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[2001] VSCA 30
Court of Appeal (Vic)
2001-03-30
WINNEKE, P., PHILLIPS and CHARLES, JJ.A.
Original judgment source is linked above.
[ 2001] VSCA 30
Accident Compensation - Workers compensation - Worker's claim for compensation duly lodged - Notice of rejection arguably out of time under s.109(1) - Whether claim deemed to have been accepted - Whether weekly payments due without further proof of entitlement to compensation generally - Entitlement to medical and like expenses - Accident Compensation Act 1958 s.109.
"109. Responsibilities of authorised insurers, self-insurers and the Authority (1) If an authorised insurer, the Authority or a self-insurer does not give written notice of a decision to accept or reject a claim for weekly payments within 28 days of receiving the claim- (a) the claim is deemed to have been accepted; and (b) the authorised insurer, the Authority or self-insurer must pay weekly payments to the worker subject to and in accordance with this Part. (2) The written notice of a decision to accept or reject a claim for weekly payments must in the case of a decision to reject the claim include a statement of the reasons for the decision. (3) A decision or deemed decision under this section is binding on the employer in respect of the employer's liability under the employer's excess."
"... notwithstanding the fact that the claim in those circumstances is deemed to be accepted under s.109(1), that section only allows an order for payment of weekly payments subject to and in accordance with Part 3 of the Act [sic] once the claim is deemed to be accepted. ... My submission is that the worker still must establish that he has an entitlement within the operation of the Act. That requires him to establish now that he has an injury which would entitle him to compensation pursuant to s.82 and that he is entitled to weekly payments for incapacity in accordance with s.93. They are still matters that must be established before an order for weekly payments can be made ...."
It was that submission which was rejected by the magistrate, so that, despite the form of the pleading, the course followed at the hearing was such as to raise for determination the ingredients for the plaintiff's success under s.109(1) when the claim for compensation was deemed by paragraph (a) to have been accepted.
"If the authorised insurer or a self-insurer does not accept or reject a claim within the relevant period specified in this section, the claim shall be deemed to have been accepted and the authorised insurer or self-insurer must pay weekly payments to the worker subject to and in accordance with this Part."
"I think the scheme of the Act at the relevant time, was that if [the Commission] did not act expeditiously with regard to claims for weekly compensation, then [the Commission] would be deemed to have accepted the claim and be under the obligation to immediately commence weekly payments of compensation. Further, I consider it is plain that if for any reason, the Commission considered that the complainant was not entitled to the weekly payments so being made, then it could give a notice of termination of such payments on the grounds set out in s.111A(1)(b)(i) and weekly payments would be so terminated. I consider that this was the scheme even in cases of a disputed claim, provided that the claimant had a prima facie claim under the Act. In the present case, I am not concerned with the position where [the Commission] wrongfully refuses to make weekly payments pursuant to s.109(11). In such a case penalties would be payable [s.121D]."
After allowing for the fact that the references to section numbers are to the precursors of those with which we are now concerned on these appeals, this seems to me to be in line with what I have said so far about the scheme of the present legislation. That scheme is to require weekly payments upon deemed acceptance, but subject always to notice of termination should the authorised insurer (and now the Authority) be of opinion that the worker had no entitlement to compensation generally.
"Before embarking on a consideration of the effect of s.109(11) in the context of this case, there is the question of whether or not the injury sustained by the plaintiff occurred in compensable circumstances."
It was held that it did not because the plaintiff, in getting into his car, had not commenced his journey to his place of employment. It was therefore said by the judge to be "plain on the agreed facts that the plaintiff has no claim for compensation under the Accident Compensation Act"[12] and the argument, then, was whether notwithstanding that lack of entitlement s.109(11) operated to require weekly payments to commence. As to that, his Honour said[13]:
"Whatever the position may be prior to a determination by the Court, once the Court determines that the plaintiff has no entitlement, the plaintiff is not entitled to receive unpaid weekly compensation pursuant to s.109(11)".
"Obviously in the absence of any contrary statutory provision intruding, the existence of a compensable injury must always be a precondition to whether compensation is payable. In the instant case, however, there is a statutory provision which creates a fiction that deems the defendant to have accepted the plaintiff's claim. Implied in the deemed acceptance is that the plaintiff has sustained a compensable injury and has then incapacity to the extent claimed. In those circumstances it is not a case where compliance with s.82 has to be shown immediately before the commencement of such payments are required to be made. The defendant is in the position of being deemed liable to pay compensation at that moment as if s.82 had been complied with."
Turning to the phrase "subject to and in accordance with this Part", his Honour held that this attracted other provisions of the Act and summed up in this way[16]:-
"Section 109(11) is in my opinion a machinery provision. It fulfils the objects of the Act to deliver compensation speedily to injured workers. But it does not mean that once a claim for compensation has been deemed to have been accepted that the defendant is liable to pay weekly compensation forever or that persons who have no legal entitlement to compensation should be paid it. ... Therefore it is argued, whilst it can be said that because a defendant through a failure to accept or reject a claim within time, is deemed to have accepted it, such a result does not prevent the defendant from serving a notice of termination on the ground that the worker is not entitled to compensation under Division 1. Such a ground would include that the plaintiff did not suffer a compensable injury arising out of or in the course of employment. Therefore it is clear from the scheme of the Act that the defendant is not placed in a position of being forever barred from contending that the plaintiff did not suffer a compensable injury."
"We hereby reject your claim for compensation for a lower back strain pursuant to Section 109(2) ..."
Undoubtedly this was a mistake; the plaintiff made no claim for injury to the lower back. According to her claim form the injury relied upon was "pain & stiffness, both shoulders muscle strain both arms neck" and her alleged injuries were so described in other portions of the notice of rejection. For example on the very same page of the attachment, under the heading REASONS FOR GIVING THE NOTICE the insurer declared in paragraph 1:-
"On 13 March 1997, you lodged a claim for compensation with your employer, Venture Industries, for an alleged left and right shoulder, left and right arm and neck injury due to continuous and repetitive work on the instrument panel line."
What followed was the detailed canvassing of the reports of a physiotherapist and a general practitioner.
"Of course the claim dated 13 March 1997 made no reference to any `lower back strain'. Several possible reasons have been advanced for what is clearly an administrative blunder, but in the event, those reasons are of no consequence."
Administrative blunder it may have been, and mistake it obviously was. Taken in context, that mistake did not deprive the notice of effect; its purport and its meaning were plain beyond argument. The mistake in the document was quite simply immaterial: compare Hills Grammar School v. Human Rights and Equal Opportunity Commission[18], a case on judicial review. Therefore I think the notice of rejection was effective and, as it was given in time, s.109(1) was not called into operation.
effective to deny operation to s.109(1) the judge either made a finding that was not open to him on the evidence or misunderstood the meaning of the relevant statutory description: either way the decision may be set aside for error of law: Edwards (Inspector of Taxes) v. Bairstow[22], Dampskibsselskabet Torm A/S v. Australian Wheat Board[23], S v. Crimes Compensation Tribunal[24].
I certify that this and the preceding 29 pages are a true copy of the reasons for judgment of Winneke, P., Phillips and Charles, JJ.A. respectively of the Court of Appeal of the Supreme Court of Victoria delivered on 30 March 2001.
[1] The sanction formerly in s.121D was described as "weak" by Judge Rendit in Fyffe v. Victorian WorkCover Authority (unreported, County Court of Victoria, 31 October 1994). That s.121D was repealed in 1994 by s.51(b) of Act No.54 of 1994, an Act which repealed the whole of division 3B of Part 4 (ss.121 to 121E) and replaced it with new ss.114C to 114F which were included within a new division 3. It was Act No.54 of 1994 which remodelled the delivery of compensation consequent upon the introduction of authorised insurers.
[2] For example Edgar v. Pennell [1958] VicRp 72; [1958] V.R. 450.
[3] The question of onus was adverted to in Green v. V.W.A. [1997] 1 V.R. 364 at 372, 379-380, 383 but no decision was reached there that is presently relevant. Contrast the views expressed by Judge Rendit in Drobis v. V.W.A. (unreported, County Court of Victoria, 15 July 1994) at 43-44.
[4] The provision now found in s.114(2)(b) may be contrasted with the original provision for review of weekly payments which turned on the view that the worker's incapacity was "no longer" related to compensable injury (as to which see Robertson v. A.C.C. [1987] 1 V.A.C.R 150). This was changed by Act No.64 of 1989 so that under a new s.111A weekly payments might be terminated on the ground that the worker "is not entitled to compensation under Division 1" of Part 4 or "is not or is no longer entitled to weekly payments".
[6] unreported, County Court of Victoria, 31 October 1994
[7] The present s.109 was substituted by Act No.50 of 1994, as to which see footnote 1.
[8] [1994] VACR para.73-388 (p.83,492)
[17] D.F.C.T. v. Woodhams [2000] HCA 10; (1999) 199 C.L.R. 370 at 384
[18] [2000] FCA 658; (2000) 100 F.C.R. 306, especially at 314-5
[20] Adams v. Chas. S. Watson Pty. Ltd. [1938] HCA 37; (1938) 60 C.L.R. 545 at 548
[21] As to which see generally Green v. V.W.A. [1997] 1 V.R. 364 at 368-9 per Tadgell, J.A. and Dunstan v. Amcor Ltd. [2000] VSCA 9 paras. 16-18 per Winneke, P.
[22] [1955] UKHL 3; [1956] A.C. 14 at 36
[23] [1981] VicRp 16; [1981] V.R. 145 at 147 per Lush, J.
[24] [1998] 1 V.R. 83 at 92