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.
Expectations | Benchmarks | |
---|---|---|
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):
| 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:
| 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:
| 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:
| 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. |