6.5.4 Worker is entitled to provisional payments

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

If the Agent/SI determines that a worker is entitled to provisional payments, this means that:

• the Agent/SI must pay the reasonable costs of medical and like services received by the worker for the claimed mental injury - s263B(1) – from the date that the Agent/SI determines that the worker is entitled to provisional payments, either until:
• the claim is accepted, in which case the reasonable costs of treatment of any accepted injuries will continue to be payable under the claim in accordance with the legislation, or
• the claim is rejected (or the mental injury component of a claim is rejected), in which case the reasonable costs of treatment for the claimed mental injury continue to be payable for 13 weeks after the day the worker is determined under section 75A to be entitled to provisional payments
  

  WIRC s263I
  
  
• the costs of any treatment relating to the claimed mental injury, such as medication, psychiatry and psychology, are payable under provisional payments, provided they are reasonable and appropriate. Existing WorkSafe policies that apply to an accepted claim for compensation also apply in respect of provisional payments – see below
• where a worker is claiming for concurrent injuries e.g. a physical injury and a mental injury, and the treatment relates to both of the claimed injuries, e.g. visit to a GP, the cost of this service is payable under provisional payments

Note: if the claim is accepted, treatment received prior to PP determination is payable under the claim.

Existing WorkSafe policies apply in respect of provisional payments

Existing WorkSafe policies apply to provisional payments, unless indicated otherwise.

This includes:

• existing medical and like policies – see 4 Medical and like services – only as relevant to the claimed mental injury
• determining what is a reasonable cost – see 4 Medical and like services
• WorkSafe’s existing Fee Schedules – see Medical Services – Reimbursement Rates fee schedule . If the provider charges more than the WorkSafe rate, workers will need to pay the difference
• provider registration requirements
• timeframes for making decisions on pre-approval of services.

Additional supports available to workers who are entitled to provisional payments

• Occupational rehabilitation (OR Occupational Rehabilitation) is available to workers for the duration of the provisional payments entitlement and can support worker returning to safe work. This includes facilitated discussion, which aims to resolve any interpersonal conflict issues that may be a barrier to the worker’s return to work.
• see 5.5 Approve occupational rehabilitation services
• note that while the claim is pending, the worker does not have return to work obligations or other obligations under the Act, even while in receipt of provisional payments. Participation in OR is voluntary on a pending or rejected claim.
• Community-based supports help workers to engage with community and public services e.g. community programs and connect workers with organisations that can provide medical or financial support.

Effect of provisional payments entitlement on claim determination

A decision about whether a worker is entitled to provisional payments does not affect the liability decision, or the liability decision timeframes, on the claim for compensation:

• provisional payments for a mental injury are not a payment of compensation under the Act
  

  WIRC s263J(1)
  
  
• a decision to make provisional payments is not an admission of liability to pay compensation under the Act
  

  WIRC s263J(2)
  
  
• a early notification of a mental injury does not of itself affect the claim determination timeframes.
  

  WIRC s73A(3)
  
  

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