AMA calls for workers compensation and MAIB reform

The Australian Medical Association (AMA) Tasmania has called for a review of Workers
Compensation and MAIB claims processes amid fears the system is risking optimum health
outcomes, is too expensive and is forcing some doctors out.

AMA Tasmania President Dr John Davis said as it currently stands, medical practitioners are
being overburdened by the claims management practices of insurance companies when
dealing with Private Workers Compensation Insurers and the MAIB.

“Increasingly we are getting more and more reports of our members being frustrated with
unnecessary paperwork when dealing with compensation claims through the MAIB and
private insurers,” Dr Davis said.

“More importantly this is leading to poor outcomes for people who have the misfortune to
suffer an injury at work or on our roads.”

Dr Davis’s comments are part of an AMA submission to the Tasmanian Chamber of
Commerce and Industry’s review of red tape in Tasmania.

“The problems tend to centre on patients with injuries that take longer to resolve or improve
or that require spinal surgery, with private insurers and the MAIB increasing their
requirements as part of the claims processes and often adopting an unnecessary legalistic
approach,” he said.

“The extra burdens required often leads to delays in the provision of appropriate care.
Assumptions are made that the injury is simple and will be resolved, delaying access to
consultant medical practitioners. The insurers attempt to exert control over the level of care
provided to the patient.

“Approval for recognised investigation and treatment procedures are often rejected or
decisions delayed on the basis of clerical decisions or the opinion of doctors engaged by the
insurance industry.

“These can lead to significant delays as practitioners are forced to wait for an insurer to
obtain an independent medical opinion to approve a relatively straightforward investigation
or treatment procedure.”

Dr Davis said these delays can have significant implications for the recovery of patients and
in some cases have a negative impact on their psychological wellbeing, compounding the
risk of a poor outcome.

“In the long term, these delays also cost the system more, as more treatment is then
required,” Dr Davis said.

The AMA has recommended a series of reforms designed to reduce disputation, create
protocols for claims managers, promote the use of case conferences, review mechanisms to
appoint rehabilitation providers and develop a code of conduct for independent medical
assessors.

“Strategies to improve the independence of medical assessors and mechanisms to resolve
claims without undue legal involvement, in combination with measures to assist doctors to
better identify the prognosis early in the course of a claim, would substantially improve
efficiency and outcomes,” Dr Davis said.

“While there is a need for financial organisations to control their costs, it is also important not
to lose sight that aggressive or overly bureaucratic claims management contributes to poor
medical outcomes, which in turn lead to increased costs.

“If something isn’t done, there is a risk that doctors will withdraw from the system and the
whole community will suffer the burden of poorer health outcomes and increased insurance
costs.”
AMA Tasmania President Dr John Davis