Complete medical panel referral forms

The Workplace Injury Rehabilitation and Compensation Act 2013 empowers the Convenor of Medical Panels to issue directions as to the arrangement of business of the Medical Panels. These are published as 'Convenors Directions' and provide administrative guidance for referral.

Current versions available at the Medical Panels website.

In general, Medical Panel Under the legislation, unless inconsistent with the context or subject-matter — Medical Panel means a Medical Panel constituted under Division 2 of Part 12 referral forms should be used for referrals only and must be typed.

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Please refer to the following specific instructions when completing referral forms.

By Action
Worker’s address

Provide the worker’s current address when making a referral to a Medical Panel.

Confirm the current address with the worker before completing the referral document.

Accepted injuries

Provide an accurate and full description of those injuries for which liability has been accepted as arising out of the one event or circumstance. Be precise as the worker may accept the psychiatric assessment but reject the physical assessment or vice versa.

For assessments of psychiatric impairment, occupational asthma or infectious occupational disease, please state whether or not the updated guidelines apply in particular whether the initial impairment assessment was conducted on and after 28 July 2006.

Date of Injury Referrals should be limited to injuries arising from a single incident. If the worker has claimed for multiple incidents on the same claim form, a separate referral form for each incident should be submitted.
Issues and reason for referral Record details of independent impairment assessment, the worker’s response to this assessment and any other information relevant to the Medical Panel referral. Also record details of any facts relevant to the IB claim and whether they are agreed or disputed.
Schedule of reports

Enclosure A: must always be on a separate page. All reports and correspondence relevant to the assessment should be recorded on this form and provided to the Medical Panel.

Also include any:

  • prior Medical Panel opinion and reason
  • Conciliation Outcome Certificate
  • Notice of Entitlement and worker’s response and
  • videotape/s /DVD/CD from any surveillance reports obtained.
Certification Ensure that the information detailed in this section has been provided to the worker or their representative.

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