Appendix 1: Context and relevant provisions - Standard 3 - initial liability decisions

Standard 3 - Initial liability decisions – general, provisional, reasonable excuse or full liability.

Making initial liability decisions promptly, in consultation with key stakeholders and based on all available evidence will ensure that workers and employers can focus on recovery and return to work.

Liability decisions must be made in accordance with the legislation and informed by the careful consideration of all evidence. Key to the principles of fairness and transparency is the observation of procedural fairness and proactive consultation with the worker and employer.

When determining initial liability for an injury, insurers are to gather the relevant evidence, consult with key stakeholders (including the employer and worker) and ensure that the decision is made in a timely manner and communicated appropriately.

Insurers can accept liability for weekly benefits outright or they may accept liability on a provisional basis for a period of up to 12 weeks, having regard to the nature of injury and period of incapacity.

Alternatively, the insurer can delay making a liability decision on the claim by applying a reasonable excuse to the claim if they have sufficient reason for doing so. Reasons for when a “reasonable excuse” are detailed in the Workers compensation guidelines.

Once the reasonable excuse has been resolved, the insurer can either provisionally accept within seven days or, fully accept, or deny liability for the claim within 21 days.

If a claim for weekly payments has been accepted provisionally, the insurer is required to determine the claim, by either accepting or disputing liability, before the end of the provisional period. This does not apply to claims finalised before the expiration of the provisional period.

Proactive communication with the worker and the employer is an integral part of sound decision-making. Decisions need to be made in a fair and transparent manner – this requires full and open communication between stakeholders.