New South Wales

Victoria

Queensland

Western Australia

South Australia

Tasmania

Northern Territory

Australian Capital Territory

C’wealth Comcare

C’wealth Seacare

C’wealth DVA

New Zealand

Timeframe for claim lodgement

Within 6 months — s261(1) Workplace Injury Management and Workers Compensation Act 1998; or If injury resulting in death or serious and permanent disablement within 3 years — s261(4), 1998 Act; or longer period with approval of SIRA s261(5), 1998 Act.

As soon as practicable with injury employer for weekly payments, 2 years for death claims, 6 months after relevant service for claim for medical and like service — s20(8), Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act). For certain employers, claims must be lodged within 5 days of receiving it - s31(3).

6 months — s131(1), Workers’ Compensation and Rehabilitation Act 2003

(if beyond 20 days, extent of the insurer’s liability to pay compensation is limited to a period starting no earlier than 20 business days before the day on which the valid application is lodged) — s131(2)

Beyond 6 months — s131(5)).

12 months --s178(1)(b), Workers’ Compensation and Injury Management Act 1981

Beyond 12 months — s178(1)(d).

Within 6 months of the day on which the entitlement to make the claim arises — s30(1)(b), Return to Work Act 2014

A claim can be made later if the determination has not been substantially prejudiced or if the time frame was missed due to ignorance, mistake, absence from the State or other reasonable cause—s30(3).

Within 6 months after the date of the occurrence of the injury, or where the injury results in the death of the worker, within 6 months after the date of the death — s32(1)(b), Workers Rehabilitation and Compensation Act 1988

Beyond 6 months if the failure to make the claim was occasioned by mistake, absence from the State of the worker, or other reasonable cause — s38(1).

6 months — s182(1) Return to Work Act 1986.

Beyond 6 months — s182(3)

3 years — s120(1)(b), or

Beyond 3 years — s120(2), Workers Compensation Act 1951.

No specified time — s54, Safety, Rehabilitation and Compensation Act 1988.

No time specified — s63, Seafarers Rehabilitation and Compensation Act 1992.

Military Rehabilitation and Compensation Act 2004 (MRCA) — No specified time — s319.

Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA) — As soon as practicable after employee becomes aware of the injury or as soon as practicable after the death — s53.

Within 12 months — s53, Accident Compensation Act 2001.

How a claim must be lodged

A workplace injury must be notified to the employer as soon as possible. – s44 and s254, 1998 Act

The employer must notify the insurer within 48 hours of becoming aware that a worker has received a workplace injury– s44, 1998 Act

A worker, employer or their representative can make initial notification of the injury to the insurer, either electronically, in writing or by phone

In an approved form given or served on the employer — s20.

It may be lodged with the Authority in certain circumstances — s31(4), s29.

With the insurer in the approved form (whether by paper form, online, telephone or submitted by doctor).

Worker must lodge claim form and first certificate of capacity with employer.

For workers of an employer who is not a self-insured employer, the claim form must be given by the worker, or their representative to:

their employer direct (if the worker is in employment at the commencement of incapacity), or the Corporation, or the employer’s claims agent in one of the following manners:

in person, via post, via facsimile, via telephone or via email

30(1)(a).

Claim form plus medical certificate to be given to employer or person designated by employer s34

May be given to employer personally or by post s35.

On approved form — s82, if claiming for lost time must be accompanied by Medical certificate of capacity - First

Giving or serving personally on employer. Posting to employer — s83.

s94 — Injury notice must be given to the employer.

s116 — A worker may claim compensation under this Section.

Section 54(2) — A written claim on a form substantially complying with the form approved by Comcare, given to the relevant authority.

s63(2) — A written claim on a form substantially complying with the form approved by the Seacare Authority, given to the employer.

MRCA s319(2) — A claim under paragraph (a), (b) or (c) must:

(a) be in writing; and

(b) be given to the Commission; and

(c) satisfy the requirements (if any):

(i) prescribed by the regulations; or

(ii) determined in writing by the Commission;

as to the form and content of claims, or claims of that kind.

MRCA s319(2A) — A claim under paragraph (1)(d) must:

(2A) A claim under paragraph (1)(d) must:

(a) be in writing and be given to the Commission; or

(b) be made orally to the Commission.

Note: Section 323 sets out when a claim is taken to have been given to the Commission.

DRCA s54(2) — A claim shall be made by giving the relevant authority:

(a) a written claim in accordance with the form approved by MRCC for the purposes of this paragraph; and

(b) except where the claim is for compensation under section 16 or 17— a certificate by a legally qualified medical practitioner in accordance with the form approved by MRCC for the purposes of this paragraph.

Claim form or in a manner specified by the Corporation.

The Corporation may impose reasonable requirements such as requiring the person to lodge a written claim.

Employer acknowledges receipt of claim

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As soon as reasonably practicable — s21.

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—

—

—

N/A

—

N/A

—

N/A

N/A

Employer passes on claim form to insurer/authority

Notification must occur within 48 hours (s44, 1998 Act) and the claim must be forwarded within seven days of receiving claim or other documentation in respect of a claim — s264(1), 1998 Act.

Within 10 days after the employer receives the claim — s73(1).

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Five working days — s57A(2A).

Five business days — s30(5).

Employer must notify insurer of claim within 3 working days of receiving claim — s36(1AA).

Employer must immediately complete employer’s report section of claim and forward it to insurer within 5 working days of receiving claim — s36(1)

Three working days — s84(1).

Seven days — s126(1).

N/A

—

N/A

N/A

Employer/ worker supplies further information to insurer on request

Seven days from insurer request — s264(2), 1998 Act.

No time limit except decision must be made on claim for weekly payments or deemed accepted.

10 business days of receiving notice — s167(2).

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N/A

—

—

Seven days — s126(2).

28 days — s58.

No time specified — s67.

DRCA s58 – 28 days

MRCA s330 – 28 days

No time limit on the claimant but ACC must make request for additional information within 21 days after claim is lodged — s56(2).

Insurer passes on claim form to authority

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N/A. Authorised agent of authority has claims management function.

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Within 21 days after payments commence — s57C(2).

N/A

Five working days — s36(2).

10 working days — s84(2).

N/A

N/A

—

N/A

N/A

Availability of provisional liability

Yes

Commence weekly payments on a provisional basis within seven days of receiving initial notification, unless the insurer has one of the seven prescribed reasonable excuses (s267, 1998 Act) Provisional medical expenses up to $10,000 (s280, 1998 Act). However reasonable excuse cannot be applied to medical expenses.

Provisional payments for reasonable medical expenses are available for eligible employees with a mental injury - s263B. Provisional payments can be made where it appears that a person may be entitled to compensation in respect of the death of a worker — s243. Maximum amount for medical and other costs $9,600 (indexed each year in accordance with CPI).

Yes - for psychological injury, an insurer must take all reasonable steps to provide reasonable services to support the worker in relation to the psychiatric or psychological injury during the claim determination period - s232AB.

No

No

However, obliged to offer interim benefits to a worker if the claim has not been determined within 10 days of receipt s32.

Yes, employer obliged to commence weekly payments — s81. Payments are not an admission of liability — s81AA.

Liability is deemed accepted if decision not made within 10 working days of receiving claim (s85). Liability continues until 14 days after the employer notifies the claimant of the decision.

N/A

N/A

N/A

N/A

N/A

Timeframes for claim decision

Decision liability for all or part of a claim within 21 days of the claim being made —s274(1) and s279(1), 1998 Act.

28 days for weekly payments if received by insurer within 10 days or 39 days in other circumstances— s75. Provisional payments are payable up to the date of claim acceptance or in any other case, 13 weeks after the day the worker is determined to be entitled to provisional payments - s 263I.

No statute for deemed acceptance or rejection, however claims must be determined within 20 business days — s134(2) where practical.

Insurers have up to

14 days —s57A(3).

10 Business days — s31(4) (wherever practicable).

If the liability has not been disputed via a referral to the Tribunal within 84 days, the liability is taken to have been accepted. — s81A(1), s81AB.

10 working days after receipt by employer — s85(1).

If no decision within 10 days has been made 14 days after the employer notifies the claimant of the decision — s87.

28 days — s128(1).

No legislated timeframes for claim decisions. Determining authorities are required to make determinations accurately and quickly — s69(a) and 108E(b)

Claims are deemed to be rejected if not determined within the following statutory time frames: 60 days for death claims (s72), 12 days for incapacity, loss of property and medical expenses (s73), 30 days for permanent impairment (s73A).

N/A

The Corporation must make a claim cover decision within 21 days or seek an extension. If an extension is sought the Corporation must make a decision within 4 months from the date the claim is lodged. For complicated claims the Corporation has up to 9 months to make a decision — s56 and s57.