2.5.5 Claim registration details
2.5.5.1 Claim type definitions | 2.5.5.2 Coding guide | 2.5.5.3 Create claimant ID
Agents register standard and under excess claims.
Note that all claims including a mental injury must be registered as standard claims in order for provisional payments to be made.
Agents must:
- accurately and consistently code claims when registering them
See: Coding guide - follow the additional requirements for claims made by students
See: Work experience students - register under excess claims as standard claims if the employer:
- disputes liability
- advises the Agent that the claim is likely to exceed the employer’s excess.
2.5.5.1 Claim type definitions
This table sets out how each claim type is defined, what documents are required to be served to constitute a valid claim and the coding required.
| Claim type | Definition | Documents required to be served and received | Code |
|---|---|---|---|
| Minor injury – medical and like expenses only (MEO) | A claim for medical and like expenses only which is under the employers excess | Original workers claim form sent in by the employer |
MI – 10 E – employer lodged MEO flag = Y DL flag =N |
| Minor injury – time loss/weekly compensation claim | A claim for time loss/weekly compensation which is under the employers excess | Original workers claim form and original medical certificate sent in by the employer |
MI-TL E – employer lodged Medical only flag = N DL flag = N |
| Minor injury – notification of claim by worker | A claim for weekly payments/time loss which is under the employers excess which has been served on the employer but a copy of the claim has been lodged with the Agent or WorkSafe by the worker | Copy of the workers claim form and copy of medical certificate following service of documents on the employer |
MI – EN C – claimant lodged Medical only flag = N DL flag = N |
| Minor injury – medical and like expenses only (MEO) (direct lodgement) | A claim for medical and like expenses only which is under the employers excess | Original workers claim form sent in by the worker with reasons why not served on employer |
MI – 10 C – claimant lodged MEO flag = Y DL flag = Y |
| Minor injury – time loss/weekly compensation claim (direct lodgement) | A claim for time loss/weekly compensation which is under the employers excess | Original workers claim form and original medical certificate sent in by the worker with reasons why not served on the employer |
MI-TL C – claimant lodged Medical only flag = N DL flag = Y |
| Standard MEO claim | A claim for medical and like expenses only which exceeds the employers excess | Original workers claim form sent in by the employer |
ST E – employer lodged MEO flag = Y DL = N |
| Standard time loss/weekly compensation claim | A claim for time loss/weekly compensation which exceeds the employers excess | Original workers claim form and original medical certificate sent in by the employer |
ST E – employer lodged Medical only flag = N DL flag = N |
| Standard claim - notification of claim by worker | A claim for weekly payments/ time loss which exceeds the employers excess which has been served on the employer but a copy of claim has been lodged with the Agent or WorkSafe by the worker | Copy of the workers claim form and copy of medical certificate following service of documents on the employer. |
ST C – claimant lodged Medical only flag = N DL flag = N |
| Standard MEO claim (direct lodgement) | A claim for medical and like expenses only which exceeds the employers excess | Original workers claim form sent in by the worker with reasons why not served on employer |
ST C – claimant lodged MEO flag = Y DL flag = Y |
| Standard time loss/weekly compensation claim (direct lodgement) | A claim for compensation in the form of weekly payments which exceeds the employers excess | Original workers claim form and original medical certificate sent in by the worker with reasons why not served on the employer |
ST C – claimant lodged Medical only flag = N DL flag = Y |
2.5.5.2 Coding guide
Agents need to be familiar with the VCODE: The Nature of Injury/Disease Classification System for Victoria when registering new claims and coding medical certificates.
Use the codes in the VCODE guide to record the following details:
- occupation
- nature of injury/disease
- bodily location of injury/disease
- mechanism of injury/disease
- agency of injury/disease
- breakdown of injury/disease.
Whenever possible any injury information recorded on the system should be based on information provided by the treating doctor.
Where to get information
Base the nature of injury and bodily locations recorded for the claim on the details supplied by the medical practitioner on the initial medical certificate The first medical certificate is for a maximum of 14 days and can only be issued by a registered medical practitioner. if provided.
A medical certificate is not required, refer to the Worker's Claim form, incident report or employer's report form for coding.
If the claim involves more than one injury or disease, the first injury/disease mentioned by the doctor is usually the most serious.
Record only the most serious injury/disease. Record only the bodily location which corresponds to the most serious injury/disease.
If a diagnosis changes
A worker's condition is likely to change over time, with a more accurate diagnosis given by the doctor as more investigation is done.
If a worker's medical condition changes:
- do not update the initial injury details recorded at initial claim registration
- record progressive changes to the worker's medical condition as part of recording ongoing medical certificates.
If a claim is a result of a significant event
Workers may sustain an injury arising from or relating to a significant event which can also impact more than one employer or organisation. In such incidents the claim is to be identified at registration and the significant event coded.
2.5.5.3 Create claimant ID
The Agent needs to ensure that enough information has been verified to register the claim accurately. Each worker is provided with a unique claimant ID. Subsequent claims for that worker must be entered using the same claimant ID.
It is essential that before entering claim details, Agents check if the worker has lodged a prior claim by searching to see if the worker’s name, date of birth and address are recorded.
Accuracy is necessary for ensuring that a worker does not simultaneously receive payments on two separate claims.
Agents are required before registration to:
- check if the worker has lodged a prior claim by searching the workers name, date of birth and address
- where a claimant ID already exists for the worker, register the claim using that claimant ID
- create a claimant ID where a claimant ID does not exist for the worker.
Note: If similar details are found but there is a minor difference the Agent must clearly establish whether the claim is for the same or a different worker. If it is the same worker, update the Worker ID.
