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If the insurer refuses to make provisional payments to the injured worker, it may be necessary to consult compensation claims lawyers. When a worker sustains a work related injury, he can make a workers compensation claim, which will be either accepted or rejected by the insurer after the claims process. However, in the meantime, the insurer may be required to provide financial assistance to the worker who is undergoing medical treatments. In New South Wales for example, the employer’s Scheme Agent or the insurer must provide provisional payments to the worker within seven days of being informed of the injury. If the insurer or the Scheme Agent refuses to pay provisional payments, he should show some “reasonable excuse.” There are various reasonable excuses the Scheme Agent or the insurer can use in this regard. If the medical information provided or accessible to them is not sufficient to determine that there is an injury or the injury is work related, the Scheme Agent or the insurer may refuse to make provisional payments. However, the Scheme Agent or the insurer must make a reasonable attempt to obtain such information and allow special consideration for workers employed in remote areas where the medical treatments may not be readily available. If the person injured cannot establish that he is a worker within the definition of relevant legislation or if the employer can establish that the person injured is not a worker, the Scheme Agent or the insurer may refuse to make provisional payments. If the Scheme Agent or the insurer fails to contact the inured worker after reasonable attempts, it can also be used as an excuse for not providing provisional payments. Obtaining information relating to the worker’s medical condition is important for the Scheme Agent or the insurer to determine the amounts and time period of such payments. Thus, if the worker refuses to release such information, the Scheme Agent or the insurer can use it as an excuse for not providing the payments. Where it can be established clearly that the injury is not related to employment or is not a significant injury, provisional payments can be refused. The Scheme Agent or the insurer is also excused in refusing the provisional payments where he is not notified of the injury within two months of the date of occurrence. However, if a worker thinks that his provisional payments are refused by the Scheme Agent or the insurer without such an excusable reason, getting assistance from compensation claim lawyers may be advisable.
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