wayground logo

Free Printable Worksheets

Font size

S
M
L
XL
Worksheets

Date claim made

Total questions: 8

Worksheet time: 5mins

Name
Class
Date
1.

What is date claim made

a)

The date the claim was lodged

b)

The date we have both a signed Employer claim form and SIRA Cert Cap or the date we assess there is sufficient information received to determine a claim

c)

The date we have both a signed Worker claim form and SIRA Cert Cap or the date we assess there is sufficient information received to determine a claim

d)

The date we received a signed claim form

2.

If we receive the CoC on 08/01/2020 and we receive the claim form on 10/01/2020.

What is the date claim made?

(a)  

3.

Waiving the requirement for a claim form must not occur on a claim under reasonable excuse should there not be sufficient medical evidence on file confirming a work-related injury. In this instance, the ‘Date Claim Made’ is to remain as blank.

a)

True

b)

False

4.

What is considered valid for a Worker’s Injury Claim Form

 

a)

The claim form must be signed by the Worker and all applicable answered

 

b)

The claim form must be signed by the employer; and all applicable answered

c)

The claim form must be signed and dated by the Worker

d)

The claim form must be signed and dated by the Worker and Employer

5.

If we receive a valid CoC and completed claim form for a claim under RE, that is the ‘Date Claim Made’ and we must either PL, Accept or Dispute the claim within ___ days.

 

a)

7

b)

5

c)

21

d)

When we have the information that resolves the excuse or 21 days, whichever is the later

6.

If you received a claim form that is not valid, you should immediately advise the Worker of the issues, advise it is not valid, resent them a claim form and ask it be resubmitted

a)

True

b)

False

7.

If you have entered the Date Claim Made as there was sufficient information to accept or decline, upon receiving a claim form do you change the date?

a)

Yes

b)

No

8.

Date Claim made is entered when we

a)

Make an outright decision to accept or decline without both the claim form and COC

 

b)

Have both a valid CoC and Worker Claim form