Part A - How claims process works Flashcards
A1 Initial Notification of an Injury -1st step in claiming compensation for work-related injury
notify the employer and the insurer
a worker must notify the employer as soon as an injury happens, unless special circumstances apply. A worker can do that by
written or verbal notification
the employer must keep
a readily and accessible register of injuries in the workplace
when the employers become aware, they must
notify their insurer within 48 hours.
an insurer can also be notified by the
worker or the representative of the worker or the employer (ie doctor or union rep)
notification to the insurer can be by
a written form (email) or verbal (phone)
initial notification
notification to the insurer
if the worker or the rep of the worker asks for the insurer’s name, the employer must
provide it to the worker. Otherwise if it cannot be done, the worker can contact SIRA
the following details are required to notify the insurer: worker:
name and contact details
the following details are required to notify the insurer: employer
business name and contact details
the following details are required to notify the insurer: treating doctor (if relevant)
name and name of medical centre or hospital
the following details are required to notify the insurer: injury:
date, time, description of injury, and how it was acquired
the following details are required to notify the insurer: notifier:
name, relationship to the worker or employer, contact details
if insurer cannot find a policy cover within 3 business days of the notification, the insurer should contact the employer: If it cannot identify the policy, the notified insurer should:
■ tell the worker, employer and notifier that it is not the current insurer
■ refer the notification to the SIRA Customer Service Centre.
if insurer cannot find a policy cover within 3 business days of the notification, the insurer should contact the employer: If the current insurer can be identified, the notified insurer should
■ pass the notification on to the current insurer immediately
■ advise the worker, employer and notifier in writing
If the insurer receives an incomplete notification, it should tell the notifier (and the worker, where
possible) within
three business days and specify the information needed.
The date the notification is completed becomes the
‘initial notification date’, which affects provisional
payments (see A2).
Once the notification is complete, the insurer must review the information and take one of these
actions:
- Start provisional payments (see A2).
- Delay starting provisional weekly payments due to a reasonable excuse (see A2).
- Determine liability (see Part B or Part C).
A2 Provisional payments: The insurer may make provisional payments before it determines liability (see Part B or Part C) to cover:
■ up to 12 weeks of payments for loss of income
■ up to $7,500 for reasonably necessary medical treatment
Starting provisional payments: Once the insurer has received an initial notification of an injury, it must
start provisional weekly
payments within seven calendar days unless it has a reasonable excuse not to.
The insurer may also commence payments for
medical expenses on a provisional basis.
A reasonable excuse may apply to provisional weekly payments, but not to
provisional medical
payments