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Process in NSW workers compensation claims

Practice

 

Process steps

 

Time limits

   

WCC Forms

   

Worker’s right to information: s 232

     

WCC may extend time: Rule 3.2

Notice of injury >>

Injury claim form >>

Permanent impairment claim form >>

 

Notice, claim

 

Notice: as soon as possible after the injury: s 254

         

Centrelink recovery: Centrelink >>

Medicare history statement request: Medicare forms >>

     

Claim: within 6 months of injury or death: s 261, or, 3 years, if excused by ignorance &c: s 261(4)

         
       

Employer must forward to insurer within 7 days: s 264

         
       

Provisional weekly payments within 7 days of insurer notification: s 267

         

Furnish relevant particulars of claim:s282

S 282 Precedent >>

 

Particulars

 

Insurer has 2 weeks to assert insufficiency: s 282(3)

   

Expedited assessment

   

Parties must exchange information: s 290

 

Interim payment direction

 

Insurer must accept and offer, or deny, within 2 months of full particulars, or 1 month of WPI ascertainment: s 281

Trained assessor required for assessments in WPI demand

       
         

Restrictions on medical reports: Reg'n cl 49+ by s 294

       

Applicant requests review by insurer: s 287A

     

Liability to be accepted and weekly payments commenced within 21 days: s 274

       

Insurer to give notice and reasons when liability disputed: s 74

If liability disputed, refer to WCC: s 289

 

Claims Assistance Service

 

Telephone

131 050

Mo-Fr: 8:30am - 5pm

Referral of disputes to Commission: s 288

       

Lodgement and service on WCC: Rule 8.1

       

Schedule of earnings: Rule 15.5WCC Forms

       

Material to be lodged with application or reply: Rule 10.3, includes surveillance and other documents: Rule 14.1

       

Evidence: Rules Pts 14, 15

       

WCC Forms

 

Application for Resolution of Dispute

   
   

Joinder: R 11.1

   

WCC Forms

 

Reply

 

21 days from lodgement of ARD: Rule 10.4

         

WCC Forms

 

Application to admit late documents

   
         
   

Telephone conference

 

About 35 days from lodgement:Guideline Practice

         

Seek informally first;

Rule 12.2WCC Forms; conduct money:Rule 12.6

  Direction for production    
         
s 293 Medical assessment: not where liability disputed; WCC Forms;  

Referral to Approved Medical Specialist: AMS

   
         
    Medical assessment certificate: MAC    
         
s 378; No form, apply by letter:Registrar's Guideline   Reconsideration of MAC   21 days to reply: Registrar's Guideline
         
s 327WCC Forms   Appeal against MAC    
         
s 378; No form, apply by letter:Registrar's Guideline   Reconsideration of Medical Appeal Panel MAC   Panel to deliver reconsideration within two Within two months
         
SCA s 69   Supreme Court judicial review   No time limit but see cases >>
Notice of intention to call witness: Rule 14.2        
Discontinuance: Rule 15.7  

Arbitration hearing

   
         
s 294 Certificate of Commission’s determinationRule 15.6   Certificate of Determination/Statement of Reasons    
        Medicare notice 28 days after judgment: Medicare
         
s 350; No form, apply by letter:Registrar's Guideline   Reconsideration of arbitrator's decision   21 days to reply: Registrar's Guideline
         
         
Rules Pt 16   Question of law appeal    
Thresholds s 352   Appeal against arbitrator   Lodge within 28 days of decision:s352Rule 16.2; serve 14 days;  lodge certificate of service within 7 days of service: 16.2; application to extend time
        Notice of opposition to an appeal: 28 days of being served: Rule 16.2; lodge certificate of service 7 days: 16.2;
         
Costs demand: see Costs summaries >>        
WCC Forms   Application for costs assessment    
         
Recovery of amounts ordered to be paid: s 362, Certificate as to amount ordered to be paid: Rule 18.2   Execution   14 days of statutory declaration:Rule 18,2
         
Parties limited to pre-filing statement and defence: s 318   Work injury damages   Defective pre-filing statement >>

Prerequisites:

1. Whole denial of liability: s 315; or 1 month after offer under s 281; or no offer under s 281: s 315;

2s 282 particulars;

3. Claim for lump sum compensation: s 280A;

4. Payment of lump sum compensation: s 280B (uncommenced);

5. MAC 15% WPI, or acceptance: ss 313,314315;

  Pre-filing statement   Plaintiff serves after 2 months from service of s 282 particulars.

Defendant has 28 days from service to serve particulars of grounds and evidence of defence:s 316(1)

On D's failure after 28 days, plaintiff may refer to mediation: s 318A

On D's failure after 42 days, plaintifff may commence in Court:s 316(2)

 

    Mediation    
         
    Court process    
         

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