ASHLEY RUSSELL PRINCIPAL LAWYER WORKERS COMPENSATION INDEPENDENT REVIEW OFFICE INDEPENDENT LEGAL ASSISTANCE REVIEW SERVICE (ILARS) APPLICATIONS FOR GRANTS - WHAT WE NEED 1

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ILARS Policy for funding of applications by injured workers to pursue claims for compensation at page 2 states; “As long as the matter appears to have some prospects of success funding will ordinarily be granted to conduct preliminary enquiries.” Whilst WIRO do not expect a lawyer to incur disbursements prior to obtaining a WIRO grant of assistance we do require some supporting documents to establish that a claim has some prospects of success. Once preliminary funding has been approved WIRO expects that lawyers will deal with and seek to resolve matters expeditiously. APPLICATIONS FOR GRANTS OF FUNDING FOR PRELIMINARY INVESTIGATION 1.THE GENERAL TEST APPLIED WHEN ASSESSING APPLICATIONS FOR PRELIMINARY INVESTIGATION Page 3

ILARS Policy for funding of applications by injured workers to pursue claims for compensation at page 1 states; “In order for ILARS to consider approving funding a brief statement of the basis for a potential claim is essential.” This statement should at a minimum provide the following details; Name and Date of Birth of the worker; Employer and job description; Date of Injury; Circumstances surrounding the injury; Name of treating doctors and specialists; Details of whether the insurer has accepted liability for the injury. APPLICATIONS FOR GRANTS OF FUNDING FOR PRELIMINARY INVESTIGATION 2.THE IMPORTANCE OF A BRIEF STATEMENT OF THE WORKER Page 4

Documents and/or information to support that the worker has some prospects of success of being assessed as having an impairment for a physical injury that is “greater than 10%” (s66(1)) and/or a primary psychological injury that is “at least 15%” (s65A(3)). Documents and/or information to support your submission that the worker has some prospects of success of being assessed as having reached Maximum Medical Improvement (MMI)? Examples of documents that could be provided; Brief statement from the worker as to; Date of injury; Previous injuries/claims; Ongoing effects of the injury and ongoing impairment; Treatment information – when the worker last saw the specialist and what did the specialist tell them? s126 treating doctor and specialist reports. APPLICATIONS FOR GRANTS OF FUNDING FOR PRELIMINARY INVESTIGATION 3.GRANTS FOR PRELIMINARY INVESTIGATION OF LUMP SUM COMPENSATION Page 5

If your application seeks to make a claim for lump sum compensation - documents and/or information to support that the worker has some prospects of success of being assessed as having an impairment that is “greater than 10%” (s66(1)) or 6% BHL where the date of injury is prior to 1 January (BP v Greene). Where funding is granted on the basis of BP v Greene WIRO will only provide conditional funding. A brief statement addressing; Details of the tendencies, incidences or characteristics of the workers employment which would give rise the claimed hearing loss during the course of the employment; Details of any previous claims for industrial deafness. If your application seeks to make a claim for hearing aids - documents and/or information to support your submission that the worker requires hearing aids. An audiogram as to BHL should be annexed to all applications for claim for impairment for hearing loss. If the date of injury is prior to 2002 proof of employment. At the very least this would involve a the statement from the worker as to the name and address of the employer, the specific part of the business where the worker was employed and the name of a boss and/or colleague. APPLICATIONS FOR GRANTS OF FUNDING FOR PRELIMINARY INVESTIGATION 4. GRANTS FOR PRELIMINARY INVESTIGATION OF HEARING LOSS CLAIMS Page 6

A copy of the s74 notice you are seeking to challenge. Provide quantification of the claim you are seeking funding to pursue - ILARS grants of funding will generally not be made where the amount in dispute is less than $3,000. Consider the application of the decision of Sabanayagam v St George Bank [2016] NSWWWCCPD 3 and the WIRO WIRE dated 1 February Provide documents to support the submission that the proposed claim to challenge the insurer’s decision has some prospects of success. This would include; Workers statement – This is essential for psychological injuries; Witness statements; Certificates of Capacity; s126 documents (if available)- treating doctor reports from insurers. APPLICATIONS FOR GRANTS OF FUNDING FOR PRELIMINARY INVESTIGATION 5.GRANTS FOR PRELIMINARY INVESTIGATION OF WEEKLY BENEFITS Page 7

A copy of the s74 notice you are seeking funding to challenge. Provide quantification of the claim you are seeking funding to pursue - ILARS grants of funding will generally not be made where the amount in dispute is less than $3,000. Consider the application of the decision of Sabanayagam v St George Bank [2016] NSWWWCCPD 3 and the WIRO WIRE dated 1 February Information relevant to the application of s59A – when was the claim first made or were weekly benefits last paid? Provide documents to support the submission that the proposed claim to challenge the insurer’s decision has some prospects of success. This would include; Treating doctor request for treatment and/or service; Workers statement; Certificates of Capacity. APPLICATIONS FOR GRANTS OF FUNDING FOR PRELIMINARY INVESTIGATION 6.GRANTS FOR PRELIMINARY INVESTIGATION OF MEDICAL EXPENSES Page 8

Documents to support that the worker satisfies the preconditions to a commutation (s87EA Workers Compensation Act 1987). For example provide copies of previous complying agreements or award which establish that the worker’s degree of impairment is at least 15%. Attached a document to establish that the insurer is open to commutation of the claim. APPLICATIONS FOR GRANTS OF FUNDING FOR PRELIMINARY INVESTIGATION 7.GRANTS OF PRELIMINARY INVESTIGATION OF COMMUTATIONS Page 9

If the matter appears to be arguable before the Commission funding will ordinarily be extended to proceed to the Workers Compensation Commission. In order for funding to be extended to the Workers Compensation Commission page 3 of the ILARS Policy for funding of applications by injured workers to pursue claims for compensation states; “Where the worker wishes to lodge an application to resolve a dispute for a matter that appears arguable before the Commission and no attempts to resolve the dispute with the insurer have been made, WIRO may refer a pre-litigation inquiry back to the insurer.” APPLICATIONS FOR GRANTS OF FUNDING TO PROCEED TO THE WORKERS COMPENSATION COMMISSION 1.THE GENERAL TEST APPLIED WHEN ASSESSING APPLICATIONS FOR FUNDING TO PROCEED TO THE WORKERS COMPENSATION COMMISSION Page 10

Copies of the medical and other material obtained to support that the matter is arguable before the Workers Compensation Commission. Material to support that attempts have been made to negotiate the matter with the workers compensation insurer prior to seeking the funding to proceed to the Workers Compensation Commission. For example: A copy of an application for review of the claim on behalf of the worker under section 287A of the Workplace Injury Management and Workers Compensation Act A copy of the permanent impairment claim form and insurer’s response. APPLICATIONS FOR GRANTS OF FUNDING TO PROCEED TO THE WORKERS COMPENSATION COMMISSION 2.DOCUMENTS AND INFORMATION REQUIRED FOR GRANTS AND EXTENSION OF GRANTS OF FUNDING TO PROCEED TO THE WORKERS COMPENSATION COMMISSION Page 11

Establish that the matter is set down for a conciliation/arbitration hearing before the Workers Compensation Commission. Provide details of the date and time for the conciliation/arbitration hearing. Provide brief submissions to support that retaining counsel is reasonably necessary. Page 10 of ILARS Policy for funding of applications by injured workers to pursue claims for compensation states that funding for counsel will be considered reasonably necessary if; The issues in dispute are complex and/or; The matter involves poorly understood, poorly articulated, novel and/or significant area of the law and/or; Counsel is local to the venue for the hearing and it is reasonable to attend in place of an instructing solicitor. APPLICATIONS FOR GRANTS OF FUNDING TO PROCEED TO THE WORKERS COMPENSATION COMMISSION 3.INFORMATION REQUIRED FOR GRANTS OF FUNDING FOR COUNSEL Page 12

Where a worker is unsuccessful before the Commission or receives a Medical Assessment Certificate that she or he wishes to dispute, funding for legal assistance to appeal these decisions may be available. The Lawyer should provide a copy of the decision that the worker wishes to dispute and reasons why the Lawyer believes that an appeal would be arguable. If the matter appears to be arguable funding will be available for an appeal. APPLICATIONS FOR GRANTS OF FUNDING TO PROCEED TO THE WORKERS COMPENSATION COMMISSION 4.INFORMATION REQUIRED FOR GRANTS OF FUNDING FOR APPEALS Page 13

GRANTS OF FUNDING FOR TRAVEL Travel expenses for attendance at conciliations and arbitrations before the Commission and attendance at medical examinations will be reasonably necessary where: A worker needs to travel to a medical appointment or the Commission and cannot meet their own travel expenses; and/or A Lawyer needs to travel to a Commission; and/or The injured worker needs a support person to travel with them, particularly if the claim relates to a psychological injury. – please provide medical support as to the need for a support person. When booking IME appointments for a worker be sure to book the appointment with the suitably qualified examiner that is as close to the workers home as possible. If an IME is booked that is not the closest IME kindly provide WIRO with submissions supporting the need for the worker to travel the extended distance. Page 14

MATTERS TRANSFERRED BETWEEN LAW FIRMS ILARS grants of assistance are non transferrable between law firms. A new application for funding must be made by the new law firm. Where a matter is transferred from one Lawyer to another before the matter is resolved the amount of any existing grant will be apportioned between the Lawyers according to the amount of work done by each Lawyer. The Lawyers should attempt to negotiate between themselves as to how the grant should be apportioned and render invoices accordingly that do not exceed the amount of the grant. If the Lawyers are unable to reach agreement on the amounts payable, WIRO will make a determination about the apportionment of the grant. Page 15

DOCUMENTS AND INFORMATION REQUIRED FOR ASSESSMENT AND PROCESSING OF TAX INVOICES Be addressed to WIRO and be forwarded electronically to the WIRO Principal Lawyer handling the matter; Be generated on your firm’s letterhead and include your registered business name, address and Australian Business Number; Include the worker’s name and our ILARS reference number; Include your Bank details for EFT purposes; Not include GST on any disbursement; Provide tax invoices to support any disbursements that are listed in the tax invoice; Include a unique invoice number for the firm rendering the invoice; Be forwarded as a separate PDF document - This includes separating the law firm tax invoice from the supporting disbursement invoices and settlement/COD documents; A copy of the documentation which explains how the matter resolved. For example: A copy of the signed Complying Agreement; A copy of any Consent Orders, Certificate of Determination or Medical Assessment Certificate; Other documentation which explains how the matter has been resolved. For example if the worker withdraws their application provide an explanation of what has occurred. Page 16

HOW CAN WIRO/ILARS HELP YOU? Assistance with obtaining s126 documents Follow up of IME’s or treating doctors who are seeking to charge outside the relevant fees order Any general enquires about ILARS funding call Page 17

QUESTIONS ? Page 18

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