Your employer’s insurer is obliged, in most cases, to begin weekly compensation payments within seven days of being notified of your injury.

In some cases, however, the insurer will have a 'reasonable excuse' not to start payments within seven days, such as when there is insufficient medical information or the injury is not work related.

The only reasons that an insurer can use to not commence payments within the usual seven days are listed below. No other reasons are considered to be a 'reasonable excuse'. These are taken from the guidelines that insurers are required to comply with.

Insufficient medical information

The insurer has a reasonable excuse if it does not have enough medical information. For example, the insurer may have been unable to confirm with your treating doctor, hospital or employer that you have been treated for a workplace injury and the period you will be away from normal duties.

However, the insurer may have to allow special consideration for workers in remote rural areas, where access to medical treatment is not readily available.

Worker unlikely to be a 'worker'

The insurer has a reasonable excuse if:

• the worker has been unable to verify their status as a worker (under NSW workers compensation legislation)
• the employer is able to verify that the worker is not a worker.

Insurer unable to contact the worker

The insurer has a reasonable excuse if it needs to contact the worker to determine whether to pay or not, and is unable to do so after trying repeatedly, by phone, electronic means or in writing.

Worker refuses access to information

The insurer has a reasonable excuse if the worker will not consent to the release or collection of personal and health information in relation to the workplace injury to determine the worker's entitlement to provisional payments.

Injury is not work related

The insurer has a reasonable excuse if the employer has provided evidence that the worker's employment is not a substantial contributing factor to the injury.

Acceptable forms of evidence could include:

• a signed statement from a third party specific to the circumstances of the worker's injury that conflicts with the workplace injury as notified
• available public information specific to the circumstances of the worker's injury that conflicts with the workplace injury as notified
• medical information that confirms the existence of the workplace injury before the date of the injury reported by the worker. This excludes initial notifications for aggravation, acceleration, exacerbation or deterioration of a pre-existing condition.

However, in these cases, anecdotal or unsupported information received from any source, including the employer, is not acceptable on its own.

Injury is not significant

If the injury is not significant – ie. the worker is likely to be off work for less than seven continuous days, even if any of the days are for partial incapacity – then the insurer may extend the time to assess entitlements to 21 days after the initial notification is made.

If the insurer does that then, within seven days after the initrial notification, they will notify the worker in writing that a decision will be made within 21 days of the initial notification.

Injury notified after two months

The insurer has a reasonable excuse if the notice of injury is not given to the employer within two months after the date of the injury.

However, the insurer may ignore this excuse if a liability is likely to exist and if it believes paying provisional payments to the worker will be an effective injury management intervention.

If you are unhappy with the decision made by the insurer, contact them and speak to the case manager coordinating the claim.

If you need further help or advice, contact the WorkCover Assistance Service on 13 10 50.