Process late request

A late request for reimbursement is any request for reimbursement submitted by an employer
more than three months after the payment to the worker. Agents must send copies of the
Reimbursement Request form to employers with the acceptance of claim letter.

See:

Process reconciliation requests

WorkSafe Compensation Reimbursement Request form

Reasons for delay not provided by employer

If the employer has not provided written reasons for the delay in sending the request for
reimbursement, agents must write to the employer requesting written reasons and evidence of
those reasons.

Delay considered reasonable

If an agent considers the delay was reasonable the reimbursement should be processed.

The agent must record the decision and the reasons why the delay was considered to be
reasonable.

Determine reasonableness for delay

Agents must determine whether the reasons given by the employer for the delay are reasonable
on a case by case basis, both objectively and fairly.

There can be no definitive list or prescribed set of criteria for a reasonable delay. Employers
must establish that the delay was due to circumstances beyond their control.

Although each case needs to be assessed on its merits, examples of what may constitute
reasonable delay include:

fire, flood or other major disaster at the employers workplace

death or serious injury to the person responsible for seeking reimbursement where
there are a very small number of employees

major industrial action (within 30 days after the payment made to the worker).
Examples of what would not constitute reasonable delay include:

employer ignorant of its obligations

employer is too busy or has more important things to do

employer contracted a consultant to manage the claim.

The onus is on the employer to satisfy the agent that the delay to seek reimbursement was
reasonable.

Decision to reimburse late request for reimbursement

Any decision to reimburse an employer where a request for reimbursement has been made more
than three months after the employer made the payment to the worker must be made by the
Technical Manager/Team Manager or above.

See: Assess & process request for reimbursement

Delay is not considered reasonable

If any agent is not satisfied that the employers delay was reasonable, the agent must write to the
employer to seek further information. Use the Reason for delay in seeking reimbursement letter.

advising them that the reasons provided are not considered reasonable

giving the employer the opportunity to provide further information

confirming that unless further information is received upon which the agent
concludes that the delay was reasonable, reimbursement will not be paid.

If further information is provided by the employer, available information must be assessed to

determine if reimbursement should be paid. If the agent is still not satisfied, they must inform the
employer that the delay is not reasonable and reimbursement will not be paid.

Inform the employer of the decision not to reimburse

A standard letter will be generated and sent to the employer about the decision not to reimburse
weekly benefits for a period whenever reason code 210 or 211 selected.

The agent must type in the reasons for not reimbursing the employer.

Approval to change a recorded decision

If a decision has been recorded not to reimburse an employer and the agent wants to reverse that
decision, the agent must contact WorkSafe and:

provide reasons why the original decision needs to be changed

obtain approval to change the decision.

The outcome of the request must be recorded on the claim file.

3.4.1.4 Process reconciliation requests

A reconciliation request is where the employer has already submitted a request for
reimbursement for the period claimed and has not been reimbursed by the agent.

Before processing reconciliation requests and agent must adhere to the following policy.

Employer to provided documented evidence

Before an agent processes reconciliation request for reimbursement from an employer, the agent
must be satisfied that the employer had previously submitted a request for reimbursement within
three months after making the payment to the worker.

If the employer provided the previous request for reimbursement after three months of making
the payment the employer must provide reasons for the delay in submitting the request late and
in writing.

See: Process late request

Confirm previous request for reimbursement

Before an agent processes a reconciliation request, the agent must be satisfied that the employer
had previously sent a valid request for reimbursement for the period claimed.

Note: In the event that an agent cannot determine whether they previously received a request for
reimbursement from the employer for the period claimed due to lack of evidence, the agent must
consider the employers claim that such a request was sent to the agent based on the
documentary evidence provided by the employer.

Application of six year limitation on reimbursements

The Limitations of Actions Act 1958 limits the right to start proceedings for reimbursement of
weekly payments to six years from the date on which the agent should have made the
reimbursement.
The employer is not entitled to reimbursement if they submitted a valid request for
reimbursement within three months (or outside three months provided reasons for the delay
which the agent accepted) and more than six years have elapsed since the agent was required to
reimburse the employer (ie more than six years after 30 days after lodgement).

A decision to enforce the limitations period should be recorded on the claim file along with the
reasons.

Agents must inform the employer of the decision to apply six year limitation defence and not to
reimburse the employer for the period claimed. Use letter Notice of decision - Application of six
year limitation.

Reconsider decision to apply six year limitation defence

Employers may seek reconsideration of the agents decision if they are of the view that there are
reasons not to apply the six year limitations defence to reimbursements.

Employers in this position should contact the agent in writing. As there are limited legal ground
upon which the six year limitations defence will not apply, employers should seek independent
legal advice before contacting the agent.

Manage the reconsideration process

All matters where employers are seeking reconsideration of the agents decision to apply the six
year limitations defence must be handled by the Senior Legal Manager of the agent. Upon receipt
of any such request, the Senior Legal Manager must forward relevant correspondence to
WorkSafe marked to the attention of the General Counsel.

Confirm entitlement to weekly payments

To confirm that the worker is entitled to weekly payment agents must check:

the claim file including ACCtion and file notes

non entitlement periods, court decisions and other settlements which may affect
the workers entitlement to compensation

past payment records for the period claimed

archived payments (if applicable).

Check archived payments

If the payment period in which the employer is seeking reimbursement is within an archived
period, agents must retrieve the archived payment details and check:
 whether payments have been made previously for the period claimed

whether there are current weekly earnings for the period claimed.

When no reimbursement is to be paid

No reimbursements should be paid if the information given by the employer is inconsistent with
the information available on ACCtion and claim files.

Onus of proof

The onus is on the employer to demonstrate that the payment has been made to the worker and a
valid request for reimbursement was sent to the agent within three months of paying the worker
(or a longer period in reasonable circumstances) by submitting necessary documentation to the
agent to support the payment made to the worker.

Process payment

Agents must use Certificate of Capacity Code / Payment form when processing payments. A
copy of this form must be filed in the claim file with the certificate of capacity and the request
for reimbursement.

The agent must reimburse the employer within 30 days of receipt of a valid request for
reimbursement from the employer.