Workers’ Compensation and Rehabilitation Act 2003

The insurer may decide, or the worker may ask the insurer, to have the worker’s injury or injuries assessed to decide whether the worker is entitled to treatment, care and support payments for the injury or injuries.

The insurer must decide the worker is entitled to treatment, care and support payments for an injury if the injury—

is a serious personal injury that meets the criteria (the eligibility criteria) for the injury prescribed by regulation; or

resulted from the same event as an injury mentioned in paragraph (a).

If the worker asks for an assessment under subsection (1), the insurer must ensure the assessment is carried out within 20 business days, or a longer period agreed between the insurer and the worker, after—

receiving the request; or

if the insurer asks the worker for further information to help the insurer carry out the assessment—the day the information is received.

After carrying out an assessment under this section, the insurer must decide—

that the worker is entitled to treatment, care and support payments for the worker’s injury or injuries—

for an interim period; or

if the insurer is satisfied the worker’s serious personal injury is likely to continue to meet the eligibility criteria after the interim period ends—for the rest of the worker’s life; or

that the worker is not entitled to treatment, care and support payments for the worker’s injury or injuries.

If the worker has multiple injuries resulting from the same event, the insurer’s decision under subsection (4)(a) must be made in relation to the worker’s serious personal injury even though the worker may not need treatment, care or support for the other injuries for the whole period decided under the subsection.

The insurer must give the worker written notice of the insurer’s decision under subsection (4) within 10 business days after the decision is made.