THE MAKING OF A CLAIM
7 The Safety, Rehabilitation and Compensation Act provides for the making of a "claim for compensation" and for the review of determinations made in respect to such claims.
8 Section 14(1) of the Act provides that, subject to Part II of the Act, "Comcare is liable to pay compensation in accordance with this Act in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment". Section 5A defines the term "injury" but relevantly excludes from the definition "a disease, injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner…". The phrase "as a result of" requires there to be a "causal relationship", with causation being "a matter of common sense": Martin v Comcare [2015] FCAFC 169 at [107] to [108], (2015) 148 ALD 1 at 23 to 24 per Murphy J (Siopis J agreeing). Section 54(2) of the Act requires a claim to be made "in accordance with the form approved by Comcare".
9 Section 7(4) of the Act provides that an employee is taken to have sustained an injury, disease, or an aggravation of a disease when the employee first sought medical treatment, or when the disease or aggravation first resulted in the incapacity for work or impairment, whichever happens first. Attention need only be given to s 7(4) once liability under s 14 has been established: Gaffey v Comcare [2015] FCA 1024 at [79] per Wigney J.
10 Section 61(1A) provides that a determining authority is to "determine each claim for compensation under section 14 within the period prescribed by the regulations". Section 62 provides for the reconsideration of a determination.
11 It is s 64 which provides for the review of a "reviewable decision" by the Administrative Appeals Tribunal. Section 60 relevantly defines a "reviewable decision" as one made under s 62.
12 The Safety, Rehabilitation and Compensation Act thus establishes a three tiered decision-making process: Lees v Comcare [1999] FCA 753, (1999) 56 ALD 84 at 91. Wilcox, Branson and Tamberlin JJ there observed:
[32] Pt VI of the Act is headed "Reconsideration and Review of Determinations". It establishes a three tiered decision-making process: the original decision or determination to be made by an authorised person within Comcare or a licensed authority, a reconsidered determination to be made within the same authority as the original decision - but ordinarily by a fresh decision-maker, and a decision of the AAT reviewing the reconsidered determination.
With respect to the powers and discretions that may be exercised by the Tribunal, their Honours went on to conclude:
[39] In considering the extent of the power of the AAT when reviewing decisions under the Act, it is to be noted, first, that the AAT is authorised by s 64 of the Act to review only reviewable decisions - that is, for present purposes, second tier or reconsideration decisions made under s 62 of the Act. Decisions under s 62 of the Act are the result of the reconsideration by Comcare or a licensed authority of a determination, as defined by s 60 of the Act, concerning which a claimant will have received a notice in writing setting out the terms of the determination and the reasons for the determination (s 61(1)). Secondly, it is to be noted that the powers of the AAT under s 43(1) of the AAT Act are powers "[f]or the purpose of reviewing" the reviewable decision, not powers that may be exercised at large. Further, the powers and discretions that the AAT may exercise under s 43(1) are the powers and discretions conferred by the Act on the determining authority for the purposes of reconsidering a determination under s 62 of the Act. The AAT will not be authorised on review of a reviewable decision to exercise any powers and discretions which would not have been available to the determining authority at the second tier decision-making stage, albeit that such powers and discretions might have been available to the determining authority at the first tier decision-making stage.
13 The manner in which these statutory provisions have been interpreted and applied has been the subject of some consideration by this Court. A recurring issue presented for resolution is the extent to which the description of an injury may later confine the jurisdiction entrusted to the Tribunal for review. Not surprisingly, some flexibility in the formulation of a claim has been permitted. Frequently, many claims for compensation have been drafted by claimants without the benefit of legal assistance, and in many cases a medical condition may change and evolve over time.
14 Summarising some of the principles to be applied, Madgwick J in Abrahams v Comcare [2006] FCA 1829, (2006) 93 ALD 147 at 152 observed:
[18] …
1. In construing a document purporting to be a notice of injury under the Act, a broad, generous and practical interpretation should be made, consistent with both the beneficial purposes of the Act and the likelihood that laypeople of differing levels of education, differing levels of medical advice and differing levels of legal advice (indeed in most cases they would not have any) will be giving the notice.
2. In deciding what injury it is, as to which a claimant has given notice, the purposes of giving notice must be borne in mind. These are to enable Comcare, with the aid of the relevant employing agency, to determine whether the claim should be met.
3. The powers of an original decision-maker would extend to regarding informal notice as having been given in amplification of a notice formally given.
4. Those powers would further extend to enabling a consideration of a claim better explaining, or better justifying, a claim in respect of an injury in respect of which notice had been fairly given.
5. There is not always a bright dividing line available to assist in the decision whether powers of the kinds mentioned are being exercised in aid of a better understanding of a claim made in respect of an injury of which notice has been given, or whether the changed notice is sufficiently fundamental as to indicate that a different injury is being asserted, which will require a different decision from a decision in respect of the originally claimed injury under consideration. In determining that matter, considerations of the purpose of giving notice of injury, and more generally of enabling the decision-maker to have a fair opportunity to investigate the claim properly, are paramount.
It was there concluded that the Tribunal had jurisdiction to review a claim originally formulated as "right carpal tunnel syndrome" and later reformulated as a broader right arm and shoulder condition. These principles were subsequently endorsed by the Full Court in Szabo v Comcare [2012] FCAFC 129 at [33] per Emmett and Greenwood JJ, at [50] per Bennett J. It is, accordingly, accepted that a "claim seeking compensation obviously need not be expressed with the same degree of particularity or formality of a pleading or a statement of claim in a superior Court": Farrell v Comcare [2015] FCA 1337 at [31] per Flick J.
15 As Madgwick J in Abrahams envisaged, it is on occasions difficult to draw a "bright dividing line" between whether a claim is one in respect to which notice has been given "or whether the changed notice is sufficiently fundamental as to indicate that a different injury is being asserted."
16 A further instance of where that "line" should be drawn came before the Court in Kennedy v Comcare [2014] FCA 82, (2014) 63 AAR 100. Ms Kennedy had worked as a customer service adviser in a Centrelink call centre. She lodged a claim for compensation. The claim form she submitted described her injury as follows:
Anxiety disorder, stress & panic attacks, headache migraines, hair loss, prolonged illness, due to stress, hearing loss, trauma, dental.
She maintained that she was injured or first noticed she was ill in August 2005. She made no specific reference to anything occurring in 2009. But the statement submitted in support of her compensation claim referred to events in 2009 including "inappropriate comments" and an account of harassment and bullying in that same year. In concluding that the Tribunal had jurisdiction to consider a claim for compensation in respect to a 2009 injury and that the Tribunal had erred in not considering that claim, Katzmann J relevantly concluded:
[45] In a case of psychiatric injury, however, it is not always easy to discern the nature of a claim. Neither the original decision-maker nor the review officer referred to a claim for compensation for injury in 2009. But the tribunal's jurisdiction does not depend on how Comcare characterises the claim. To the contrary, "the tribunal must assess for itself the true scope of the claim" and conduct the review on that basis … The question of whether the tribunal lacked jurisdiction to deal with the submission depends on the scope of the applicant's claim for compensation …
…
[53] Similarly, in his summary of Ms Kennedy's compensation claim the review officer did not refer to an allegation of bullying and harassment by Ms Oostendorp that preceded the home visit. Comcare explained this omission by arguing that in her request for reconsideration Ms Kennedy had resiled from making the allegation. I am persuaded, however, that she did not. The contention could certainly have been put with greater precision in the request for reconsideration, but "a broad, generous and practical interpretation" is called for: Abrahams v Comcare (2006) 93 ALD 147, [2006] FCA 1829 at [18]; Szabo at [50]. Construed broadly, generously and practically Ms Kennedy was asking Comcare to reconsider several aspects of her case. One of them was her claim that bullying and harassment at the workplace from June/July 2009 caused her injury.
…
[58] If the review officer did not make a decision on the matter of the 2009 injury, it is at least arguable that this amounted to a refusal to make a decision … A refusal to make a decision is a "decision" for the purposes of both the AAT Act and the SRC Act: AAT Act, s 3(3)(a); SRC Act, s 60. No such argument was advanced in the present case and it is unnecessary to consider the matter further. That is because I am persuaded that the review officer did make a decision.
[59] If an issue is before a review officer on an application for reconsideration and the officer does not deal with it expressly, (s)he might be taken to have implicitly rejected it: Irwin v Military Rehabilitation and Compensation Commission (2009) 174 FCR 574 at [26]; Telstra Corporation Ltd v Kotevski (2013) 209 FCR 558 at [52], [56]. Here, in the light of the evidence before him and the statement that he had had regard to all of it, as well as his assertion that the "numerous other workplace incidents" would be addressed in his reasons, the review officer should be taken to have implicitly rejected Ms Kennedy's contention that she suffered injury as a result of Ms Oostendorp's behaviour towards her during 2009.
[60] I am therefore satisfied that the preconditions to the exercise of the tribunal's jurisdiction to consider the submission have been made out. Ms Kennedy had given notice to Comcare of an injury in 2009 and had made a claim that she be compensated for it. In the original determination Comcare did not allow it. Ms Kennedy sought to have Comcare's determination reconsidered. The reconsideration was unfavourable. It follows that the tribunal had jurisdiction to consider the submission relating to the alleged injury and it erred in law in neglecting to do so.
Similarly, in Comcare v Lofts [2013] FCA 1197, (2013) 217 FCR 220 it was concluded that the Tribunal had no jurisdiction to make a decision in respect to a claim for medical expenses which were not "expressly or impliedly" the subject of a claim resolved by the "reviewable decision".