was not on an approved worker's compensation medical certificate I am satisfied the certificate issued identified a medical condition/injury that according to Dr Matthews' evidence had arisen "secondary to his work pressures". In the workers' compensation medical certificate issued on 6 March 2015 by Dr Matthews he stated the "worker was first seen at this practice/hospital for this injury/disease on 9.9.13".
Entitlement to compensation
- [85]The entitlement to compensation and an entitlement to weekly payments are the subject of separate provisions in the Act. At s 141(1) of the Act it states:
"The entitlement to compensation for an injury arises on the day the worker is assessed by -
- (a)a doctor;…"
- [86]In this case the entitlement to compensation arose on 9 September 2013 when Dr Matthews assessed Weder as being unfit for duty due to a medical condition that was secondary to his work pressures. That Weder ignored the advice to absent himself from work for the two week period does not in my view detract from having been assessed with an injury. He was prescribed medication to treat the condition and in the six month period crucial to the failure to lodge the application for compensation he undertook a further eight consultation with Dr Matthews relevant to his psychiatric condition.
- [87]In Blackwood v Toward in respect of s 141(1) Martin P found:
- "[29]Section 141(1) concerns the worker and whether, in the opinion of a doctor or other nominated medical professional, the worker has suffered a 'personal injury arising out of, or in the course of, employment if the employment is a significant contributing factor to the injury' as described in s 9. That is what is meant by 'the worker is assessed by … a doctor'. To confine it as the respondent suggests is to equate assessing a worker with assessing an injury.
- [30]The respondent also argued that to construe s 141(1) as I have would create an anomaly because, in his situation, no medical treatment or rehabilitation was required. Thus, says the respondent, it would be anomalous to require the lodgement of an application for compensation 'at that time when no compensation would have been payable'. But that is incorrect. The respondent was entitled to compensation - for the treatment he received and for the medication he took. The issue here is entitlement - not its quantum."
- [88]Clearly as from 9 September 2013, Weder if a claim for compensation had been lodged and accepted would have had an entitlement for the costs of medical treatment and medications prescribed in relation to the work-related medical condition.
- [89]Section 141(2)(a) of the Act states:
"However, any entitlement to weekly payment of compensation starts on -
- (a)if a doctor, nurse practitioner or dentist assesses the injury as resulting in total or partial incapacity for work on the day the worker stops work because of the injury - the day after the worker stops work because of the injury; or…"
- [90]In respect of an entitlement to the weekly payment of compensation it is not ambiguous, that such an entitlement is enlivened when a doctor (in this case) assesses the injury as resulting in total or partial incapacity for work on the day a worker stops work because of the injury.
- [91]Weder despite being issued with a medical certificate on 9 September 2013 that rendered him unfit for duty for a two week period continued to work and therefore the entitlement to a weekly payment of compensation would not have "kicked in" at that time but upon the acceptance of a claim would have applied from 13 March 2015 as he stopped work because of the injury.
- [92]On the changes to the law as at 24 March 2015 as a consequence of the decision of Martin P in Blackwood v Toward, the appellant relied upon the previous law that the assessment for a person seeking compensation was a diagnosis of injury that ruled a person had to be totally or partially incapacitated for work to access compensation which would have been an applicable standard in this case because the workers'injury was sustained prior to 24 March 2015 and would have been assessed on the previous law. Any consideration of this aspect of the appellant's case would in the present day be undertaken with the knowledge that Martin P in Blackwood v Toward had found that the decision in Downey was no longer good law and reliance on bad law brings with it its own consequences. Further it must be noted the application for compensation was lodged on 4 August 2015 at a time beyond the release of the decision in Blackwood v Toward.
- [93]The Act at s 141(1)(a) in its own right provided an entitlement to the payment of the costs of medical treatment and other associated expenses pursuant to s 210(1) of the Act once the worker had been assessed by a doctor:
- "210Insurer's liability for medical treatment, hospitalisation and expenses
- (1)The insurer must pay the cost of the medical treatment or hospitalisation that the insurer considers reasonable, having regard to the worker's injury."
- [94]In any event it was rightly conceded by the appellant in written submissions that a technical entitlement to compensation had arisen on the day a doctor first assessed the injury. The submission stated:
- "18.An entitlement to compensation arises which is the day a doctor first assess the injury.
- 19.However this is a technical only entitlement as there is no actual entitlement to payment of compensation until a doctor assesses the injury as resulting in total or partial incapacity for work and the worker stops the work.
- 20.The time limit for making a claim for compensation runs for 6 months after the technical entitlement to compensation arises (whether or not an actual entitlement for payment has arisen).
- 21.It is not contested that as a result of the statement of Dr Matthews in the March 2015 Certificate that the date that Mr Weder was first seen for the injury was 9 September 2013 means that a technical entitlement to compensation arose on that day and accordingly the legislative time limit for a claim was 6 months from that day (the 6 month limitation period)."
- [95]As mentioned in paragraph 79 of this decision the entitlement for compensation arose on 9 September 2013 in accordance with s 141(1) of the Act.
Ability to waive s 141(1) of the Act
- [96]The relevant provisions of the Act for the purposes of consideration around the waiving of the six month time period are at s 131(5):
- (5)An insurer may waive subsection (1) or (2) for a particular application if the insurer is satisfied that a claimant's failure to lodge the application was due to -
- (a)mistake; or
- (b)the claimant's absence from the State; or
- (c)a reasonable cause."
- [97]In Black it was stated:
"In Akermanis' Case, Sholl, J, held, correctly in our view, that what has to be shown is that the failure to give the statutory notice within six months was occasioned by mistake or reasonable cause. Delay after that period has expired is irrelevant for this purpose, though it may in some cases be relevant to the question of prejudice, or to the manner in which the court's discretion should be exercised."
- [98]The period for consideration in this case is from 9 September 2013 until 9 February 2014.
- [99]The appellant in choosing Dr Matthews as the medical specialist of choice had done so for reasons that related to the doctor's experience with WorkCover and identified a level of consideration that was evident prior to the first consultation on 9 September 2013 regarding the possibility of a WorkCover claim or at the very least something worthy of further enquiry. Dr Matthews on 9 September 2013 had suggested to Weder that he consider making a WorkCover claim and at a consultation the following week (16 September 2013) Weder had informed the doctor that he was not at that time considering a WorkCover claim.
- [100]Weder held a position within QIC that attracted a relevantly high salary commensurate with the duties he was required to undertake and was not by any means an "unsophisticated" person without the knowledge or whereto to have made a claim for compensation within the relevant period pursuant to s 131(1) of the Act. The evidence was that he only made an application for compensation following the severing of the employment relationship with QIC and for reasons best known to him had decided against making a claim in the relevant time frames.
- [101]There was no evidence before the proceedings that would satisfy the failure to lodge the application was due to mistake, an absence from the State or a reasonable cause.
Finding
- [102]Having considered the evidence, material and submissions before the proceedings I find the appellant had not established on the balance of probabilities that the failure to lodge a claim for compensation within the six month statutory period for lodging a claim was due to the provisions of s 131(5) of the Act being:
- "(a)mistake; or
- (b)the claimant's absence from the State; or
- (c)a reasonable cause."
- [103]Accordingly having made the abovementioned finding that no grounds existed to support the waiving of s 131(1) of the Act it is not necessary to give consideration to the exercise of discretion.
- [104]The appeal is therefore dismissed.
- [105]The decision of the Regulator dated 31 March 2017 is confirmed.
Costs
- [106]The appellant is to pay the Regulator's costs of and incidental to the appeal to be agreed or failing agreement to be the subject of a further application to the Commission.
- [107]I so order.
Footnotes
[1]Simon Blackwood (Workers' Compensation Regulator) v Toward [2015] ICQ 8
[2]Quinlivan v Portland Harbour Trust [1963] VR 25
[3]Van Dongen v Northern Territory of Australia [205] NTCA 6
[4]WorkCover Queensland v Downey (2001) 168 QGIG 381
[5]Appo v Q-COMP (2003) 174 QGIG 1120
[6]DeAlwis v Simon Blackwood (Workers' Compensation Regulator) [2016] ICQ 008
[7]Black v City of South Melbourne [1963] VR 34
[8]Augustynski v Simon Blackwood (Workers' Compensation Regulator) [2014] QIRC 207
[9]Quinlivan v Portland Harbour Trust [1963] VR 25
[10]Appo v Review Unit Q-COMP (unreported, Industrial Magistrates Court of Queensland, Barrett IM, 15 May 2003)
[11]Wiley v Q-COMP (unreported, Industrial Magistrates Court of Queensland, 30 May 2003)
[12]Cook v Q-COMP (2008) QGIG 220
[13]Susan Marshall AND Q-COMP (WC/2011/386) - Decision <http://www.qirc.qld.gov.au>
[14]Telstra Corporation v Roycroft (1997) 77 FCR 358
[15]Whitehead v Workers' Compensation Regulator [2012] QIRC 71
[16]R v Workers' Compensation Board of Queensland ex parte Heffernan (1979) Qd R 563
[17]Australia and New Zealand Banking Group Limited v Q-COMP (2004) 175 QGIG 1125
[18]Cook v Q-COMP (2008) QGIG 220
[19]Churchill v Q-COMP (2009) 190 QGIG 247
[20]Nuttall v Workers’ Compensation Regulator [2017] QIRC 069
[21]Appo v Q-COMP (2003) 174 QGIG 1120