Workers Compensation Regulation 2016

For the purposes of paragraphs (a) and (d) of the definition of cost of claims in clause 143(1), the cost of payment of provisional weekly payments of compensation and provisional payment of medical expenses compensation, if any, with respect to a particular injury is (except as provided by subclause (2)) the sum of the following—

the sum of the payments of provisional weekly payments of compensation and provisional medical expenses compensation, if any, made by the insurer in respect of the injury pursuant to the 1998 Act,

fees and expenses, if any, paid by the insurer to medical practitioners, investigators or assessors in respect of the investigation of the injury,

legal costs, if any, paid by the insurer in relation to the investigation of the injury, the determination of liability to make provisional weekly payments of compensation or provisional payment of medical expenses compensation and otherwise in complying with Divisions 1 and 3 of Part 3 of Chapter 7 of the 1998 Act,

the most accurate estimation for the time being of the insurer’s outstanding liability to make provisional weekly payments of compensation and provisional payment of medical expenses compensation, if any, with respect to the injury,

However, the cost of provisional weekly payments of compensation and provisional payment of medical expenses compensation with respect to a particular injury—

does not include any amount calculated by reference to the insurer’s costs of administration or profit, and

in relation to a policy (other than a retro-paid loss premium policy)—is to be reduced by the amounts, if any, that have been recovered or are recoverable by the insurer from any source, other than an amount recovered or recoverable under section 160 of the 1987 Act, from the Insurers’ Contribution Fund or pursuant to a policy of reinsurance, and

in relation to a retro-paid loss premium policy—is to be reduced by the amounts, if any, that have been recovered or that, in the opinion of the Nominal Insurer, are recoverable by the insurer from any source, other than an amount recovered or recoverable under section 160 of the 1987 Act, from the Insurers’ Contribution Fund or pursuant to a policy of reinsurance, and

is to be reduced by—

in the case where the injured worker’s provisional weekly payment of compensation is less than $500 or is not known (for example, the claim is for provisional payment of medical expenses compensation only)—$500 or, if the cost of the payments is less than $500, that lesser cost, or

in any other case—an amount that is the lesser of the following—

the amount that the injured worker is entitled to receive as one week’s provisional weekly payment of compensation,

if the payment is under a policy of insurance that was issued or renewed so as to take effect before 4 pm on 30 June 2006—$1,449.50,

if the payment is under a policy of insurance that was issued or renewed so as to take effect on or after 4 pm on 30 June 2006, the amount specified by the relevant insurance premiums order that applies to that policy, and

does not include any amount paid or payable under section 64A (Compensation for cost of interpreter services) of the 1987 Act, and

does not include any amount that section 54(4)(b) of the 1998 Act (Second-injury scheme) requires to be excluded from the claims experience of the employer, and

is to be reduced by an amount that is the most accurate estimation for the time being by the insurer of the amount of any input tax credit or decreasing adjustment that may be claimed or has been claimed by the insurer in respect of the payments, fees, expenses or costs included in the cost of provisional weekly payments of compensation or provisional payment of medical expenses compensation under subclause (1), pursuant to the A New Tax System (Goods and Services Tax) Act 1999 of the Commonwealth.

In this clause, references to the insurer’s outstanding liability to make provisional weekly payments of compensation or provisional payment of medical expenses compensation with respect to an injury are references to the amount calculated to be sufficient to meet all reasonably likely future provisional payments of weekly compensation or medical expenses compensation in respect of the injury.