2.2.7 Forward claim to Agent
2.2.7.1 Photocopies or faxes of forms | 2.2.7.2 Claim for medical & like services for a physical injury only under employer excess | 2.2.7.3 Lodged claim directly | 2.2.7.4 Worker gives claim directly to Agent | 2.2.7.5 Claim lodgement system
An employer must forward any claim received to their Agent.
Timeframes to forward claims
An employer must forward to their Agent a claim for weekly payments and/or medical and like expenses as follows:
- Impairment benefits – within 10 calendar days of receiving the claim from the worker
- Dependency benefits relating to the death of a worker – within 10 calendar days of receiving the claim from the worker
- Maims – within 10 calendar days of receiving the claim from the worker
Methods of forwarding claims
An employer can forward a claim to their Agent as follows:
- electronically using myWorkSafe
- other electronic methods
- fax
- to their Agent’s nominated fax number for receiving claims. Note: the employer should keep the successful fax confirmation as evidence of transmission.
- Workers Compensation Claim Lodgement System
- Electronically via Workers Compensation Claim Lodgement System.
Note: When a claim is forwarded in this manner, the employer must ensure that they have emailed scanned copies of all original signed documents.
2.2.7.1 Photocopies or faxes of forms
Photocopies or faxes of approved forms can be acceptable if all copies contain the appropriately signed authority and are clearly legible.
While it is still recommended that the worker and/or employer forwards the original copy of all forms, the Agent must start the claim registration and liability process using the photocopied/faxed forms.
2.2.7.2 Claim for medical & like services for a physical injury only under employer excess
Employers notify the Agent of physical injury only claims with no time loss and under the medical excess by completing the employer questions on the Worker's Injury Claim Form .
2.2.7.3 Lodged claim directly
A worker may only lodge a claim directly with the employer’s Agent or WorkSafe if the worker becomes aware that the employer:
- has not and is unlikely to forward the claim to the Agent in the time required or
- is refusing to receive the claim or
- cannot be identified after the worker has taken reasonable steps to identify the relevant employer or
- cannot be found after the worker has taken reasonable steps to find the employer or
- is dead or is under external administration or has ceased to exist.
Claims against employers whose rateable remuneration is below the exemption limit
A claim against an employer whose rateable remuneration is below $7,500 (the premium and registration exemption limit) and does not employ an apprentice must be given to or served on the employer.
The employer must lodge the claim with WorkSafe within five days of receiving it.
Employer early notification requirements also apply for claims including a mental injury.
See: 6.5.1 Employer obligations for mental injury claims
The worker may lodge the claim directly with WorkSafe if they become aware that the employer:
- has not lodged the claim with WorkSafe within five calendar days of receiving it or
- is refusing to receive the claim.
After receiving a claim, the employer must:
- apply to WorkSafe within 30 days of receipt of the claim to be recorded as an exempt employer and
- pay any registration fee as set out in the relevant Premiums Order.
Registering claims against unregistered or uncontactable employers
A claim against an unregistered or uncontactable employer must be registered within five days of receipt by WorkSafe or Agent.
Incorrect registration
A duplicate registration must be cancelled as ‘Incorrectly Registered’ in the following situations:
- the incorrect employer type code has been used
- the Agent establishes that the employer is registered for the period of the claim. In these cases the claim must be transferred to the registration covering the period of the claim.
Determining liability
A claim against an employer who:
- has not and is unlikely to forward the claim to the Agent in the time required or
- is refusing to receive the claim or
- cannot be identified after the worker has taken reasonable steps to identify the relevant employer or
- cannot be found after the worker has taken reasonable steps to find the employer or
- is dead or is under external administration or has ceased to exist
should be accepted or rejected within 28 days of receipt unless the employer has not been identified or found within the 28 days. If the employer has not been identified or found within 28 days the period to determine liability is 35 days from receipt of the claim.
Liability for payments
Employers that are not registered when they are required to be are still liable for payments. Agents should advise employers of this obligation and attempt to have them pay compensation to the worker. If efforts are unsuccessful or the employer cannot be found the Agent can make these payments.
Circumstance investigations
A circumstance investigation must be undertaken before determining liability.
If the investigator is not able to provide enough information to enable an Agent to determine the employer’s status or claim liability, a Notice may be issued after consultation with WorkSafe’s Insurance Division.
If the employer fails to respond to the Notice, the following information must be forwarded to WorkSafe’s Insurance Division:
- details of the claim
- a copy of the investigator’s report
- other relevant information.
Rights of recovery by WorkSafe
WorkSafe may recover the amount of compensation paid in relation to a claim against an employer who was not registered when required by the WIRC Act Workplace Injury Rehabilitation & Compensation Act 2013 by serving a written notice on the person who at the time of the injury is considered to have been the employer and was liable to pay a premium.
WorkSafe may waive its right to recover against the unregistered employer in writing if it is satisfied:
- the amount sought is beyond the capacity of the employer to pay
- the employer could not reasonably have been expected to regard himself or herself as an employer at the relevant time
- the employer, not being a corporation, is insolvent under administration and the recovery liability is not provable in the insolvency
- the employer, being a corporation, is under external administration and the recovery liability is not provable in the administration
- the employer, being a corporation, has ceased to exist
- it would not be commercially feasible to recover the amount.
2.2.7.4 Worker gives claim directly to Agent
Worker notifies Agent of a claim
A worker may notify WorkSafe that a claim in the form of weekly payments has been given to or served on the employer by forwarding a copy of the:
- claim form signed and dated by the worker (for a worker signing their claim form electronically / digitally, see: 2.2.7 Forward claim to Agent) and
- relevant medical certificate The first medical certificate is for a maximum of 14 days and can only be issued by a registered medical practitioner..
The Agent needs to establish:
- if the claim has been given to or served on the employer, for example, by checking if the copy of the worker’s claim form has been signed by the employer or by contacting the employer
- that it is a worker notification of a claim and not a direct lodgement.
See: Claims lodged direct
Direct lodgement applies
If direct lodgement apples, the Agent must immediately:
- send the employer their copy of the worker’s claim form or a photocopy of the worker’s claim if the employer’s copy is not available
- ask the employer to complete and send an employer’s claim report
- advise the employer of their legal obligations
- start the liability determination process.
Direct lodgement does not apply
If circumstances for direct lodgement do not apply and the claim form is otherwise valid, the Agent must advise the worker of the correct method for serving a claim on their employer.
The Agent should then:
- return the claim and any supporting documentation to the worker
- keep record of the returned claim.
2.2.7.5 Claim lodgement system
The Workers Compensation Claim Lodgement System is a secure way for employers to forward claims to their Agent electronically. WorkSafe has given express consent in line with the Electronic Transactions (Victoria) Act 2000 (ETA) for employers to use this system to forward claims.
Workers cannot use the Electronic Claims Lodgement Facility to lodge a claim and if a claim is received from a worker by this method it will be returned and considered invalid. The Workers Compensation Claim Lodgement System can be accessed through a link on:
- WorkSafe website or
- the employer’s Agent website.
Agents will be required to confirm receipt with the employer once a claim has been received via the electronic Claims Lodgement Facility.
Employer lodges claim
Employers can access the electronic claim lodgement facility through WorkSafe or their Agent’s website.
The Workers’ Injury Claim Form (Parts A and B) and completed Employer Injury Claim Report with any supporting documents are scanned and uploaded. A prompt will be received to confirm the claim lodgement.
Agent retrieves claim
The Agent will receive the documents via the ‘claim lodgement’ tab of the Agent Portal.
The Agent will be required to monitor the Agent Portal for claim lodgements and ensure claims are processed within required timeframes.
The Agent will be required to manually check the claim details before commencing the claim registration process and:
- open all attachments to ensure the correct forms have been provided
- contact the employer to determine whether they have submitted the information
- if they have submitted the forms, then discuss worker status (eg have they returned to work, PIAWE details etc) and collect any other information required
- register the claim and start liability determination process.
Where the employer did not forward the claim
If the claim was not forwarded by the employer, the Agent must contact the worker:
- to ascertain if the claim has been given to or served on the employer or lodged with WorkSafe and
- where the claim was not served on the employer or lodged with WorkSafe, investigate if the incident occurred and if they intend to give, serve or lodge a claim.
If it is confirmed that the worker sent the claim forms via the electronic lodgement system, they will be informed that it is not a valid lodgement as a worker is not authorised to use the electronic claims lodgement facility. The Agent will then print off the scanned documents and return them to the worker within five working days of receipt advising that:
- the claim is invalid as a worker is not authorised to lodge a claim via the electronic lodgement system, that the claim must be served on their employer and about the methods of service and
- any time frames that apply do not start until the claim has been given to or served on their employer.
Printing claim forms
Once a claim has been received through the Agent Portal Agents must:
- print the claim and any other documentation
- date stamp all documents (Agent received date)
Note: Agents must print the email cover sheet and attach it to the claim form and attach to the file.
After the documentation has been printed, move the lodgement out of the Agent Portal 'inbox' and place it into the 'actioned' box.