6.2.2.2 Check claim validity

6.2.2.2 Check claim validity

An IB Impairment Benefits Specialist is responsible for IB claims lodged with the Agent.

Process

Follow these steps to check that the claim is valid.

Step	Agent action
Receive claim	The worker lodges a claim for impairment benefits with their employer or if the employer has ceased or is no longer in existence, on the Agent. The worker must use a Worker’s Claim for Impairment Benefits form. A worker is not required to provide any medical evidence in support of the claim, however, if the worker is legally represented, the worker’s solicitor may enclose a copy of all the gathered treating medical evidence along with a Solicitor Inquiry Form (SIF). The claim form, the SIF and the enclosed material is then submitted to the managing Agent by either the employer or the worker’s solicitor.
Check correct form is used	Ensure the correct claim form is used and that the claim does not contain a material defect, omission or irregularity. However, a claim will still be deemed to have been made despite any material defect, omission or irregularity in the claim if it relates to information that is within the knowledge of the employer or the Agent. The IB Specialist may want to consult with the multidisciplinary team when checking for material defects. Examples Here are some examples of a material defect omission or irregularity: unsigned claim form amended or unsigned Authority to Release Medical Information failure to provide a residential street address if worker cannot be contacted to provide this information failure to complete one or more sections on the form. WIRC s198 AC s104B(1BA) WIRC s22 WIRC s20 AC s103
Return claim with material defect	If the claim for impairment benefits has a material defect, omission or irregularity, it must be returned to the worker within 14 days. The Agent must send a letter explaining: the material defect that the 120 day period for determining liability and entitlement to compensation does not begin until a valid claim form is received by the Agent. WIRC s201(1) AC s104B(2) WIRC s20 AC s103
Determine liability	On receipt of the worker’s valid claim form the Agent must progress the claim. See: Liability determination
Lodgement after leaving job	If the claim for impairment benefits is the first notification of injury and it has been lodged after the worker has stopped working for the injury employer: notify the worker, within 14 days of receipt, that the claim is deemed not to have been made until the Agent is satisfied that the claim could not have been made while the worker was still employed with the injury employer ask the worker to explain why the claim could not have been made while they were still employed with the injury employer. WIRC s20 AC s103 The senior legal manager must be consulted before applying these steps. Do not take this course of action if the worker has sustained a delayed onset injury such as asbestosis or cancer.
Injuries from motor vehicle accidents	Report motor vehicle accidents that cause injuries that are later claimed to the police. When a claim for impairment benefits is lodged for injuries resulting from a motor vehicle accident, check that the accident has been reported to police. If the accident was not reported to police: consult the TAC to determine liability for concurrent claims consult the senior legal manager inform the worker that the claim is deemed not to have been made. WIRC s20 AC s103
Claims made within 12 months of injury	A claim for impairment benefits (except a claim solely for hearing loss) cannot be made until 12 months or more after the date of injury. The Agent: has a discretionary power to waive the 12 months provision, if they are satisfied and have medical evidence to substantiate that the injury has stabilised must contact WorkSafe’s Impairment Benefit Team before agreeing to waive the 12 month period. WIRC s197(3) AC s104B(1B) WIRC s197(2) AC s104B(1A)
Concurrent impairment claims and serious injury application for common law	If before 29/7/10 an IB claim and a serious injury application were received at the same time, the two claims should be managed concurrently. If after 29/7/10 an IB claim and a serious injury application are received at the same time, the serious injury application is invalid until the claim for impairment benefits is accepted. The worker should be advised that a worker can only make a serious injury application in relation to an injury arising from the same circumstances after the impairment process is finalised. If a serious injury application is received followed by an IB claim, the IB claim should be considered ‘invalid’ and returned to the worker (or their legal representative). Write to the worker to advise that they cannot make an impairment claim if they have commenced a serious injury application. The impairment claim is not recorded in ACCtion.

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