Claims management other

Overpayments of weekly benefits or medical expenses may occur. In these instances, the insurer is to manage the recovery of the overpayment in a fair and transparent manner.

Overpayment due to insurer error

Overpayments to a worker resulting from insurer error are only to be recovered with the informed and written consent of the worker.

The insurer is required to write to the worker clearly identifying the overpayment and the correct entitlement.

Insurers should negotiate with the worker and come to a mutually acceptable repayment arrangement. Insurers should take into account any financial hardship to the worker.

Overpayment as a result of a change in employment

When an overpayment has resulted from the worker’s return to work, or other change in their employment, the insurer can apply to the Personal Injury Commission (the Commission) to order a refund of any amount the worker was not entitled to receive.

Overpayment as a result of fraud or false claim

If the insurer believes the overpayment is a result of fraud or a false claim they may refer the matter to SIRA.

If SIRA is satisfied that a person has received an overpayment as a result or partly as a result of fraud or a false claim, then SIRA can order the person to refund the amount of the overpayment to the person who made the payment. The order is enforceable as a civil debt and can be recovered in any court of competent jurisdiction.