Medical evidence is required to assist the Claims Manager to address the following questions.
Is there a medical condition?
Unless the employee suffers from an identifiable medical condition there is no 'injury' within the meaning of Section 4 of the SRC Act 1988. It is particularly important in stress related cases to differentiate between what might be described as 'a fit of temper', generalised feelings of distress or inability to cope and a genuine psychological condition.
What is the nature of that condition?
Mental Health specialists consider “stress” to be an umbrella term covering a range of more specific psychological disorders, including post traumatic stress syndrome, anxiety conditions and depression. These conditions may be distinguished from more everyday occurrences such as moodiness or a temper outburst according to defined diagnostic criteria.
Generic terms such as “work related stress” are not sufficiently specific, just as a diagnosis of “RSI” does not accurately describe tenosynovitis of the right wrist.
Diagnosis of specific psychological conditions may be made by specialist practitioners such as psychiatrists and clinical psychologists.
What factors influenced the development and course of the condition?
Medical specialists may make judgements about what factors have genuinely contributed to an illness and what weight these factors can be given; something a Claims Manager may not do.
Of course, it is important to establish whether the history on which this opinion is based is an accurate reflection of the facts. If there is conflict between what is fact and the history on which the specialist makes his or her assessment, the Claims Manager has a number of options.
- Choose not to accept the medical opinion since it is not based in fact;
- Put the accepted facts to the specialist and seek clarification by asking
- questions;
- In the event of conflicting medical opinion, make a judgement about
- what is considered to be the preferred opinion; there must be reasons for the
- stated preference, e.g., the opinion of one specialist may be preferred over
- another if the former did not have the benefit of a complete history.
The Claims Manager MAY NOT at any time reach a conclusion on a medical issue on the basis of personal understanding, observation or instinct.