Standard 23 - recovery of overpayments due to insurer error
Managing overpayments to workers in a fair and transparent manner contributes to the viability of the system and helps to preserve the relationship between the insurer and the worker.
Recovery of overpayments due to insurer error
Principle: Risks relating to overpayment or duplication of payments to workers will be mitigated where practicable while ensuring efficient management of claims, and overpayments will be managed in a fair and transparent manner.
| Expectations | Benchmarks | |
|---|---|---|
| S23.1 | Where an insurer identifies an overpayment to a worker due to an error and wishes to seek recovery, the insurer must advise the worker of the details of the payment(s) and clearly describe the error and the potential impact to the worker. | Evidence on claim file. |
| S23.2 | Where the insurer negotiates a repayment arrangement with the worker, the insurer must demonstrate they have considered the individual circumstances of the worker and potential financial hardship. | Evidence on claim file. |
| S23.3 | The insurer must obtain informed consent from the worker prior to commencement of any repayment arrangement. | Evidence on claim file. |