When will a Case Manager Require a New Claim Form?

Published: 23 October 2009

Sometimes an injured worker with an approved claim for a compensable disability might be taken by surprise when the case manager requests another claim form to be lodged if the injured worker seeks compensation for a new period of time off work or wants an assessment for permanent disability.  If the time off or the permanent disability all relate to the previously accepted claim, why is a new claim form required? 

Under section 52(1) of the Workers Rehabilitation and Compensation Act 1986 a claim for compensation must be made in the manner and form approved by WorkCoverSA.  Technically, WorkCoverSA could require a claim form to be lodged for every new type of entitlement being claimed because each new entitlement is a claim for compensation, regardless of whether the entitlements relate to the same injury.  The lodgement of a claim form allows WorkCoverSA to investigate the claim and decide whether it will approve the compensation being sought. Fortunately, section 52(6a) of the Act allows WorkCoverSA to dispense with the requirement of a claim form, so in obvious cases where a claim has been approved and the entitlement clearly relates to the approved claim, no new claim form will be required.

However, in the following circumstances it is likely that WorkCoverSA will request a new claim form to be lodged:
1.      Where a new disability is suffered as a result of different circumstances even if it is an aggravation of a previously accepted disability;
2.      Where a worker suffers a new type of disability (sometimes called a “sequelae”) as a development of an accepted compensable disability and seeks compensation in the way of medical treatment, a lump sum for permanent disability or income maintenance for time off due to that sequelae;
3.      Where a worker wants income maintenance for a new period of incapacity as a result of a previously accepted disability (whether or not a specific incident occurred) after a significant time has lapsed since the last period of incapacity;
4.      Where a worker wants to recover costs of medical treatment for a previously accepted disability but has not had any medical treatment or time off in relation to that disability for a lengthy period.

Many self-insured employers take a similar approach to WorkCoverSA on this issue, whereas others use their discretion more widely to process entitlements without a claim form.  The case manager should be able to identify the need for a worker to submit a new claim in particular circumstances.

Sometimes the lack of a claim form will delay the processing of a claim for compensation.  Therefore, if you have any concerns about whether a claim for a new entitlement relating to a previously accepted claim requires a new claim form, you should contact your case manager to obtain confirmation of the compensating authority’s requirements.  This is especially true if you are about to incur costs of a new type of medical treatment or about to take time off for surgery after being back at work for several months.