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20.7.8 Use of appropriate medical specialists
In most cases, the medical opinion of the client's treating medical specialist is (at least initially) to be sought in preference to other (i.e. consultant) specialist medical opinion.
This is because the various appeal forums (AAT, Federal Court) generally give greater credence to the opinion of a specialist who has seen the client over a period of time and for the purposes of treatment, rather than a consultant who has seen the person only once and only for the purposes of writing a report.
However, it frequently happens that a client does not have a treating specialist. Also, but more rarely, there may be a treating specialist but the Delegate may be unsatisfied with that doctor's response. In either case, the Delegate may need further medical advice to make an informed decision on Incapacity.
The medical specialist commissioned to conduct this medical examination should be selected with care, having regard to qualifications, known experience or expertise in the field and – if known – the quality and comprehensiveness of previous reports.
While the cost of the doctor's services is certainly a factor, given the large sums potentially at stake in either a concession or denial of Incapacity and the issues of client welfare, the quality of advice is a much higher priority. In general, therefore, Delegates should choose medical referees primarily on the basis of quality of advice rather than primarily on the cost of the service.
Section 54(2)(b) of the SRCA requires medical certificates in support of a claim, to originate from a 'legally qualified medical practitioner'. This includes claims for payment as well as initial liability. See 20.4.1 and 20.5 of the SRCA Incapacity Handbook. Delegates may not, therefore, accept certificates of Incapacity written by persons other than medical doctors i.e. persons legally qualified and licensed to practice medicine under Australian law.
Certificates from para-professionals such as physiotherapists, chiropractors, podiatrists etc. are not acceptable. Of course delegates should not accept Incapacity certificates – or in fact any form of advice – from practitioners of non-mainstream practices such as traditional Chinese medicine, 'natural' therapists, herbalists etc.
With respect to cases involving mental illness, delegates should be aware that while psychiatrists are specialist medical doctors – i.e. licensed to practice medicine – psychologists are not. Nevertheless, certificates of Incapacity may usually be accepted from the clients' treating clinical psychologist, at the discretion of the delegate, providing that the client has been properly referred to that psychologist by either the treating GP, or by a qualified psychiatrist i.e. for the purposes of ongoing therapy. Where however all of a client's certificates of Incapacity over a six month period come exclusively from a psychologist, a delegate should require periodic validation of that ongoing Incapacity by a specialist psychiatrist or, if seen regularly by a GP for treatment, medication, etc. – that treating GP.
Whichever doctor referred the client to the psychologist should also provide an opinion as to whether the program of psychological treatment continues to be of benefit.
Most (though not all) Incapacitated clients consult both a Specialist and a General Practitioner. Medical certification of Incapacity for employment may of course be accepted from either that medical specialist or the GP. However, where specialist and GP advice conflicts, the specialist advice is to be preferred (always provided, that the specialty is in the field relevant to the compensable injury).
Independent advice will often be appropriately obtained from an Occupational Physician rather than a specialist in assessing capacity for work issues.
Ensure that the appropriate specialist is utilised for reports and opinions, e.g. use a Psychiatrist (rather than a Psychologist) for a psychiatric disorder.
Where multiple conditions are involved or there are particular complexities consider using a specialist organisation such as Medico-Legal Consultants for comprehensive reports.