Claims management other

Overview

The insurer should communicate regularly with the worker, employer and stakeholders throughout the life of the claim regarding the worker’s entitlements.

Providing early notification prior to cessation of weekly payments helps to ensure that workers have sufficient time to prepare for cessation and make any necessary arrangements.

This guidance considers the effect of retiring age on entitlements to weekly payments, and the importance of providing notice to impacted workers.

General

Workers who reach retiring age while in receipt of weekly payments may have been in receipt of weekly payments for an extended period, and may be in a financially vulnerable position.

Under section 52 of the Workers Compensation Act 1987 (1987 Act), weekly payments cease:

• one year after retiring age for those injured before retiring age, or
• one year after the first period of incapacity for those injured on or after retiring age.

Determining retiring age

Insurers should have appropriate systems and controls in place to ensure accurate payment of weekly payments in accordance with the Act.

As provided for in section 52(1) of the 1987 Act, retiring age is the age at which a worker would, subject to satisfying any other qualifying requirements, be eligible to receive an age pension under the Social Security Act 1991 (Cth).

Eligibility for the age pension varies according to a worker’s date of birth. Current information is available on the Commonwealth Department of Human Services’ website, and should be used to identify affected workers well in advance of reaching their retiring age anniversary.

Termination of weekly payments on retiring age

The worker should be advised of their entitlements throughout the life of the claim. However, the insurer remains responsible for explicitly informing the worker (verbally and in writing) of the effect of section 52 of the 1987 Act and the impact this will have on their entitlements.

Insurers should carefully consider those workers who have been identified as high risk, and what support may be required when communicating termination of weekly payments. For these workers, appropriate communication may involve a support person and/or health or legal representative.

Section 52 notification prior to cessation after retiring age

Insurers should ensure the worker is fully informed well in advance of the termination of weekly payments.

Insurers should provide written notification to a worker at least 13 weeks prior to cessation of weekly benefits (see Standard of practice S18. Retiring Age notification for what the written notice should include).

Where other support services are available that may help a worker adjust to the end of weekly payments, details should be provided to the worker.

Where appropriate, insurers should encourage workers to be fully informed and prepared regarding superannuation, Centrelink payments and other services which may be available.