My son was injured in a car accident while at work in 2006. He spent a long time in rehab and has ongoing issues due to

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Customer: Good morning, my son was injured in a car accident while at work in 2006. He spent a long time in rehab and has ongoing issues due to his injuries. The outcome of legal proceedings at the time was that he was entitle to lifelong medical cover through Workcover. During the last few years he has battled continuously to be reimbursed for medications, medical appointments etc. The most recent incident started back in February 2020 when he sent some receipts for medication to CGU for reimbursement. He has in the last couple of weeks contacted a lawyer, Workcover assist and conciliation and CGU to try and get the "right" to be reimbursed for medicinal cannabis which he has been prescribed by his doctor and has been approved for by the Australian Department (Im not sure of the exact title. My son rang me last night in tears as he is sick of fighting an insurance company to get medication he needs to relieve spinal pain (which he will have for the rest of his life). He has a very supportive wife and family but finds he cant cope anymore. He has had suicidal thoughts many times over the last 15 years but none as strong as he currently has now. My son is 31 years old and married with a young family. For him to ring me in tears about this upsets me deeply and I am looking for advice as to how to fix the problem and stop it from continuing to happen over and over and over. He has a right to live his life pain free and is up against people who control this without any medical knowledge or understanding of the pain he suffers. Your advice would be very much appreciated. My son and his wife and 18 month old daughter are coming to my house today to discuss this and try and find a way forward. Janet Smartt
JA: What state/territory are your son and his wife in? It matters because laws vary by location.
Customer: Victoria
JA: What steps have your son and his wife taken so far?
Customer: Spoken to CGU case manager (which changes regularly without notification), spoken to the lawyer who ran his original case, spoken to Worksafe Assist, cried, and cried some more
JA: Anything else you want the Lawyer to know before I connect you?
Customer: I am concern about my sons mental health and the anguish this causes him time and time again
Answered by John Melis in 7 mins 2 years ago
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John Melis, Expert

Hi, I’m John, solicitor, and reviewing your post, and may need to ask a few questions a long the way to assist you.

Concerning your important comments, what is the outcome you would like to see result.

Customer
Hello John, I hope you can help prevent my sons anguish
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John Melis, Expert

Janet, when you say: My son rang me last night in tears as he is sick of fighting an insurance company to get medication he needs to relieve spinal pain

Can you Explain in more detail exactly what difficulty he is having with WorkCover getting the compensation for the medications?

Customer
His latest request for medicinal marijuana (prescribed by GP) was met with the comment of "medicinal cannabis is only prescribed for cancer patients" from CGU
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John Melis, Expert

Has your sons medical practitioners actually prescribed marijuana as a prescription medication for him?

Customer
I believe so. He has been approved by a Federal department to receive it. CGU have denied his claim for payment of it
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John Melis, Expert

The way to deal with this particular denial by the insurer with the federal government has approved it and his medical practitioners, is the race proceedings immediately in the Victorian civil administrative tribunal.

​The VCAT process is very good to meditate disputes of this type as it forces the parties to come together to discuss the issues involved.

In most cases at mediation the matter will settle.

The VCAT process is very good to meditate disputes of this type as it forces the parties to come together to discuss the issues involved.

In most cases at mediation the matter will settle.

The matter is Civil.

You will be the applicant and the insurer the respondent.

The important filing document is the points of claim. This document needs to be carefully drafted. 

I recommend that you download the application first, complete the same and then upload as required to commence the claim.

The alternative to this is filing an application in the local court, in which case you will be able to recover your legal fees as well in pursuit of the debt amount.

What you need to do is to write the complaint in a chronological order detailing what is the issue and what action you have taken to try and rectify the matter.

The chronological order need to be numbered with points 1, 2, 3, etc. with each point being a separate item. 

I recommend that you download the application first, complete the same and then upload as required to commence the claim. 

I recommend that you download the application first, complete the same and then upload as required to commence the claim.

The following link will assist you further. 

https://www.vcat.vic.gov.au

You may also consider the option of using the small business commissioner as well. 

https://www.vsbc.vic.gov.au/about-vsbc/about-us-and-what-we-do/

Would you like to consider this option ?

You have a legal right to protect your interests in this important situation.

Does this help with your question today?

Customer
By doing this will it stop the same thing happening again when he needs a change in medications or treatment, or another operation?
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John Melis, Expert

As long as the process is followed correctly with the tribunal this will resolve all issues.

Have I answered your question today

Customer
Each time he has gone to conciliation with Workcover it is resolved, until the next timeThank you for your help. It seems we need to seek legal assistance.
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John Melis, Expert

Thank you for your follow-up, you can resolve this matter with the Victorian civil administrative tribunal.

​Thank you for reaching out today.

You have a legal right to protect your interests in this important situation.

I am a user like you in this chat forum to assist in your important question today.

Thank you kindly for rating me with 5 stars, which helps me support the community.

You can come back to this post any time to ask questions without additional charge.

I hope I have assisted with answering your important question today, and thank you for supporting the community.

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