This section covers the obligations you are required to meet following the receipt of a workers’ compensation claim from one of your workers.Receiving the claim
It is not your decision to accept liability for the claim. Your insurer must assess the claim and advise you and the injured worker of their decision, in writing, within 14 days of receiving the claim. The advice must indicate whether it is accepted or disputed, or if they need more time to make a decision.Claims that involve a journey
A worker may be covered if they are injured whilst travelling under instruction from their employer in the course of their work, for educational purposes, or to attend at a place for treatment of a workers’ compensation injury.
However, a claim must still be lodged if received from a worker and the insurer will determine whether the claim is accepted.
An injured worker cannot be required to attend medical appointments arranged by you or your insurer more than once every two weeks and only during reasonable hours.
If you would like a second opinion, you can request a medical review through your insurer.
A worker also cannot be required to see more than three medical practitioners who are specialists in the same field.
An employer cannot insist on being present at an injured worker’s medical appointment.
If a worker’s claim is accepted, their medical bills can usually be forwarded straight to the insurer for payment.
Prior to commencing any treatment, the worker should be advised to check with your insurer that any proposed treatments will be covered and costs reimbursed.
Click for information about employer attendance at medical consultations (PDF – 151KB).
Getting feedback from your insurer
Ask your insurer for feedback regarding all claims, and consider arranging regular meetings. You can expect your insurer to inform you of the following:
- the cost of any claims made on your policy at least once a year
- any dispute referred to the Workers’ Compensation Conciliation Service and the outcomes of each stage of the dispute
- the renewal date for your policy.
- they may wish to take leave while the claim is being assessed
- any leave they may take while the claim is being assessed is not workers’ compensation
- if the claim is accepted, any leave taken during that time will be re-credited.
If the claim is accepted, your insurer will refund any payment from accrued leave entitlements and you must re-credit your worker with the leave they took during that period.
You should begin workers’ compensation payments without delay, and consult with your insurer regarding the amount. Once payments begin, you are required to pay your worker in the usual manner and on their usual payday, unless notified by the insurer to cease payments.
If you feel that you may be unable to pay an injured worker’s weekly payments in this manner, you should contact your insurer as soon as possible to discuss what options are available. If you cannot resolve the issue with your insurer, contact Advice and Assistance on 1300 794 744.
If your injured worker attains partial or total capacity to work during this time, you must provide their original position (where reasonably practicable), or another of equal status and pay for which they are qualified and capable of performing.
Intention to dismiss the worker
During the 12 month period, if you intend to dismiss your injured worker, 28 days’ notice of that intention must be given to them and to WorkCover WA by completing Form 15G – Notice of Intention to Dismiss a Worker.
WorkCover WA will then determine if any further information is required, and a Compliance Officer may contact you to discuss details of the termination.
Note: If your worker is in receipt of weekly payments at the time of dismissal, they will continue to receive statutory weekly payments and medical/related benefits.
In order to access certain benefits or settlements, or pursue common law damages, it may be necessary for your injured worker to obtain an impairment assessment from an approved medical specialist of their choice.
Impairment assessments are usually required when you (or your insurer) and your injured worker have not agreed on a level of impairment.What is an approved medical specialist?
An AMS is trained to evaluate impairment using the WorkCover WA Guides for the Evaluation of Permanent Impairment and the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fifth edition.
An injured worker obtains an assessment from an AMS of their choice.
As part of managing the workers’ compensation claim, your insurer may arrange for your injured worker to be reviewed by an AMS. Alternatively, your injured worker may arrange for their own review.
Your injured worker will be required to attend the assessment at an arranged time, date and place.
After the assessment, the AMS is required to provide a written report and a certificate to you and to your injured worker.
The AMS may also require you or your insurer to produce or consent to the production of any relevant document or information. Time limits may apply for meeting these requirements, and penalties exist for non-compliance.