2.6 Manage claims

2.6.1 Determine liability | 2.6.2 Medical expenses only | 2.6.3 Weekly payment claim segments | 2.6.4 Community integration program | 2.6.5 Object to acceptance of liability | 2.6.6 Social media | 2.6.7 Communicating with injured workers

2.6.1 Determine liability Time limits to determine liability | Liability decisions | Steps to determine liability | Further enquiries to make a liability determination | Prior claim information | After employer has exited scheme | Liability accepted incorrectly | Determining liability for firefighter cancer claims

After a claim has been registered, Agents must make a determination of liability.

Experienced and skilled Agent staff accept or reject liability for a claim.

IB Impairment Benefits and death claims are assessed by those who have specialist case law and legislative skills specific to IB and death claims.

For details about IB and death claims see: Specialised Payments.

For details about provisional payments on claims including a mental injury, see: Provisional payments for a mental injury.

Source of information

The liability on most claims can be determined based on information from:

  • the Worker’s Injury Claim form
  • the Employer Injury Claim Report
  • Certificates of Capacity
  • contact with the employer and the worker.

Liability can be accepted where there is a RTW Return to Work date or the amount of time lost is under 10 days.

Claims that do not require a liability decision

Agents must determine liability on all claims, except those for medical expenses only (MEO Medical expenses only) which are:

  • for a physical injury only and
  • under the employer excess and
  • for which the employer has accepted liability.

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