Overarching claims management principles

These overarching claims management principles apply generally across all aspects of claims management, to provide direction for the handling and administration of claims under the workers compensation system. These principles support the workers compensation system objectives outlined in section 3 of the 1998 Act.

Principle 1 - Fairness and empathy

The management of claims will be undertaken in an empathetic manner intended to maximise fairness for workers by:

  • ensuring that workers understand their rights, entitlements and responsibilities, and making clear what workers and employers can expect from insurers and other scheme participants; and
  • ensuring workers are afforded procedural fairness and decisions are made on the best available evidence, focused on advancing the worker’s recovery and return to work.

Principle 2 - Transparency and participation

Workers, employers and other scheme participants will be empowered and encouraged to participate in the management of claims by:

  • ensuring transparent and timely communication of the reasons and information relied upon for decisions and facilitating right-of-reply and prompt, independent review of decisions; and
  • ensuring opportunities are provided to workers, employers and other scheme participants to contribute information that can support and inform claims management.

Principle 3 - Timeliness and efficiency

Claims management decisions will be made promptly and proactively, and claims will be managed in a manner intended to reduce delays and costs and maximise efficiency by:

  • promptly and efficiently processing claims, responding to inquiries, determining entitlements and making payments;
  • progressing claims without unnecessary investigation, dispute or litigation.