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
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
(No Transcript)
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