- GN 3.1 Initial notification of injury
- GN 3.2 Initial liability decision - provisional, reasonable excuse or full liability
- GN 3.3 Certificate of capacity
- GN 3.4 Pre-approval of treatment
- GN 3.5 Injury management plans
- GN 3.6 Investigating changes in capacity
- GN 3.7 Case conferencing
- GN 3.8 Rehabilitation services during case management
- GN 3.9 Work capacity assessments and decisions
- GN 3.10 Section 39 notification
- GN 3.11 Section 59A
- GN 3.12 Surveillance
- GN 3.13 Factual investigations
- GN 5.1A Calculating PIAWE
- GN 5.1 Calculating PIAWE for workers injured before 21 October 2019
- GN 5.2A Calculating weekly payments
- GN 5.2 Calculating weekly payments for workers injured before 21 October 2019
- GN 5.3 Making weekly payments
- GN 5.4 Weekly payments after the second entitlement period
- GN 5.5 Payments to workers with highest needs
- GN 5.6 Weekly payments for exempt workers
- GN 5.7 Permanent impairment
- GN 5.8 Property damage
- GN 5.9 Domestic assistance
- GN 5.10 Commutations
- GN 5.11 Compensation and other work entitlements
- GN 5.12 Death claims
- GN 6.1 Determining liability for medical and related treatment
- GN 6.2 Surgery
- GN 6.3 Nominated treating doctor and specialists
- GN 6.4 Allied health practitioners
- GN 6.5 Independent consultants
- GN 6.6 Referral to an injury management consultant
- GN 6.7 Aids and modifications
- GN 6.8 Independent medical examinations
GN 3.1 Initial notification of injury
Application: This guidance applies to exempt workers
An ‘initial notification of injury’ is the first notice an insurer receives regarding an injury to a worker.
An injury is usually notified to the insurer by the employer but may also be notified by the worker, doctor or other party.
This guidance covers an insurer's obligations following initial notification.
When the initial notification of injury is incomplete
If the insurer receives an incomplete initial notification of injury, they should contact the notifier (and the worker where possible) within three business days and specify what additional information is needed (see Part 1 of the Workers compensation guidelines).
The date the missing information is received is taken to be the date the initial notification of injury is made. This date will determine the timeframe for commencing weekly payments.
The insurer requires the following information for the initial notification of injury as specified by Part 1 of the Workers compensation guidelines.
Treating doctor (where known)
When the notified insurer is not the current insurer of the employer
If the insurer cannot find a policy that covers the employer, the insurer should contact the worker and employer (and the notifier, if not the worker or employer) within three business days of receiving a notification of injury, to gather more information to try and identify the policy.
If the insurer still cannot identify the policy, they should:
- tell the worker, employer and notifier (if applicable) that they are not the current insurer
- refer the notifier to the SIRA Customer Service Centre (on 13 10 50) or icare Uninsured Liability Insurance Scheme (on 13 44 22).
Once the current insurer has been identified, the notified insurer should:
- immediately pass the notification on to the current insurer
- advise the worker, employer and notifier of the current insurer’s details by phone, and then follow-up in writing.
If the initial notification is for a significant injury, the insurer must make contact with the worker, the employer (except when the employer is a self-insurer) and (if appropriate and reasonably practicable) the worker’s nominated treating doctor, within three working days, and initiate action under the insurer’s injury management program.
During this contact, the insurer should gather information that will help the insurer make a full or provisional liability decision. It also provides an opportunity to establish the worker’s injury management plan in consultation with the worker, nominated treating doctor and employer. See Standard of practice S12. Injury management plans.
During the initial contact the insurer should discuss:
- the importance of recovery at work
- the injury management plan and the activities to be undertaken as part of this plan
- roles, responsibilities, rights and obligations of each stakeholder.
As this is often the first point of contact between the insurer and the worker, it is important to build rapport and establish transparent and open communication.
Insurers should be aware that for many workers this is their first exposure to the workers compensation system and they may be feeling confused and overwhelmed.
Insurers should clearly explain the claims management process to the worker and inform them what they can expect to happen next.
Insurer obligations after receiving initial notification of injury
When an initial notification of injury is received, the insurer should first check that sufficient information has been provided to identify the employer’s current policy of insurance.
If the insurer is the current insurer of the employer, then sections 267 and 268 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) provide that within seven days of the initial notification to the insurer of an injury to a worker, the insurer must either:
- commence provisional payments of weekly compensation (for up to 12 weeks), or
- if a reasonable excuse exists for not commencing weekly payments, send the worker a written notice giving details of the reasonable excuse and advising that the worker is entitled to make a claim (and explain how that claim can be made).
Note: When counting seven calendar days:
- start the seven-day count the day after the notification is received by the insurer (see section 36(1) of the Interpretation Act 1987)
- if the last day for the seven-day count is a Saturday, Sunday, public holiday or bank holiday, then the last day for compliance will be the next business day (see section 36(2) of the Interpretation Act 1987).
When a claim for weekly payments is the first notification of injury
If a claim for weekly payments is the first notification of injury received by the insurer, they must treat it the same way as any other initial notification of injury - see above.