Workers' Compensation and Injury Management Amendment Regulations (No. 2) 2016 (WA)
| 4242 | GOVERNMENT GAZETTE, WA | 4 October 2016 |
WORKCOVER
WC301
Workers’ Compensation and Injury Management Act 1981
Workers’ Compensation and Injury
Management Amendment Regulations
(No. 2) 2016
Made by the Governor in Executive Council.
1. Citation
These regulations are the Workers’ Compensation and Injury
Management Amendment Regulations (No. 2) 2016.
2. Commencement
These regulations come into operation as follows —
(a) regulations 1 and 2 — on the day on which these regulations are published in the Gazette;
(b) the rest of the regulations — on 17 October 2016. 3. Regulations amended
These regulations amend the Workers’ Compensation and Injury
Management Regulations 1982.
4. Regulation 10 replaced
Delete regulation 10 and insert:
10. Worker not residing in State
(1) For the purposes of section 69, a worker must send to the employer or the employer’s insurer a declaration by the worker and a medical practitioner in the form of Appendix I Form 6 —
(a)
within 3 months after the date on which the worker is no longer residing in the State; and
(b)
for each subsequent period during which the worker continues to receive weekly payments while not residing in the State, within 3 months after the date of the previous declaration by the worker and a medical practitioner.
4 October 2016 GOVERNMENT GAZETTE, WA 4243
(2) A declaration under subregulation (1) is taken to have been sent to an employer or an employer’s insurer at the time it was —
(a) delivered personally to the last known business address of the employer or the employer’s
insurer; or
(b) posted to the last known business address of the employer or the employer’s insurer; or
(c) sent by electronic means to the last known email address or fax number of the employer or the employer’s insurer.
(3) An employer or an employer’s insurer who disputes the identity or entitlement, or both, of a worker may apply —
(a) under section 182E of the Act for resolution of the dispute by conciliation; and (b) under section 182ZT of the Act for determination of the dispute by arbitration, if the dispute is not resolved by conciliation.
5. Appendix I amended
In Appendix I delete Form 6 and insert:
Form 6
[r. 10(1)]
Workers’ Compensation and Injury Management Act 1981
(Section 69)
DECLARATION OF WORKER NOT RESIDING IN W.A.
IF A WORKER RESIDES OUTSIDE THE STATE, PROOF OF THE
WORKER’S IDENTITY AND CONTINUING INCAPACITY IS
REQUIRED EVERY 3 MONTHS
PART 1 - WORKER’S DECLARATION
WORKER’S DETAILS
First name Last name
Date of birth / / Claim no.
| 4244 | GOVERNMENT GAZETTE, WA | 4 October 2016 |
DETAILS OF EMPLOYER or EMPLOYER’S INSURER
Name
Address
DECLARATION BY WORKER
I have truthfully answered all the questions I have been asked and have fully cooperated to the best of my ability during the course of the medical examination by the medical practitioner
named in PART 2 of this declaration.
Worker (print name)
Worker’s signature
Date sent to employer or
Date of declaration / / / /
employer’s insurer
Sent by: Email Post Fax PART 2 - MEDICAL PRACTITIONER’S DECLARATION
MEDICAL ASSESSMENT
Date of this assessment / / Date of injury / / I declare that I have examined the person named in PART 1 of this declaration and I have confirmed that the person who I examined was that person through the sighting of an official
document of the government of the country in which the person resides.
The document I used to confirm the identification of the person was
(for example a passport)
MEDICAL MANAGEMENT
Clinical findings/
diagnosis
Medication
Imaging
Referral to specialist or
hospital (name)
Approved health
treatments (specify
type and number of
sessions)
4 October 2016 GOVERNMENT GAZETTE, WA 4245 WORK CAPACITY
Worker’s usual
duties
I find this worker to have:
full capacity for work from / / but requires further treatment
some capacity for work from / / to / / performing:
pre-injury duties modified or alternative duties workplace modifications pre-injury hours modified hours of
hours/day days/week
no capacity for any work from / / to / / Specify any work restrictions below. Where there is no capacity for work, please provide clinical reasoning.
MEDICAL PRACTITIONER’S DETAILS
Name Medical registration number/country Address Medical specialty Phone Signature
R. KENNEDY, Clerk of the Executive Council.
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