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Know Your Rights: Understanding the 28-Day Liability Determination Process for WorkCover Claims in Victoria

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Please note that this post was written for Victorian audiences and the information within may not apply to other regions.

WorkCover claims are important for workers who have suffered injuries or illnesses as a result of their work. It is essential for those injured at work to understand the process in making a WorkCover claims as they aid an individual financially during such a stressful time.

A particular aspect of a WorkCover claim that is important to understand is the 28 -day liability determination process. This blog will:

  • Provide you with an overview of the liability determination process.
  • Explain the role of WorkSafe Victoria Agents
  • Describe the steps involved in the process, including the obligations of employers and workers rights
  • The guide will also discuss the legal consequences if the employers WorkSafe Victoria Agent fails to meet the 28-day deadline.

What is a WorkSafe Victoria Agent?

The Victorian WorkCover Authority does not deal with most WorkCover claims directly. Instead, there is a panel of insurers that administer the day-to-day aspects of WorkCover claims that employers may choose between. These insurers are known as Agents. Some larger employers will deal with claims more directly through their own insurance arrangement. These employers are known as ‘self-insured’ employers.

The 28-Day Liability Determination Process

The 28-day liability determination process is the period during which the WorkSafe Victoria Agent investigates the claim and decides on whether the injured worker is entitled to compensation. During this period, the WorkSafe Victoria Agent may request additional information from the injured worker or their employer to assist with the investigation. The injured worker has the right to provide medical and factual evidence to support their claim.

The role of the employer’s WorkSafe Victoria Agent is to investigate the claim and make a determination on liability. The role of the injured worker is to provide information about the injury and cooperate with the investigation.

What Happens During the 28 – Day Period

During this 28 Day period there are an array of steps taken to determine liability:

  • Gathering of Medical Evidence: Medical evidence is collected to assess the worker’s injuries and their connection to the workplace incident. This evidence plays a significant role in determining liability. This can include the Agent arranging an Independent Medical Examination to assess the worker’s injuries.
  • Contact with the Worker and Employer: The WorkSafe Victoria Agent may contact both the worker and the employer to gather additional information or clarify any details related to the claim.
  • Investigation of the Claim: The WorkSafe Victoria Agent investigates the claim to assess its validity and determine the extent of liability. The Agent may engage an investigator to prepare a report about the circumstances of the claimed injury and take statements from relevant parties.
  • Determination of Liability: Within the 28-day period, the WorkSafe Victoria Agent is required to make a decision regarding liability for the injuries. This decision is communicated to the worker through a Notice of Decision

Your rights during the 28 Day Period

During the 28-day period, workers have important rights that protect their interests throughout this process. These rights include:

Timeframes for Receiving a Notice of Decision: Workers have the right to receive a Notice of Decision within the 28-day period. If this deadline is not met, the worker may be entitled to compensation benefits until a decision is reached. The claim for weekly payments will be deemed to be accepted.

Appealing a Decision: If a worker disagrees with the determination of their claim, they have a right to appeal. Workers have the right to appeal a decision if they disagree with the liability determination. The appeals process provides an opportunity for a thorough review of the decision. Claimants have the option of proceeding to an informal review, or alternatively disputing the decision by a process known as Conciliation. More information can be found in our blog about conciliation here.

Employer Obligations

Employers also have obligations during the 28-day liability determination process, including:

Providing Medical Evidence: Employers must provide any relevant medical evidence they possess to the WorkSafe Victoria Agent. This evidence aids in the investigation and determination of liability.

Responding to Requests for Information: Employers must promptly respond to any requests for information from the WorkSafe Victoria Agent. Cooperation in providing necessary details is crucial for a fair and accurate liability determination.

Understanding the 28-day liability determination process is vital for both workers and employers involved in WorkCover claims in Victoria. By being aware of their rights and obligations, individuals can navigate the process effectively. If further assistance is required, it is advisable to seek guidance from legal or professional source.

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