6.5.2 Agent receives early notification of a mental injury

Note: employer early notification obligations commence on, and provisional payments are only available for claims made on or after, 1 July 2021.

The Agent registers the receipt of Part A of the claim form in ACCtion. The claim should be registered in line with existing rules, and no differences in coding/registration are required as a result of the mental injury box being ticked.
Where Part A is coded in ACCtion with one of the following mental affliction codes:
700 - Anxiety Disorder
701 - Acute Stress Disorder
702 - Post-traumatic stress disorder
704 - Depressive Dissorder
705 - Adjtmt Disorder with depressed and/or anxious mood
708 - Other DSM5 Diagnosis
709 - Mental injury with no DSM5 diagnosis

the Novus process will be triggered via the provisional payments entitlement assessment eform. The Agent then completes the eform in Novus to assess PP entitlement and letters are generated for the worker and employer.

If a claim is registered with the primary injury being physical the Agent will be required to manually trigger the PP Novus process and also to activate PP in ACCtion.
Agents are required to determine whether the worker is entitled to provisional payments, and to activate provisional payments within 2 business days of receiving the early notification. This also applies where Part A has been lodged directly on the Agent or WorkSafe.

A claim is not considered a complete claim and the timeframe to determine liability does not commence until Part B has been received. The only exclusion to this is when a claim has been lodged in accordance with s29 requirements.

See 2.5.2 Claims lodged direct

If Part B has been received at claim lodgement, Part B received date needs to be recorded in ACCtion when registering the claim. The Initial Assessment eform in Novus can be completed.
If Part B has not been received at claim lodgement, the Agent is required to follow this up and then record the date received in ACCtion. The Initial Assessment eform in Novus cannot be completed until Part B has been received and date recorded in ACCtion.

As provisional payments are available from the provisional payment activation date, it is crucial that activation is completed in ACCtion on the same calendar day as the provisional payments entitlement assessment eform is complete.

Agent receives claim/early notification from employer

	Scenario	Agent Actions
1	Agent receives early notification (Part A) for a mentail injury (MI) claim from employer within 3 bus days, and receives Part B within 10 days	Agent decides PP entitlement in 2 business days of Part A receipt, and claim determination in 28 days of Part B receipt. A claim is not considered a complete claim until Part B is received. The Initial Assessment eform in NOVUS cannot be completed until Part B is received. The Agent is to update Part B received date in ACCtion.
2	Agent receives Part A from employer on time, but no Part B is received within 10 days	Agent decides PP entitlement in 2 business days of Part A receipt. A claim is not considered a complete claim until Part B is received. Agent contacts employer asking to forward Part B. If employer fails to do so, Agent asks worker to lodge directly on Agent (go to scenario 7)
3	Agent receives MI claim from employer (both Parts A and B; or old claim form)	Agent decides PP entitlement in 2 business days, and claim determination in 28 days from ARD
4	Agent receives MI claim from employer (Parts A and B) and the claim is to be outright accepted without pending	Agent does not need to send PP letters for outright MI acceptances; but PP must still be flagged in ACCtion. Where the claim is to be accepted, the Agent has the option to suppress the PP letters on the PP entitlement eform in NOVUS and proceed with the normal initial assessment eform. The employer acceptance letter will then include the new para to indicate that no medical excess is payable
5	Agent receives Part A from employer late	Agent informs employer that they have breached early notification requirements and that penalty provisions will come into effect for this. Remind employer that Part B must also be sent in. Continue with scenario 1 or 2
6	Agent receives Part B only from employer	Agent contacts employer asking to forward Part A, as Part B alone does not constitute receipt of a claim. If employer fails to do so, Agent asks worker to lodge directly on Agent. If Part A received late, see scenario 5.

Agent receives claim from worker

	Scenario	Agent Actions
7	Worker lodges claim including MI direct on Agent/WorkSafe with valid s29 reasons	Agent decides PP entitlement in 2 business days of ARD of Part A by Agent/WorkSafe Advisory, claim liability determination is to be made within 28 days of receipt of the claim. Advisory to have fast-tracked process to forward claims to Agent.
8	Worker lodges claim including MI direct on Agent/WorkSafe without valid s29 reasons	Agent advises worker that claim needs to be submitted to employer.
9	The worker provides notification of a claim to the Agent under s21(2) by providing Part A of the claim form.	This does not constitute receipt of an MI early notification for the purposes of s75(1)(c) therefore the Agent does not need to make a decision about PP entitlement until the mental injury early notification (i.e. completed Part A) is received from the employer.

Agent receives notification of MI after the claim has been received

	Scenario	Agent Actions
10	Agent receives claim with no indication of MI, then other indication of MI exists (e.g. on CoC, prior to the claim being determined)	Agent decides PP entitlement in 2 business days of the indication of MI occurring
11	Agent receives information that would have affected the decision about PP entitlement (e.g. indicating claimant is not a worker or there is no MI) after PP has been activated but before a claim decision is made	PP entitlement should not be affected, but the information may affect the claim determination. PP should not be deactivated based on information received after PP activation - that information is relevant to claim determination.
12	There is an indication of MI on a claim after the claim has been accepted	If claim has already been determined with no MI component, and later there is an indication of MI, refer to WorkSafe's secondary mental injury policy. PP should not be activated; and medical excess will still be payable by the employer.

Transition arrangements

	Scenario	Agent Actions
13	Employer receives claim (on old or new claim form) prior to 1 July 2021 (and Agent receives claim before or after 1 July 2021)	Workers are not entitled to PP where a claim is made prior to 1 July 2021 (i.e. the Employer Received Date is prior to 1 July 2021).

Invalid claim form issues/material defect

See: 2.2.4 Invalid claims

Agent or Self-Insurer (SI) receives early notification with insufficient information to make a decision about PP

It is incumbent on the Agent/SI to obtain the required information to determine if a worker is entitled to provisional payments where early notification of a mental injury has been received.

If the Agent/SI is unable to determine whether a worker is entitled to provisional payments because the early notification or claim does not contain sufficient relevant information, the Agent must make reasonable attempts to request the information from the employer or worker.

WIRC s75A(3)

WorkSafe considers the following to be reasonable attempts:

At least two attempts to contact the employer in the period after receipt of Part A and prior to 10 calendar days. The employer should be reminded of their obligations under the legislation and additional liability penalties.

If the Agent/SI is unsuccessful in obtaining the required information, the Agent/SI must give written notice of the determination about the entitlement to provisional payments within 10 business days after:

the claim was received by the employer
the claim was lodged directly under section 29
the worker notified the Agent of a mental injury in relation to a claim forwarded by the employer to the Agent or lodged directly.

If the required information cannot be provided within time, PP should be accepted.

WIRC s75A(4)

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