Provisional Liability

What is provisional liability?

Provisional liability is an interim decision on liability. It allows for financial assistance to be provided whilst the claim is investigated and a decision on actual liability is made.

How long is provisional liability?

Provisional liability is for a period of 12 weeks or up to $7,500 in medical expenses whichever occurs first.

Why can the insurer refuse provisional liability?

When the insurer refuses provisional liability the claim is reasonably excused. The reasons the insurer can reasonably excuse the claim include:

  • Insufficient evidence that the injured person is a worker
  • Insufficient medical evidence
  • The worker cannot be contacted
  • The worker refuses to allow the insurer to access personal information such as health records
  • The insurer believes the injury is not work related
  • There is no requirement for weekly compensation
  • The injury was reported more than 2 months after it occurred

When can provisional payments be ceased?

Provisional payments can be stopped if:

  • The worker doesn’t provide a certificate of capacity
  • The worker doesn’t provide an authority allowing the insurer to obtain information about the injury
  • The worker has returned to work and there is no further loss of earnings or need for medical treatment
    Liability is determined