Workers' Compensation Claims Guide

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Workers' Compensation Claims Guide Powered By Docstoc
					Workers’ Compensation Claims Guide
 How Gallagher Bassett Services Pty Ltd can help?                             Accident Make Up Pay
 Gallagher Bassett Services Pty Ltd (GB) has a proven history in              Under the Victorian Catholic Education Multi Employer Agreement
 delivering workers compensation solutions that minimise the cost and         2008 (VCEMEA), an employer is responsible for making up the
 impact of workplace injuries. We have the scale, resources and               difference between the weekly benefit paid under workers
 commitment to deliver workers compensation claims management                 compensation and the employee’s normal wage should they have not
 and related advisory services that will supplements and add value to         been injured. This Make Up Pay lasts for a period of 26 weeks from
 your business operations. At GB we work in collaboration with our            the date of injury and includes the ten (10) days of employer liability
 clients, specialist providers and intermediaries to develop targeted         mentioned above.
 claims management, OHS and injury management programs.
                                                                              Return to Work (RTW) Plans/Offer of Suitable
 If you are in any doubt, please call your GB Case Manager on                 Employment (OSE)
 (03) 9297 9366.
                                                                               RTW plans must be completed by the Employer if an Injured
                                                                                Worker is unfit or expected to be unfit for 20 days or more
 How to Lodge a Claim
                                                                               An OSE must be completed for all Injured Workers a soon as they
 Send to GB
                                                                                are certified with a capacity to undertake alternative or modified
  Employer’s claim form available at
  Injured Worker’s claim form, available at
                                                                               GB can assist you to complete these forms
  Medical certificate (WorkSafe Certificate of Capacity)                     Superannuation
 NB: You may be subject to fines if you do not send the Injured               The employer pays superannuation during the period of accident
 Worker’s documentation to GB within 10 days of the date of receipt.          make up pay only and for hours actually worked whilst on the RTW. If
 Check that both claim forms and the medical certificate (WorkSafe            the employee is still on workers compensation after 52 weeks the
 Certificate of Capacity) are complete.                                       insurer will pay superannuation in respect of weekly benefits.

 Employer Liability                                                           Reimbursement/Scheduled Fees
 Upon acceptance of a claim the Employer must:                                 Once you have paid the Employer liability, all ongoing medical
   Pay wages for the first 10 days of time lost.                               accounts should be sent to GB for reimbursement
   Pay initial medical and like expenses in line with current liability       WorkSafe sets the scheduled fees for most services engaged to
    limit (currently $610 – effective 1 July 2011 and subject to                assist Injured Workers recovering from injury e.g. physio,
    indexation).                                                                chiropractor, doctor, surgery etc. The fee schedules can be
                                                                                downloaded from the WorkSafe website
 WorkSafe Certificates of Capacity
  Initial medical certificate must not be for a period greater than 14
                                                                              Obligation to Maintain Employment/Vocational
   days and does not need to be signed and witnessed to be valid.             Assessment/New Employer Services (NES)
   This initial certificate can only be issued by a doctor                      Following an accepted claim, the pre-injury job or an equivalent
  Continuing certificate of capacity must not certify greater than 28           job must be made available for 52 weeks
   days. Injured Worker’s must complete the patient declaration and             If at any time it is suggested that the Injured Worker will be unable
   have the certificate witnessed. This certificate can be issued by a           to return to their pre-injury role, a vocational assessment and NES
   doctor, physio or chiropractor.                                               should be organised
                                                                                GB will advise you on a referral to this service
 Key Milestones of a Claim
 (incorporating compensation reductions)                                      GB Contact Details
 The following week count starts after the first ten (10) days. This is an    Fax:   (03) 8623 9701
 employer liability.                                                          Phone: (03) 9297 9355
 13 Weeks                                                                     Mail:  Locked Bag 3570, Melbourne VIC 3001
  Reduction in weekly payments from 95% of pre-injury average
                                                                              Other Resources
     weekly earnings (PIAWE) to 80% (depending on Injured Worker’s
                                                                             WorkSafe Victoria     
     capacity at time of reduction).
                                                                                  Employer’s claim form
 26 Weeks
                                                                                  Inured Worker’s claim form
  Weekly benefits continue at 80% PIAWE but for claims received
     by GB prior to 5 April 2010, shift allowance and overtime are
                                                                             CECV                   or phone
     excluded from the PIAWE at 26 weeks.
                                                                                                            (03) 9267 0228 
 52 Weeks
  Ongoing Employer obligations should be discussed with your                Glossary
                                                                             MDM               Multi-Disciplinary Management
     Case Manager.
                                                                             LTM               Long Term Management
  For claims received by GB on or after 5 April 2010, shift                 MEO               Medical Expenses Only
     allowance and overtime are excluded from the PIAWE at 52                PIAWE             Pre-Injury Average Weekly Earnings
     weeks.                                                                  IMA               Injury Management Advisor
 130 Weeks                                                                    
                                                                             WorkSafe          Governing body responsible for workers safety and
                                                                                               compensation in Victoria
  Injured Worker’s entitlement to weekly benefits cease if they have        Voc Assessment    Vocational Assessment
     a capacity for suitable employment.                                      
                                                                             NES               New Employer Services
                                                                             Finer details: In Victoria, Gallagher Bassett Services Workers Compensation Vic Pty Ltd is an agent
                                                                             for the Victorian WorkSafe Authority Correct as at July 2011

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