Claims management other

An insurer may be able to close a workers compensation claim when a worker returns to their pre-injury duties and does not require any further compensation. However, returning to pre-injury duties doesn’t automatically mean a claim can be closed. Each claim should be considered on its own facts and circumstances.

Before returning to pre-injury duties, the worker should obtain a certificate of capacity from their nominated treating doctor and submit it to their employer or the insurer. The certificate should indicate that the worker has capacity to carry out their pre-injury duties.

The insurer should speak to the worker and employer to confirm the return to work, and any return to pre-injury duties should be monitored for a period of time to ensure the worker’s safe and durable return to work.

When the insurer is confident that the return to pre-injury duties is sustainable with no need for further treatment, the claim may be able to be finalised.

Closing a claim

Before closing a claim, the insurer is to advise both the worker and employer of their intention to close the claim.

The insurer should confirm the details of the closure, in writing, and include the reasons for closing the claim, and provide an opportunity for further accounts or reimbursements to be paid.

The insurer is to actively attempt to obtain and finalise all outstanding invoices, including directly from providers, before closing the claim.