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.
They work with the employee, their employer, treating practitioners and rehabilitation case manager to support the employee to return to health and safely remain at, or return to, work where possible.
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. |
The employer or their approved claims management provider. |
Information for claims managers
Core capabilities
- Claims manager core capabilities (PDF, 119.8 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).
In August 2020, eight new scheme guidance were released to assist claims managers.
Discover our guidance on applying the SRC Act
Training and e-guidance modules
We provide face-to-face training and digital learning. See Training and learning for more information.
Our scheme e-guidance modules are designed to develop or improve your skills and knowledge. Each module includes case studies and questions to help you manage the return to work process and assess claims.
Our scheme e-guidance modules are provided through Comcare's learning management system called Comcare LMS. You first need to create an account in Comcare LMS and then login with your email and password. See steps to create an account. After you create an account, login to Comcare LMS and view learning options.
Scheme e-guidance designed for claims managers is:
- Scheme e-guidance module – Incapacity payment provisions
- Scheme e-guidance module – Permanent impairment provisions
- Scheme e-guidance module - SRC Act and Comcare scheme e-guidance
Select the link to open the module and login to Comcare LMS with your email and password.