Workers' Compensation and Rehabilitation Amendment Regulations (No. 4) 1993 (WA)
6844 GOVERNMENT GAZETTE, WA [24 December 1993 WORKERS COMPENSATION AND REHABILITATION
WC3031. WORKERS' COMPENSATION AND REHABILITATION ACT 1981
WORKERS' COMPENSATION AND REHABILITATION AMENDMENT
REGULATIONS (NO. 4) 1993
Made by His Excellency the Governor in Executive Council.
Citation
1. These regulations may be cited as the Workers' Compensation and
Rehabilitation Amendment Regulations (No. 4) 1993.
Commencement
2. These regulations come into operation on the day on which section 25 of
the Workers' Compensation and Rehabilitation Amendment Act 1993 comes
into operation.
Principal regulations
3. In these regulations the Workers' Compensation and Rehabilitation
Regulations 1982* are referred to as the principal regulations.
[* Reprinted as at 30 April 1992.
For amendments to 20 December 1993 see 1992 Index to Legislation of Western Australia, Table 4, p. 324, and Gazette of 5 February, 17 ,September and 29 October 1993.1
Regulation 3 inserted
Before regulation 4 of the principal regulations the following regulation
4.
is inserted —
CC
AMA Guides
3. The first edition is prescribed for the purposes of the
definition of "AMA Guides" in section 93A of the Act.
Regulation 8 amended
5. Regulation 8 of the principal regulations is amended in
subregulation (1) —
(a) by deleting "shall be required, after" and substituting the
following —
CC
shall not be required under section 64 or 65 of the
Act, before
and
(b)
by deleting "not more frequently" and substituting the following —
CC , nor to do so more frequently
Regulation 10 amended
6. Regulation 10 of the principal regulations is amended by repealing
subregulation (1) and substituting the following subregulation —
CC
For the purposes of section 69 of the Act, a worker shall prove his identity and the continuance of the incapacity in respect of which a weekly payment is payable, by delivering to the employer or the employer's insurer, at intervals of 3 months, a declaration by the worker and by a medical practitioner in the form of or to the effect of Form 6. 71 (1)
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Regulations 10A and 10B inserted
7. After regulation 10 of the principal regulations the following regulations are inserted —
it
Request for reference to medical assessment panel
10A. A worker or employer requesting a reference to a medical
assessment panel under section 70 (1) of the Act is to —
(a)
request the reference in the form of Form 20 in Appendix I, modified as the case requires; and
(b) pay to the Executive Director a fee of $50.
Proceedings before medical assessment panel
10B. (1) When referring a question to a medical assessment panel the Director is to provide the panel with any medical certificates or reports or other documents that it may have that are relevant to the question to be determined by the panel.
(2) A medical assessment panel may determine the times
and places at which a worker is to attend before it.
(3) The form in which a medical assessment panel may require a worker to attend before it is the form set out in Form 13.
f 9
Regulation 19C amended
8. Regulation 19C (4) of the principal regulations is amended —
(a)
by deleting "subsection (5)" and substituting the following — „
subregulation (5) "; and
(b) in paragraph (b), by deleting "subregulation (4) (a) (i)" and substituting the following — iI4
paragraph (a) (i)
Regulation 19G amended
9. Regulation 19G of the principal regulations is amended —
(a) by inserting before "panel" the following — u
assessment "; and
(b) in paragraph (b), by deleting "Executive".
Appendix I amended
10. Appendix I to the principal regulations is amended —
(a) in Form 2, by deleting items 1 to 5 under the heading
"DETERMINATION" and substituting the following —
S4
1. Is, or was, the worker suffering from pneumoconiosis, mesothelioma or lung cancer?
2. If so, is, or was, the worker thereby disabled from earning full wages?
6846 GOVERNMENT GAZETTE, WA [24 December 1993 3. To what extent if any does, or did —
(i) pneumoconiosis;
(ii)mesothelioma;
(iii) lung cancer,
cause impairment of his ability to undertake
physical effort?4. What other, if any, disease or physical condition is, or was, contributing to the worker's disablement or death and to what extent?
5. Is, or was, the worker fit for work? If so, at
what level — light, moderate, or heavy?
(b) in Form 2B, by deleting " — travelling between home and work? 0 4";
(c) by deleting Form 3 and substituting the following Form — gg
FORM 3
Workers' Compensation and Rehabilitation Act 1981
[sections 57A (1) (b) and 57B (1) (b)] FIRST MEDICAL CERTIFICATE
= tick where appropriate. = delete where appropriate)
A. WORKER'S DETAILS
To: (Name and address of worker's employer)
Employer's contact person: (Supervisor) Phone Worker's name in full
Address:Phone
-
Occupation Date of birth: / /19 ....
Date and place of disability: . / 119 Worker's description of how the disability occurred:
Worker's description of the injury or disease: B. MEDICAL ASSESSMENT OF DISABILITY (see definition of 'disability" on reverse)
1. Date of 1st attendance- / /19 at: AM/PM 2.Diagnosis (include location of injury on the body, likely complications, effect of any
prior injury or medical condition)*
Is this diagnosis provisional? 0 Yes 0 No
3.It is my opinion that as from the date of this certificate the worker is:
(a) 0 Fit.
(b) 0 Fit BUT requires further treatment.
(c) 0 Unfit for normal duties *for .... weeks .... days/*until .... / .... /19... BUT may be fit for alternative duties. (See
C.1 below)
(d) U Totally unfit for work *for .... weeks .... days/
*until .... / .... /19 ...
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4. Management and/or treatment:
(a) 0 Home based (e) 0 Imaging
(b) 0 At surgery (f) 0 Physiotherapy (c) 0 Hospital (g) 0 Other (please specify) (d) 0 Referred to specialist, name.
C. VOCATIONAL REHABILITATION
(see definition of "vocational rehabilitation" on reverse)
1.If alternative duties are available, I am prepared to review the worker's
ability to carry out those duties.
2.Is vocational rehabilitation likely to be necessary?
0 Yes 0 No 0 Subject to review.
3. If referred to a rehabilitation provider, please specify:
This certificate has been compiled on the basis of the worker's statements to me and my physical examination of the worker. In my opinion the above diagnosis *does/does not correlate with the disability described to me by the worker.
I "will/will not review the worker.
Next appointment: / /19 at: AM/PM Should you wish to discuss the management and/or treatment of the worker, please contact me.
Name and address of registered medical practitioner: (please print or use stamp) Phone.
Signature: Date- / /19 .... WORKER'S AUTHORITY (to be signed at the option of the worker) certificate or not) to give to my employer, or his or her insurer, any information in relation to my claim for worker's compensation which he or she may have acquired with regard to me.
Signature: Date. / /19 ....
REVERSE OF FORM 3 Workers' Compensation and Rehabilitation Act 1981
Extracts from section 5 of the Act:
" [Here the form is to set out the definition of "disability" that is in the1/ Act.]
[Reference should also be made to sections 5 (4) and (5) of the Act.)
[Here the form is to set out the definition of "vocational rehabilitation"
"
that is in the Act.)
6848 GOVERNMENT GAZETTE, WA [24 December 1993
(d) by deleting Form 4 and substituting the following Form — tt
FORM 4
Workers' Compensation and Rehabilitation Act 1981
[section 61 (1)]
FINAL MEDICAL CERTIFICATE
[0 = tick where appropriate. * = delete where appropriate)
A. WORKER'S DETAILS
To: (Name and address of worker's employer) Worker's name in full:
Address:
Phone-
Date and place of occurrence of disability: / /19
B. MEDICAL ASSESSMENT OF DISABILITY
(see definition of "disability" on reverse)
1. Date of this attendance: / /19 at: AM/PM 2. Having examined the worker, it is my opinion that
as from / /19 .... :
(a) 0 the worker has wholly recovered from the effects of
the disability; OR(b) 0 the worker has partially recovered from the effects of
the disability; OR(c) 0 the worker's incapacity is no longer a result of the
disability.3.
It is also my opinion that as from / /19 .... the worker is:
(a) 0 Fit.
(b) 0 Fit BUT requires further treatment. (c) 0 Unfit for normal duties *for .... weeks .... days/
*until .... / .... /19... BUT may be fit for alternative
duties with the following limitations:(d) 0 Totally unfit for work *for .... weeks .... days/
*until .... / /19...
4. Grounds for the opinions in item 2 above:
(include clinical findings and diagnosis if necessary)
Name and address of registered medical practitioner: (please print or use stamp) Phone.
Signature: Date. / /19 .... REVERSE OF FORM 4
Workers' Compensation and Rehabilitation Act 1981
Extracts from section 5 of the Act:
" [Here the form is to set out the definition of "disability" that is in the ,, Act.]
[Reference should also be made to sections 5 (4) and (5) of the Act.]
ft;
| 24 December 1993] | GOVERNMENT GAZETTE, WA | 6849 |
(e) by deleting Form 6 and substituting the following Form — it
FORM 6
Workers' Compensation and Rehabilitation Act 1981
[section 691
DECLARATIONS IN RESPECT OF WORKER NOT RESIDING IN WA.
(0 = tick where appropriate. * = delete where appropriate]
To: (name and address of employer or employer's insurer) A. WORKER'S SECTION (full name of worker)
of
(residential address)
Postcode:. . .....
Occupation: Date of birth: .... / .... /19 .... *being duly sworn, say that/do solemnly and sincerely affirm that —
I. The above details about me are correct.
2. I reside at the above address.
3. On / .... /19 .... I suffered a disability when employed by (name and address of employer)
*Sworn/affirmed at
in (State or country) ) this day of 19
Before me: (a person having authority to administer an oath) B. DOCTOR'S SECTION (full name of medical practitioner)
of
(address)
Postcode.
*being duly sworn, say that/do solemnly and sincerely affirm that —
1. I am a duly qualified medical practitioner.
2. On / .... /19 ... I examined the above person and am of the opinion that he/she is —
(a) 0 Fit.
(b) 0 Fit BUT requires further treatment.
(c) 0 Unfit for normal duties *for .... weeks .... days/
*until .... / .... /19... BUT may be fit for alternative duties.
(See C.1 below)(d) 0 Totally unfit for work *for .... weeks .... days/
*until .... / .... /19 ...*Sworn/affirmed at
in (State or country) ) this day of 19 Before me: (a person having authority to administer an oath)
IF A WORKER RESIDES OUTSIDE THE STATE, PROOF OF THE
WORKER'S IDENTITY AND CONTINUING INCAPACITY IS
REQUIRED EVERY 3 MONTHS ft;
6850 GOVERNMENT GAZETTE, WA [24 December 1993
(f) by inserting before Form 14 the following Form — tt
Form 13 [Reg. 10B (3)]
Workers' Compensation and Rehabilitation Act 1981
REQUIREMENT TO MEND BEFORE A
MEDICAL ASSESSMENT PANEL
You are required to attend before a medical assessment panel at
at the hour of
on the day of 19 * and at that time to produce to the panel
(specified documents)
* delete if inapplicable
Dated
CHAIRMAN
Medical Assessment Panel
(g)
in Forms 14 and 15, by inserting after "mesothelioma" in each case the following —
a 01; /lung cancer
and
(h) in Form 20 —
(i)
in the heading, by inserting before "PANEL" the following —
" ASSESSMENT
(ii)by deleting "EXECUTIVE DIRECTOR" and substituting the
following —
"
DIRECTOR OF CONCILIATION AND
REVIEW
and
(iii) by inserting before "panel" the following —
a a assessment
By His Excellency's Command,
D. G. BLIGHT, Clerk of the Council.
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