The workers compensation insurer's role

The insurer makes decisions regarding:

• Approving or declining a workers compensation claim

  They are required to make a provisional liability decision within 7 days provided they are able to contact all parties (injured worker, treating doctor and employer).

  The insurer is required to:

  • Contact all staff with new claims where they have medical recommendations for restrictions to their duties at work.
  • Formally notify staff if their claim has been declined. Find out more about what happens if your workers compensation claim is declined.

• Reasonable medical treatment

  What treatment is approved for each claim based on the medical advice available and what they consider to be reasonable.

The insurer may choose to seek independent advice:

• Medical examinations

  To send staff to independent medical examinations to assist in clarifying the progress in injury recovery and to review treatment needs. Attendance at these insurer medical examinations is compulsory.

• Investigator

  To appoint an independent investigator to a claim to conduct factual interviews with various key parties. This is commonly the case with claims for psychological injury or illness. This type of factual investigation is aimed at assisting the insurer in determining their acceptance or decline of the claim.