6.2.1.7 Inactive claim
If a worker is beyond reach, communication or influence (such as overseas for an extended period of time) or refuses to cooperate at any stage during the IB Impairment Benefits process, the Agent may not be able to process the claim within the legislated time frames.
The Agent may seek approval from WorkSafe to determine that the worker’s claim has now become inactive and the claim can now be considered resolved/inactive in line with the IB Datamart rules.
It is the Agent’s responsibility to ensure that all reasonable attempts to contact the worker and progress the claim have been made and appropriately documented before a request can be made. If the worker is overseas for an extended period of time or refuses to cooperate, it is the Agent’s responsibility to ensure that the worker (or their legal representative) is assisted with the impairment process and made aware of the implications of not pursing their claim. The legislation allows only one claim for compensation for injuries arising out of the same event or circumstance.
The purpose of this policy is to ensure that Agents are not disadvantaged by their inability to contact the worker or progress the claim.
Define an inactive claim
There are various reasons why a worker cannot be located and each claim must be assessed on its own merits. The following is a (non-exhaustive) list of reasons why a claim may be considered inactive:
- Agent correspondence to the worker is ‘returned to sender’.
- telephone calls to the worker and/or nominated are unanswered or the contact telephone number is disconnected.
- the worker’s legal representative has advised of their inability to contact the worker.
- the worker (or their legal representative) has advised that they are going overseas for an indefinite or extended period of time and request that their claim is withdrawn, cancelled or held in abeyance until they return.
- a worker who has zero-dollar entitlement has requested that their claim be withdrawn or cancelled after they have made a request for Conciliation a Medical Panel Under the legislation, unless inconsistent with the context or subject-matter — Medical Panel means a Medical Panel constituted under Division 2 of Part 12 referral.
- a worker refuses to attend an impairment examination.
- a worker refuses to respond to a Worker’s Response Form after a $- offer has been made by the Agent.
- there is a lack of consistent activity on the primary claim file.
- a worker has not and will not, be stable for an extended period of time.
- the Agent cannot obtain vital treating information to progress the claim.
When to refer the matter to WorkSafe
If the Agent has made reasonable but unsuccessful attempts to contact the worker, the Agent can request WorkSafe to consider the claim in line with the Inactive Claim Policy if:
- there has been no Independent Impairment Assessment, the claim is at least six months old and there is no entitlement owing to the worker.
- all Independent Impairment Assessments have been undertaken, at least 12 months have passed since the last Assessment and there is an entitlement owing to the worker.
Define reasonable attempt to contact a worker
Attempts to progress a worker’s IB claim must be documented on ACCtion and/or the Agent’s file notes and copies of all correspondence must be held on the claim file.
The following work practices (non-exhaustive) are considered reasonable ‘attempts’ to progress a worker’s IB claim:
- a reasonable amount of correspondence sent to the worker’s last known address (‘reasonable’ will depend on the claim circumstances). It will be expected that more than one attempt is made.
- copies of ‘return to sender’ letters have been received by the Agent.
- use of Yellow Pages/White pages/other phone directory services to locate the worker’s current residence have not been successful.
- attempts to obtain the worker’s current contact details from a third party (ie employer/worker’s legal representative/family member/treating doctor) have not been successful
- the Agent has been advised by the worker’s legal representative that their client is no longer represented by them as they are unable to contact the worker.
- a circumstance investigation report (to be used only in instances where the worker has an entitlement to compensation) has failed to obtain current worker details.
- reasonable attempts to obtain vital treating information have been made by the Agent.
- reasonable attempts have been made to ascertain when the worker will undergo further treatment/surgery or evidence obtained confirms the condition is not stable.
The Agent must determine whether to pursue all or some of the above recommendations based on the particular circumstances of the IB claim and justify their actions with file notes.
When not to refer the matter to WorkSafe
The Agent should not refer inactive claims to WorkSafe if the worker has been assessed with a $0- entitlement (either by the Agent or the Medical Panel) and a Notice of Liability and Entitlement (NOLE) has been issued and the worker has not returned the Worker’s Response Form.
Such claims will be resolved for Agent remuneration purposes in line with the Datamart Business rules.
For claims assessed by the Agent where the Worker’s Response Form has not been received, the claim will resolve in line with the Datamart Business rules after a period of 90 days after the NOLE is issued.
For claims assessed by the Medical Panel where the Worker’s Response Form has not been received, the claim will resolve in line with the Datamart Business rules when the worker is issued with a NOLE and the Agent enters a ‘09’ code on ACCtion confirming the $0- offer.
The Agent should not refer claims that can be suspended. The legislation allows the Agent to suspend a claim within 90 days if there is insufficient medical evidence to make a determination or the worker’s condition is not stable. If a worker has failed to attend required impairment assessments within 80 days, then this suspension should be used on the basis that there is insufficient medical information to determine the claim. In such circumstances, please refer to Independent impairment assessment (Worker Non-Attendance at IIA Independent impairment assessment-HLA Hearing loss assessment Policy).
How to refer a matter to WorkSafe
The Agent is required to send to WorkSafe (via ib_helpdesk@worksafe.vic.gov.au) the following information:
- worker’s name.
- worker’s claim number.
- Agent received date (ARD Agent received date).
- a chronology of the Agent’s attempts to locate the worker, including the relevant dates and details of attempts.
- details of any IB examinations arranged or attended by the worker.
- reason/s why the Agent believes the claim should be considered in line with the Inactive Claim Policy.
Agent’s role in managing an inactive claim
The claim will no longer appear on the weekly unresolved stock list sent to Agents. However, it is expected that both WorkSafe and Agents keep a register of claims resolved in line with the Inactive Claim Policy.
WorkSafe recommends that Agents conduct periodic reviews of the information on file (including the primary claim file) to establish if at any point the IB claim needs to be reactivated or to identify that circumstances may have changed and a further contact with the worker should be made.
What happens when the claim can be reactivated
If a worker’s IB claim has been determined inactive in line with the Inactive Claim Policy and the Agent has evidence and/or the worker has advised that they wish to pursue their IB claim, the Agent must contact WorkSafe and confirm that the claim no longer meets the Inactive Claim Policy requirements.
WorkSafe will ensure that the IB claim is reactivated (and will considered unresolved in line with the IB Datamart Rules) on ACCtion so that the Agent can proceed to progress the claim in line with the legislative requirements.
Business rules
Upon reactivation of a claim on ACCtion and removal of that claim from the A2 process flow, the period in which the claim was inactive will be deducted from the calculation of the ‘Unresolved Claim Age in Days’ when the Agent has notified WorkSafe within 28 days with evidence and/or information the IB claim can proceed
If the Agent does not notify WorkSafe within the required time frame, the period in which the claim was inactive will not be deducted from the calculation of the ‘Unresolved Claim Age in Days’.
Inactive claims will be reviewed by WorkSafe periodically to ascertain Agents compliance with the policy.
For the Aged Claim Measure, the age of claims will be determined by the ‘Unresolved Claim Age in Days’.
The reinstatement of an inactive claim will not alter the ‘Unresolved Day Count’ of a claim.
See: Request to withdraw, cancel or hold in abeyance | Suspend impairment process (Suspension Policy) | Independent impairment assessment (Worker Non-Attendance at IIA-HLA Policy)