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WORKERS' COMPENSATION AND INJURY MANAGEMENT ACT 1981 - SECT 57A

57A .         Claims procedure where employer insured

        (1)         This section applies where —

            (a)         a claim for compensation by way of weekly payments for total or partial incapacity is made on an employer in accordance with section 178(1)(b); and

            (ba)         the employer is indemnified by a policy of insurance against liability to pay the compensation claimed; and

            (b)         the worker suffering the injury serves on the employer a certificate signed by a medical practitioner —

                  (i)         in or to the effect of the form prescribed containing substantially the information sought in the form; or

                  (ii)         to the effect that the worker is unfit for work because of a recurrence of an injury in respect of which a certificate as referred to in subparagraph (i) has previously been served.

        (2A)         In the circumstances mentioned in subsection (1), before the expiration of 5 full working days the employer must claim under and in accordance with his or her policy of insurance in respect of liability to pay the compensation claimed.

        Penalty: a fine of $1 000.

        (2)         Where, in the circumstances mentioned in subsection (1), an employer fails to make a claim under and in accordance with his policy of insurance before the expiration of 5 full working days of his insurer after the day on which the circumstances mentioned in subsection (1) arose or, where the making of a claim within that time would not be reasonably practicable, as soon as reasonably practicable thereafter, the insurer may, in the Magistrates Court, sue and recover from the employer, as a debt due, any amount that, under the policy of insurance, he is liable to pay by way of indemnity in respect of the first 5 working days for which weekly payments are claimed by the worker.

        (3)         Upon an employer making a claim as mentioned in subsection (2), the insurer must, before the expiration of 14 days after the claim was made by the employer —

            (a)         give the worker to whom the claim relates and the employer notice, in accordance with section 57BA and the regulations, that liability is accepted in respect of the weekly payments claimed; or

            (b)         subject to section 75, give the worker to whom the claim relates and the employer notice, in accordance with section 57BA and the regulations, that liability is disputed in respect of all or any of the weekly payments claimed; or

            (c)         give the worker to whom the claim relates, the employer and the Director notice, in accordance with section 57BA and the regulations, that a decision as to whether or not liability is to be accepted in respect of the weekly payments claimed is not able to be made within the time allowed by this subsection.

        Penalty: $1 000.

        (3a)         If within 10 days after the Director is notified under subsection (3)(c) that a decision is not able to be made, the insurer has not —

            (a)         notified the worker to whom the claim relates, the employer and the Director that liability is accepted in respect of the weekly payments claimed; or

            (b)         subject to section 75, notified the employer, the worker and the Director that liability is disputed in respect of all or any of the weekly payments claimed and of the reasons why it is disputed,

                the claim by the worker shall be deemed to be disputed.

        (4)         Where the Director has requested an insurer to do so, the insurer shall cause each notification to the Director under subsection (3)(c) to be accompanied by a means specified by the Director for conveying to the Director, in a machine-readable form so specified, the information contained in the notification.

        Penalty: $1 000.

        (5)         Where an insurer fails to comply with subsection (3) in respect of a claim for weekly payments under this Act, the worker who made the claim is, by force of this subsection, entitled to the weekly payments claimed and the insurer is liable to indemnify the employer in respect of those weekly payments, but either the employer or the insurer may apply for a determination under subsection (6).

        (6)         On an application under subsection (5) an arbitrator may determine the entitlement that the worker would have but for the operation of subsection (5), and thereupon the entitlement of the worker is as so determined but without affecting his entitlement under subsection (5) in respect of the period before that determination.

        (7)         An employer shall make the first of the weekly payments not later than 14 days after —

            (a)         he is notified that the insurer accepts the claim or the time prescribed by subsection (3) expires without the employer having received any notification as required by that subsection from the insurer; or

            (b)         on an application made under section 58, an arbitrator has ordered the commencement of weekly payments under this subsection,

                and subsequent weekly payments shall be made on the employer’s usual pay days.

        (8A)         An employer who fails to make a weekly payment by the due date under subsection (7) commits an offence.

        Penalty for each weekly payment not made when due: a fine of $2 000.

        (8)         An employer who having received a payment from an insurer in respect of the employer’s liability to make a weekly payment to a worker fails to make that weekly payment to the worker in accordance with subsection (7) commits an offence.

        Penalty: $2 000.

        [Section 57A inserted: No. 96 of 1990 s. 8; amended: No. 72 of 1992 s. 6; No. 48 of 1993 s. 28(1) and 34; No. 34 of 1999 s. 11; No. 42 of 2004 s. 41, 146, 147 and 154(4); No. 59 of 2004 s. 133; No. 31 of 2011 s. 90.]



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