Motor Accident Injury Assessment Scheme Accreditation Panel

Transcription

1 5 October 2018 The Hon Vickie Chapman MP Attorney-General GPO Box 464 ADELAIDE SA 5001 via Dear Ms Attorney Motor Accident Injury Assessment Scheme Accreditation Panel 1. I refer to your letter of 26 September 2018 in relation to the Motor Accident Injury Assessment Scheme (MAIAS) Accreditation Panel ( the Panel ). 2. The Society notes that you are considering the ongoing role for and retention of the Panel. The Society appreciates the opportunity to consider your proposal that the current functions performed by the Panel be formally transferred to and undertaken by the CTP Insurance Regulator ( the Regulator ). 3. The Society considers that while the Panel was integral in the establishment of the MAIAS, it also has an important ongoing role in the administration and management of the Scheme. As such, it does not support the proposal that the functions of the Panel be absorbed by the Regulator. 4. The Panel was established by your predecessor under section 76(2) of the Civil Liability Act (1936). It comprises of broad membership including the Australian Medical Association (AMA) (SA), the Law Society of South Australia, the Regulator and a nominee of the designated Minister. For the reasons explained below, the presence of representatives from the AMA and the Society provide expertise and industry knowledge that are integral in ensuring the Scheme and that those accredited under it are of a high standard. 5. It is unclear what the benefit would be of losing the broader input of the AMA and the Society in relation to the accreditation of medical experts by confining this role to the Regulator. With respect, the Society is firmly of the view that this is inappropriate, considering the specific statutory role of the Regulator, which is to regulate the behavior of CTP insurers.

2 2 The role and functions of the Panel 6. As noted above, the Panel played a significant role in the establishment of the MAIAS. The purpose of the MAIAS is to ensure that medical practitioners providing Injury Scale Value (ISV) reports are familiar with the ISV process for mental and physical harm and their obligations under the legislation. It is deemed necessary for practitioners assessing physical injuries to be trained in the use of the AMA Guide to the Evaluation of Permanent Impairment (AMA-5) and the important differences in the application of the Guide between the CTP Scheme and Return to Work SA (RTWSA). For those assessing psychiatric injuries, it is necessary for them to be trained in the use of the Guide to the Evaluation of Psychiatric Impairment for Clinicians (GEPIC). 7. The Panel has also developed and administered a Quality Assurance process to assess whether the ISV tables, AMA-5 and GEPIC are being used correctly and whether the practitioners are complying with the Service Standards outlined in the Scheme. 8. The Panel continues to plays an important role in the administration and management of the MAIAS. The responsibilities of the Panel include but are not limited to: 8.1 Prescribing the processes and documentation of the MAIAS; 8.2 Prescribing accreditation training courses and overseeing their implementation; 8.3 Make recommendations to the Minister for approval of applications who meet the accreditation criteria; 8.4 Monitoring the performance of Accredited Medical Practitioners to ensure conformity with accreditation obligations; 8.5 Conducting investigations into alleged breaches of these conditions and imposing sanctions authorized by the MAIAS; 8.6 Maintaining and keep an up-to-date register of all Accredited Medical Practitioners; and 8.7 Ensuring continuing oversight of the MAIAS. 9. Going forward, the Panel will be faced with ensuring that there are pathways for medical practitioners to obtain accreditation on an ongoing basis. At present, RTWSA has no plans to open its scheme to new applicants and therefore the CTP

3 3 Accreditation Scheme is presently blocked to new applicants. The Panel will be considering opening pathways to allow accreditation by new practitioners. 10. Therefore, an important ongoing function of the Panel will be quality assurance. The Society is informed by its representative on the Panel, Mr Michael King, that it is intended that follow up quality assurance exercises will be undertaken by the Panel going forward. The Society considers it important that an accredited workforce undergoes continual refreshment. Expert reports 11. The Panel performs an important function of accrediting doctors for the purpose of providing expert opinion reports and possibly oral expert evidence under the CTP Scheme. These reports are vital to the assessment of entitlement to damages for both economic loss and non-economic loss. 12. The expertise of the AMA and the Society are particularly important with respect to this aspect, and is why these bodies were included in the Panel when it was established. 13. It is integral that the South Australian branch of the AMA has a continuing role on the Panel because it has an associated role of reviewing the competency of its members and is in a good position to inform the panel of the reputation and standing of the particular medical practitioners within the medical profession. 14. Furthermore, the presence of the Society through its representative (a legal practitioner with relevant experience and expertise) is important for a number of reasons. First, whilst the assessments undertaken by accredited medical practitioners are intended to be objective, there is some subjective component involved in the application of some chapters of the American Medical Association Guidelines for the Evaluation of Permanent Impairment, Fifth Edition and the consideration of the ISV Scale. Legal Practitioners are in a good position to know whether any particular practitioner falls outside of the acceptable range of discretion in the assessment of impairment. 15. In this regard it should be noted that the Regulator has a limited role of only being involved in the CTP Scheme. Many of the doctors who seek accreditation under that Scheme are likely to have also sought accreditation under the ReturnToWork Scheme. Legal practitioners therefore have valuable knowledge with respect to work of doctors who have provided reports under the ReturnToWork Scheme and have given evidence before the South Australian Employment Tribunal. Those accredited doctors also have regard to the AMA5 Guidelines.

4 4 16. Secondly, there is an ongoing problem of medical practitioners not complying with the requirements for the admissibility of medical reports as evidence in disputed proceedings. This is both at common law and having regard to the relevant Rules of Court. The legal practitioner would be in the best position to consider, in the accreditation process, how to address that issue. The role of the Regulator 17. The Society notes that the Regulator s functions as set out in section 5 of the Compulsory Third Party Insurance Regulation Act 2016, include regulating approved insurers; determining premium amounts payable and terms and conditions of CTP insurance policies; to monitor, audit and review the operation and efficiency of CTP insurers; and to provide, or facilitate the provision of, information to consumers about the CTP insurance business and approved insurers. 18. The Regulator was established to oversee the behaviour of insurers and ensure that the CTP insurance companies operate as model insurers. As these companies have a primary duty to their shareholders it is important that their behavior is closely monitored to ensure the Scheme is operating in a fair and just manner. The Society supports the role of the Regulator with respect to the regulation of insurers. 19. However, it was not envisaged that the role of the Regulator would be to oversee the CTP Scheme. The Society considers this role incompatible with the Regulator s specific statutory duties to monitor and regulate insurers. 20. While the Society has no issue with the Regulator being a member of the Panel, to which the Regulator brings perspective and knowledge in relation to the behavior of insurers, it sees no sensible reason why the Panel should be disbanded, losing the independence, broad experience and expertise it currently holds. The Society strongly speaks against that change. 21. The Society notes the Regulator provides some basic administrative support to the Panel. However, the key role and functions of the Panel are still undertaken by its expert members. We suggest any cost saving achieved by the proposal would be negligible, with any such saving being outweighed by the benefits associated with the points referred to above. 22. The Society submits that the Panel should remain and continue its important work with respect to accreditation under the Scheme. Changes to the MAIAS could have serious implications for persons injured in a motor vehicle accident. It would not be in the interest of Scheme for this independent and expert Panel to be disbanded. As such, Society does not support the proposal to transfer the functions and role of the Panel to the Regulator.

5 5 I trust these comments are of assistance. We would be pleased to provide further comment or assistance. Yours sincerely Tim Mellor PRESIDENT Phone: (08) President@lawsocietysa.asn.au