If you have a workers’ compensation insurance policy with an insurer or through an insurance broker, there are clear guidelines on what you can expect from them.

WorkCover WA acknowledges the achievement of Western Australia’s licensed workers’ compensation insurers in collaboratively developing a framework for the management of claims made by workers following a work related injury.

The Best Practice Guidelines 2008 set parameters for the insurers to follow and by doing so provides consistency across insurers for injured workers and employers with respect to processes associated with claims management.

It is advisable to check whether your insurer can assist you in these various activities to ensure your workers’ compensation claims are effectively managed.

The most crucial way you can assist your insurer in managing your claims is by immediately providing them with any relevant information you obtain regarding an injured worker. You need to involve them as soon as possible after the injury occurs.

It is not your decision to accept liability for the claim. Your insurance company must assess the claim and notify you and the injured worker in writing within 14 days of receiving the claim, whether it is accepted or disputed, or if they need more time to make a decision.

If your insurer fails to reply within 14 days of your lodging the claim, then the worker becomes entitled to weekly payments of compensation until determined by an arbitrator. The insurer must indemnify you for these payments and they are also liable to a $1,000 penalty.

If, after 17 days of the worker lodging their claim, the worker has not received notification or the first of their weekly payments, then the matter is deemed to be in dispute and the worker may file an application with the Dispute Resolution Directorate (DRD) for a decision.

Note: The employer may advise the worker of the option to use sick leave or annual leave until the insurance company makes a decision on the claim. If the claim is accepted, weekly payments begin and any sick leave taken should be recredited.

REMEMBER!

Ask your insurer for feedback regarding all claims, and perhaps consider arranging regular meetings with your insurer to discuss any claims.

You can expect your insurer to at least inform you of the following:

• the cost of any claims made on your policy at least once a year;
• any dispute referred to the Dispute Resolution Directorate and the outcomes of each stage of the dispute; and
• the renewal date for your policy.