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:
- 702 – Post-traumatic stress disorder
- 703 – Other reaction to stressors
- 719 – Other mental disorders not elsewhere classified
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.
- If ‘No’ is selected on the provisional payments entitlement assessment eform for ‘Has a completed Part B been received?’ the Part B receipt eform must be completed on receipt of Part B. Otherwise Part B should be completed on the same date as Part A.
- 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.
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 completed.
Agent receives claim/early notification from employer
|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 bus days of Part A receipt, claim determination in 28 days of Part B receipt. NOVUS triggers task for recording receipt of Part B. Agent resolves the task when Part B is received.|
|2||Agent receives Part A from employer on time, but no Part B is received within 10 days||Agent decides PP entitlement in 2 bus days of Part A receipt. NOVUS task triggers follow up for Part B - 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 bus days, 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
|7||Worker lodges claim (Parts A and B) including MI direct on Agent/WorkSafe with valid s29 reasons||Agent decides PP entitlement in 2 bus days of ARD of Part A by Agent/WorkSafe Advisory, claim determination in 28 days of both Parts. Advisory to have fast-tracked process to forward claims to Agent.|
|8||Worker lodges claim (Parts A and B) including MI direct on Agent/WorkSafe without valid s29 reasons||Agent advises worker that claim needs to be submitted to employer. Agent determines PP entitlement within 2 bus days of receiving Part A from the worker.|
|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
|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 bus 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. <![CDATA[ ]]>|
|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.|
|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.
WorkSafe considers the following to be reasonable attempts:
- At least two attempts to contact each the worker and the employer, within 2 business days of receiving the early notification, and each contact attempt to the same party being at least 2 days apart.
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.