3.3.5.5 Process for application after second entitlement period

Follow these steps to manage an application for weekly payments after the second entitlement period.

Step Agent action
Advise worker

Write to advise workers who have weekly payments terminated after the second entitlement period of their right to apply for a continuation of weekly payments.

The notice includes an explanation of the eligibility criteria that a worker must satisfy to be eligible for continuing weekly payments beyond the second entitlement period.

If the Agent is satisfied at the time of issuing the notice that the worker may meet the criteria then an Application for Weekly Payments after the Second Entitlement Period form should be provided with the notice.

Worker makes application If a worker considers they meet the criteria, the worker must make an application to the Agent.
Review application

Send an acknowledgement letter to the worker.

Contact the worker if further information is required to assess the application.

Determine eligibility

Review the worker’s application and establishes the worker’s eligibility.

Workers with a date of injury on or after 5 April 2010

The Agent has 28 days from receiving the worker’s application to write to the worker to advise if the application has been approved or rejected.

Give the worker a statement of the reasons for its decision if the application is rejected.

Workers with a date of injury before 5 April 2010

The Agent has 90 days from receiving the worker’s application to write to the worker to advise if the application has been approved or rejected.

Give the worker a statement of the reasons for its decision if the application is rejected.

Conciliation - medical panel referral

If the worker disagrees with the Agent’s decision the worker can lodge a Request for Conciliation.

If a medical question arises in a dispute about a workers entitlement to weekly payments after the second entitlement period, the Conciliation Officer must refer the medical question to the Medical Panel within seven days of becoming aware of the medical question.

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3.3.5.6 Ongoing management

After deciding the worker’s ongoing entitlement the Agent should diarise the claim for ongoing review.

Information to be provided

The Agent should ensure they receive regular, clear and written information to assess the worker’s ongoing entitlement. This information includes:

Information to be assessed

The information needs to be assessed to:

  • determine if the worker continues to work the necessary hours per week
  • confirm the worker’s capacity to work a minimum of 15 hours per week
  • confirm the worker is earning at least $222 per week.

If the information provided indicates that any of the criteria are not being met, the Agent needs to determine if the worker continues to have an entitlement to weekly payments.

See: Six monthly reviews

If information is not provided

If the information is not received the Agent should contact the worker or their representative and advise them that weekly payments cannot be calculated until the required information is provided.

If the information is still not received within a reasonable timeframe - see: Terminate weekly payments after second entitlement period.

Changes to worker’s status

If the information provided indicates that there has been a change in the worker’s work or medical circumstances a review will need to be conducted to determine the worker’s ongoing entitlements.

See: Terminate weekly payments after second entitlement period

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3.3.5.7 Six monthly reviews

Reviews should be conducted at least every six months.

Information for six monthly reviews

As part of the review Agents should consider a:

  • review by the worker’s treating practitioner of whether the worker:
  • continues to have no capacity to increase hours or take on additional work because of the injury
  • is likely to continue indefinitely to be incapable of undertaking further or additional employment
  • review by an independent medical examiner of whether the worker has a capacity to:
  • take on additional work because of the injury
  • is likely to continue indefinitely to be incapable of undertaking further or additional employment
  • vocational assessment
  • a vocational assessment could be used to assess the worker’s capacity to increase hours.
Outcome of review

If the review indicates that the worker has and is likely to continue to have, no capacity to increase their hours or take on additional duties, a further review should be conducted at either:

  • six months from the date of previous review or
  • at a date determined by the Agent to be more appropriate.

If the review indicates that the worker has a capacity to increase their hours - see: Terminate weekly payments after second entitlement period.

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3.3.5.8 Weekly payments for surgery post 130 weeks


A worker who suffers an injury on or after 5 April 2010 may apply to the Agent to receive up to 13 weeks of weekly payments after the second entitlement period if they require time off work for surgery for their work-related An injury/disease is work related if it arose out of or in the course of employment and the scope of employment. injury.

Criteria

If an application for weekly payments for incapacity from surgical treatment post 130 weeks is accepted a worker may receive weekly payments for the period of incapacity resulting from or materially contributed to by the surgery for up to a period of 13 consecutive weeks commencing on the day on which the surgery is performed.

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