An overview of the legislative changes regarding Provisional Payments for psychological injury:
- The changes are being brought in, in response to a trend developing that suggests 1 third of all claims will be primary psychological by 2030.
- Victorian Scheme Agents will now be required to make provisional payments for ‘Reasonable and Necessary’ treatment expenses (not wage payments) for up to 13 weeks where a primary, secondary or concurrent psychological injury is claimed by an injured person.
- These provisional payments will be made until the claim is accepted (at which point they no longer become provisional) or disputed.
- In the instance where provisional payments are made for psychological treatment and the psychological injury is subsequently declined by the agent, those costs will not be considered in premium calculation for the employer.
- The scheme agent stance, in accordance with the legislation, a worker is entitled unless determined otherwise (i.e. disputed).
- Claims determination and provisional payments are to be treated as distinctly different streams. For example, if a primary physical injury is declined and secondary psychological treatment is requested through provisional payment; those provisional payments for psychological treatment can still be claimed up to a maximum of 13 weeks.
- WorkSafe VIC have developed some internal processes to cross-check and validate claims to ensure workers are not duplicate claiming for provisional payments on their claims.
- In the instance where a claim is ‘withdrawn’; entitlement to provisional payments are also withdrawn.
- An employer will not be required to pay the medical excess (currently $735) on provisional payments. This will be handled by the scheme agent directly.
- The timeframes for lodging a claim remain the same; a worker is required to submit the completed claim form within 3 business days from the date of injury (early notification) and an employer has 10 calendar days to send the completed claim form in full along with any supplementary material regarding the claim. The scheme agent has 28 days to determine liability from the date on which they receive the signed claim form from the employer.
- Even where a psychological injury arises from a Management Action (Section 40 of Victorian Workers Compensation Act), provisional payments are still required.
- Provisional Payments can be requested at any point throughout the claims lifecycle up to a maximum of 13 weeks.
- The costs associated with Provisional Payments are still expected to be in line with the gazetted ‘Schedule of Fees’. Where a worker makes payment for costs above the gazetted rate, they will be out of pocket for the gap between capped rate and billed rate.
For more information please contact us on (02) 9587 3500 or email your account manager.