3.4.1.4 Process reconciliation requests
A reconciliation request is where the employer has already submitted a request for reimbursement for the period claimed and has not been reimbursed by the Agent.
Before processing reconciliation requests and Agent must adhere to the following policy.
Employer to provided documented evidence
Before an Agent processes reconciliation request for reimbursement from an employer, the Agent must be satisfied that the employer had previously submitted a request for reimbursement within three months after making the payment to the worker.
If the employer provided the previous request for reimbursement after three months of making the payment the employer must provide reasons for the delay in submitting the request late and in writing.
See: Process late request
Confirm previous request for reimbursement
Before an Agent processes a reconciliation request, the Agent must be satisfied that the employer had previously sent a valid request for reimbursement for the period claimed.
Note: In the event that an Agent cannot determine whether they previously received a request for reimbursement from the employer for the period claimed due to lack of evidence, the Agent must consider the employer’s claim that such a request was sent to the Agent based on the documentary evidence provided by the employer.
Application of six year limitation on reimbursements
The Limitations of Actions Act 1958 limits the right to start proceedings for reimbursement of weekly payments to six years from the date on which the Agent should have made the reimbursement.
The employer is not entitled to reimbursement if they submitted a valid request for reimbursement within three months (or outside three months provided reasons for the delay which the Agent accepted) and more than six years have elapsed since the Agent was required to reimburse the employer (ie more than six years after 30 days after lodgement).
A decision to enforce the limitations period should be recorded on the claim file along with the reasons.
Agents must inform the employer of the decision to apply six year limitation defence and not to reimburse the employer for the period claimed. Use letter Notice of decision - Application of six year limitation.
Reconsider decision to apply six year limitation defence
Employers may seek reconsideration of the Agent’s decision if they are of the view that there are reasons not to apply the six year limitations defence to reimbursements.
Employers in this position should contact the Agent in writing. As there are limited legal ground upon which the six year limitations defence will not apply, employers should seek independent legal advice before contacting the Agent.
Manage the reconsideration process
All matters where employers are seeking reconsideration of the Agent’s decision to apply the six year limitations defence must be handled by the Senior Legal Manager of the Agent. Upon receipt of any such request, the Senior Legal Manager must forward relevant correspondence to WorkSafe marked to the attention of the General Counsel.
Confirm entitlement to weekly payments
To confirm that the worker is entitled to weekly payment Agents must check:
- the claim file including ACCtion and file notes
- non entitlement periods, court decisions and other settlements which may affect the worker’s entitlement to compensation
- past payment records for the period claimed
- archived payments (if applicable).
Check archived payments
If the payment period in which the employer is seeking reimbursement is within an archived period, Agents must retrieve the archived payment details and check:
- whether payments have been made previously for the period claimed
- whether there are current weekly earnings for the period claimed.
When no reimbursement is to be paid
No reimbursements should be paid if the information given by the employer is inconsistent with the information available on ACCtion and claim files.
Onus of proof
The onus is on the employer to demonstrate that the payment has been made to the worker and a valid request for reimbursement was sent to the Agent within three months of paying the worker (or a longer period in reasonable circumstances) by submitting necessary documentation to the Agent to support the payment made to the worker.
Process payment
Agents must use Certificate of Capacity Ongoing certificate is issued for up to 28 days and can be issued by a: medical practitioner, osteopath, physiotherapist, chiropractor. Code / Payment form when processing payments. A copy of this form must be filed in the claim file with the certificate of capacity and the request for reimbursement.
The Agent must reimburse the employer within 30 days of receipt of a valid request for reimbursement from the employer.
See: Certificate of Capacity code / payment form
