Enforcement of claim management obligations

If an insurer:

• • fails without reasonable excuse to determine a claim as and when required by the 1998 Act and the Regulation, or
  • refers a matter to the Commission that the person knows is not a genuine dispute for the purpose of delaying, without good cause, the determination of the claim,

the insurer will be guilty of an offence punishable by a penalty of up to $5,500: sections 283 and 285.

Only those excuses set out in the SIRA Guidelines will be reasonable excuses for failing to comply with the obligations to determine claims: section 283(2). An insurer which has or anticipates having a reasonable excuse must notify the worker in writing as soon as practicable: section 283(3).

In addition to the penalty under section 283, an insurer may also be liable for an ‘administration fee’ of $250, payable to the the Authority, if a matter is referred to the Commission for determination of a dispute or for assessment, and the Registrar believes that the insurer has failed without reasonable excuse to determine the claim, or has referred the matter ‘for the purpose of delaying, without good cause, the determination of a claim’: section 284.