Q1. When assessing a claim, what steps would you take to ensure the determination is appropriate and in accordance with the terms and conditions of the relevant state authority?
When assessing a claim the agent will follow a number of processes and procedures to ensure the correct determination has been made. This will include having a full understanding and access to the relevant state legislation which will outline the terms and conditions which employers are bound by.
1. The agent will begin by checking to ensure all paperwork is complete as required, for example the claim will contain:
• A Notice of Disability
• Compensation claim form
• Completed employer report form
2. The agent will ensure that the obligations in Section 51 and Section 52 of the Workers Rehabilitation and Compensation Act have been covered.
3. If the documentation required has not been provided the agent must make arrangements to collate the remaining information. This could include medical information to clarify injury. The agent must determine the case as quickly as possible.
4. If the claim is for income maintenance, the agent must make contact within 10 business days after receiving the claim. If there is any dispute then both parties can apply to the Workers Compensation Tribunal, Section 97 or the Workers Rehabilitation and Compensation Act outlines the information regarding the Tribunal.
5. If the claim requires an investigator, an approved service provider must be used and a computer generated referral letter can be downloaded from the state authority website. The information that should be included should be:
• Details of the investigation
• Objectives and background information (previous injuries etc..)
• Employment history
(The agent must also apply to the manager of the investigation unit where entry and inspection are required).
6. If an agent needs to clarify the nature, extent of probable duration of a claim the employee can be asked to submit an...