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No prior approval not a bar to payment for emergency surgery by insurer

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Peter Muscutt, an Assistant Horse Trainer, had a serious injury to his back at work on 13 January 2015. When he told his boss he needed immediate spinal surgery, the boss insisted that Peter be examined by a GP before he could agree to the surgery.

Peter couldn’t wait, and had surgery on 21 January and further surgery on 3 February.

The workers compensation insurer didn’t dispute that the surgery was reasonably necessary, but tried to wriggle out of paying for it by claiming that Peter didn’t get prior approval (as required by the Workers Compensation Act). The Workers Compensation Commission tossed out that argument and made the insurer pay on the basis that it was “emergency surgery”.

Chris Waller Racing Pty Ltd v Muscutt [2016] NSWWCCPD 57