An employer’s Scheme Agent or insurer is obliged, in most cases, to begin provisional liability payments within seven days of being notified of a worker’s injury.
In some cases, however, the Scheme Agent or insurer will have a 'reasonable excuse' not to start provisional liability payments. The reasonable excuses that a Scheme Agent or insurer can use to not commence payments within the usual seven days are listed below.
There is insufficient medical information
The Scheme Agent or insurer has a reasonable excuse if after attempting to obtain medical information it does not have sufficient information to establish that there is an injury or that the injury is related to the worker’s employment.
However, the Scheme Agent or insurer may have to allow special consideration for workers in remote rural areas, where access to medical treatment is not readily available.
The injured person is unlikely to be a 'worker'
The Scheme Agent or insurer has a reasonable excuse if:
- the worker has been unable to verify their status as a worker (under NSW workers compensation legislation)
- the employer is able to verify that the injured person is not a worker.
View more information on workers and contractors.
The Scheme Agent or insurer is unable to contact the worker
The Scheme Agent or insurer has a reasonable excuse if it is unable to contact the worker after trying repeatedly, by phone, electronic means or at least once in writing.
The worker refuses to release information
The Scheme Agent or insurer has a reasonable excuse if the worker will not consent to the release or collection of personal and health information in relation to the workplace injury to determine the worker's entitlement to provisional payments.
The injury is not work related
The Scheme Agent or insurer has a reasonable excuse if the employer has provided evidence that the worker's employment is not a substantial contributing factor to the injury.
The injury is notified after two months
The Scheme Agent or insurer has a reasonable excuse if the notice of injury is not given to the employer within two months after the date of the injury.
However, the Scheme Agent or insurer may ignore this excuse if a liability is likely to exist and if it believes paying provisional payments to the worker will be an effective injury management intervention.
The injury is not a significant injury
If the injury is not significant – ie the worker is likely to be unfit to do their normal work for less than seven continuous days – then the Scheme Agent or insurer may extend the time to assess entitlements to 21 days after the initial notification is made.
For further help or advice, contact the WorkCover Assistance Service on 13 10 50.