Approved form AF2002-142

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 17
(see r 32)

Award
Note	These forms are intended for use in ordinary cases only.  The award in any special case must be settled under rule 32, in accordance with the directions given by the Court.
	(i)	IN CASE OF APPLICATION BY WORKER
[Heading as in Request for arbitration.]
Having duly considered the matters submitted, the Court hereby orders and awards as follows:
[Here insert any introductory recitals of findings on which the award is made which the Court may direct.]
1	That the respondent, C.D.			         , do pay to the applicant, A.B.,		, the weekly sum of	             as compensation for personal injury to A.B.		  arising out of and in the course of his or her employment as a worker employed by the respondent, such weekly payment to commence as from the			    day of			    , and to continue during the total or partial incapacity of A.B.			     for work, or until the same shall be ended, diminished, increased, or redeemed in accordance with the provisions of the Workers Compensation Act 1951.
2	That C.D.			do forthwith pay to A.B.		the sum of			    being the amount of such weekly payments calculated from the			day of			 until the			day of			        [first Friday or other usual pay day after date of award] and do afterwards pay the said sum of		 to A.B.			on Friday [or other usual pay day] in every week.
3	That C.D.			do pay to the Registrar of this Court, for the use of the applicant, the sum of		being his or her costs of and incident to this arbitration, such costs to be taxed by the Registrar in the prescribed manner and to be paid by C.D.			to the Registrar within		       days from [or forthwith after] the date of such taxation.
Dated:							
J.S.
Magistrate.
	(ii)	IN CASE OF APPLICATION BY DEPENDANTS
[Heading as in Request for arbitration.]
Having duly considered the matter submitted, the Court hereby orders and awards as follows:
[Here insert any introductory recitals of findings on which the award is made which the Court may direct.]
1	That the respondent, C.D.			, do pay the sum of	 to the dependants of A.B.			, late of		, deceased, as compensation for the injury resulting to such dependants from the death of A.B.		           , which took place on the			    day of			          from injury to A.B.			 arising out of and in the course of his or her employment as a worker employed by the said respondent.
2	That the following persons are entitled to share in such compensation as dependants of A.B.			, that is to say			         J.B.		, the widow of A.B.			   , and [name the other persons.]
3	[Add, if so found.] That the respondent, G.H.,			the			of A.B.			     , is not entitled to share in such compensation as a dependant of A.B.
4	That the said sum of			 be apportioned between J.B.			and [name the other persons] in the following proportions:
The sum of		to or for the benefit of J.B.		 , and the sum of			to or for the benefit of [specify the persons entitled and the sums apportioned to them.]
5	That C.D.		          do pay the said sum of	to the Registrar of this Court within	        days from [or forthwith after] the date of this award.
6	That on payment to the Registrar of the sum of			 the Registrar do forthwith pay to J.B.			the sum of		 apportioned to her, [or the sum of 			out of the sum of		 apportioned to her], and that the balance of the lastmentioned sum (less any court fees payable by her be invested by the Registrar in his or her name in the Commonwealth Savings Bank of Australia for the benefit of J.B.,			and that out of the sum so invested and the accruing interest the Registrar do from time to time until further order pay to J.B.			the weekly sum of		           , the first payment to be made on the			day of			       , and afterwards every fortnight [or every four weeks, or as the case may be].
7	That on payment to the Registrar of the sum of			  the sums of			and			         hereby apportioned to or for the benefit of			       respectively (less any Court fees payable by them) be invested by the Registrar in his or her name in the Commonwealth Savings Bank for the benefit of			         and			             respectively, and that interest arising from such investments be from time to time until further order paid to J.B.,		               to be by her applied for the maintenance, education, or benefit of	            and			respectively.
8	That J.B.			and			 or any of them be at liberty to apply to the Court from time to time as they may be advised for any further or other order as to the application of any of the sums so ordered to be invested and the accruing interest.
9	That C.D.			do pay to the Registrar of this Court, for the use of the applicants, the sum of			      being their costs of and incident to this arbitration, such costs to be taxed by the Registrar in the prescribed manner and to be paid by C.D.			to the Registrar within 			days from [or forthwith after] the date of such taxation.
[Add directions (if any given) as to costs occasioned by claim of person claiming as a dependant whose claim is disallowed.]
Dated:						
J.S.
Magistrate.
	(iii)	IN CASE OF APPLICATION BY PERSON TO WHOM EXPENSES OF MEDICAL TREATMENT OR BURIAL ARE DUE
[Heading as in Request for arbitration.]
Having duly considered the matters submitted, the Court hereby orders and awards as follows:
[Here insert any introductory recitals of findings on which the award is made which the Court may direct.]
1	That the respondent, C.D.,			do pay the sum of			 for or towards the expenses of medical treatment on and the burial of A.B.,		            late of			, deceased, who died on the			day of	          from injury arising out of and in the course of the employment of A.B.	               as a worker employed by C.D.
2	That the following persons are entitled to share in such compensation:
The applicant, E.F.,		    in relation to charges amounting to		 due to (or payable by) him or her for medical treatment on A.B.,		 and the respondent, G.H.,			  in relation to charges amounting to			due to him or her for the burial of A.B.
3	That the respondent, C.D.,			do pay that sum of		               to the Registrar of this Court within			   days from the date of this award, and that the sum of		be apportioned between and paid to E.F. and G.H. in proportion to the amounts due to them respectively.
4	That C.D.			do pay to the Registrar of this Court for the use of the applicant, E.F., and the respondent, G.H., the sum of		          being their respective costs of and incident to this arbitration; such costs to be taxed by the Registrar in the prescribed manner and to be paid by C.D.				     within			days from (or forthwith after) the date of such taxation.
Dated: 						
J.S.
Magistrate.
Note	The above forms will serve as guides for framing awards in other cases.

Endnotes
1	This form was originally in the Workers Compensation Rules 1938, schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the rules and became a form approved under the rules, rule 89 (see amdt 1.2805, amdt 1.2807).
2	This republication includes amendments made under the Legislation Act 2001, part 11.3 (Editorial changes).

©  Australian Capital Territory 2002