First Steps in the Claims Process: Insurers First Steps - Insurers Insurer notified of injury by employer, employee or 3 rd party Contact the worker and employer within 3-days Consult with relevant parties, including treating doctor, to ensure worker receives necessary assistance to recover, return to work Provide information regarding the claims process Within 7-days of notification decide whether to approve provisional liability payments for up to 12-wks (unless unreasonable to do so) Decide whether: to approve provisional medical expenses for up to $7500 the insurer or the employer will pay the worker the worker needs to complete a claim form If a claim has been made inform the employer, within 7-days. Make a decision about the ongoing liability of the claim within 21 days or before the end of the period of provisional liability provide worker with contact details of the WorkCover Assistance Service AND a written explanation of a decision to decline the claim or any aspect of the claim tify the injured worker and employer, in writing, about the amount and duration of provisional payments Develop an injury management plan for workers with a significant injury Comply with insurer obligations under the injury management plan
Sample Incident Form Instructions: Please complete within 24 hours of the event occurring, and forward to Manager immediately. Please attach extra sheets if you require more on this form. INCIDENT FORM - Part A: Details of incident (eg property, plant or environmental damage) Date of incident Time of incident am / pm Nature of incident Physical assault Verbal assault Slip and/or trip Self-harm Near miss (i.e. incident nearly occurred and could be prevented in the future) Left premises Medical condition Other Location of incident Description of incident Name of person who received the report Telephone
INCIDENT FORM - Part B: Details of injury (e.g. to a staff member or client) and treatment Date of incident Time of incident am pm Name of injured person Date of birth Exact site location where injury occurred Telephone Activity in which the person was engaged at the time of injury (e.g. during a visit, in a break, in the office) Sprain / strain Open wound Fracture Bruising (contusion) or crushing Nature of injury Burn Psychological injury (e.g. from aggression or harassment) Slip, trip or fall Object in the eye Choking Body location of injury if physical (indicate location of injury on the diagram) Near miss (i.e. an injury that nearly occurred and could be prevented in the future) Other: Treatment given on site Name of treating person
Referral for further treatment? Yes Name of doctor or hospital: Medical certificate received? Yes Attach copies Injury management required? Reported to authorities Yes tify return to work coordinator Yes Provide details (when and whom): Name of return to work coordinator Witness to event (each witness may be contacted to provide an account of what happened) Witness name Witness phone number Witness name Witness phone number INCIDENT FORM - Part C: tification: tifiable Incident? Yes If it is a notifiable incident, has NSW WorkCover and or Insurer notified? Yes Body tified NSW WorkCover Insurer Date and time of notification Method of notification Name of notifier
INCIDENT FORM - Part D: Investigation and Follow-Up What actions (if any) contributed to this incident? What were the reasons for these actions? What conditions (if any) contributed to this incident? What were the reasons for these conditions existing? Provide details of any further action required eg changes to training, equipment modifications, changes to procedures
INCIDENT FORM - Part E: Action Plan Preventative actions include what needs to be done, who will do it and when it will be done Person to action: Due Date: Actions complete: Yes Due date extended to: Additional comments: Completed by Name Position Signature Date Manager s Signature Date All material presented or produced by the Mental Health Coordinating Council (MHCC) is for guidance purposes only. The information should be reviewed in relation to your organisation s individual circumstances and policies