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insurers and claims

How an insurer can help the injured worker, and the claims process they must follow.

If you’re an insurer, you must do the following when notified of an injury:

  • contact the worker and the employer within three days, and consult with all relevant parties including the treating doctor, to ensure that the worker receives necessary assistance to recover and return to work
  • provide information regarding the claims process
  • start provisional weekly payments within seven days, for up to a maximum of twelve weeks (unless there is a reasonable excuse not to do so)
  • decide whether you or the employer will pay the worker
  • decide whether to approve provisional medical expenses for up to the prescribed statutory amount  and start these payments
  • notify the injured worker and employer, in writing, about the amount and time period of the provisional payments
  • develop an injury management plan for a worker with a significant injury and comply with their obligations under the injury management plan.

New guidelines for claiming workers compensation came into effect on 1 August 2016, refer to injury claims for more information.

When starting the claim process, you must follow these steps:

  • decide whether the injured worker needs to complete a claim form, and help the worker complete the form if required
  • inform the employer (within seven days) if a claim has been made, and make a decision about the ongoing liability of the claim within 21 days or before the end of the period of provisional liability
  • provide the worker with contact details of our Customer Service Centre on 13 44 22, to facilitate communication of accurate information and prevent disputes
  • should you decide to dispute or decline any aspect of the claim you must provide the worker with a written explanation of your decision, attaching all relevant reports and documents and provide the worker with information on how to ask for a review of the decision and where to seek further assistance (refer to SIRA’s Guidelines for claiming workers compensation).

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