Making relevant conduct claim
42G Making relevant conduct claim
A claim under the 1998 Act, Chapter 7, Part 3, Division 3A is made when the worker gives the insurer—
a completed claim form, and
the information required by clauses 42E and 42F.
An insurer that receives an incomplete claim must, within 3 business days after receiving the incomplete claim, contact the worker and explain the following in a way, including using language, the worker should reasonably be able to understand—
that the worker’s claim is incomplete and cannot be progressed until the claim is complete,
how the worker may complete the claim,
that the worker is only entitled to payments under the 1998 Act, section 280AD from the date the claim is complete and not from the date of the worker’s injury,
if the claim does not include a claim form—how the worker may obtain a claim form.
If contact or attempted contact under subclause (2) is not by way of writing, the insurer must, within 3 business days after contact or attempted contact is made, give the worker written notice, in language the worker should reasonably be able to understand, of the information required by subclause (2).
An insurer that receives a claim may require the worker to give the insurer authorisation for the worker’s relevant treatment providers to give the insurer information regarding treatments or services given to the worker.
In this clause—
claim form means a claim form approved by the Authority.
relevant treatment provider, for a worker, means a person who provides one or more of the following services to the worker in connection with the worker’s injury—
medical or related treatment,
hospital treatment,
workplace rehabilitation services.
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