Claims managers
A claims manager manages an employee’s claim for compensation for a work-related injury or illness, under the Safety, Rehabilitation and Compensation Act 1988.
This includes determining if the claim is accepted and if there is liability for support and benefits.
The role explained
Claims managers assess and manage claims for compensation.
They support employees throughout the compensation claim process.
Claims managers recognise that each individual claim is unique, which requires a personal approach to support the differing needs of each employee.
They work closely with the employee, their employer, treating practitioners and rehabilitation case manager to support the employee to achieve return to health and work outcomes in a safe and sustainable manner.
Responsibilities of claims managers
Claims managers have a responsibility to:
- make accurate and timely decisions on claims
- provide clear reasons for decisions and determinations
- ensure that entitlements for treatment and income support are processed
- ensure treatment meets the principles of the Clinical Framework for the Delivery of Health Services (PDF, 1.2 MB) and provides the best health outcomes.
Who manages the claim
| For employees of: | The claim is managed by: |
|---|---|
| Australian Government agencies and statutory authorities | Comcare |
| Australian Government agencies with a delegated claims management arrangement | The employer, a claims management provider contracted by Comcare, or Comcare. |
| Self-insured licensees | The employer or their approved claims management provider. |
Information for claims managers
Core capabilities
- Claims manager core capabilities (PDF, 193.1 KB) – defines the capabilities required of a claims manager to work effectively with a rehabilitation case manager to coordinate an employee's rehabilitation and return to work.
Scheme guidance
We provide scheme guidance to help you understand and apply the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).
Go to Guidance on applying the SRC Act to find guidance.
