- Workers Compensation Act 1987
- Workplace Injury Management and Workers Compensation Act 1998
- Workers' Compensation (Dust Diseases) Act 1942
- Workers Compensation (Bush Fire, Emergency and Rescue Services) Act 1987
- Workers Compensation Regulation 2016
- Workers Compensation (Dust Diseases) Regulation 2018
- Workers Compensation (Bush Fire, Emergency and Rescue Services) Regulation 2017
- Workers compensation guidelines
- NSW workers compensation guidelines for the evaluation of permanent impairment
- Workers compensation medical dispute assessment guidelines
- Guidelines for workplace return to work programs
- Workers compensation market practice and premiums guidelines
- Guidelines for the approval of treating allied health practitioners 2016 No 2
- Workers compensation licensed insurer business plan guidelines
Standards of practice
- Overarching claims management principles
- Standard of practice principles
- S1. Worker consent
- S2. Worker access to personal information
- S3. Initial liability decisions – general, provisional, reasonable excuse or full liability
- S4. Liability for medical or related treatment
- S5. Recurrence or aggravation of a previous workplace injury
- S6. Recoveries
- S7. Interim pre-injury average weekly earnings calculation
- S8. Insurer making weekly payments
- S9. Reduction in payments of compensation
- S10. Payment of invoices and reimbursements
- S11. Changes in capacity
- S12. Injury management plans
- S13. Additional or consequential medical conditions
- S14. Referral to an injury management consultant
- S15. Approval and payment of medical, hospital and rehabilitation services
- S16. Case conferencing
- S17. Section 39 Notification
- S18. Retiring age notification
- S19. Section 59A notification
- S20. Permanent impairment assessment reports
- S21. Negotiation on degree of permanent impairment
- S22. Insurer participation in disputes and mediations
- S23. Recovery of overpayments due to insurer error
- S24. Factual investigations
- S25. Surveillance
- S26. Arrangement for payments to Medicare Australia
- S27. Notification and recovery of Centrelink benefits from lump sum payments
- S28. Interpreter services
- S29. Cross-border provisions
- S30. Closing a claim
- S31. Death claims
- S32. Managing claims during the COVID-19 pandemic
- Workers compensation benefits guide
- Fees and rates orders
- Standards of practice
S24. Factual investigations
Factual investigations can play an important role in the workers compensation scheme; however, they can erode worker trust and must therefore be used judiciously.
Factual investigations will only be used when necessary and will always be undertaken in a fair and ethical manner.
Insurers are only to undertake factual investigations when required information cannot be obtained by another less intrusive means. Insurers must also clearly document the purpose for undertaking any factual investigation.
Evidence on claim file
If the worker is requested to participate in a factual investigation, the insurer is to advise the worker in writing and provide the following information:
Complete advice provided to the worker at least five working days before the proposed factual interview.
If a shorter time is required because of exceptional and unavoidable circumstances, a reduced timeframe is to be agreed by all parties.
Factual investigations play an important role in the workers compensation scheme; however, they can erode worker trust and must therefore be used judiciously.
Factual investigations involve the use of a third-party service provider to conduct an investigation to determine the available facts of a claim.
Factual investigations may be used to gather information to inform decision-making with respect to liability and other entitlements. Circumstances under which a factual investigation may be warranted include but are not limited to:
- determining if a worker meets the legislative definition of a worker
- where the issues surrounding the injury are unclear or disputed, or
- when there may be potential for recovery from a third-party.
A factual investigation may involve an interview with the worker, employer and/or witnesses, as well as a physical inspection or other external enquiries required to determine relevant details. Factual investigators are not to provide an opinion on medical aspects of the claim.
Factual services should only be used when necessary and should be conducted in an ethical manner. Any information obtained must be used and stored appropriately