Claims received after licence commencement

9.Notwithstanding the licensing arrangements, it is possible that claims may occasionally be received in Comcare from ADI employees.  Such claims must be rigorously examined to establish:

• the date of injury;

• in the case of claimed recurrences or aggravations of conditions previously accepted as compensable under the SRC Act, whether the condition under claim should be treated as a continuation of the previous claim, or whether there is evidence of a fresh injury which occurred after licence commencement.

Date of injury

10.In cases of simple traumatic injury, the date of injury should be fairly easy to establish.  Where the claim concerns a disease the date of injury shall be the day when:

• the employee first sought medical treatment for the disease or aggravation; or

• the disease or aggravation resulted in the death of the employee or first resulted in the incapacity for work, or impairment of the employee;

whichever happens first [section 7(4) of the SRC Act].

11.Particular care should be taken when examining claims for conditions of gradual onset such as occupational overuse syndrome, behavioural disorders, degenerative back conditions, rotator cuff syndrome and noise induced hearing loss.

12.Where the date of injury is 7 February 1996 or later, the claim and supporting documents should be forwarded to ADI, and the employee given the following advice:

'ADI now administers its own compensation claims under licence from the  Safety, Rehabilitation and Compensation Commission, effective from 7 February 1996.  As the date of your injury appears to be after that date, your claim should be considered by ADI, and has accordingly been referred to:

The Rehabilitation and Compensation Manager

ADI Ltd

PO Box 5214

CHATSWOOD WEST   NSW   2067'.

[Note: In cases of disease it may be necessary to advise ADI of the basis on which the date of injury was decided].

13.Compensation will not be payable by Comcare for loss of hearing unless it can be established that the date of injury was prior to 7 February 1996.

Recurrences and aggravations

14.The fact that the condition under claim is a 'recurrence' or 'aggravation' of an injury or disease for which compensation was previously paid under the SRC Act does not necessarily mean that an episode that occurs after licence commencement should be regarded as being a continuation of the previous claim.

15.Claims for recurrences, aggravations or continuation of prior claims must be thoroughly investigated to establish whether there has been a new incident or further employment contribution which occurred after licence commencement, which would be sufficient to conclude that the current episode is unrelated to the condition previously accepted under the SRC Act.

16.Section 4 of the SRC Act makes it clear that both 'injury' and 'disease' include the aggravation of an injury or disease and that 'aggravation' includes an acceleration or recurrence.  An employee who, for example, suffers a clearly defined aggravation of a previously accepted back condition while lifting at work may be eligible for compensation on the basis that a new injury has occurred.  Should an ADI employee be injured in these circumstances after licence commencement, it should be determined that the current episode is an aggravation that arose out of or in the course of his or her post-licence ADI employment [rather than pre-licence ADI employment] and that the claim is to be decided by ADI rather than Comcare.

17.Where the employee has claimed for a recurrence as being a continuation of a condition that was previously accepted under the SRC Act and Comcare is satisfied that the recurrence is attributable to an incident after licence commencement, the claim must be decided by ADI.  The claim and supporting documents should be returned to ADI [with an explanation to the above effect], and the employee given the following advice:

'ADI now administers its own compensation claims under licence from the  Safety, Rehabilitation and Compensation Commission, effective from 7 February 1996.  As the date of the incident appears to be after that date, your claim should be considered by ADI, and has accordingly been referred to [appropriate officer in ADI]'.