Western Australian Numbered Acts Western Australian Numbered Acts (1) A worker may apply
to an arbitrator for an increase for special expenses in the medical and
health expenses general limit amount for the worker’s injury (the
general limit for the claim ) beyond the standard increase limit amount.
Note for this subsection:
Subsection (6)
imposes a 5-year limit on an application under this section for a special
increase.
(2) An application
under this section may be made only if —
(a) the
general limit for the claim has been increased by a standard increase; and
(b) the
worker has incurred, or is likely to incur, reasonable special expenses in
excess of those that can be provided for by a standard increase.
(3) On application
under this section, an arbitrator may order that the general limit for the
claim is increased if —
(a) the
worker has a degree of permanent whole of person impairment of at least
15% as a result of the worker’s injury as determined under
section 79; and
(b) the
arbitrator is satisfied that the worker has incurred, or is likely to incur,
reasonable special expenses in excess of those that can be provided for by a
standard increase; and
(c) the
arbitrator is satisfied in accordance with the regulations of any other matter
of which the regulations require the arbitrator to be satisfied under this
paragraph; and
(d) the
arbitrator considers that the increase should be allowed, having regard to the
social and financial circumstances and the reasonable financial needs of the
worker.
(4) The amount of a
special increase —
(a)
applies only for the payment of compensation for special expenses; and
(b) must
be decided after taking into account the amount of any payment for medical and
health expenses that, since the most recent standard increase, the employer or
insurer voluntarily made to the worker beyond the general limit for the claim;
and
(c) is
limited by the requirement that the increase (or the total of all special
increases), together with any amounts required by paragraph (b) to be
taken into account, must not exceed the special increase limit amount.
(5) The arbitrator is
not required to be satisfied of the matters described in
subsection (3)(c) if the expenses for which the special increase is
sought are incurred or likely to be incurred in the course of following a plan
for managing and treating the worker’s medical and associated conditions
with which the arbitrator granting a previous special increase was satisfied.
(6) An application for
a special increase cannot be made more than 5 years after the relevant
determination of liability for the injury and for that purpose the relevant
determination of liability is considered to have occurred on the latest of the
following —
(a) the
day on which the worker is first notified that the insurer or self-insurer has
accepted that the employer is liable to compensate the worker for the injury;
(b) the
day on which the insurer or self-insurer is taken to have accepted that the
employer is liable to compensate the worker for the injury;
(c) the
day on which it is determined by an arbitrator that the employer is liable to
compensate the worker for the injury.