Workmen’s Compensation Regulations (ACT)
THE TERRITORY FOR THE SEAT OF
GOVERNMENT.
Regulations under the Workmen's Compensation
OrdinanceI1931-1933.
r JOHN ARTHUR P E R K I N S , Minister of State for the Interior, »-, in pursuance of the powers conferred by the Seat of Government (Administration) Ordinance 1930-1933 and the Workmen's Com- pensation Ordinance 1931-1933, hereby make the following Regulations to come into" operation on the date of the commencement of the Workmen's Compensation Ordinance 1931.
Dated this fourteenth day of July, 1933.
J. A. P E R K I N S
Minister of State for the Interior.
WORKMEN'S COMPENSATION REGULATIONS.
| Short title. | 1. These Regulations may be cited as the "Workmeu's Compensation Regulations. |
| Interpretation. | 2.— (1.) In these Regulations " the Ordinance" means the |
Workmen's Compensation Ordinance 1931-1933.
(2.) Any reference in these Regulations to a form shall be read as a reference to a form in the Schedule to these Regulations.
Claim by
| omployee. | 3. A claim by a workman for compensation under the Ordinance shall be made in accordance with Eorm A and shall be delivered or sent by post to the person against whom the claim is made. |
| Claim by | 4. A claim by a dependant for compensation under the Ordinance |
| dependant. | shall be made in accordance with Eorm B and shall be delivered or sent by post to the person against whom the claim is made. |
| reefere°'mediea' | •*• "^e fees payable to a medical practitioner or a medical referee shall be as follows:— |
£ s. d.
For a first examination . . 2 2 0 For any subsequent examination 1 1 0
Form of
| medical | 6. The medical practitioner or medical referee to whom any matter |
| certificate. | is referred shall give a certificate in accordance with Form C. |
| Frequency of | |
| medical | 7. A workman shall not, after the expiration of one month from the date on which the first payment of compensation was made, be required to submit himself for medical examination pursuant to clause 9 of the First Schedule to the Ordinance except as follows:— |
| examinations. | |
| with forms, | 10. Strict compliance with the forms in the Schedule shall not be required and substantial compliance shall suffice for the purposes of |
|
At reasonable hours, once a week during the second month, and once a month during the third, fourth, fifth and sixth months after that first payment, and thereafter, once every two months.
Employer not
| to give false | 8. Any employer who for the purpose of procuring the issue or renewal of a policy of insurance or indemnity supplies to an insurer any information which is false in a particular, or- who wilfully fails to observe any of the terms of the policy or indemnity shall be guilty of an offence. |
| particulars. |
Penalty: Fifty pounds.
Provisions of
| insurance | 9. Any insurer who issues a policy of insurance or indemnity to any employer in respect of' that employer's liability under the Ordinance shall include in that policy all provisions determined by the Minister under sub-section (3.) of section seventeen of the Ordinance. |
| policy. |
Penalty: Fifty pounds.
Compliance
11. Declarations under tliese Regulations may be made before any Declarations
of the following persons:—
A postmaster or person in charge of a post office, a police or special magistrate, a justice of the peace, a barrister or solicitor, a school head teacher, a member of the police force, a legally qualified medical practitioner, a notary public, a commissioner for declarations, a minister of religion, or a member of Parliament.
THE SCHEDULE.
FORM A.
T H E TERRITORY FOB THE SEAT OF GOVERNMENT.
Workmen's Compensation Ordinance 1931-1933.
CLAIM FOR COAIPEfcTSATION BY .INCAPACITATED WORKMAN.
To* '
1 [here write full name] of [here write full postal address] hereby claim compensation under the Workmen's Compensation Ordinance 1931-1933 in respect of personal injury sustained by me and arising out of and in the course of my employment and declare that, to the best of my knowledge and belief, the following replies to the questions and requests for information are true and correct in every particular:—•
Questions and Bequests for Information. Kcplies.
Ill what capacity were you employed at tho time of your injury ?
State the nature of your injury ; also how, when and where it
was caused
If you are claiming in respect of incapacity arising from an
industrial disease :—•
(a) What is nature of the disease ?
(6) When wa9 it caused ?
(c) When were you first incapacitated by such disease ? . .(d) What was the nature of your employment and for what
period were you engaged thereon ?
(e) I f you have previously suffered from such disease state :—
(i) The approximate date on which it first manifested , itself
(ii) The extent to which it interfered with your employ-
ment
Was notice of the accident or incapacity served 1
If so, on whom, and on what date ?
Have you engaged in any employment since the date of your
injury or incapacity 7 If so, give full particulars
If this claim is made more than six months after the occurrence of
the accident or incapacity, give reasons for failure to mako the
claim within that period . . ..
Have you a claim against any person, firm or company for compensation, or for any payment in respect of the injury under any other law in force in the Territory or any other plaoe ?
If you have any living children uuder the age 6f fourteen years, give particulars :—• Extent of dependence on Full uauies of children.- Datea of birth. employee at time ot injury.
, - • : •
Declared at on the day of 19 Signature of Declarant
Before me f
t -
* The claim should be addressed to tho person, ftrm or company in or by which the workman was employed at tho time of the accident.
t Tho person before whom this declaration Is made should sign here and add the title by which he takes the declaration, such as " Postmaster ", <fco.
t: The declaration may bo made before any ot the following persons:—
A' postmaster or person In charge of a post office, a police or special magistrate, a Justice of the peace, a barrister or solicitor, a school head-teacher, a member of the police force, a legally quallfled medical practitioner, a notary public, a commissioner for declarations, a minister of religion, or a member of Parliament.
FORM B.
T H E TERRITORY FOR THE SEAT OP GOVERNMENT.
Workmen's Compensation Ordinance 1031-1033. CLAIM FOE COMPENSATION BY DEPENDANT OF WORKMAN.
To*
I [here write full name] of [here write full postal address], hereby claim compensation under the Workmen's Compensation Ordinance 1031-1033 for myself and the children named below in respect of the death of [here write full name of deceased employee] and declare that , to the best of my knowledge and belief, the following replies to the questions and requests for information are true, and
correct in every par t icu lar :—
Questions and Bequests lor Information, Replies.
In what capacity was the above-named workman employed a t
the time of his injury ? . . . . . . ' State the nature of such injury; also how, when and where it
was caused
If the death of the workman was caused by an industrial
disease:—
(a) What was nature of disease ?
(o) When was i t caused ?
(c) When was he first incapacitated by such disease ?(d) What was the nature of his employment and for what
period was he engaged thereon ?. .
(c) If he over previously suffered from such disease, state :— (i) The approximate date on which it first manifested
itself
(ii) The extent to which it interfered with his employment
Was notice of the accident or incapacity served ?
If so, on whom and on what date 1
What is your relationship to the deceased workman ?. .
Were you dependent upon his earnings at the time of his death 1
If so, state whether you were wholly dependont
If you were only in part dependent, give full particulars
Was any other person contributing towards your maintenance
a t the time of his death, or did you a t that time have any othor
means of support ? . . If so, give full particulars
Are you in receipt of an Invalid or Old-age Pension ? . . . If so, give particulars . . . . . . . . .
Are you receiving or entitled to receive any payment under any law other than the Workmen's Compensation Ordinance 1931- 1933 in respect of the death of the aforesaid workman ?
If so, givo particulars
Give the names, addresses, and relationships to the workman, of all other persons (except children) known to you, who were dependent upon his earnings a t the time of his death
If this claim is made more than six months after the accident or incapacity, give reasons for failure to make the claim within that period
Have you a claim against any person, firm or company for compensation, or for any payment in respect of the injury under any other law in force in the Territory or any other place ?
State whether wholly
Full names of children of dependent on earnings of If not wholly dependent, Dates of blith.
deceased workman. workman at time of his give full particulars. death.
Declared a t on the day of 19 Signature of Declarant
Before me t
X
* The claim should be addressed to the person, firm or company in or by which thew orkman wns
employed at the time of the accident.
The person before whom this declaration is made should sign here and add the title by which ho takes the declaration, such as "Postmaster", &c.
t
t The declaration may be made before any of the following persons :•— A Postmaster or person in charge of a post office, a police or special magistrate, a Justice of the peace, a barrister or solicitor, a school head-teacher, a member of the police forco, a legally qualified medical practitioner, n notary public, a commissioner for declarations, a minister of religion, or a • member of Parliament.
[Front of Form.]
FORM. C.
T H E TERRITORY FOR T H E SEAT OF GOVERNMENT.
Workmen's Compensation Ordinance 1931-1933.
REPORT OF MEDICAL R E F E R E E , OR MEDICAL PRACTITIONER. I, , a Medical Referee appointed under
the Workmen's Compensation Ordinance 1931-1933, or Medical Practit ioner, have
this day examined of ,
a claimant for compensation under the above-named Ordinance. On examination—
,1 find tha t claimant is suffering from (")
The above condition is the result of CO and is such t h a t the claimant is thereby incapacitated a t present to the extent of per cent, of total incapacity a t his usual occupation, and
per cent, of to ta l incapacity in the general labour market.
Claimant is fit to undertake employment in. such occupations a.s
(°) The above condition is the result of an industrial disease mentioned in the first column of the Four th Schedule to the above-named Ordinance. Such disease . caused within twelve months prior to the date of claimant's becoming incapacitated tiy his employment by
in tho process of
In my opinion claimant j l a g ^ ^ previously suffered from the above-mentioned
industrial disease. The disease .ls , of such a na ture as is contracted by a J 18 not gradual process. General remarks—
*Medical Referee.
Medical Practitioner.
Date / /19 .
* Strike out what la inapplicable. («) Fu ly describe claimant'1! condition. (6) State whether accident or Industrial disease.
(c) This part to be filled In only In caso of claimant suffering from an Industrial disease.Attention is invited to the provisions of tho Third and Fourth Schedules to . the Ordinance, copies of which are shown on the back of this form.
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