| Worker Injured | |||
| Worker obtains a First Certificate of Capacity (FCOC) from a doctor using the approved FCOC form – determine date of incapacity | |||
| Worker completes the approved Claim Form | |||
| Worker gives their claim to their employer (must include both the FCOC and Claim form) within 12 months after the injury | SECTION 25(1)(2) | ||
| if a worker fails to submit a claim within the required timeframe, or makes a mistake or includes incorrect details in any claim information, the claim is not automatically invalid provided (a) the delay or error was due to a mistake, being absent from WA, or another reasonable cause, AND (b) the delay or error does not disadvantage the employer’s ability to defend themselves in any legal proceedings related to the claim. | SECTION 25(5)(a)(b) | ||
| Employer must give the worker’s claim (must include both the FCOC and Claim form) to their insurer within 7 days of receiving the claim from the worker | SECTION 26 $5000 |
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| Insurer assesses the claim | |||
| Within 14 days after a claim is given to the insurer, the insurer must give the worker and employer a liability decision notice for the claim (DN1 accepted, DN3 not accepted, DN4 deferred). If an insurer or self‑insurer fails to give a liability decision notice or deferred decision notice as and when required, the insurer is taken to have accepted that the employer is liable to compensate the worker and is liable to pay income compensation for incapacity for work. | SECTION 28(6)(a)(b) | ||
| DEFERRED – DN4 | ACCEPTED – DN1 | ||
| Insurer usually (but not legally required to) issues a weekly provisional payment rate | Insurer usually (but not legally required to) issues a weekly provisional payment rate | ||
| Insurer must give a liability decision notice within 120 days (as per Regs s19) of receiving the claim | SECTION 29 | Employer must begin compensation payments within 14 days of the Liability Decision Notice and back paid to the date of incapacity | SECTION 47(2)(a) $5,000 |
| Employer must begin provisional payments within 28 days (as per Regs s22) of the insurer receiving the claim, back paid to the date of incapacity | SECTION 36(2) $10,000 |
Employer must make subsequent payments of income compensation to the worker on the employer’s usual pay days and in the way the worker would normally be paid | SECTION 47(2)(b) $5,000 |
| A provisional payment must be paid at the time and in the manner the same as if they were having compensation payments | SECTION 39 | Employer must not reduce, suspend or discontinue compensation payments to a worker
EXCEPT with the written consent of the worker given in the approved form |
SECTION 62 $5,000 EXCEPT/UNLESS |
| An employer must not reduce or discontinue income compensation payments to a worker EXCEPT if a worker earns the same or more, then compensation may stop. If they earn less, partial compensation may apply. The employer must explain. See and approved form: SECTION 63 – returns to work | |||
| An employer cannot reduce or stop a worker’s income compensation based on medical evidence UNLESS they follow these steps:
1. Provide written notice explaining why and a copy of the medical report If the worker does not apply within 21 days, the employer can proceed with the reduction or stoppage. A dispute is considered finalised when resolved by conciliation or arbitration. See and approved form: SECTION 64 – medical evidence |
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| s65. A worker who resides outside WA, they may be required to submit approved declarations (from both themselves and a medical practitioner) regarding their work capacity. If these declarations are not provided on time, the insurer may suspend income compensation payments after issuing a formal warning notice at least 14 days prior to the suspension date. Payments resume once the declarations are received.
CN4 – Non-resident worker – declaration warning notice s66. Compensation payments must be suspended if a worker is in custody. CN6 – Custody or imprisonment notice |
SECTION 65, 66 – outside WA, in custody | ||