GUIDE TO COMPLETING THE - PDF document

GUIDE TO COMPLETING THE APPLICATION FO
GUIDE TO COMPLETING THE APPLICATION FORM FOR AN ILARS GRANT OF FUNDING 1 INFORMATION FOR WIRO APPROVED LAWYERS PURPOSE This Guide explains how to complete the ILARS Grant Application Form, available at www.wiro.nsw.gov.au. If the Application is urgent contact WIRO ILARS by calling 13 94 76. WIRO is unable to pay costs where proceedings have already commenced in the Workers Compensation Commission or the Supreme Court and no ILARS grant of funding has been made. This Guide should be read in conjunction with the WIRO Funding Policy for the Independent Legal Assistance and Review Service. This Guide is not legal advice. This document should be considered only as a Guide for Approved Lawyers to complete the ILARS Grant Application Form. If you have any questions about completing the ILARS Grant Application Form please contact WIRO ILARS on 13 94 76. WHEN YOU SHOULD USE THIS FORM This Application Form should be used by an Approved Lawyer to request an ILARS grant of funding to provide legal services to an eligible injured worker in New South Wales regarding their potential statutory workers compensation benefits. This Application Form should not be used for exempt workers including police officers, firefighters, paramedics, coal miners, workers suffering a dust disease and workers subject to the Workers Compensation (Bush Fire, Emergency and Rescue Services) Act 1987. This Application Form should not be used for replacement hearing aids or for hearing aids where the injured worker is eligible for hearing aids under the Australian Government Department of Health Hearing Services Program. WORKER DETAILS Insert the preferred title, name, address, date of birth, and the occupation of the worker at the date of the injury. Indicate whether an interpreter is required. If you know there has been a previous ILARS grant of funding for this worker, which may include a grant made to a solicitor previously instruc

ted by the worker in this claim, inc
ted by the worker in this claim, include the ILARS Grant Number/s (eg C/--/----). If the worker is deceased or there is a claim for death benefits, insert the worker’s date of death and the details of the deceased worker’s representative and/or dependant/s. 2 APPROVED LAWYER DETAILS Insert the name of the Approved Lawyer acting for the worker, their firm, email address and contact telephone number, their ILARS number and the firm’s file reference. EMPLOYER DETAILS Insert the name of the worker’s employer at the time of the injury, their address/place of business and their Australian Business Number (ABN) if known. INSURER DETAILS Insert the name of the relevant insurer, the claim number and the type of insurer if known. INJURY DETAILS Indicate whether the employer and/or insurer has been notified of the claim, or that the claim has been made. Insert the date of the injury, the body part or location/s of the injury and briefly outline how the injury occurred (eg The worker injured his/her back, neck and shoulders due to repetitive heavy lifting in the course of their employment as a concretor.) INITIAL FUNDING TYPE REQUESTED WIRO ILARS has adopted a staged funding approach to simplify the funding structure to ensure eligible injured workers can access early legal advice and assistance. WIRO will determine the funding stage initially approved based on the information provided with the Application Form and the nature of the work contemplated and identified by the Approved Lawyer. Indicate what Stage of funding is requested on the Application Form; Stage 1 Funding Stage 1 Funding is provided to provide preliminary legal advice to an eligible injured worker about their rights and entitlements under the workers compensation legislation. Available medical reports and a Statement from the Applicant injured worker should be attached to the Application Form. Stage 2 Funding If you are applying for Stage 2 fu

nding to make the claim, dispute the ins
nding to make the claim, dispute the insurer’s decision, assert a threshold (except in a work injury damages claim), or in order to attempt to resolve the claim or dispute, you must provide an explanation or short reasons in support of the request outlining why the matter has merit. Available medical reports, a Statement from the worker and any other relevant information should be attached to the Application Form. 3 Stage 3 Funding If you are applying for Stage 3 funding to proceed directly to the Workers Compensation Commission you must provide all available material that demonstrates an arguable case. DOCUMENTATION Where available and relevant, the following documents should be attached to the Application Form; • Selected relevant clinical notes • Claim form • Medico legal reports • Medical reports • Section 78 Notice • Work Capacity Decision • Relevant/most recent Certificate/s of Capacity • Injured Worker Statement (may be unsigned) • WCC Medical Assessment Certificate/s • WCC Certificate/s of Determination or Decisions • Hearing Loss matters – a recent audiogram, proof of employment for deemed date of injury before 1 January 2002 Please limit attachments to essential documentation only. CONSENT AND DECLARATION The Approved lawyer must certify that the Applicant injured worker has been advised of the purpose of providing their personal and health information to WIO, that WIRO may attempt to resolve the dispute, that they consent to the release of this information, and that the contents of the Application Form are true and correct and they are not aware of any other relevant information, and where it is a permanent impairment claim, that the Applicant injured worker has been advised that only one claim can be made. The Approved Lawyer must sign the Application Form and insert their name and the date of their signature. Unsigned Applications will not be processed