Operation of s 260, Workplace Injury Act
31 The purpose, scope and operation of s 260 must be identified by reference to the language of the provision in its statutory context. The Workers Compensation Act states that a worker who has received an injury "shall receive compensation" from the worker's employer in accordance with this Act: s 9(1). The circumstances in which compensation is payable, the amount payable and the means by which it is payable are all specified. Both the Workers Compensation Act and the Workplace Injury Act make reference in various parts to claims for compensation, but the term "claim" is not defined: cf definitions of derivative phrases in s 250(1) of the Workplace Injury Act.
32 The procedures specified for making claims are to be found in Ch 7 of the Workplace Injury Act. Those provisions commence with the requirement that "notice of the injury" be given to an employer as soon as possible after the injury happened, with the sanction that compensation is not recoverable unless such notice is given: s 254(1). There is, however, an exception for special circumstances, which are defined in s 254(3) to include:
"(b) the failure to give notice of injury, or the defect or inaccuracy in the notice, was occasioned by ignorance, mistake, absence from the State or other reasonable cause,
(c) the person against whom the proceedings are taken had knowledge of the injury from any source at or about the time when the injury happened …."
33 A notice of injury may be given "orally or in writing": s 255(2). Notification of an injury engages an obligation on the part of an insurer (or the Bank, as a self-insurer) to commence payments of compensation within seven days unless it has a "reasonable excuse for not commencing those weekly payments": s 267(1). That obligation is neither dependent upon nor affected by the making of a claim for compensation: s 267. If the insurer does not commence payments, it must provide written notice to the worker of its reasonable excuse, including details of that excuse and what steps the worker may take: s 268.
34 Chapter 7, Part 2, Div 2 deals with "[m]aking a claim for compensation or damages". It requires that a claim must be made "in accordance with the applicable requirements of the WorkCover Guidelines": s 260(1). The relevant Guidelines are those which came into operation on 1 January 2002. The explanatory note with which they commence states that they are "primarily intended to assist WorkCover NSW Licensed Insurers". They cannot, and do not purport to, affect the proper construction of the Act, as accepted by this Court in Fletcher International Exports Pty Ltd v Barrow [2007] NSWCA 244 at [32] and [41] (Mason P, Santow and Tobias JJA agreeing).
35 Subsections 260(2)-(4) provide for matters in relation to which the Guidelines may make provision and include the form and manner in which a claim "is to be made" and the means by which a claim "may be made". Although they do not presently do so, the Guidelines may provide for waiving a requirement for the making of a claim in specified cases: s 260(4)(a). The insurer can waive a requirement of the Guidelines with respect to the making of a claim: s 260(6). The Guidelines can also require an insurer to notify a worker of a failure to comply with a requirement of the Guidelines and can provide for waiver of any such failure if the insurer fails to give the required notification: s 260(7). It is in that statutory context that s 260(5) provides:
"(5) The failure to make a claim as required by this section is not a bar to the recovery of compensation or work injury damages if it is found that the failure was occasioned by ignorance, mistake or other reasonable cause or because of a minor defect in form or style."
36 Chapter 7, Part 4 deals with "[c]ompensation dispute determination". It applies to a dispute "in connection with a claim for compensation": s 287(1). Any party to a dispute about a claim may refer the dispute for determination by the Commission: s 288. Section 289 provides that a dispute about a claim for weekly payments "cannot be referred for determination by the Commission" unless the insurer disputes liability or fails to determine the claim as and when required by the Act. This provision no doubt assumes the existence of a "claim" and the existence of a "dispute" about the claim.
37 Section 289A imposes a further requirement, in relation to notification of disputes before referral for determination by the Commission. However, that provision commenced on 7 December 2005 and is not applicable to the present case.
38 A number of points of significance can be derived from these provisions. First, s 260 clearly envisages that a claim may not be made as required by the Guidelines and may yet constitute a "claim". Secondly, it may readily be envisaged that factual disputes could arise as to whether a claim has been made and whether a dispute has arisen. Because the Commission is required to operate with as little formality and technicality as the proper consideration of matters before it permits (s 354(1)) and without regard to technicalities or legal forms (s 354(3)) the legislative scheme should be understood to confer on the Commission the power to determine whether or not a dispute has arisen or a claim has been made. That is not to say that the statute may not impose legal constraints, but the Commission is entitled to determine these matters for itself and an error will not be jurisdictional. The dicta to that effect in Fletcher at [39] should be followed.
39 The next question is whether s 260(5) operates where there has been no claim made, or only where a claim is defective or fails to comply with a requirement specified by a guideline.
40 The opening words of the provision are consistent with it operating where there has been a failure to make a claim at all. This conclusion receives support from the language of s 254(3)(b) in relation to a notice of injury. In that paragraph, the "failure" to give notice is compared with a "defect or inaccuracy" in the notice. While the language is not mirrored precisely in s 260(5), there is no reason to suppose that the more serious failure does not incorporate a lesser failure.
41 The alternative argument is that the reference to a failure to make a claim should be understood as a reference to the making of a defective claim. Section 260(5) expressly provides that a minor defect in form or style will not operate to bar recovery and, by implication nor will a substantial defect where occasioned by ignorance, mistake or other reasonable cause. However, the only textual support for reading-down the reference to a failure to make a claim to mean the making of a defective claim, is to take the subject-matter of a failure as making a "claim as required by this section", thereby implying that a claim has indeed been made, but that it fails in some respect to comply with the requirements of the Guidelines. The difficulty with this approach is that the only formalities with respect to a claim are those specified in guidelines provided for by the section. Absent applicable guidelines, there would be no formal requirements.
42 The objectives of the Act, which are directed primarily to ensuring compensation for work-related injury, will not be promoted by a narrow reading of a provision which allows for recovery of compensation in circumstances where procedural requirements have not been followed. It was not in dispute in the present case that the Commission was bound to accord procedural fairness to each party. Accordingly, an inadequate, defective or even non-existent claim might require the adjournment of proceedings, or part thereof, and the provision of further information by the worker to the insurer. The adoption of a flexible procedure, expressly provided for by s 354, would be more conducive to the purposes of the legislative scheme than the adoption of a technical approach to a procedural requirement. It was, therefore, not correct to dismiss s 260(5) as unavailable in circumstances where there is "no claim at all".
43 Support for that conclusion may be found in the factual circumstances of the case. What precisely did the Deputy President intend by saying that there was "no claim at all"? As the Guidelines recognise, a "claim" is a means of providing certain information: WorkCover Guidelines, Part 2, r 4. The "minimum information" is specified in r 6. It includes information about the date and time of the injury, how the injury happened, what part of the body was injured and whether the part was normal before the injury: r 6.5. The Guidelines say that the information must be in writing "on a form designed for making a claim": r 4. They do not prescribe a form, nor a person or body to design a form, nor any specific requirements of the form otherwise than being in writing (which is inherent in the notion of a form). The application to resolve a dispute filed in the present case (and served on the respondent) contained, in Part 4, "claim details". As already noted, those details included a claim for payment for total incapacity from 5 April 2004; and that the injury was identified as a psychological injury, which (apart from a period in late 2003) was identified as one involving part incapacity. The form also referred to medication, other forms of treatment and to the applicant's "recent relapse as evidenced by her certification as unfit on 5 April 2004". The application included much other formal information required to be supplied in a claim under the Guidelines. What the application clearly did not do was identify the "relapse" on 5 April 2004 as a separate and independent injury. In that sense, it was no doubt a deficient form of claim. At best it was ambiguous. Nevertheless, it is by no means clear that it did not constitute a claim at all, assuming that some clear dichotomy was required to be drawn between claims and non-claims.
44 That the Deputy President did draw such a dichotomy is clear from the fact that she did not consider the reasons for the failure to make a claim. It is clear that, had she done so, she would not have dismissed the argument peremptorily. Thus, in rejecting the Bank's contention that the new claim was "a recent invention" she noted that it had been a submission adopted by Ms Tan at the request and encouragement of the arbitrator and "as she clearly states, was unaware of the complex legal issues that were involved": at [119]. Had there been a "claim", albeit inadequate in form, such a reason might well constitute ignorance or mistake of a kind constituting a reasonable cause for the failure. Whether or not it did in the particular circumstances of the case was a matter to be determined by the Commission, not by the Court.
45 If the matter is to be reconsidered, it may be helpful to note that the manner in which the Bank presented its grounds of appeal was potentially misleading. Subsection 260(5), like sub-s 254(2) in relation to a notice of injury, is not formulated in terms of a discretionary power. It is formulated upon the assumption that a failure to comply with the statutory requirements is, in each case, a bar to recovery and identifies circumstances in which that bar does not operate. The circumstances require a finding of either special circumstances (as defined) in relation to the notice of injury, or a form of reasonable cause, in relation to the failure to make a claim. In each case an evaluative finding is required and, by necessary implication, on the part of the Commission. However, once that finding has been made, the statutory bar is automatically lifted without further exercise of a discretionary power by the Commission. Accordingly, to speak of the Commission exercising a discretion in this context is apt to mislead.