Back to top

Section 39 Fast Track ILARS Grant Application Form

INSTRUCTIONS

This form is to be used for applications for grants of funding for the provision of advice to injured workers in relation to section 39 of the Workers Compensation Act 1987.  

This form should only be used if the insurer has notified an injured worker that weekly benefits may cease because of the operation of section 39 of the Workers Compensation Act 1987.

APPLICANT INFORMATION

Worker Details

Solicitor Details

RESPONDENT INFORMATION

Employer Details

Insurer Details

DETAILS OF CLAIM

Files must be less than 5 MB.
Allowed file types: jpg jpeg rtf pdf doc docx.