Making a Claim
Making a claim doesnt have to be hard. To make it easier we have detailed the correct procedure to follow when making a claim.
Select your type of Claim below to find out more about what procedure you need to follow.
GENERAL CLAIM PROCEDURES
- Report the incident to us by telephone, facsimile or email, wherever practicable, within 24 hours of the incident
- We will provide you with a claim form to complete and return to our office.
- Attach all original quotations or invoices, valuations or photos obtained for replacement of or repair to the damaged or missing property.
- In the event of loss by burglary, housebreaking, theft, suspected malicious damage, contact the Police.
- Also make sure the premises are secure to avoid further incidents. Record their report number.
- For Public Liability claims, attach any letter of demand or other correspondence that you may receive from any Third Party.
- Whatever the circumstances of the incident, DO NOT ADMIT LIABILITY EVEN IF YOU THINK YOU ARE AT FAULT.
- Your Insurer is entitled to deny a claim or pay a reduced amount if statements made by you or your employees prejudice the Insurer’s position.
WHEN WE RECEIVE YOUR FORMS WE WILL:
- Submit the claim form to the Insurer
- We may contact you for further information
- If the claim has not been paid within 30 days we will contact the Insurer and then advise you accordingly
- We will then follow up the claim on a weekly basis until settlement is reached.
- As soon as we know something, you will know something.
AN ASSESSOR MAY BE APPOINTED UNDER CERTAIN CIRCUMSTANCES:
- The assessor will then become your contact point
- An assessor is an independent person who is appointed by the Insurer to help finalise a larger or more difficult claim
- The assessor will obtain details of a loss and may help arrange for quotes and prepare the necessary paperwork
- They will write a report to the Insurer recommending what action to take
- This can take time depending on their work load and Police Reports.
- The insurer will act on their report whilst cross referencing with the policy and covers applicable
- If you are unhappy with the way the claim is progressing, advise the assessor.
- If the assessor’s responses is unsatisfactory, contact us immediately.
WORKERS COMPENSATION PROCEDURES
By keeping a current workers’ compensation insurance policy and having an injury management system in place, the employer will ensure compliance with the Workers Compensation Act for your State.
WHEN CAN A WORKER MAKE A CLAIM FOR WORKERS’ COMPENSATION?
Workers can make a claim for workers’ compensation if they suffer any of the following, and any one of them results in time off work or requires medical treatment.
- a personal injury by accident arising out of, or in the course of employment, or while acting on the employer’s instructions
- a disabling disease
- a disease contracted in the course of employment, or the recurrence or aggravation of a pre-existing disease where the employment contributed to a significant degree
HOW DOES THE WORKER MAKE A CLAIM?
Initially, the employer should ensure a worker who has been injured receives first aid, reports and records the incident and sees a doctor as soon as possible.To lodge a claim the worker needs to follow these steps to make a claim for workers’ compensation.
Immediately seek first aid and report the injury to your employer.
- As soon as possible, see the doctor of your choice and ask for a First Medical Certificate.
- Fill out a Workers Compensation Claim Form 2B.
- Take a copy of the Certificate and Claim Form, and then give both to the employer.
- The employer then has three working days to pass the Certificate and Claim Form onto their insurer.
- The insurer will notify the worker within 14 days after receiving your claim form. The notification will indicate if the claim has been:
- Held / Pended
ASSISTING THE INSURER
The most crucial way an employer can assist the insurer in managing claims is by immediately providing them with any relevant information they obtain regarding an injured worker. The employer should involve the insurer as soon as possible after the injury occurs.
MAKING PAYMENTSWhile the claim is being assessed
The employer may consider paying accrued leave to the injured worker (such as annual or sick leave). They should ask the injured worker first, make it clear this is not workers’ compensation, and that payment of accrued leave or sick leave is a voluntary option until a decision regarding liability is made. If the claim is approved, and payment from accrued sick leave entitlements has been made, these entitlements must be refunded to the employer by the insurer and recredited to the worker.If the claim is accepted
The employer should begin workers’ compensation payments without delay, consulting with the insurer regarding the amount. Once payments begin, you are required to pay the worker in the usual manner and on their usual payday, unless notified by the insurer to cease payments. If you feel that you may be unable to pay an injured worker’s weekly payments in this manner, you should contact your insurer as soon as possible to discuss what options are available.
IMPLEMENTING YOUR INJURY MANAGEMENT PLAN & RETURN TO WORK PROGRAM
An employer is required to have an injury management policy setting out their organisation’s approach to injury management, and an injury management system describing the steps to be followed if a workplace injury occurs. An employer is also required to develop a return to work program for an injured worker unless the worker has total capacity to return to their pre-injury position.
For more information and templates, see the injury management systems and return to work programs pages under the Returning to Work channel.
The Employer must keep the worker’s position available an employer is obliged to keep an injured worker’s position available during the worker’s incapacity for a period of 12 months. For more information, see the employers obligation on the Workover WA website.
MOTOR VEHICLE CLAIMSNeed to know what to do when you have a car accident? Even the most careful and aware drivers may find themselves in this position. In the event you are in an accident we recommend you do the following:
- Do not admit liability for the accident
- Call the police/emergency services if anyone is injured
- Swap details with the other parties – you will also need to record:
- Date, time and location of accident
- The other driver’s details: full name and address, date of birth, driver’s licence number and contact details.
- Other car’s registration number, make and model
- The car owner’s full name, address and contact numbers (if the driver is not the owner)
- Witnesses contact details (if there are any)
- Car owner’s insurance company and policy number
- Photos of damage to both cars
- Lodge a police report if:
- the incident resulted in bodily harm to any person; or the total value of property damage to all involved parties exceeds $3,000; or
- the owner or representative of any damaged property is not present.
- Lodge a claim with your insurance broker