(3) For subsection (2) , for a worker with a terminal
condition, the insurer must give the claimant the written notice within 3
months.
(4) The written notice must—
(a) state whether liability in
connection with the event to which the claim relates is admitted or denied
and—
(i) if liability is admitted—
(A) state whether contributory
liability is claimed from the worker or another party; and
(B) state the
extent, expressed as a percentage, to which liability is admitted; and
(ii)
if liability is denied, completely or partly—give particulars of the basis
on which liability is denied; and
(b) state whether the insurer accepts or
rejects any offer of settlement that may be made by the claimant; and
(c) if
the claimant did not make an offer of settlement in the notice of claim or the
insurer is rejecting the offer—contain a genuine offer or counter-offer of
settlement, or a statement of the reasons why an offer or counter-offer of
settlement can not yet be made; and
(d) be accompanied by copies of all
medical reports, assessments of cognitive, functional or vocational capacity,
or other material in the insurer’s possession not previously given to the
claimant that may help the claimant to make a proper assessment of the offer.
(4A) The insurer must, within 5 business days after giving the claimant the
written notice, give a copy of the notice to any contributor.
(5) If the
insurer is WorkCover, WorkCover must also, within 5 business days after giving
the claimant the written notice, give a copy of the notice to the worker’s
employer.
(6) The insurer or the claimant to whom a written offer or
counter-offer of settlement is made must respond in writing to the offer
within 10 business days after receiving it, indicating acceptance or rejection
of the offer, unless a response to the offer is to be made under subsection
(4) (b) .
(7) The offer or counter-offer of settlement is made on a without
prejudice basis and must not be disclosed to a court except on the issue of
costs.
(8) An admission of liability by an insurer under this section—
(a)
is not binding on the insurer at all if it is later shown at the trial in the
proceeding for damages that the claimant has been relevantly guilty of fraud
or attempted fraud; and
(b) is not binding on the insurer at all if it is
later shown that liability was admitted because of misrepresentation by any
person; and
(c) is not an admission about the nature and extent of the
claimant’s loss or damage or that the claimant has sustained loss or damage,
unless it specifically states otherwise; and
(d) does not entitle the
claimant to apply for judgment, summary or otherwise, in a court of competent
jurisdiction; and
(9) In
calculating the period of 6 months mentioned in subsection (2) , any period
during which a decision of the insurer relevant to the claim is subject to a
review or appeal is not counted.
(10) In this section—
"decision" , for subsection (9) , includes failure to make a decision.
"review or appeal" means a review or appeal under chapter 13 that has been
started.
