Making medical or treatment liability decisions promptly, in consultation with key stakeholders and based on all available evidence, will reduce the likelihood of disputes and ensure workers can focus on recovery and return to work.
Principle
Liability decisions will be informed by careful consideration of all available information and proactive consultation with relevant stakeholders.
Expectations
Benchmarks
S4.1
When determining liability for medical or related treatment, insurers are to obtain and consider all relevant information, consult with the worker and relevant parties as required, and make a decision at the earliest possible opportunity.
Evidence on claim file
S4.2
When a claim for medical or related treatment is received, the insurer is to acknowledge the request and keep the worker informed of the status of their claim.
Request acknowledged within 10 working days
S4.3
The insurer is to advise the relevant parties of the outcome and reasons for a decision regarding liability for medical or related treatment.
Advice provided within two working days after decision
Making medical or treatment liability decisions promptly, in consultation with key stakeholders and based on all available evidence will reduce the likelihood of disputes and ensure workers can focus on recovery and return to work.
Insurers are required to make liability decisions at various points during a claim. Each time a worker makes a claim for medical or related treatment, the insurer is required to determine liability in accordance with the legislation. Insurers are to gather the relevant evidence, consult with key stakeholders and ensure that the decision is soundly based, made in a timely manner and communicated appropriately.
Liability decisions must be made in accordance with the legislation and informed through careful consideration of all evidence. Key to the principles of fairness and transparency is the observation of procedural fairness and proactive consultation with the worker and employer.
NSW workers compensation legislation requires liability to be determined within 21 calendar days after a claim for medical expenses has been made. If the treatment requested is already covered under the pre-approval provisions of the Workers compensation guidelines, the worker and provider are to be informed to avoid unnecessary delay.
Decisions should be made in a fair and transparent manner and include communication with the worker, nominated treating doctor and other relevant parties.
