What are workers compensation provisional payments?

Published 09 Jul 2018

In the majority of workers compensation claims, insurers will not start payments to cover medical bills or other costs until your case has been accepted. However, this process can take time, which often leaves workers short in the intermittent weeks they're unable to work.

In order to compensate for this shortfall, the NSW State Government determines that provisional payments can be made to victims for a period while the case is processed.

What are workers compensation provisional payments?
Under the Workers Compensation Act 1998, weekly provisional payments need to be made to any injured worker while their compensation claim is processed. These periodic payments are a safety blanket for employees that cover lost wages and medical expenses.

How does the process begin?
Provisional payments from the insurer need to begin within seven days of initial notification of an injured worker. Insurance companies need to tell the employee, in writing, that these payments are commencing. The written notice must explain:

  • That payments are on a provisional basis in line with state legislation.
  • The period of time the payments are expected to last for.
  • Details of an injury management plan (to be agreed upon by both parties) if the worker is unable to return to work for seven consecutive days.
  • The worker is eligible to make a claim for compensation and the steps for doing so.

This notice must also include information on the worker's average weekly earnings prior to their injury, how much the provisional weekly payments are and how they have been calculated, and whether it's the insurance company or the employer themselves paying out.

What do provisional payments cover?
Unless the insurer has a reasonable reason for doing so, provisional payments will cover up to 12 weeks of lost income or $7,500 of necessary medical treatment. This will usually be paid out in weekly increments at an amount decided in the written notice sent by the insurer. However, in certain circumstances, these payments can be made over other periods of time or in lump sums, depending on the circumstances of the injury and the treatment.

It's important to note that provisional payments are not an acceptance of liability - a worker isn't certain to win a compensation claim just because an insurer pays out provisionally.

Fighting your corner can be an intimidating task, which is why workers compensation claims should be left to legal experts. If you want help with your own case, contact Gerard Malouf Compensation Lawyers today.