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Understanding rights and responsibilities of workers compensation claims


To help you manage workers compensation claims smoothly and correctly, here’s a quick guide to the frequently asked questions about the rights and responsibilities of you and your employee.

1. The notification process: who needs to notify whom of what?

“The employee has to notify the employer. The employer has to notify the insurer and they can choose to notify their broker. And, under certain conditions of the injury, they may need to notify WorkSafe,” says Toni Strutt, Head of WA Workers Compensation Claims at QBE.

2. Who is responsible for the safekeeping of medical certificates and other records and forms?

“The employer’s HR department should keep a copy of the claim file, but they also need to make sure it is in a secure place to protect the worker’s privacy,” says Shalene Watson, Head of ACT, TAS & NT Workers Compensation Claims.

“The ideal situation is that the employee provides documentation like medical certificates to the employer and to us at the same time,” says Strutt.

“It is the employee’s responsibility to make sure the medical certification is kept up to date.”

3. What needs to get done to ensure financial considerations are taken care of as soon as possible?

“The employer needs to provide details of the employee's wages to us,” says Strutt.

“The employer also needs to send in the duly made claim, which is the worker reported injury form and medical certificate,” says Watson.

Employers need to also be aware of provisional liability and whether it’s applicable to them as it’s only relevant for some states in Australia.

“If we have a claim come in and we can't determine liability straightaway, in some states the injured worker is entitled to provisional liability,” says Watson, which means the onus is on the employer to continue to pay as long as there is a medical certificate. QBE will then reimburse the employer regardless of the decision of liability.

4. What are the employee’s responsibilities while on workers compensation? Can they go on holiday?

“Yes, they can go on holiday,” says Strutt. “We tend to work with the injured person to be paid from their accrued annual leave.”

“The employee’s responsibilities are providing the workers comp medical certificates ongoing,” says Watson.“They also need to participate in their treatment plan as directed by their doctor."

5. What is the broker’s role? How can they help?

“Brokers can be very valuable in the process,” says Watson.

“The best relationships work when our mutual customer, the employer, sees benefit in having both a broker and an insurer. Together, we can act as a united front if situations get difficult,” says Strutt.

With multiple legislations across the country around workers compensation, one example of how a broker can help, is to work with employers to work out possible work issues or entitlements for different legislations to ensure employers understand their obligations and how best to help their people.

 

  Responsible party
 Item Employer  Employee (worker) QBE  Doctor
 Notifying insurer of injury      
 Notifying WorkSafe of injury (if required)      
 Deciding the RTW goal
 Deciding on an RTW plan  
 Storing and monitoring the RTW plan    
 Staying in contact with worker, keeping them interested in work      
 Paying wages to worker      
 Usual HR and performance management      
Getting and providing medical certificates      
 Booking appointments e.g. physio, GP      
 Choosing a doctor      
 Attending, and getting to and from treatment      
 Notifying employer of injury      
 Monitors treatment suitability and RTW suitability    
 Pays for treatment      
 Calculating wage entitlement during claim    
 Deciding liability    
 Dispute management - claim related      
 Diagnosing the injury and treatment requirements      
 



The advice on this website is general in nature and has been prepared without taking into account your objectives, financial situation or needs. You must decide whether or not it is appropriate, in light of your own circumstances, to act on this advice. You should ensure you obtain and consider the policy wording or Product Disclosure Statement for the policy before you make any decision to buy it.

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