A Guide to the Workers Compensation System in NSW by pengxuezhi

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									                                         Labor Council of NSW
A Guide to the Workers
Compensation System in NSW

 For Union Organisers, Delegates &
             Activists.

           http://council.labor.net.au
                                            Labor Council of NSW
Authorised Officers
     • What are their powers?
     • What are certificates of currency?
     • What to look for in an employers
       policy?


http://council.labor.net.au
                                         Labor Council of NSW
Workers Compensation
     •   What is workers compensation?
     •   Who pays for it ?
     •   How are premiums calculated?
     •   What effects premiums?

http://council.labor.net.au
                                                 Labor Council of NSW
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?

 http://council.labor.net.au
                                         Labor Council of NSW
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?
http://council.labor.net.au
Workers Compensation




                                         Labor Council of NSW
(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?
http://council.labor.net.au
                                   Labor Council of NSW
Workers Comp claims
     • Who is entitled to claim?
           – Employees
           – Casuals
           – Deemed employees
     • When and what for?

http://council.labor.net.au
                                          Labor Council of NSW
Injuries Outside NSW
  • Conduct of a worker.
  • Aggravation of an injury or illness
Wilful Misconduct
  • Self-inflicted injury
http://council.labor.net.au
                                          Labor Council of NSW
What to do if you are injured at
work
       • Notifying injuries
       • Employers obligation to report
         injuries
       • Significant Injury
       • Putting in a claim
 http://council.labor.net.au
                                          Labor Council of NSW
Workers Compensation
     • What is a notification number?
     • What are provisional liability
       payments?
     • When do payments commence?
     • Are self insurers any different?

http://council.labor.net.au
Medical and Hospital




                                           Labor Council of NSW
Treatment
     • What about medical or hospital
       treatment?

     • Can I still choose my own doctor?



http://council.labor.net.au
                                           Labor Council of NSW
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

http://council.labor.net.au
What the injured worker must




                                           Labor Council of NSW
be told
     • The insurance company has
       decided to pay – what happens
       next?
     • What if the insurance company
       decides to not pay within 7 days?
http://council.labor.net.au
Benefits




                                                                  Labor Council of NSW
                          Total        Partial
                          Incapacity   Incapacity
                                       Suitable     Fit for
                                       Duties       suitable
                                                    duties but
                                                    not at work
      First 26            CWWR
      weeks
      After 26            Statutory
      weeks               Rate

 http://council.labor.net.au
                                                      Labor Council of NSW
       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 ?




http://council.labor.net.au
                               Labor Council of NSW
Benefits - Total Incapacity
      • First 26 weeks

      • After 26 weeks



 http://council.labor.net.au
                                               Labor Council of NSW
Casuals
     •   What rate are they paid?
     •   How is this determined?
     •   What benefits are they entitled to?
     •   Two contracts of employment

http://council.labor.net.au
                                          Labor Council of NSW
Partial Incapacity (1)
      • Back at work on suitable duties
      • First 26 weeks
      • After 26 weeks



 http://council.labor.net.au
                                             Labor Council of NSW
Partial Incapacity (2)
      • No Suitable Duties available
      • First 26 weeks
      • 26 weeks to 52 weeks
                            (section S 38)

 http://council.labor.net.au
                                           Labor Council of NSW
Reviews / Assessment
     • One Year (Sec 40 Fit for Suitable
       Job Assessment)

     • Two year (52 Review)


http://council.labor.net.au
                                                                      Labor Council of NSW
Benefits
                          Total            Partial
                          Incapacity       Incapacity

                                           Suitable     No Suitable
                                           Duties       duties
                                                        available
      First 26 weeks CWWR


      After 26            Statutory Rate
      weeks


 http://council.labor.net.au
                                                                           Labor Council of NSW
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)



 http://council.labor.net.au
Reinstatement Of Injured




                                          Labor Council of NSW
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.
http://council.labor.net.au
                                      Labor Council of NSW
Leave Entitlements
     •   Annual Leave
     •   Sick Leave or Accident Pay
     •   Public Holidays
     •   Long Service Leave
     •   Maternity Leave

http://council.labor.net.au
                                          Labor Council of NSW
Medical Benefits
     •   Hospital and Medical Treatment
     •   Chiropractor
     •   Physician
     •   Rehabilitation, ie: workplace
         assessment
http://council.labor.net.au
                              Labor Council of NSW
Miscellaneous Benefits
     • Property Damage
     • Travel Property
     • Domestic Care



http://council.labor.net.au
                                            Labor Council of NSW
Permanent Impairment
     • New Guides for assessing permanent
       injury
     • New Formula @ = $ amount
       max is $200,000. For 75%+
     • 6%+ threshold for hearing loss
     • 15% to access psy & psy injuries

http://council.labor.net.au
                                               Labor Council of NSW
Permanent Impairment (2)
     • Injuries not previously entitled to
       lump sum - now covered.
           –   Respiratory
           –   Internal organs
           –   Psychological and Psychiatric
           –   Cardiovascular
http://council.labor.net.au
                                             Labor Council of NSW
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
 http://council.labor.net.au
                                                     Labor Council of NSW
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


http://council.labor.net.au
Common Law (2)




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


http://council.labor.net.au
Commutations/Lump Sum Buy




                                          Labor Council of NSW
Out
     • 15% threshold whole of body
     • On compensation for 2 years
     • All Rehabilitation and return to
       work options have been
       exhausted
http://council.labor.net.au
                              Labor Council of NSW
Disputes Module



http://council.labor.net.au
                                           Labor Council of NSW
Dispute Resolution
     • Workers Compensation
       Commission
     • Role of the Workers
       Compensation Court
     • What claims will be dealt with by
       the Commission and the Court
http://council.labor.net.au
                                                                   Labor Council of NSW
                              President


Deputy Presidents                              Deputy Presidents


                               Registrar


                    Arbitrators & Medical Assessors


Expedited Disputes             Medical                 Legal
                              Assessments             Disputes




http://council.labor.net.au
                                                    Labor Council of NSW
How will the New Commission Operate?
      • Disputes fall into categories:
            –   Expedited – provisional liability
            –   Return to Work
            –   Medical
            –   Complex
                 • Liability causation
                 • 52A
                 • Section 40

 http://council.labor.net.au
                                 Labor Council of NSW
The New Dispute Resolution
     • Expedited Assessments -
       Provisional Liability
     • Return to Work
     • Complex Legal Disputes


http://council.labor.net.au
                                   Labor Council of NSW
Interim Payment Directions
     • No decision with required
       timeframe




http://council.labor.net.au
                                                     Labor Council of NSW
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

http://council.labor.net.au
                                                      Labor Council of NSW
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
http://council.labor.net.au
                                       Labor Council of NSW
Medical Disputes
     •   S 66 – Permanent Impairment
     •   S 67 – Pain & Suffering
     •   Stabilisation of a injury
     •   Other Medical Disputes

http://council.labor.net.au
                                                                  Labor Council of NSW
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

 http://council.labor.net.au
                                                   Labor Council of NSW
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

http://council.labor.net.au
                                          Labor Council of NSW
Complex Legal Disputes
     • Liability denied weekly benefits
       medical, ie: physician
     • S40 Assessment – 12 month
       benefit assessment
     • S52 – 2 year benefit assessment
http://council.labor.net.au

								
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