Abbreviations
What is IPC?
Independent Physio/Psych Consultant
Can we accept a claim once notified of an injury?
No.
What does Provisional Liability entitle a worker to?
12 weeks of weekly benefits and up to $10,000 in medical expenses
Can you apply a reasonable excuse on a claim after day 7?
NO.
No one - NO FAULT SCHEME
What is IPP?
Information prediction principles
What are the different types of Liability?
Decline/Dispute
Reasonable Excuse
Provisional Liability
When should we make the initial weekly benefit payment?
Within 7 days
How long should a reasonable excuse be applied?
RE should be applied until the reasonable excuse grounds have been satisfied OR if a Workers Injury Claim Form and valid COC (or appropriate alternative medical evidence) is received.
If EML accepts a claim, is EML or the employer liable forever.
No. Benefits for a claim are only available for a closed period of up to 5 years (if the worker is able to demonstrate some capacity).
What is MSP
Medical Support Panel
How many days to make an initial liability decision?
7 calendar days
What happens when provisional payments expire?
We are required to make a further liability decision on the claim.
What is a worker entitled to under a Reasonable Excuse?
Up to $10,000 in medical expenses.
If a worker has been terminated prior to the claim lodgement, are they able to make a claim?
Yes they can! As with any claim you should gather as much information through discussion with all stakeholders to make an informed and soundly based decision.
CDD
Communication, Documentation, Data
What is the eligibility criteria for a claim?
2. Worker must meet the location territory requirement (NSW)
3. Worker must be defined as a worker
4. Employment must be a main or substantial contributing factor
True or False: Provisional acceptance of a claim cannot be made if there is insufficient information.
FALSE!
TRUE or FALSE: You have 7 days from receipt of a Workers Injury Claim Form and valid COC (or alternative appropriate medical evidence) to apply a subsequent liability decision.
FALSE - you have 21 calendar days
If an employee is injured at a work event, can they put in a claim?
If an injury arises from an activity where the Worker was authorised, encouraged, or permitted by their Employer to attend, this would be reasonably open to satisfy the requirements of a workplace injury.
HPP
Health Protection Principles
What are the three main responsibilities as a CM in determining liability
1. review evidence
2. soundly based evidence (based on current law and all available evidence)
3. Engage stakeholders in decisions
What information is provided in the standard PL letter
PIAWE
indicative amount of weekly payment and how the amount has been calculated
what to do if the worker disagrees with the amount or does not receive payment
initial injury management information
What are the 7 reasons that constitute a Reasonable Excuse?
Can a worker who has had property/valuables damaged during the course of a workplace incident have this reimbursed, repaired, or replaced?
Yes.