2.2.4 Invalid claims

If a worker’s claim for compensation is invalid it must be returned to the worker immediately accompanied by a notice specifying the reasons for invalidity.

If the claim for compensation is invalid due to a material defect Material defects, omissions or irregularities can affect the decision to accept or reject a claim., irregularity or omission it must be returned to the worker and accompanied by a notice specifying the reason for the claim being invalid within 14 days of being given to or served on the employer, unless the information can be collected by other means (such as telephone contact with worker).

If the claim for compensation is not returned to the worker within 14 days of the employer receiving it, the claim form must not be sent back and will be treated as valid regardless of the defect.

If the claim includes a mental injury, Agents should return the invalid claim form/early notification to the worker within 3 business days of receipt.

myWorkSafe will not allow an invalid claim to be submitted online. Where a worker is experiencing difficulty submitting a form using myWorkSafe, this may indicate they have not completed all steps to submit a valid form, and should seek assistance.

A worker’s claim for compensation is invalid and considered not to have been made in the following circumstances

The worker has not made the claim using an approved form or has incorrectly used an approved form for the type of claim being made (eg a form to claim impairment benefits for a medical and like expenses claim). In these circumstances the Agent must:

• return the original form and any Certificate of Capacity Ongoing certificate is issued for up to 28 days and can be issued by a: medical practitioner, osteopath, physiotherapist, chiropractor. to the worker with a copy of the approved claim form and ask the worker to supply the correctly completed approved claim form for the type of claim being made and any required Certificate of Capacity to the employer
• keep a copy of the original form on file
• advise the employer that the claim is invalid.

What the worker is required to do

The worker is required to correctly complete the approved claim form for the type of claim made and give to or serve the claim on the employer as soon as possible.

When the employer receives the corrected/completed form from the worker

They must:

• sign and date the form; and
• where the claim includes a mental injury:
• forward Part A of the claim form to the Agent within 3 business days of receiving it from the worker and
• forward Part B within 10 calendar days of receiving it from the worker
• where the claim does not include a mental injury, forward the claim form (Parts A and B) to the Agent within 10 calendar days of receiving it.

Returning an invalid claim where the authority has not been signed

Except for claims relating to fatal incidents or serious incidents which leave the worker medically unable to sign the claim form, if the 'authority to release medical information and declaration' section is not signed by the worker, the claim is invalid even if the form is otherwise complete.

See: Signing the claim form | Medically unable to sign the claim form

Where the claim form has not been validly signed, the Agent must:

• return the original claim form to the worker asking the worker to sign the form giving authority to release medical information
• keep a copy of the original worker’s claim form on file
• file the Certificate of Capacity if it has been completed correctly
• advise the employer that the worker’s claim is invalid and has been returned to the worker.

Claim invalid as worker lodged claim directly on WorkSafe via the claim lodgement system

The Workers Compensation Claim Lodgement System is for use by employers only. If a worker lodges a claim via this facility their claim will be regarded as invalid.

The Agent must return the original form and any Certificate of Capacity to the worker with a letter explaining the correct procedure for service or lodgement of claims.

What the worker is required to do

The worker is required to give or serve their claim on the employer or where direct lodgement applies lodge their claim in an approved manner on WorkSafe.

See: Claim lodgement system

Returning a claim with a relevant defect, omission or irregularity

If the worker’s claim form is invalid because it has defect, omission or irregularity relating to relevant information which cannot be obtained by the Agent, the Agent must:

• return the original claim form to the worker detailing the relevant defects, omissions and irregularities
• keep a copy of the original claim form on file
• file the medical certificate The first medical certificate is for a maximum of 14 days and can only be issued by a registered medical practitioner. (where provided) if it has been completed correctly
• advise the employer that the claim form has been returned to the worker as it contains relevant defects, omissions or irregularities
• advise that the period of time in which the claim will be determined will not start until the errors have been corrected/completed and the claim form is given or served on the employer.

What the worker is required to do

If the claim form is invalid because it has relevant errors and defects, the worker is to sign and date any addition, deletion or change of information on the worker’s claim form and give it to or serve it on the employer as soon as possible.

When the employer receives the corrected/completed form from the worker

The employer must:

• re-sign and re-date it and
• where the claim includes a mental injury:
• forward Part A of the claim form to the Agent within 3 business days of receiving it from the worker; and
• forward Part B within 10 calendar days of receiving it from the worker
• where the claim does not include a mental injury, forward the claim form (Parts A and B) to the Agent within 10 calendar days of receiving it.

Note: The claim for compensation in the form of weekly payments is deemed to have been made on the day the employer receives the valid claim form and the normal time limits apply for determining liability.

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2.2.5 Invalid medical certificate

Where a worker provides an invalid medical certificate, the claim will still be considered a time loss claim (where the claim form identifies a cease work date) and liability is to be determined within 28 days of the Agent receiving the claim but weekly payments cannot be made and the deeming clock will not start.

See: Valid certificate of capacity

Returning an invalid certificate where claim form has a cease work date

If a worker serves an invalid medical certificate:

• register the claim as a time loss claim (note that deeming clock will not start until a valid medical certificate is received)
• return the original medical certificate to the worker within 14 days detailing why the medical certificate is invalid and advising the worker that the claim has been registered (either as time loss or medical and like expense)
  See: Time limits to determine liability
• advise the employer that the claim has been registered as a claim for compensation in the form of weekly payments
• remind the employer of their obligation to forward the medical certificate given to or served on them to their Agent within 10 days of receiving the medical certificate.

Returning an invalid certificate where claim form has no cease work date

• Register the claim as a no time loss claim.
• Return the original medical certificate to the worker, detailing why the certificate is invalid and advising the worker:
• that the claim has been registered as a no time loss claim and
• a claim for compensation in the form of weekly payments is deemed not to be made until a valid medical certificate is supplied to the employer
• Advise the employer that the claim has been registered as a no time loss claim and a claim for compensation in the form of weekly payments is deemed not to be made until a valid medical certificate is supplied to the employer
• Remind the employer of their obligation to forward a medical certificate given to or served on them to their Agent within 10 days of receiving the certificate
• Manage the claim as a pending time loss claim until such time a valid medical certificate is received and the claim registered as a time loss claim.

What the worker is required to do

If the initial medical certificate is invalid, the worker will need to get their treating medical practitioner to:

• amend the certificate
• re-sign and re-date the certificate.

The worker will then give to or serve the valid medical certificate on their employer as soon as possible.

Note: A worker who is unable to supply a valid medical certificate can lodge a referral with the Accident Compensation Conciliation Service. The worker can then apply to the Magistrates or County Court for a decision on his/her entitlement to weekly payments if the Conciliator is satisfied that the worker has made all reasonable attempts to obtain a medical certificate.

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2.2.6 Service of claim on employer

Workers are required to give to or serve the claim form and documents on their employer.

The worker may give or serve the claim form on their employer by:

• mail or in person
• electronic methods
• fax
  If the employer has a nominated fax number for receiving claims, the worker must ensure that all sides of the document are faxed and keep the successful fax confirmation as evidence of transmission.
• email
  Where the employer consents to receive claim forms via email and has nominated an email address for this use.

  Note: When a claim form is served in this manner, the worker must ensure they have emailed a scanned copy of the original signed document. For electronic / digital signatures, see: 2.2.4 Invalid claims

• myWorkSafe

If the worker has used myWorkSafe to submit a claim for weekly payments and/or medical and like expenses, myWorkSafe will serve the claim form on the employer where a Claims Administrator is enrolled. If no claims administrator is enrolled, myWorkSafe will take steps to notify the employer, seek to enrol a Claims Administrator, and serve the claim form.

A worker may not use myWorkSafe to serve a claim for impairment benefits on their employer. This must be done using one of the other methods above.

Employers must:

• complete and sign all relevant sections of the claims form:
  • paper/PDF form: Part A (question 7) and Part B of the claim form
  • myWorkSafe claim form: All questions as prompted. If a relevant question is not completed, the employer will not be able to submit the form online.

• acknowledge receipt of the claim form in writing

Employers may incur a penalty if they fail to forward the claim to their Agent within the time constraints imposed under the legislation.

See: Valid claims

Timeframes for serving claims on employers

Type of claim	Time limit
Compensation in the form of weekly payments	As soon as practicable after the incapacity arising after the injury becomes known.
Compensation for medical and like expenses	Within six months after the date of the relevant service.
Permanent disability and pain and suffering (Maims)	No time limit applicable but any claim for pain and suffering in relation to the permanent disability must be lodged at the same time.
Non-economic loss (impairment benefits)	No time limit applicable.
Death of a worker	Within two years after the date of death of a worker.

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