2.1.14 Medical Examinations - Overview

Medical Examinations - Overview

Where a claim has been lodged under Section 319, the MRCC has the power to require, where necessary, a person to undergo medical examinations with a medical practitioner of its choice.

Legislative authority

The authority to require a claimant undergo a medical examination is contained in Section 328 of MRCA [2].  When a letter is issued requesting that a claimant undergo a medical examination then this section of MRCA and section 329 which outlines the consequences of not attending must be quoted.  Failure to inform the claimant of their rights and obligations and directly refer to Sections 328 and 329 could contribute towards a contention by the claimant that they have a reasonable excuse for their failure or refusal to attend, and therefore prevent the suspension of compensation under s329(1) .  See also administrative procedures below at 2.1.14.2.

Section 329 provisions are to be used as a last resort and the delegate is to use discretion in its application. Section 329 also has sub-clauses that are designed to prevent hasty punitive action:

• Section 329(2) & (3) states that no sanctions can be applied if a reasonable excuse is provided.  If the excuse is provided after the scheduled appointment but within 14 days, then the MRCC can decide what day the suspension takes effect from.  This enables the delegate to effectively cancel the suspension in the event of a reasonable excuse for non-attendance, eg sickness or absence.
• Section 329(4) states that the delegate who decides to lift the suspension (if the person provides a reasonable excuse as per s329(3)) must be different to the delegate who applied the suspension.
• Section 329(5) states that once compensation is suspended the person cannot subsequently claim arrears for any period of suspension.  Any lump sum compensation that was payable in that period will be paid once the suspension is lifted.

2.1.14.1   Refusal or failure to undergo medical examination or obstruction of examination

If a person refuses or fails to undergo a medical examination without a reasonable excuse, or obstructs a medical examination, section 329 gives the MRCC the power to suspend compensation payments (except medical treatment) until the examination takes place. After any suspension commences, if the client subsequently complies and attends the required medical examination, the requirements of 328 (2) are satisfied and any entitled compensation payments can recommence. Any arrears during the suspension period is not payable. The lifting of a section 329 (1) suspension through eventual compliance by the client is self-executing and does not require a different delegate to make the determination.

Note, however, that a suspension in respect of a claim for one injury or disease does affect compensation payments in respect of all claims for all other conditions under this Act (excluding medical treatment).

Suspensions apply for the period of the suspension with any arrears that would otherwise have accrued during that period and would have been paid after the acceptance of liability not payable.

The MRCC will pay for the costs of medical examinations it has asked the person to attend and will also pay the cost of reasonable travel and accommodation expenses associated with attendance at such a medical examination.

2.1.14.2   Medical Examinations – Administrative Procedures

The following steps are to be followed for requiring claimants to attend medical examinations, and to pursue should the claimant fail to attend:

1. Identify the need for a medical examination and discuss possible appointment options with the medical practitioner.
2. Contact and advise claimant of the reason for the appointment. Ensure claimant is available to attend the medical examination. If not, ensure claimant has reasonable reasons for not attending. Liaise with medical practitioner for a suitable appointment.  Normally a suitable appointment can be arranged but the claimant may be unwilling to have a medical examination. In either event;

a)    make appointment and advise the claimant of the details in writing. Include in the letter the implications of not attending the medical examination as per section 329; and

b)    also specify that the information is required to determine the claim accurately and their failure to attend may result in the claim being determined with only the available information.

1. If the claimant fails to attend the medical examination then repeat steps (2a) and (2b).  When advising of this second appointment emphasise the sanctions that can be applied under section 329.
2. If the claimant again fails to attend the medical examination but has a valid excuse then repeat steps (2a) and (2b) as necessary.  However, if no valid reason is provided, advise the claimant in writing that they have twenty-eight days to comply with the Commission’s demand for them to attend a medical examination. The letter must specify Section 329 in advising the consequences of their failure to attend, especially that all payments other than for medical treatment will cease.
3. If the claimant still fails to attend a medical examination then cease all compensation payments.  This delegation rests at Executive Level 1 and above.
4. If the claimant provides a reasonable excuse for not attending the medical examination within fourteen days after the date fixed for the examination then the suspension of payments must be terminated by a date determined by the delegate.  This delegation rests at Executive Level 1 and above.  Section 329(4) specifies that any determination to terminate the suspension of payments must be made by a different delegate from the one who imposed the sanctions in the first instance.   

At the delegate's discretion claims may be determined using the information at hand.  If this results in the claim being rejected, the claimant may then follow the appeal process.