External

It is reasonable to assume that, over time, products initially provided for those with long term compensable conditions will require replacement.

Determining replacement will mean addressing all the following aspects:

  • the length of time the employee has had the product;

  • the quality of the product;

  • the cost of replacement; and

  • whether the product is being replaced with the same or similar item.

Take the following case in point.

Example

An employee was provided with an orthopaedic mattress and base set in 1993 at a cost of $2,000.

In 1997, the employee requests a replacement bed worth $5,000.

In this case, it is not reasonable that the mattress be replaced as:

  •       the employee has had the mattress for only 4 years; well under the time that a mattress with ordinary wear and tear would require replacement;
  •       orthopaedic and other specialist mattresses are of a high quality, commensurate with their cost, and will always carry a set warranty period, of usually between 10 to 15 years;
  •       the replacement cost requested is far greater than that of simply replacing a mattress; and
  •       the mattress is clearly not being replaced by the same or a similar product – its cost alone supports this contention.

As with all replacement items under section 16, do not simply provide replacement at the employee's request.  It is important to consider all the 'reasonableness' aspects associated with replacement in the first instance.

  •       Contact reputable dealers regarding warranty periods, and where these are not available, still seek a professional opinion about the ordinary wear and tear expected lifespan of the product in question.
  •       Ensure that the requested replacement item is the same or similar to that originally purchased.  While it is expected that some increase in cost will occur due to inflation, any costs far in excess of that of the original purchase price should, at the very least, be questioned.
  •       Frequently, and in particular with mattresses, the cost of investigating 'reasonableness' issues easily balances against the cost of a replacement product.  Take the time to investigate thoroughly.
  •       Consider updating medical opinion on the employee's condition.  It may well be that replacement of the item is no longer a compensation issue.

Example

A mattress is purchased for an employee with a severe back condition.

Some 10 years later, the employee requests a replacement mattress be purchased.

However, he has not claimed any compensation for the past 3 years and medical evidence on the file indicates the condition at that time had resolved.

However, be careful not to assume that because there is little if any activity on a claim, the condition has resolved.  This cannot be automatically assumed.

Consideration should also be given to the product alleviating symptoms of the compensable condition to such an extent that claims for medical treatment and/or incapacity are not required.

The unreasonable refusal to provide a replacement product may mean a relapse in symptoms and subsequent alternative compensation payments.  This situation must at least be considered.

While product replacement is ultimately an individual case by case issue, common factors associated with the reasonable length of time for wear and tear, costs, and what the product is to be replaced with should be minimum considerations.