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Managing work-related mental injury claims

In response to the influx of mental injury claims and delays for workers obtaining medical treatment until their liability issues are determined, the Victorian Government has introduced the Workplace Injury Rehabilitation and Compensation Amendment (Provisional Payments) Act 2020 (Provisional Payments Act). This has been in effect since 1 July 2021.

Kim McLagan
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What has changed?

  • The Provisional Payments Act allows eligible workers and volunteers to receive up to 13 weeks of medical treatment whilst the insurer’s liability decision is being determined.
  • All workers and volunteers who lodge a mental injury or ‘stress claim’ are considered eligible and are entitled to the provisional payments. Note: They are not eligible if they are not a Victorian worker or the claim is a duplicate of an existing claim.
  • The Worker’s Injury Claim Form now comes in two parts and different timelines apply, as follows: 
    Part A: 3 business days
    • An employer must provide early notification of mental injury claims to their insurer and must complete and forward Part A of the Worker’s Injury Claim Form within 3 business days of receiving it.
    • Insurers will have 2 days to determine if the worker is entitled to provisional payments for medical treatment.
    Part B: 10 calendar days

     

    • Part B of the Worker’s Injury Claim Form must be provided to their insurer within 10 calendar days of receiving the mental injury claim.
    • An employer can provide Part B to their agent at the same time as Part A provided it’s within the 3 days.
    • Employers must still complete and forward the Employer Injury Claim Report, Certificate/s of Capacity and any other relevant documentation (including invoices for medical expenses – if any) within 10 calendar days of receiving the claim.
    • The insurer will still have 28 days from when Part B is lodged to make the eligibility decision on the primary claim.
  • The insurer will notify the parties if the worker is entitled to provisional payments.
    • If the claim is rejected, the worker’s ability to access medical treatment can continue (up to 13 weeks).
    • If the claim is ultimately rejected, the payments will not impact an employers’ insurance premiums.

Why is this important?

This is a great step towards improving return to work outcomes in workers by encouraging early treatment for a medical condition. Statistics confirm a direct correlation between the length of time a person is off work and the chance of them returning to work following an injury:

  • 20 days > chance of them returning to any work is 70%
  • 45 days > chance of them returning to any work is 50%
  • 70 days > chance of them returning to any work is 35%

Prior to these changes, a worker could wait up to 38 days from claim lodgement until knowing if their claim was accepted which meant many delayed obtaining essential treatment until the liability decision was made. This often resulted in conditions worsening and the likelihood of returning to work quickly diminishing.

What do employers need to do to comply?

From January 2022, if employers do not meet these early notification requirements they will be subject to penalties of up to $54,522.00 (for corporate entities).

  1. Display the updated “if you are injured at work posters” in every workplace.
  2. Review all internal processes, procedures and/or documents to ensure you meet the new early notification obligations when a claim is received.
  3. Communicate these changes and assess training needs for key staff.

For further details:

Kim McLagan
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Friday Workplace Briefing – Finale

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