Workers Compensation WA Notice: Liability is Accepted for Medical Expenses Only

After you make a workers compensation claim in Western Australia, the insurer must give you a formal decision on liability. Some workers receive a notice stating that liability is accepted for medical and health expenses, but that liability to pay income compensation (weekly payments) is not accepted. If you have received a notice like this, it is a formal liability decision under the Workers Compensation and Injury Management Act 2023 (WA) — and it is a decision you can dispute. This article explains how the claim and liability decision process works, and what you can do.

How a Claim Is Made (Sections 25 to 27)

A claim for compensation must be made within 12 months after the injury occurs, although a late claim is not invalid if the delay results from mistake, absence from the State or another reasonable cause, or would not prejudice the employer’s defence. You make the claim by giving your employer a completed claim form in the approved form together with a certificate of capacity (section 25).

Your employer must give your claim to its insurer within 7 days — failing to do so is an offence. If your employer does not pass your claim on, you can give the claim directly to the insurer yourself, and it is then treated as if the employer had given it to the insurer (sections 26 and 27).

The Liability Decision Notice (Section 28)

Within 14 days after the claim is given to the insurer (or self-insured employer), the insurer must give you and your employer a liability decision notice in the approved form stating one of the following:

1. liability to compensate you for the injury is accepted; or
2. liability is or may be accepted, but there are one or more liability questions in relation to the acceptance (for example, where more than one employer may be liable); or
3. liability is not accepted.

If your certificate of capacity states that you have an incapacity for work (an incapacity claim), the liability decision notice must also state whether or not the insurer accepts liability to pay income compensation for your incapacity.

This is where a “medical expenses only” outcome arises under the current law: the insurer accepts that the employer is liable to compensate you for the injury, but states that it does not accept liability to pay income compensation. That is a formal decision with real consequences for your weekly payments — and it can be disputed (see below).

Deferred Decisions and Deemed Acceptance (Sections 28 and 29)

If the insurer cannot make a decision on liability within 14 days, it may instead give a deferred decision notice within that period. It must then give a liability decision notice as soon as practicable, and in any event before the day prescribed by the regulations (the deemed liability acceptance day). If a liability decision notice has still not been given before the provisional payments day prescribed under the regulations, the employer must also commence provisional payments of compensation in the meantime.

The Act contains a strong protection for workers here. If the insurer fails to give the required notice in time — either no notice within the first 14 days, or no liability decision notice before the deemed liability acceptance day after a deferral — the insurer is taken to have accepted that the employer is liable to compensate you for the injury and, for an incapacity claim, to pay income compensation for your incapacity for work. Failing to give the required notices is also an offence.

What You Can Do About a “Medical Expenses Only” Decision (Section 30)

A liability decision notice that does not accept liability to pay income compensation is treated by the Act as a notice stating that liability is not accepted for income compensation. You can apply to have the question of liability to make income compensation payments heard and determined by an arbitrator at WorkCover WA’s Conciliation and Arbitration Services. When the arbitrator determines the question of liability, the arbitrator may also determine the compensation to which you are entitled and make any order the arbitrator considers appropriate.

This process is usually easier than the process of challenging a denial, as the employer and insurer at least accept that you have a work related injury.

If Your Employer Is Uninsured (Section 31)

The same claim and liability decision process applies where the employer is uninsured, as if the employer were a self-insurer, and the employer must notify WorkCover WA within 7 days of receiving a claim. WorkCover WA can also tell you the identity and details of your employer’s insurer if you need to give your claim to the insurer directly.

If you have received a notice accepting liability for medical and health expenses only, you should seek legal advice promptly. Foyle Legal worker compensation Lawyers are experts in WorkCover WA worker’s compensation claims; we act for personal injury victims on a No Win No Fee basis. Contact Foyle Legal for an obligation free claim review.