A Guide to the Workers Compensation System in NSW

1
A Guide to the Workers Compensation System in NSW

• For Union Organisers, Delegates Activists.

2
Authorised Officers

• What are their powers?
• What are certificates of currency?
• What to look for in an employers policy?

3
Workers Compensation

• What is workers compensation?
• Who pays for it ?
• How are premiums calculated?
• What effects premiums?

4
Self Insurers

• What are their obligations?
• Are there any differences in insurance
  arrangements?
• Does it impact on my workers comp?
• What are the licensing arrangements?

5
Workers Compensation

• When and how are you covered?
• What about journey claims?
• Recess claims
• Trade Union Training Meeting
• Strike Meeting
• Do you have to prove fault?

6
Workers Compensation (continued)

• When and how are you covered?
• What about journey claims?
• Recess claims
• Trade Union Training Meeting
• Strike Meeting
• Do you have to prove fault?

7
Workers Comp claims

• Who is entitled to claim?
• Employees
• Casuals
• Deemed employees
• When and what for?

8
Injuries Outside NSW

• Conduct of a worker.
• Aggravation of an injury or illness

• Wilful Misconduct
• Self-inflicted injury

9
What to do if you are injured at work

• Notifying injuries
• Employers obligation to report injuries
• Significant Injury
• Putting in a claim

10
Workers Compensation

• What is a notification number?
• What are provisional liability payments?
• When do payments commence?
• Are self insurers any different?

11
Medical and Hospital Treatment

• What about medical or hospital treatment?
• Can I still choose my own doctor?

12
Rules for Paying Claims

• What is a reasonable excuse
• Must send a letter detailing the exact reasons
  for not paying the claim
• What next?
• Invite a claim
• Contact union/CAS

13
What the injured worker must be told

• The insurance company has decided to pay what
  happens next?
• What if the insurance company decides to not pay
  within 7 days?

14
Benefits
Total Incapacity Partial Incapacity
Suitable Duties Fit for suitable duties but not at work
First 26 weeks CWWR
After 26 weeks Statutory Rate
15
Definition of First 26 Weeks for the avoidance
of doubt The first 26 weeks is calculated on
periods where any weekly compensation benefit is
paid. For example? - off work 2 weeks back 3
months. Do not count the 3 months unless being
paid make-up ?
16
Benefits - Total Incapacity

• First 26 weeks
• After 26 weeks

17
Casuals

• What rate are they paid?
• How is this determined?
• What benefits are they entitled to?
• Two contracts of employment

18
Partial Incapacity (1)

• Back at work on suitable duties
• First 26 weeks
• After 26 weeks

19
Partial Incapacity (2)

• No Suitable Duties available
• First 26 weeks
• 26 weeks to 52 weeks
• (section S 38)

20
Reviews / Assessment

• One Year (Sec 40 Fit for Suitable Job Assessment)
• Two year (52 Review)

21
Benefits
22
IR Act 1996 Protection of Injured Workers

• A worker cannot be terminated because they are
  not fit for work due to injury within six (6)
  months. Sec 99 (1) (a)
• If the worker has an entitlement under a
  Commonwealth or State Industrial Instrument for
  accident pay then the period during which they
  cannot be dismissed increases to the period
  during which they are entitled to accident pay.
• sec 99( 1) ( b)

23
Reinstatement Of Injured Workers

• If a worker becomes fit within 2 years of being
  terminated the union apply for reinstatement
• Worker must produce medical evidence fit for
  prior job.

24
Leave Entitlements

• Annual Leave
• Sick Leave or Accident Pay
• Public Holidays
• Long Service Leave
• Maternity Leave

25
Medical Benefits

• Hospital and Medical Treatment
• Chiropractor
• Physician
• Rehabilitation, ie workplace assessment

26
Miscellaneous Benefits

• Property Damage
• Travel Property
• Domestic Care

27
Permanent Impairment

• New Guides for assessing permanent injury
• New Formula _at_ amount
• max is 200,000. For 75
• 6 threshold for hearing loss
• 15 to access psy psy injuries

28
Permanent Impairment (2)

• Injuries not previously entitled to lump sum -
  now covered.
• Respiratory
• Internal organs
• Psychological and Psychiatric
• Cardiovascular

29
Pain Suffering

• Entitled to an additional lump sum / maximum
  50,000
• Threshold is 10 or more to access this benefit
• 75 receive maximum lump sum

30
Common Law

• Must have 15 whole of body impairment
• Applies to all claims beyond 27/11/01
• Disputes for 15 threshold referred to the
  Commission
• Commission issues certificate binding and
  conclusive

31
Common Law (2)

• Claim for economic loss- income loss only
• All other entitlements i.e. lump sum for pain and
  suffering etc - under stat scheme
• Workers entitlements to weekly and medical
  benefits no longer continue until the claim is
  settled
• All benefits cease after settlement

32
Commutations/Lump Sum Buy Out

• 15 threshold whole of body
• On compensation for 2 years
• All Rehabilitation and return to work options
  have been exhausted

33
Disputes Module
34
Dispute Resolution

• Workers Compensation Commission
• Role of the Workers Compensation Court
• What claims will be dealt with by the Commission
  and the Court

35
President
Deputy Presidents Deputy Presidents
Registrar
Arbitrators Medical Assessors Arbitrators Medical Assessors Arbitrators Medical Assessors
Expedited Disputes Medical Assessments Legal Disputes
36
How will the New Commission Operate?

• Disputes fall into categories
• Expedited provisional liability
• Return to Work
• Medical
• Complex
• Liability causation
• 52A
• Section 40

37
The New Dispute Resolution

• Expedited Assessments - Provisional Liability
• Return to Work
• Complex Legal Disputes

38
Interim Payment Directions

• No decision with required timeframe

39
Suitable Duties

• Unions can pursue these disputes in the new
  Workers Compensation Commission
• Employer fails to provide suitable duties
• Union/delegate identify suitable duties
• Employer continues to refuse
• Union files dispute in the Commission

40
Banning and Great Lakes Council 18.3.02 -IRCNSW-
Harrison DP

• Relief unfair dismissal
• Dismissal due to injury
• Contravention of S99-Dismissal less than 6
  months form first becoming unfit for employment
• Rehabilitation policy not followed.
• Held dismissal harsh, unreasonable and unjust.
• Reinstatement ordered, costs to Banning

41
Medical Disputes

• S 66 Permanent Impairment
• S 67 Pain Suffering
• Stabilisation of a injury
• Other Medical Disputes

42
Appeals Against Medical Assessment

• A dispute is referred to AMS
• AMS opinion conclusive
• Workers have 4 grounds for appeal
• Deterioration of condition
• Further information becomes available, ie CTScan
• Assessment made on incorrect criteria
• Medical Assessment contains a demonstrable error

43
Medical Assessment Appeals

• Appeal panel 2 Doctors (AMS) Arbitrator
• Hear appeal from binding decisions
• Worker represented by an Advocate
• Worker able to tell their story
• Pain Suffering-Section 67 dealt with
  separately

44
Complex Legal Disputes

• Liability denied weekly benefits medical, ie
  physician
• S40 Assessment 12 month benefit assessment
• S52 2 year benefit assessment