The claims journey
The milestones of a claims journey.
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While no claim is the same, the milestones below can help you understand the general claim journey.
Initial stages of a claim
It's important to notify icare of the workplace injury within 48 hours of it being reported to you. The claims service provider allocated case manager will contact your injured worker, you and your injured worker's Nominated Treating Doctor to find out more information about the injury within three days from notification.
After the case manager contacts all stakeholders, they must make an initial liability decision by day seven. This decision will be based on the factual and the medical information that is available at the time.
The initial liability decision will determine whether they can commence paying weekly payments immediately or whether further information is required.
Reasonably necessary medical and rehabilitation expenses can be approved regardless to ensure that your injured worker receives immediate support. This decision referred to as provisional liability is not a formal liability decision and further investigations may still be required. The provisional liability period can last up to 12 weeks.
Back to top ⇡Investigations
Psychological injuries can be quite complex so there may be additional investigations required.
This may be a factual investigation, where other workers involved in the injury are asked to provide statements and evidence regarding the incident that led to the injury. Your injured worker will be asked to do the same.
In addition, if there is outstanding medical information required to understand the psychological injury, your injured worker might be required to attend a psychiatric Independent Medical Examination (IME).
During the initial stages of a psychological injury, it is vital for you to try to understand your injured worker's situation and offer them support to promote recovery and return to work.
Back to top ⇡Liability
There will be another liability decision made once the claims service provider is able to obtain medical and/or factual evidence to establish that the injury is work related.
Proactive communication between the case manager, injured worker, employer and treating parties is required to achieve soundly based decision making.
Back to top ⇡Return to work
When your injured worker starts to recover and their Nominated Treating Doctor deems they can upgrade in capacity and return to work, you have an obligation to provide suitable duties for your injured worker that is in line with their capacity and any medical/functional restrictions (as far as reasonably practical).
SIRA's workers compensation guide for employers
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