Provisional Payments and Initial Notification
Published: 8 July 2010
When an injured worker or their representative give the compensating authority an “initial notification” of a disability, the compensating authority must commence provisional weekly payments within 7 days unless it determines that there is a reasonable excuse for not commencing those weekly payments. The reasonable excuses are described in the Provisional Payment Guidelines which were published in the Government Gazette on 25 June 2009.
As the name suggests, the payment of provisional weekly payments is on a provisional basis only and does not constitute an admission of liability by the compensating authority. Payments may be made for up to 13 weeks while the compensating authority investigates the claim. The payments will cease once the claim is determined. If the claim is accepted the provisional weekly payments will be taken to constitute a payment of income maintenance. If the claim is rejected, the provisional weekly payments can only be recovered from the worker if the worker has acted dishonestly in making the claim.
The compensating authority’s obligation to assess whether or not to commence provisional weekly payments only arises when it has received an “initial notification”. This notification is defined in the Workers Rehabilitation and Compensation Act 1986 as the notification of a disability that is given in the manner and form required by the Provisional Payment Guidelines. The manner and form required is the WorkCoverSA claim form with the shaded panels for certain mandatory information completed. The Guidelines further define the meaning of initial notification as the first notification of a disability that is given. What this means is that lodging a completed claim form will only constitute an initial notification if it gives notice of a disability for the first time.
Sometimes workers will be asked by their case manager to lodge a claim form to claim income maintenance for a new period off work due to a previously accepted disability. Their income maintenance may have stopped because they have been back at work but they now need some time off because they are having treatment for the disability or they are not coping with the duties. In this situation, the claim form will not be an initial notification that requires provisional weekly payments to be commenced within 7 days because it is not the first notification of the disability. Actually, it is not even a notification of a disability. Rather it is a claim for income maintenance for a further period of incapacity associated with a previously notified and accepted disability. On receiving this type of claim, the compensating authority does not have to consider making provisional weekly payments (but it must investigate and determine the claim as quickly as possible).
If an injured worker has lodged a claim form and has not heard back from the compensating authority within 7 days about whether provisional weekly payments will be commenced, they should first contact their case manager to obtain an explanation. It may be that the claim form is not an initial notification. If the injured worker is not satisfied with the explanation from the case manager, they should contact WorkCoverSA’s Service Improvement Unit (phone 13 18 55) or the WorkCover Ombudsman.