Part 3Division 1 Special provisions for commencement of weekly payments after initial notification of injury
This Division applies in respect of the initial notification of an injury after the commencement of this section (even if the injury concerned was received before the commencement of this section).
266 Meaning of initial notification of injury
In this Part, initial notification to an insurer of an injury to a worker means the first notification of the injury that is given to the insurer, in the manner and form required by the WorkCover Guidelines, by the worker or the employer or by some other person (for example, a medical practitioner) acting for or on behalf of the worker or the employer.
267 Duty to commence weekly payments following initial notification of injury
(1) Provisional weekly payments of compensation by an insurer are to commence within 7 days after initial notification to the insurer of an injury to a worker, unless the insurer has a reasonable excuse for not commencing those weekly payments.(2) A person does not have a reasonable excuse for not commencing those weekly payments unless the person has an excuse that the WorkCover Guidelines provide is a reasonable excuse.(3) The payment of provisional weekly payments of compensation under this section is on the basis of the provisional acceptance of liability by the insurer for a period of up to 12 weeks determined by the insurer having regard to the nature of the injury and the period of incapacity.(4) The acceptance of liability on a provisional basis does not constitute an admission of liability by the employer or insurer under this Act or independently of this Act.(5) An insurer who fails to commence weekly payments of compensation as required by this section is guilty of an offence.Maximum penalty: 50 penalty units.
268 Insurer must notify worker of reasonable excuse for not commencing weekly payments
If an insurer does not commence weekly payments of compensation because the insurer has a reasonable excuse for not doing so, the insurer must within 7 days after receiving the initial notification of injury give the worker notice in writing that the insurer has a reasonable excuse for not commencing weekly payments of compensation and include in that notice:(a) details of that reasonable excuse, and(b) a statement that the worker is entitled to make a claim for compensation and that the claim will be determined within 21 days, and(c) details of how that claim can be made.Maximum penalty: 50 penalty units.
269 Notice to be given of commencement of weekly payments
As soon as practicable after an insurer commences weekly payments of compensation under this Division, the insurer must give the worker a notice in writing notifying the worker that:(a) weekly payments of compensation to the worker have commenced on the basis of provisional acceptance of liability by the insurer, and(b) the payment of weekly payments of compensation to the worker will continue for a period (up to a maximum of 12 weeks) determined by the insurer having regard to the nature of the injury and the period of incapacity, and(c) the insurer will develop an injury management plan for the worker (if required to do so by Chapter 3), and(d) the worker is entitled to make a claim for compensation (and include details of how that claim can be made).
270 Obligations of worker to provide authorisations and medical evidence
(1) An insurer who commences weekly payments of compensation under this Division may require the worker to provide the insurer with:(a) a medical certificate certifying as to the worker’s incapacity for work, and(b) a form of authority signed by the worker authorising a provider of medical or related treatment, hospital treatment or workplace rehabilitation services to the worker in connection with the injury to give the insurer information regarding the treatment or service provided or the worker’s medical condition or treatment relevant to the injury.(2) The insurer may discontinue weekly payments of compensation under this Division if the worker fails to comply with a requirement under this section within 7 days after it is communicated to the worker by the insurer.
271 Liability to make weekly payments not affected by making of claim
(1) An obligation of an insurer to make weekly payments of compensation pursuant to the provisional acceptance of liability under this Division ceases if the insurer disputes liability to make those payments.Note. Section 74 requires notice of a dispute to be given.(2) Otherwise, a liability to make weekly payments of compensation pursuant to the acceptance of liability on a provisional basis under this Division is not affected by the making of a claim for compensation.
(1) If an insurer pays any compensation under this Division and another insurer or another employer accepts liability to pay compensation to the worker in respect of the injury concerned, the insurer is entitled to recover the compensation so paid as a debt from that other insurer or other employer.(2) Any amount so recoverable is taken to have been payable by the other insurer or other employer as compensation to the injured worker.
273 Provision for recovery of excess for provisional payments
Section 160 (Recovery of excess from employer) of the 1987 Act and section 152 of this Act apply to and in respect of the payment of provisional weekly payments of compensation under this Division as if the payment were payable under a weekly compensation claim as referred to in those sections.
Division 2 Claims for weekly payments
274 Liability to be accepted and weekly payments commenced within 21 days
(1) Within 21 days after a claim for weekly payments is made the person on whom the claim is made must determine the claim by:(a) accepting liability and commencing weekly payments, or(b) disputing liability.Note. Section 283 makes failure to comply with this section an offence. Section 74 requires notice of a dispute to be given.(2) An insurer can accept liability for weekly payments on a provisional basis for a period of up to 12 weeks determined by the insurer having regard to the nature of the injury and the period of incapacity.(3) The acceptance of liability on a provisional basis operates to extend the period within which the claim must be determined until the end of the period for which liability has been accepted on a provisional basis.Note. This allows the insurer more time to determine liability while providing for the commencement of weekly payments on the basis of the provisional acceptance of liability.(4) Liability cannot be accepted on a provisional basis under this section if the insurer is already making weekly payments on the basis of the provisional acceptance of liability under Division 1 when the claim for weekly payments is made.(5) The acceptance of liability on a provisional basis does not constitute an admission of liability by the employer or insurer under this Act or independently of this Act.(6) An employer is not required to determine a claim as provided by this section if:(a) the employer has duly forwarded the claim to an insurer who the employer believes is liable to indemnify the employer in respect of the claim, and(b) the employer has complied with all reasonable requests of the insurer with respect to the claim.Note. A claim forwarded to the insurer is taken to have been made on the insurer.
275 Duty to commence provisional weekly payments if claim is first notification of injury
(1) If the claim for weekly payments is the first notification that an insurer has received of the injury to the worker, section 267 (Duty to commence weekly payments following initial notification of injury) applies to require the commencement of provisional weekly payments of compensation within 7 days after the claim is made.(2) The provisional acceptance of liability pursuant to the commencement of provisional weekly payments of compensation under that section operates to extend the period within which the claim must be determined for the purposes of this Division until the end of the period for which liability has been provisionally accepted.Note. This allows the insurer more time to determine liability while providing for the commencement of weekly payments on the basis of the provisional acceptance of liability.
276 Continuation of provisional payments started before claim made
(1) If an insurer is already making provisional weekly payments when the claim for weekly payments is made (on the basis of the provisional acceptance of liability before the claim was made), the period within which liability for weekly payments must be determined is extended to the end of the period for which liability has been provisionally accepted.(2) If the period for which liability has been provisionally accepted ends before the end of the period within which liability for weekly payments must be determined, the insurer may continue to make weekly payments on the basis of the provisional acceptance of liability until the end of that period.
277 Provision for recovery of excess for provisional payments
Section 160 (Recovery of excess from employer) of the 1987 Act and section 152 of this Act apply to and in respect of the payment of provisional weekly payments of compensation under this Division as if the payment were payable under a weekly compensation claim as referred to in those sections.
278 Early acceptance of liability not prevented
This Division does not prevent the acceptance of liability and the commencement of weekly payments before the end of the provisional liability period.
Division 3 Claims for medical expenses
279 Liability to be accepted within 21 days
(1) Within 21 days after a claim for medical expenses compensation is made the person on whom the claim is made must determine the claim by accepting or disputing liability.Note. Section 283 makes failure to comply with this section an offence. Section 74 requires notice of a dispute to be given.(2) An employer is not required to determine a claim as provided by this section if:(a) the employer has duly forwarded the claim to an insurer who the employer believes is liable to indemnify the employer in respect of the claim, and(b) the employer has complied with all reasonable requests of the insurer with respect to the claim.Note. A claim forwarded to the insurer is taken to have been made on the insurer.
280 Provisional acceptance of liability
(1) An insurer can accept liability for medical expenses compensation on the basis of the provisional acceptance of liability for an amount of up to $5,000 or such other amount as may be specified by the WorkCover Guidelines.(2) The acceptance of liability on a provisional basis does not constitute an admission of liability by the employer or insurer under this Act or independently of this Act.
Division 4 Claims for lump sum compensation and work injury damages
280A Claim for lump sum compensation a pre-condition to damages claim
A claim for work injury damages in respect of an injury cannot be made unless a claim for lump sum compensation in respect of the injury is made before or at the same time as the claim for work injury damages.
280B Lump sum compensation to be paid before damages recovered
(1) An injured worker cannot recover damages in respect of an injury from the employer liable to pay compensation under this Act in respect of the injury unless and until any permanent impairment compensation and pain and suffering compensation to which the worker is entitled in respect of the injury has been paid.(2) This section does not prevent a claim for damages from being made before any permanent impairment compensation and pain and suffering compensation to which the worker is entitled in respect of the injury has been paid.Note. This section ensures that an injured worker receives the compensation to which the worker is entitled before damages are recovered (because section 151A of the 1987 Act would prevent the payment of compensation after damages are recovered).
281 Liability to be accepted and settlement offer made
(1) The person on whom a claim for lump sum compensation or work injury damages is made must, within the time required by this section, determine the claim by:(a) accepting liability and making a reasonable offer of settlement to the claimant, or(b) disputing liability.(2) A claim must be so determined:(a) within 1 month after the degree of permanent impairment first becomes fully ascertainable, as agreed by the parties or as determined by an approved medical specialist, or(b) within 2 months after the claimant has provided to the insurer all relevant particulars about the claim,whichever is the later.Note. Section 283 makes failure to comply with this section an offence. Section 74 requires notice of a dispute to be given. If an offer of settlement is not made as required by this section, the claim can be referred for assessment as soon as the time for making the offer has expired.(2A) The determination of a claim cannot be delayed beyond 2 months after the claimant has provided to the insurer all relevant particulars about the claim (that delay being on the basis that the degree of permanent impairment of the injured worker resulting from the injury is not fully ascertainable), unless the insurer has within that 2-month period notified the claimant that the degree of permanent impairment of the injured worker resulting from the injury is not fully ascertainable.(2B) When the person on whom a claim is made accepts or disputes liability, the person must notify the claimant as to whether or not the person accepts that the degree of permanent impairment of the injured worker resulting from the injury is sufficient for an award of damages.(3) An offer of settlement is to specify an amount of compensation or damages or a manner of determining an amount of compensation or damages.(4) If an offer of settlement is made on the basis that the insurer accepts only partial liability for the claim, the offer is to include details sufficient to ascertain the extent to which liability is accepted.(5) An employer is not required to determine a claim as provided by this section if:(a) the employer has duly forwarded the claim to an insurer who the employer believes is liable to indemnify the employer in respect of the claim, and(b) the employer has complied with all reasonable requests of the insurer with respect to the claim.Note. A claim forwarded to the insurer is taken to have been made on the insurer.(6) This section does not apply to a claim for work injury damages in respect of the death of a person, except as the WorkCover Guidelines may otherwise provide.
282 Relevant particulars about a claim
(1) The relevant particulars about a claim are full details of the following, sufficient to enable the insurer, as far as practicable, to make a proper assessment of the claimant’s full entitlement on the claim:(a) the injury received by the claimant,(b) all impairments arising from the injury,(c) any previous injury, or any pre-existing condition or abnormality, to which any proportion of an impairment is or may be due (whether or not it is an injury for which compensation has been paid or is payable under Division 4 of Part 3 of the 1987 Act),(d) in the case of a claim for work injury damages, details of the economic losses that are being claimed as damages and details of the alleged negligence or other tort of the employer,(e) information relevant to a determination as to whether or not the degree of permanent impairment resulting from the injury will change,(f) in addition, in the case of a claim for lump sum compensation, details of all previous employment to the nature of which the injury is or may be due,(g) such other matters as the WorkCover Guidelines may require.(2) If the employer requires the claimant to submit himself or herself for examination by a medical practitioner provided and paid for by the employer, the claimant is not considered to have provided all relevant particulars about the claim until the worker has complied with that requirement.(3) The insurer is not entitled to delay the determination of a claim under this Division on the ground that any particulars about the claim are insufficient unless the insurer requested further relevant particulars within 2 weeks after the claimant provided particulars.(4) In this section, injury is not limited by the meaning given by section 4.
Division 5 Enforcement of claims obligations
283 Offence of failing to determine a claim for compensation
(1) A person who fails to determine a claim as and when required by this Part is guilty of an offence unless the person has a reasonable excuse for the failure.Maximum penalty: 50 penalty units.
(2) A person does not have a reasonable excuse for a failure for the purposes of this section unless the person has an excuse that the WorkCover Guidelines provide is a reasonable excuse.(3) A person who has or anticipates having a reasonable excuse for the purposes of this section must notify the claimant in writing as soon as practicable.
284 Insurer liable to pay fee if claim goes to assessment
(1) If it appears to the Registrar that an insurer has:(a) failed without reasonable excuse to determine a claim as and when required by this Part, or(b) referred a matter that the insurer knows is not a genuine dispute for the purpose of delaying, without good cause, the determination of a claim,and the claim concerned is referred to the Commission for determination of a dispute or for assessment, the Registrar is to direct the insurer to pay the administration fee provided for by this section.(2) The administration fee is a fee of $250 or such other amount as may be prescribed by the regulations and is payable to the Authority for payment into the WorkCover Authority Fund.(3) (Repealed)(4) An administration fee payable under this section is recoverable as a debt due to the Authority.(5) A person does not have a reasonable excuse for a failure to determine a claim as and when required by this Part unless the person has an excuse that the WorkCover Guidelines provide is a reasonable excuse.(6) The Registrar is to notify the Authority of a direction under this section.
285 Offence of referring non-genuine disputes
A person on whom a claim is made must not refer a matter that the person knows is not a genuine dispute for the purpose of delaying, without good cause, the determination of the claim.Maximum penalty: 50 penalty units.
286 Partial acceptance of liability
(1) Liability for compensation can be partially accepted and partially disputed and references in this Part to accepting liability and disputing liability are to be interpreted accordingly.(2) A person who accepts liability for compensation on the basis of the partial acceptance of liability (including acceptance on a provisional basis) must, when notifying the claimant of the partial acceptance of liability, include details sufficient to ascertain the extent to which liability is accepted.