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WORKPLACE INJURY REHABILITATION AND COMPENSATION AMENDMENT (PROVISIONAL PAYMENTS) ACT 2021 (NO. 5 OF 2021) - SECT 11

New Division 10 of Part 5 inserted

After Division 9 of Part 5 of the Principal Act insert

' Division 10—Provisional payments for mental injuries

        263A     Definition

In this Division

"reasonable costs" has the same meaning as in section 223(2).

        263B     Entitlement to provisional payments for mental injuries

    (1)     If a worker makes a claim for compensation under this Act in respect of a mental injury, the Authority or a self-insurer must pay the reasonable costs of a service specified in section 224(1)(a) received because of the claimed mental injury as provisional payments in accordance with this Division.

    (2)     Subsection (1) does not apply—

        (a)     if the claim for compensation was made before the commencement of this Division; or

        (b)     subject to section 263I(1)(b), if the Authority or a self-insurer has previously determined a claim for compensation relating to the same mental injury and circumstances.

    (3)     Guidelines made under section 224(2) apply for the purposes of this Division.

    (4)     A worker is entitled to receive a service referred to in subsection (1) (other than an occupational rehabilitation service) from the provider of the worker's choice notwithstanding that an employer or the Authority or a self-insurer, as the case may be, offers or provides a service to the worker for the worker's use.

        263C     To whom provisional payments under this Division are to be paid

    (1)     Provisional payments under this Division must be made to a person lawfully entitled to the payment.

    (2)     If the liability to the person lawfully entitled to payment of the costs specified in section 263B(1) has already been discharged in whole or in part by a payment by the worker or any other person whether legally liable to make the payment or not, the amount by which the liability has been so discharged must be paid to the worker or other person who made the payment.

    (3)     If a worker is entitled to any of the services specified in section 263B(1) free of charge or at a reduced rate or charge because the worker—

        (a)     entered into any prior contract, agreement or arrangement; or

        (b)     was a contributor or subscriber to any institution, fund or scheme—

the payment in respect of those services must not be reduced but, after payment of the amount, if any, actually owing to the person lawfully entitled to payment, the balance of the reasonable cost must be paid to the worker.

    (4)     The payment of the whole of the reasonable costs of any service specified in section 263B(1) wholly and finally discharges the worker and any other person from all liability whatsoever in respect of those costs.

        263D     Certain actions etc. not permitted

For the purposes of this Division, section 227 applies as if in subsection (1) of that section, for "this Division" there were substituted "Division 10".

        263E     Medical and like services outside Australia

For the purposes of this Division, section 228 applies as if—

        (a)             in subsection (1) of that section, for "compensation" there were substituted "provisional payments"; and

        (b)     in subsections (1) and (2) of that section ", burial or cremation" (wherever occurring) were omitted; and

        (c)     in subsection (2) of that section, for "section 232" there were substituted "section 263I"; and

        (d)     in subsection (3) of that section ", burial or cremation" were omitted; and

        (e)     in subsection (4) of that section ", burials or cremations" were omitted.

        263F         Provisional payments not payable for certain accommodation etc.

For the purposes of this Division, section 229 applies as if in subsection (1) of that section—

        (a)         for "compensation" there were substituted "provisional payments"; and

        (b)     for "injury" there were substituted "mental injury".

        263G     Occupational rehabilitation services

For the purposes of this Division, section 230 applies as if in subsection (1) of that section—

        (a)     for "this Division" there were substituted "section 224(1)(a)"; and

        (b)     in paragraph (a)(i), for "type of injury" there were substituted "nature of the mental injury".

        263H     Modification of cars and homes

For the purposes of this Division, section 231 applies as if—

        (a)     in subsections (2), (3), (4)(a), (b) and (c) and (5) of that section, for "injury" there were substituted "mental injury"; and

        (b)     in subsection (6)(b) and (c) of that section, for "injuries" there were substituted "mental injuries".

        263I     Duration of provisional payments under this Division

    (1)     Provisional payments are payable under this Division on and from the day the worker is determined under section 75A to be entitled to provisional payments until—

        (a)     if the worker's claim for compensation in respect of the mental injury is accepted by the Authority or a self-insurer, the day the claim is accepted; or

        (b)     in any other case, 13 weeks after the day the worker is determined under section 75A to be entitled to provisional payments.

    (2)     To avoid doubt, a worker whose claim for compensation in respect of a mental injury is rejected by the Authority or a self-insurer or terminated under section 182 or 183 is entitled to provisional payments under this Division for that claimed injury until the day referred to in subsection (1)(b).

        263J     Provisional payments are not compensation

    (1)     Provisional payments made under this Division are not a payment of compensation under this Act except for the purposes of—

        (a)     seeking a refund of payments under section 599 or any other amount relating to the recovery of payments under this Act; and

        (b)     calculating employer premiums.

    (2)     A decision made by the Authority or self-insurer to make provisional payments under this Division is not an admission of liability to pay compensation under this Act.

    (3)     Except as provided in subsection (4), nothing in this Division limits or otherwise affects a worker's entitlement to compensation or damages arising from the worker's mental injury.

    (4)     If the reasonable costs of a service are paid as provisional payments under this Division, the liability of the Authority or a self-insurer to pay compensation under Division 7 in respect of that service is discharged.

        263K     Termination of provisional payments for services obtained fraudulently

For the purposes of this Division, section 233 applies as if—

        (a)     in subsection (1) of that section—

              (i)     for "payment for professional services" there were substituted "provisional payments made under Division 10"; and

              (ii)     for "payment of those professional services" there were substituted "those provisional payments"; and

        (b)     in subsection (2) of that section, for "payment of professional services" there were substituted " those provisional payments".

        263L     Guidelines for the purposes of this Division

    (1)     The Authority may make guidelines for the purposes of this Division relating to the process to be observed by the Authority or self-insurer when acting under this Division.

    (2)     The Authority must ensure that guidelines made under subsection (1) are published and are generally available.

        263M     Disputes about provisional payments

For the purposes of this Division, section 6(6)(a) applies as if     in that subsection, for "claim for compensation under" there were substituted "request for provisional payments under Division 10 of Part 5 of".

        263N     Requests for information about provisional payments

For the purposes of this Division, section 9 applies as if—

        (a)     in subsection (1) of that section—

              (i)     for "made a claim for compensation" there were substituted "requested provisional payments under Division 10 of Part 5"; and

              (ii)     for "the claim for compensation" there were substituted "the request for provisional payments"; and

        (b)     in subsection (2) of that section—

              (i)     for "made a claim for compensation" there were substituted "requested provisional payments under Division 10 of Part 5"; and

              (ii)     for "the claim" there were substituted "the request for provisional payments".'.



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