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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.

Initial liability decisions

Principle: Liability decisions will be informed by careful consideration of all available information and proactive consultation with the worker and employer.

 ExpectationsBenchmarks
S3.1
(General)  		When determining liability, insurers must obtain and consider all relevant information, consult with the worker and the employer, and make a decision at the earliest possible opportunity. Evidence on claim file.
S3.2
(Provisional ability)  		If accepting provisional liability, the insurer must provide the following information to the worker (in addition to notice set out in section 269 of the 1998 Act):
  • the worker’s pre-injury average weekly earnings (PIAWE) or average weekly earnings (AWE) and how that amount has been calculated;
  • the amount of the weekly payment and how that amount has been calculated;
  • who will pay the worker and when;
  • what the worker can do if the worker disagrees with the amount or does not receive payment; and
  • what information the worker must provide (including when and to whom) to continue to be entitled to weekly payments
 Written notice provided to the worker within two working days after decision.
S3.3
(Provisional liability)  		If accepting provisional liability, the insurer must provide the following information to the employer:
  • confirmation that weekly payments are to commence;
  • the period for which provisional payments will continue;
  • that the insurer will develop an injury management plan for the worker if required to do so by Chapter 3 of the 1998 Act; and
  • that the worker is entitled to make a claim for compensation and how that claim can be made.
 Written notice provided to the employer within two working days after decision.
S3.4
(Reasonable excuse)  		If the insurer has a reasonable excuse not to commence provisional weekly payments, the insurer must provide the following information to the worker (in addition to notice set out in section 268 of the 1998 Act) and to the employer:
  • how the excuse can be resolved;
  • details about how further information can be sought from the insurer;
  • that the worker can seek assistance from their union, a legal representative or the WIRO; and
  • that the worker has a right to seek an expedited assessment by the Workers Compensation Commission.
 Written notice provided to the worker within two working days after decision.
S3.6
(Full liability) 		If accepting liability for a claim for weekly payments, the insurer must provide the following information to the worker and the employer:
  • confirmation of the decision to accept liability;
  • the worker’s pre-injury average weekly earnings (PIAWE) or average weekly earnings (AWE) and how that amount has been calculated;
  • the amount of the weekly payments and how that amount has been calculated;
  • who will pay the worker and when;
  • what the worker can do if the worker disagrees with the amount or does not receive payment; and
  • that the insurer will develop an injury management plan for the worker if required to do so by Chapter 3 of the 1998 Act; and
  • what information the worker must provide (including when and to whom) to continue to be entitled to weekly payments.
Written notice provided to the worker and employer within two working days after decision.
S3.7
(Full liability)  		If an insurer requires a completed claim form to determine liability, they must proactively request this from the worker and allow sufficient time for the worker to complete and submit the form.Request at least four weeks before expiration of provisional period or upon  exhaustion of provisional medical expenses.
S3.8
(Full liability) 		Upon request, the insurer must provide the employer with information relevant to the liability decision, including the evidence considered and legislative provisions relied upon.Written response provided within ten working days.

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