5.5.5 OR services on pending or rejected claims
The Agent may pay the reasonable costs of OR Occupational Rehabilitation services:
- before a decision about claim liability is made
- where the worker is entitled to provisional payments (PP), after a decision to reject the claim is made
if it has been determined that the worker may benefit from the services.
Agent approval of OR service before claim accepted
Employers may pay for Agent approved OR services before a claim is accepted and claim the payment as excess should liability be accepted. However, any cost above the excess may not be claimed as a claims cost unless approved by the Agent before the OR service was delivered.
Note that where the worker is entitled to provisional payments, medical excess is not payable by the employer, and the cost of any OR services would be paid by the Agent, where reasonable and appropriate.
Once the Agent has determined the type of OR service to be approved for the worker then the worker is offered a choice of OR provider from a list of at least three OR providers (where available).
See: Worker choice of OR provider
Where a worker is not entitled to provisional payments for a claimed mental injury
Agent to write to worker if OR service approved before claim accepted
The Agent amends standard letter ORP4 to advise that OR services will cease 14 calendar days from the decision date, if a decision is made to reject their claim.
Agent approval for OR services may also cease at any time that an Agent determines the services are no longer required.
OR service provision on rejected claim
The Agent may approve an OR service such as an OES Original Employer Services Initial Report while a claim is pending. The employer may pay for this service and report as part of their excess. If the claim is then rejected, the Agent may reimburse the employer or pay the cost of the service over the excess because it was approved before the claim was rejected. OR services can continue for up to 14 calendar days after the claim liability rejection date.
Where a worker is entitled to provisional payments for a claimed mental injury
The Worker Entitled to Provisional Payments letter informs the worker that OR is available, and attaches the Worker Choice of OR Provider form.
OR is available to workers for the duration of the entitlement to provisional payments, that is worker can receive OR:
- while the claim is pending (after which it can continue on an accepted claim)
- in the case of a claim rejection, up to 13 weeks from when provisional payments were activated, including after the claim has been rejected.