Workers’ Compensation and Rehabilitation Act 2003

This section applies to a claimant who is a worker mentioned in section 237(1)(a)(ii).

The claimant can not have, and the insurer can not decide to have, the injury assessed under chapter 3, part 10 to decide if the claimant has sustained a DPI.

The insurer can not decide the claimant’s notice of claim does not comply with section 275 only because the claimant has not received a notice of assessment for the injury.

However, the claimant may seek damages for the injury only if the insurer decides the claimant has sustained an injury.

The insurer must make a decision for subsection (4) within 40 business days after—

the claimant gives, or is taken to have given, a complying notice of claim; or

the claimant gives a notice of claim for which the insurer waives compliance with the requirements of section 275 with or without conditions; or

a court makes a declaration under section 297.

The insurer must—

notify the claimant of its decision for subsection (4); and

if the insurer decides the claimant has not sustained an injury—give the claimant written reasons for the decision; and

if the insurer is WorkCover—also give the information mentioned in paragraphs (a) and (b) to the claimant’s employer.

If the insurer does not make a decision for subsection (4) within the time stated in subsection (5)—

the insurer must, within 5 business days after the end of the time stated in subsection (5), notify the claimant—

of its reasons for not making the decision; and

that the claimant may have the insurer’s failure to make the decision reviewed under chapter 13; and

the claimant may have the insurer’s failure to make the decision reviewed under chapter 13.

A person aggrieved by the insurer’s decision may have the decision reviewed under chapter 13.