6.1.3.6 Agent makes decision on liability

When the Agent receives the panel firm's advice and recommendations they must either accept or reject the recommendations.

By Agent action
Agent

Accepts or rejects recommendation

After the panel firm's advice has been received the Agent has five business days to either accept or reject the claim for entitlements.

Make a decision based on material within their file as well as:

  • the evidence obtained by the panel firm and
  • the panel firm’s recommendation.

Note: If the Agent does not agree with the panel firm’s advice and recommendations, they must immediately contact the Coordinator, Death and Dependency Claims at WorkSafe on (03) 9641 1693 to discuss their concerns.

Agent

As soon as liability has been accepted send standard letters to the:

  • claimant (for medical and like expenses only) - use letter to claimant advising claim has been accepted
  • dependant’s legal representatives - use letter to dependant's legal representative advising claim has been accepted
  • dependant if not legally represented - use letter to dependant advising claim has been accepted
  • employer - use letter to employer advising claim has been accepted
  • non-dependent family member or their legal representative.

Note: The Magistrates’ Court will determine non-dependent family member eligibility for the reimbursement of expenses.


Note: The panel firm may send a letter advising of the acceptance of the claim on behalf of the Agent. Keep a copy of this letter on File as a record of claim acceptance.

Subject to being provided with an invoice or receipt and as relevant, the Agent makes payment of the reasonable costs of medical and like expenses as follows:

  • medical and like services provided to the worker between the date of the injury and date of death
  • burial or cremation costs
  • grief counselling.

Payment of reasonable burial or cremation costs must be made within 10 business days of the Agent:

  • accepting liability
  • receiving a valid invoice or receipt
  • being advised that WorkSafe has registered the provider

whichever is the latter.

If receipts or invoices for these services have not been received, the Agent must request them using the above standard letter.

See: Medical & like expenses

The Agent registers secondary dependency claims for each accepted dependent from those listed in the original Claim for Compensation Following a Work-related Death Form/s.

The ATO advises that weekly pension payments are considered taxable income, therefore a TFN and TFN Declaration form are required for each dependent regardless of their age.

Banking details for each dependent must be obtained and recorded as soon as they are provided if the dependent seeks to have their weekly pension paid directly to their financial institution. To enable prompt payment of any entitlements, the Agent should ensure that these details are received before to the entitlement is determined.

If dependency has been accepted and the PIAWE amount agreed by the dependent’s legal representative and the Agent, the Agent must commence payment of weekly pensions on the secondary claim for each determined dependent within 14 days. Pension entitlements do not require court determination unless a dispute arises from an Agent decision on liability or the PIAWE amount.


See: Agent pays entitlements | Weekly pension

For death claims, if liability and dependency have been accepted, Agents can assess, determine and pay lump sum and interest entitlements for those claims where there are no unrepresented dependents, persons under a disability, minors or unborn children.


The Agent instructs the panel firm to prepare the necessary court documents for the Magistrates’ Court or County Court if applicable.

Panel firm Prepares the necessary court documents and files them with the Magistrates’ Court or County Court in accordance with court processes.
Panel firm/ Agent

Agent action when liability is rejected

If the death resulted from the use of a motor vehicle or public transport, the panel firm or the Agent’s Senior Legal Manager should contact TAC if considering rejection of the claim.

For some claims involving motor vehicles or public transport, the liability determination may be difficult where critical information is not available, for instance, when a Coroner's investigation is still pending.

Agent

As soon as a decision to reject liability has been made notify by telephone:

  • the claimant (if claiming medical and like expenses only)
  • the dependant’s legal representative
  • the dependant if the dependent has no legal representative
  • the non-dependent family member or their legal representative.

Send a letter advising the reasons for the rejection and the details of the appeal process.

Send a copy of this letter to the:

  • panel firm
  • employer.

Note: The panel firm may send a letter advising of the denial of the claim on behalf of the Agent. If so, keep a copy of this letter on file as a record of the rejection of the claim.

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