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Workers compensation procedures

Introduction

1. The following procedures outline the workers' compensation processes that operate in the University's New South Wales localities. The procedures are in accordance with the requirements of the Workers' Compensation Act 1987 and the Workplace Injury Management and Workers' Compensation Act 1998 and apply to all University employees.

2. Workers' compensation processes for Southern Cross University workplaces located in other States and Territories of Australia are covered by the appropriate state or territory legislation. Enquiries about the workers' compensation procedures that apply in these situations should be directed to the Manager, Workplace Health and Safety.

Definitions

3. 'Workers' compensation' is a system that provides financial benefits and other assistance to employees (and/or their dependants) who sustain an injury at their place of work, as outlined in the Workers' Compensation Act 1987.

4. 'Injury' refers to:

  • Personal injury arising out of, or in the course of, employment;
  • A disease which is contracted by an employee in the course of their employment and to which their employment is a contributing factor;
  • The aggravation, acceleration, exacerbation or deterioration of any disease, where the employment was a contributing factor to the aggravation, acceleration, exacerbation or deterioration.

5. 'Psychological injury' is an injury that results in a psychological or psychiatric disorder.

6. 'Significant injury' is where an injured employee cannot undertake their usual duties for a continuous period of seven or more days.

7. 'Partial incapacity' refers to a person who is fit to complete some work in a Return to Work Plan but not all of their normal pre-injury duties for their usual pre-injury number of hours.

8. 'Total incapacity' means that the employee is unable to perform any work.

9. 'Injury management' is a co-ordinated and managed program that integrates all aspects of injury management including treatment, rehabilitation and retraining.

10. 'Occupational rehabilitation' is a managed process aimed at maintaining injured or ill workers in, or returning them to, suitable employment. It involves early intervention by the employer with appropriate, adequate and timely services based on assessment of the injured worker's needs and capabilities.

Notification of incident/accident

11. An employee who is injured at work must notify their supervisor, and submit an incident and hazard report via the RiskWare portal, as soon as possible after the injury occurs.

12. The employee's supervisor must then log into RiskWare and complete the Action Plan for the submitted incident and hazard report indicating what can be done to prevent a recurrence of the incident/accident.

13. The supervisor is required to notify the Manager, Workplace Health and Safety that an employee has received a workplace injury within 24 hours of becoming aware of the incident/accident.

14. The Manager, Workplace Health and Safety, or their representative, must notify the University's insurer of the incident/accident on a Report Template, within 48 hours for a significant injury, or within five days for all other injuries.

15. The employee's supervisor will initially investigate the circumstances of the accident and take action to eliminate or control any hazards.

16. The Manager, Workplace Health and Safety investigates all significant incidents/accidents and recommends hazard controls to management if necessary.

17. All injuries are recorded in a Register of Incidents, Accidents and Hazards which is maintained by HR Services.

Claims

18. An injured employee must provide:

  • An incident and hazard report (submitted online via RiskWare portal);
  • A Certificate of Capacity relating to the injury; and
  • Any supporting documentation such as statements from witnesses or medical reports.

19. The employee is required to advise the Workplace Health and Safety Team of all absences resulting from a workplace injury by emailing whs@scu.edu.au or phoning 02 6620 3651 in the first instance.

20. If provisional liability is accepted by the insurer, the injured employee will be required to complete an Employee's Report of Injury (available from the Workplace Health and Safety Team).

21. Where an injured employee is unable to lodge an Employee's Report of Injury, their supervisor will arrange for the form to be completed on their behalf by either a relative, a witness to the accident, or an employee.

22. All questions on the Employee's Report of Injury must be completed to avoid delays in the determination of the claim by the insurer.

23. Forms are available from HR Services.

24. An Employer's Report of Injury must be completed by HR Services at the time the claim is submitted to the Insurer.

25. A copy of all documentation is placed on a Workers' Compensation file and stored in a secure location within HR Services. Access to the file is restricted to HR staff only.

26. A claimant must co-operate fully with the insurer in respect of their claim. In particular, they must comply with any reasonable request by the insurer to provide information.

27. WorkCover NSW Certificate of Capacity should state whether an injured employee's work was a substantial contributing factor to the personal injury or disease.

28. WorkCover NSW Certificate of Capacity and receipts for accounts for medical or other treatment, including chemist supplies relating to the injury, should be submitted to HR Services upon receipt. If the claim is accepted, the insurer will reimburse the injured employee for relevant expenses and pay the accounts received from treating doctors.

29. HR Services will forward all receipts, medical certificates etc to the insurer within 7 days of receipt.

30. A claim is not considered to have been made without a WorkCover NSW Certificate of Capacity. It is the responsibility of the injured worker to ensure their WorkCover NSW Certificate of Capacity is supplied to HR Services as soon as it becomes available.

31. The insurer will provide written confirmation to both the injured employee and the University if the claim has been accepted.

32. If an injured employee's claim is accepted and they have not ceased work as the result of an injury, the injured employee will be reimbursed by the insurer for any relevant and necessary costs associated with the claim.

Assessment of the claim

33. The insurer will assess the claim and make a decision on liability after the claim form and WorkCover NSW Certificate of Capacity are received.

34. Provisional liability allows an insurer to make weekly remuneration and medical expense payments as part of an injury management plan without admitting liability. The insurer will give written notice about their decision to accept or deny payment to the worker and employer.

35. Payments of provisional liability will commence within 7 days of initial notification.

36. If the injury is not significant (i.e. absence is for less than seven calendar days), the insurer may extend the time to assess provisional liability entitlements to 21 days after the initial notification is made. The injured employee will be advised in writing by the insurer if this happens.

Provisional payments

37. If provisional weekly payments are not made, the injured employee will be given written notice within 7 days of the initial notification. The University will also be advised.

38. The notice will include details of the grounds for not making provisional payments and contact details for claims assistance.

39. If the insurer denies liability for a claim, the injured worker will be advised in writing and will be provided with contact details for the Workers' Compensation Commission to which they can apply for determination of the claim.

Leave

40. All leave taken while provisional liability payments are made will be processed as Workers' Compensation Leave.

41. If the insurer denies liability after provisional payments have commenced, all subsequent leave after the date of denial will be processed in accordance with the University's existing leave provisions.

Disputed claim

42. Should a claim be disputed by the insurer, the insurer will advise the injured employee the reason the claim has been disputed.

Medical examinations

43. An employee who has given notice of an injury must, if required by the employer or insurer, undertake a medical examination organised and paid for by the employer or insurer.

44. If an employee is required to have a medical examination, reasonable out of pocket expenses relating to their attendance will be reimbursed upon production of original receipts or appropriate documentation.

Payments

First 13 weeks

45. Weekly compensation payments made to an injured employee in respect of any period of total incapacity for work during the first 13 weeks of incapacity are made at 95% of the employee's average weekly earnings. Where the employee's current weekly wage rate exceeds the maximum weekly payment as published in the NSW Government Gazette, the maximum weekly payment is payable.

46. Casual employees will be paid 95% of their average weekly rate up to the maximum weekly payment.

13 weeks to 130 weeks

47. An employee who is still absent from work after 13 weeks will be eligible for workers' compensation payments at a reduced rate. These benefits are 80% of the injured employee's average weekly earnings but not more than the Statutory Rate.

48. The Statutory Rate is determined by the NSW WorkCover Authority and is revised twice a year in April and October. The Statutory Rate applicable to an employee is assessed on the number of dependants an employee has. Payments are also supplemented by any work an employee undertakes on suitable duties, up to a maximum of their normal weekly earnings.

After 130 weeks

49. Weekly benefits will cease after 130 weeks unless an employee is assessed as having no current work capacity which is likely to continue indefinitely.

50. Weekly benefits will cease completely after 5 years unless an employee is assessed as having a permanent impairment greater than 20%.

51. Seriously injured employees will continue to have their medical expenses covered for 12 months after their weekly benefits cease.

Superannuation

52. Superannuation benefits may be affected by a period of workers compensation. For further information please contact HR Services.

Psychological injuries

53. Compensation is not payable in respect of a psychological injury if the injury was wholly or predominantly caused by reasonable action proposed or taken by the employer relating to the transfer, demotion, promotion, performance appraisal, discipline, retrenchment or dismissal of employees or provision of employment benefits to employees.

Rehabilitation and retraining

54. The University is required to provide an injury management program for injured employees. Further details can be found in the University's Injury Management System and the Injury Management and Rehabilitation Policy.

55. The insurer must start injury management if the employee is likely to be off work for more than seven calendar days, even if any of the days are for partial incapacity.