7.3.6 Disputes about provisional payments

A fast-tracked conciliation process has been introduced for disputes relating to provisional payments for a claimed mental injury, to meet the intent of the legislation to provide faster access to payments for treatment to workers who have made a claim for a mental injury.

Other sections of the claims manual relating to conciliation apply to PP disputes also, with the below timeframes applying:

Step Details
WIC lodges Request for Conciliation (RFC)

PP dispute will be allocated to PP stream within first 24 hours (1 business day) of RFC if:

  • RFC refers to PP
  • WorkSafe system or the self-insurer confirms that the nature of dispute relates to services requested under PP.

Other disputes will be referred to the general stream, or Early Resolution Potential stream.

WIC initiates contact with parties within 24 hours (1 business day of dispute being allocated to the Provisional Payment stream

The PP Conciliation Officer will:

  • send acknowledgment to worker and employer
  • send a copy of relevant documents to parties
  • request urgent provision of relevant documents from agent and other parties – Agent (or self-insurer) has 3 business days to respond to any requests for further information
  • initiate contact with the worker, worker representative and self-insurer or Agent.

Agents are required to keep employers updated of outcomes.

Treating health practitioner (THP) reports

If a THP report is required:

  • WIC will send a copy of the medical authority form to all parties and request the worker to sign and return the form to WIC and the THP.
  • WIC will then seek to facilitate early provision of the report and account by contacting the THP and asking the worker to do the same.
  • Invoices for THP reports related to PP disputes should be processed by Agents/SIs within 2 business days of receipt.
  • If there is an issue about whether the amount charged by the THP is reasonable, WIC will attempt to resolve this with the THP and the Agent/self-insurer
  • If the provider is not registered with WorkSafe, the CO will contact the WorkSafe Service Provider Registration team to facilitate registration, noting that the request relates to provisional payments
If further medical information is received Agent is required to review the additional information within 3 business days.
Attempt to resolve dispute within 7 days of RFC

WIC will seek to have discussions with the parties regarding settlement of the PP dispute in the first 7 days without a conference.
If unresolved, conference considered within 14 days of RFC

If unresolved by day 7, CO considers arranging conference in next 7 days to discuss PP related issues only.

If parties are not ready for conference, CO prepares Progress Certificate outlining next steps and timeframes.

CO will consider requests for Genuine Dispute and Medical Panel referral without conference.

Any requests for arranging a combined PP & non-PP conference will be considered, but will likely result in greater conference duration and lead time.

Referrals to Medical Panel (MP)

If the CO intends to refer a question to the MP:

  • Referrals to MP should be drafted as soon as possible by the CO
  • Parties will be able to provide feedback on draft referrals within 3 business days prior to the medical questions being referred (employers will be sent a copy of the draft and final referral).
  • WIC may request an expedited appointment and opinion from the MP.
Outcome certificate Outcome certificate issued in accordance with normal processes.

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