Insurers and claims

If you are an insurer, when notified of an injury you must:

  • contact the worker and the employer within three days, and consult with all relevant parties including the treating doctor, to ensure that the worker receives necessary assistance to recover and return to work
  • provide information regarding the claims process
  • start provisional weekly payments within seven days, for up to a maximum of twelve weeks (unless a reasonable excuse exists)
  • decide whether you or the employer will pay the worker
  • decide whether to approve provisional medical expenses for up to $7500 and start these payments
  • notify the injured worker and employer, in writing, about the amount and time period of the provisional payments
  • develop an injury management plan for a worker with a significant injury and comply with their obligations under the injury management plan

New guidelines for claiming workers compensation come into effect on 1 August 2016.

Regarding the claims process, you must:

  • decide whether the injured worker needs to complete a claim form, and assist the worker to complete the form
  • inform the employer (within seven days) if a claim has been made, and make a decision about the ongoing liability of the claim within 21 days or before the end of the period of provisional liability
  • provide the worker with a written explanation of a decision to dispute the claim or any aspect of the claim, attaching all relevant reports and documents and provide information on how to ask for a review of the decision and where to seek further assistance (refer to the guidelines for claiming workers compensation)