Managing payments made in error 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.
Principle
Risks relating to payments made to workers in error will be mitigated where practicable while ensuring efficient management of claims, and recovery of payments to workers in error will be managed in a fair and transparent manner.
Expectations
Benchmarks
S23.1
Where an insurer identifies a payment to a worker due to an error and wishes to seek recovery, the insurer is to advise the worker of the details of the payment(s) made in error, and clearly describe the error and the potential impact to the worker.
Note: the insurer is to consider the individual facts and circumstances of each matter, and consider whether it is appropriate to seek recovery from the worker.
Evidence on claim file
S23.2
Where the insurer negotiates a repayment arrangement with the worker, the insurer is to demonstrate they have considered the individual circumstances of the worker and potential financial hardship.
Evidence on claim file
S23.3
The insurer is to obtain informed consent from the worker before commencement of any repayment arrangement.
Evidence on claim file
Insurers should have processes in place to minimise any risk of overpayment or duplication of payments to workers. In instances where there may be an overpayment, this is to be managed in a fair and transparent manner.
Managing overpayments to workers in a fair and transparent manner, and in accordance with the law contributes to the viability of the system and minimises the likelihood of the relationship between the insurer and the worker being placed at risk.
If the overpayment is due to a return to work impacting the worker’s earnings, the insurer can seek an order for recovery from the Personal Injury Commission (the Commission).
The Commission may also make such orders as it thinks fit for the adjustment of weekly payments to a worker to take account of any overpayments in respect of any previous period. When the overpayment has arisen from fraud, SIRA may issue the order for recovery.
Overpayments to a worker resulting from insurer error are only to be recovered with informed and written consent of the worker.
