6.5.3 Agent determines provisional payments entitlement
Note: employer early notification obligations commence on, and provisional payments are only available for claims made on or after, 1 July 2021.
A worker with a claim including a mental injury* is entitled to provisional payments unless:
- the Authority or a self-insurer has previously determined a claim for compensation relating to the same mental injury and circumstances
- there is prima facie evidence at the time of determining the provisional payments entitlement that the claimant A person who applies for WorkCover benefits.’s employment is not connected with Victoria
- the claimant is not a worker of the employer on whom the claim was lodged.
The onus is on the employer to provide evidence of the worker not being entitled based on the above criteria, by attaching this evidence to the early notification (Part A of the claim form).
*A worker’s claim includes a mental injury where:
- the worker has ticked the ‘mental injury’ box in Question 2 of the Worker’s Injury Claim Form, or indicated in the free text responses that the worker has a mental injury, for example by reference to stress, anxiety, depression, psychological condition, or
- the Agent is otherwise notified of the existence of a mental injury in connection with the claim already forwarded to the Agent (e.g. through presence of mental injury on Certificate of Capacity Ongoing certificate is issued for up to 28 days and can be issued by a: medical practitioner, osteopath, physiotherapist, chiropractor.)
The Agent/SI is not required to assess if the claimant has a diagnosable injury as part of determining whether the claimant is entitled to provisional payments. The diagnosis under DSM5 is not relevant to a worker’s entitlement to PP.
Timeframes for determining PP entitlement
Agents are required to determine whether a worker is entitled to provisional payments, and give written notice of this determination, within 2 business days of:
- receiving early notification of the mental injury (Part A of the Worker’s Injury Claim Form) from the employer
- receiving a claim under section 29 in respect of a mental injury
- being otherwise notified of the existence of a mental injury in connection with the claim already forwarded to the Agent e.g. on a Certificate of Capacity
Self-insurers are required to determine whether a worker is entitled to provisional payments, and give written notice of this determination, within 5 business days of:
- receiving a claim for compensation in respect of a mental injury
- being otherwise notified of the existence of a mental injury in connection with the claim already received by the Self-insurer