Your guide to workers compensation by nhz10206


									 Your guide to workers compensation

A toolkit for small* employers with limited experience of workers compensation
This toolkit explains the basic processes of the workers compensation scheme and what you need to do should
one of your employees sustain a work-related injury or disease.
The aim throughout the workers compensation process is to ensure your employee makes a timely, safe and
durable return to work.

The basics                                                    Responsibilities of the people involved
◗ Who needs workers compensation insurance
                                                              What is the Injury Management Plan (IMP)
◗ Workers and deemed workers
◗ Sole traders and partnerships                               What is the RTW Plan
                                                              ◗ An example of a RTW Plan
Your obligations
◗ You must comply with CGU’s Injury Management                What if a worker is unable to return
  Program                                                     to the same job
◗ Why early notification of workplace injury                  ◗ The decision to terminate a worker’s employment
  is important
                                                              ◗ Workers compensation and industrial relations
◗ Providing suitable duties
◗ Developing a Return to Work (RTW) Program                   Benefits payable
◗ A standard RTW Program should include                       ◗ Wage replacement
◗ Integrating your RTW Plan                                   ◗ When the worker is certified totally unfit for work
                                                              ◗ When the worker is certified fit to perform
What to do if a workplace injury occurs                         suitable duties
◗ Activate your emergency procedure plan                      ◗ Maximum weekly benefits
◗ Notify CGU of the injury                                    ◗ Treatment and rehabilitation payments
◗ How to notify us                                            ◗ Permanent impairment – Section 66 and
◗ What you need to tell us                                      Section 67 payments
◗ What an injured worker must do                              ◗ Travel costs
◗ Record the injury in your Register of Injuries
◗ Gradual onset injuries                                      Dispute resolution

What happens next                                             How we calculate your premium
◗ We allocate you with a notification or                      ◗ WorkCover Industry classification (WIC)
  claim number                                                ◗ Wages
◗ We assign a case manager                                    ◗ Premium calculation specific to small employers
                                                              ◗ How your claims experience will impact
What is provisional liability                                 ◗ Exclusions
◗ What to do if you doubt the injury is work-related          ◗ Further information on your premium
◗ What if we do not accept provisional liability?
                                                              How CGU can assist you to reduce the cost
Lodging a claim                                               of injuries at work and improve your OHS
◗ How to submit a claim
◗ What if we dispute a claim                                  Need more information?
◗ Time limit                                                  ◗ CGU contact details
                                                              ◗ WorkCover contact details
Assisting your injured worker’s return
to work

*A small employer pays a basic tariff premium of $10,000 or
 less, or annual wages equal to or less than $300,000 and
 employs 20 or less workers.

the Basics

Who needs workers compensation insurance
All employers must have a workers compensation insurance policy.
You are deemed an employer if you employ or hire workers on a         TIP: If you are unsure if you are an
                                                                      employer, use the WorkCover
regular, casual or contract basis.
                                                                      self-assessment tool at

Workers and deemed workers
Your workers and deemed workers are covered by your workers
compensation insurance.
A worker is someone who receives wages or commission from you,
regardless of the number of hours worked each week. This includes
those who work away from your premises, your trainees and your
apprentices. (Note: apprentice wages are not considered in our
premium calculations.)
People working as contractors may be considered deemed workers and
are also covered by your workers compensation insurance policy.
                                                                      MORe INFO: See the checklist on
                                                                      the WorkCover website at
                                                                      determine if you have workers
Sole traders and partnerships                                         and/or deemed workers.
Require workers compensation insurance if they employ workers or
deemed workers but the sole traders and partners themselves are not
covered by this insurance.

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Your oBligations

You must comply with CGU’s Injury Management Program
This document outlines how we meet our statutory obligation and
collaborate with our employers to formulate employment practices
                                                                        MORe INFO: A copy of CGU’s Injury
that will facilitate the return to work of injured workers.             Management Program is available
                                                                        on request or from our website at
Why early notification of workplace injury is important
Notifying CGU promptly of workplace injuries is vital for effective
injury management. We know from our experience and research that
the sooner we are notified of an injury, the more effective we can be
in ensuring your worker receives high quality treatment and is aware
of his/her responsibilities to return to work, thereby keeping costs

Providing suitable duties
Following a workplace injury, the aim of rehabilitation is to return
your injured worker to suitable duties as early as possible. This is
to facilitate full recovery from the injury and reduce the effects
of disability. Providing suitable duties wherever possible is a key
component of this.

Developing a Return to Work Program (RTW Program)
Your RTW Program:
                                                                        TIP: WorkCover NSW has
◗ Documents your policies and procedures for managing workers
                                                                        developed a standard RTW
  who suffer work-related injuries or illnesses.                        Program that can be used and
◗ Demonstrates your commitment to assisting injured workers with        adapted by most small employers.
  accessing necessary treatment and rehabilitation.                     Some entities are exempt from
                                                                        developing a RTW Program so
◗ Outlines the steps to take to achieve a safe, timely and durable      whilst visiting the website, see if
  return to work.                                                       this condition applies to you.
It must be:
◗ Established in accordance with the regulations, and must:
    -   Comply with WorkCover guidelines.
    -   Be developed in consultation with your employees and any
        industrial union representing your workers.
    -   Be in writing and displayed or notified at your workplace(s).
    -   Be provided to any worker on request.

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Your oBligations continued

A standard RTW Program should include:
    Your commitment to:                                             evident that they are unlikely to resume their
    ◗ Preventing injury and illness by providing a safe             normal duties, or cannot do so without changes
      and healthy working environment.                              to the workplace or work practices.
    ◗ Participating in the development of an Injury              ◗ You will nominate preferred WorkCover
      Management Plan (IMP) and ensuring that injury                accredited rehabilitation providers. (CGU can
      management commences as soon as possible after                assist you.)
      an injury.                                                 ◗ You will arrange for the injured worker’s return
    ◗ Supporting the injured worker and ensuring that               to work, subject to medical and rehabilitation
      early return to work is a normal expectation.                 provider advice.
    ◗ Providing suitable duties for an injured worker as      4. Suitable duties
      soon as possible.                                          ◗ When the injured worker, according to medical
    ◗ Ensuring injured workers (and their                           advice, is capable of returning to work, you will
      representatives) are aware of their rights and                develop an individual RTW Plan.
      responsibilities – including the right to choose           ◗ You will undertake to provide suitable duties
      their own doctor and an accredited rehabilitation             that are consistent with medical advice
      provider, and the responsibility to provide accurate          and that are meaningful, productive and
      information about the injury and its cause.                   appropriate for the injured worker’s physical
    ◗ Consulting with workers and, where applicable,                and psychological condition. Depending on
      unions to ensure the RTW Program operates as                  individual circumstances, suitable duties may
      smoothly as possible.                                         be:
    ◗ Maintaining confidentiality of injured worker                 - the same job modified slightly or for less
      records.                                                          hours
    ◗ Not dismissing a worker as a result of a work-                - duties at a different site
      related injury within six (6) months of he or she             - different duties
      sustaining an injury.                                         - training opportunities
                                                              5. Dispute resolution
    Your procedures regarding:                                   ◗ If disagreements about the RTW Plan or
    1. Notification of Injuries                                     suitable duties arise, you will work together
       ◗ All injuries must be notified to the supervisor as         with the injured worker and any union
          soon as possible.                                         representing them to try and resolve the
       ◗ All injuries will be recorded in the Register of           dispute.
          Injuries.                                              ◗ If you are unable to resolve the dispute, you
       ◗ CGU is notified of any injury within 48 hours.             will involve CGU, an accredited rehabilitation
    2. Recovery                                                     provider, the NTD or an Injury Management
       ◗ You will ensure the injured worker receives                Consultant.
          appropriate first aid and/or medical treatment      6. Contacts for assistance:
          as soon as possible.                                ◗ Workplace contact for RTW Program.
       ◗ The injured worker must nominate a treating          ◗ CGU Workers Compensation.
          doctor who will be responsible for the medical      ◗ WorkCover Claims Assistance Service on 13 10 50.
          management of the injury and assist in              ◗ Workers Compensation Commission
          planning return to work.                     
    3. Return to Work
       ◗ You will arrange a suitable person to explain        Reference:
          the return-to-work process to the injured  Publication 4 – Standard
          worker.                                             Return to Work Program
       ◗ You will ensure that the injured worker
          is offered the assistance of a WorkCover
          accredited rehabilitation provider if it becomes

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Your oBligations continued

Integrating your RTW Program
Your RTW Program must be fully integrated with CGU’s Injury
Management Program. In the event of an injury:
◗ the principles outlined in CGU’s Injury Management Program are
  used to generate an individual, tailored Injury Management Plan
  (IMP) for the injured worker; and
◗ your organisation’s RTW Program is used to develop a specific
  RTW Plan for the injured worker.

        CGU’S INJURY                            EMPLOYER’S RTW
    MANAGEMENT PROGRAM                            PROGRAM

    CGU’s Injury Management                  The employer develops
     Program provides a set    PROGRAMS      an organisational RTW
     of procedures to follow                   Program which is a
     when CGU is notified of                strategy for managing all
       a workplace injury.                  aspects of the employer’s
                                                 RTW processes.

             INJURY                                   INJURY

                                             THE INJURED WORKER’S
                                                    RTW PLAN
           PLAN (IMP)
                                            The employer develops an
CGU develops an individual
                                             individual RTW Plan for
 plan for co-ordinating and
                                                co-ordinating and
 managing the treatment,
                                              managing the RTW of
   rehabilitation and RTW
                                                an injured worker.
    of an injured worker.

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 what to do if a workplace injurY occurs

 Activate your emergency procedure plan
 Your emergency plan should:
 ◗ Ensure the injured worker receives first aid treatment if necessary
   and appropriate emergency medical treatment.
 ◗ Involve immediate action to assess and control the risk of further

 Notify CGU of the injury
  You have a legislative obligation (Workplace Injury Management
 and Workers Compensation Act (s44)) to notify CGU or the
 WorkCover Authority within 48 hours of becoming aware a worker
 has sustained an injury. Notification within five (5) days of the injury
 has a financial benefit and allows CGU to waive your excess.
 Your excess is the first week's worth of wages for each and every
 claim if not notified within five (5) days.
 The information below outlines your responsibilities:

SERIOUS INJURIES                              PHONE WORKCOvER
◗ Fatalities                                  IMMEDIATELY
◗ Limb amputation                             on 13 10 50 as an urgent
◗ Loss of consciousness                       investigation may be
◗ Worker trapped by                           needed.
  machinery or in confined                    PLUS
  spaces                                      notify CGU Workers
◗ Serious burns                               Compensation within
                                              48 hours.

           OTHER INCIDENTS                             Notify CGU Workers
           involving an injury or                      Compensation within   MORe INFO:
           illness to a worker where                   48 hours.             Injury notification can be made by:
           workers compensation                                              email
           may be payable.                                         
    How to notify us                                               
    Initial notification of a workplace injury may be given by the injured   Toll free telephone number 1300 666 506
    worker, employer, or by some other person (for example, a medical
    practitioner) acting for, or on behalf of, the injured worker or         Dedicated fax line 1300 666 406
    employer.                                                                mail
    CGU staff are trained to ensure the person notifying CGU is guided       CGU Workers Compensation
    through the process and able to provide all required information for     GPO Box 9960
                                                                             Sydney 2001
    the notification to be handled promptly and professionally.

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what to do if a workplace injurY occurs continued

What you need to tell us
◗ Injured worker’s name, residential address and date of birth.
◗ Employer’s name and current business address as well as policy
  number if known.                                                         (   ) Name, address and DOB
◗ Treating doctor’s name or name of the hospital if the worker was               of injured worker
  admitted for treatment.
                                                                           (   ) Your policy number
◗ Injury, illness or accident details such as the date of injury and how
  it occurred.                                                             (   ) Treating doctor’s name
◗ Name and contact details of the person making the initial notification   (   ) Injury details
  and the relationship of the notifier to the worker or employer.
                                                                           (   ) Contact details

If the injured worker requires time off work, you need to provide
accurate information about the worker’s average weekly rate of pay
and award rate of pay (if applicable). The case manager may require
written advice of 12 months of wages to accurately determine
average weekly earnings.

What an injured worker must do
Once injured, a worker must provide you with the following
information either verbally or in writing as soon as possible.
◗ Details of where the injury occurred.
◗ Cause of the injury.
◗ Date it happened.
Even if the injured worker fails to notify you, they remain able to
lodge a claim. A worker (or representative) may also contact us directly
to notify an injury if the employer has not done so and can also submit
a claim form. Regardless, all injuries must be notified to CGU.

Record the injury in your Register of Injuries
A Register of Injuries must be kept on your premises and be
easily accessed by all workers. All workplace injuries and incidents       MORe INFO: If you haven’t got a
(including near misses) that occur (including on a journey to and          Register of Injuries, contact your
from the workplace) must be recorded in this register. This is a           CGU case manager.
legislative requirement.
An entry represents a formal notification of a workplace injury.
It should include:
◗ Injured worker’s name, address, age and occupation.
◗ Injured worker’s type of industry and type of work undertaken at
  the time.
◗ Date and time of injury.
◗ Type of injury and cause.
◗ Comments.

Gradual onset injuries
The cause of some injuries and illnesses are difficult to identify
(such as psychological disorders), while others can happen over time
(such as back injuries). If you believe these types of injuries may be
occurring at your workplace, contact your CGU case manager.

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what happens next

We allocate you with a notification
or claim number
This number must be included in all correspondence relating
to the injured worker. Have it handy every time you contact us
regarding this matter.

We assign a case manager
Your case manager is your main contact throughout your
worker’s recovery process.
CGU has a team of case managers who are dedicated to
management of claims for small employers. We also have offices
in Tamworth, Newcastle and Wollongong dedicated to the
specialist needs of our regional customers.
The case manager will contact you, the injured worker and, if
appropriate, the worker’s doctor within three (3) business days
of injury notification. The case manager will determine liability
and help you develop a RTW Plan.

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what is provisional liaBilitY

We determine provisional liability within seven (7) days of an injury
Provisional liability is not a formal admission of liability but allows
us to commence payments for weekly benefits up to a period of
12 weeks. It also allows us to pay medical, treatment and other
expenses up to an amount of $7500. If the claim is ongoing, you will
be required to complete a claim form so that CGU can consider if
payments should continue to be made.

What to do if you doubt the injury
is work-related
You must provide us with evidence to support this. This can include
a signed statement from a third party, medical evidence that the
injury existed prior to the date reported, or public information that
conflicts with the notified workplace injury.
We cannot accept anecdotal or unsupported information.

What if we do not accept provisional liability?
We will advise you and the worker in writing. This is known as issuing
a ‘reasonable excuse’. A reasonable excuse can only be given in
certain situations:
•	 Insufficient	medical	information	
    CGU has a reasonable excuse if we do not have enough medical
    information. For example, we may not be able to confirm with
    the treating doctor that the injured worker has been treated for a
    workplace injury.
•	 Worker	unlikely	to	be	a	'worker'
    CGU has a reasonable excuse if:
    -   the worker has been unable to verify their status as a worker
        (under NSW workers compensation legislation)
    -   you can verify the worker is not a worker.
•	 We	are	unable	to	contact	the	worker
    CGU has a reasonable excuse if we need to contact the worker
    and are unable to do so after trying repeatedly, by phone,
    electronic means or in writing.
•	 Worker	refuses	access	to	information
    CGU has a reasonable excuse if the worker will not consent to
    the release or collection of personal and health information in
    relation to the workplace injury to determine his/her entitlement
    to provisional payments.

                                                          continued over

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       what is provisional liaBilitY continued
•	 Injury	is	not	work	related
   CGU has a reasonable excuse if you have provided evidence that the
   worker's employment is not a substantial contributing factor to the
                                                                              MORe INFO:
   injury. Acceptable forms of evidence include:
   -   a signed statement from a third party specific to the circumstances
       of the worker's injury that conflicts with the workplace injury as
   -   available public information specific to the circumstances of the
       worker's injury that conflicts with the workplace injury as notified
   -   medical information that confirms the existence of the workplace
       injury before the date of the injury reported by the worker.
       This excludes initial notifications for aggravation, acceleration,
       exacerbation or deterioration of a pre-existing condition.
   However, in these cases, anecdotal or unsupported information
   received from any source, including the employer, is not acceptable on
   its own.
•	 Injury	is	not	significant
   If the injury is not significant – i.e. the worker is likely to be off
   work for less than seven (7) continuous days, even if any of the days
   are for partial incapacity – then CGU may extend the time to assess
   entitlements to 21 days after the initial notification is made.
   If CGU does that, then within seven (7) days after the initial
   notification, CGU will notify the worker in writing that a decision will
   be made within 21 days of the initial notification.
•	 Injury notified after two (2) months
   CGU has a reasonable excuse if the notice of injury is not given to the
   employer within two months after the date of the injury.
   However, CGU may decide to pay provisional payments to the worker
   if we determine that a liability is likely to exist.

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 lodging a claim

 An injured worker can lodge a workers compensation claim at any
 time, although this may not be necessary if benefits are being paid
 under provisional liability.
 A claim form must be submitted when:
 ◗ requested by us
 ◗ the provisional liability limits are exceeded but the injured worker
   requires further benefits (i.e. there has been more than 12 weeks
   of either total or partial incapacity, or over $7,500 of medical and
   other expenses paid)
 ◗ we decide to cease provisional payments and the injured worker
 ◗ there is a claim for permanent impairment or work injury

 How to submit a claim
 You and your injured worker can use the Workers Compensation
 Claim Form/Journey Claim Form and Employer Claim Form to make a
                                                                          MORe INFO: Contact your case
 claim for compensation. A claim must be in writing and signed            manager for copies or download
 by the injured worker.                                                   the forms from our website at
 We will determine liability within 21 days after receiving a claim
 form except in exceptional circumstances.

 For weekly benefit claims
 A WorkCover medical certificate must be provided to cover any
 period that your worker is unable to perform his/her normal job.

 For permanent impairment claims
 Relevant particulars must be provided (see Section ‘Benefits payable’

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 lodging a claim continued

 What if we dispute a claim
 Before the worker is notified, we are required to undertake a
 compulsory review of all decisions to:
 ◗ not commence paying weekly benefits;
 ◗ cease or reduce weekly payments after they have started; or
 ◗ decline to pay for a service that has been requested.
 The internal review must be conducted by someone other than the
 person who made the original decision. CGU internal reviews are
 conducted by Injury Management Advisers and/or Technical Advisers
 with relevant subject knowledge.
 Notice to the worker must include:
 ◗ A statement of the issue/matter in dispute.
 ◗ A statement indicating that any matters that may be referred to
   the Workers Compensation Commission are limited to matters
   notified in the dispute notice.
 ◗ Reasons for our decision, including all supporting documentation.
 ◗ A statement indicating the worker can request a review of our
 If a worker requests an optional review, the review is undertaken by
 a designated Injury Management Adviser or a Technical Adviser not
 associated in any way with the original decision or the original review
 process, but with the relevant subject knowledge.
 If after the optional review we maintain the decision to dispute the
 claim, we must issue a further notice. Any further reports received by
 CGU which are relevant to the review decision, are attached.
 You will receive copies of all documentation provided to the worker.

 Time limit
 A claim for workers compensation should be made within six (6)
 months of the date of injury. In special circumstances this can be
 extended to three (3) years but not before CGU investigates the claim
 and communicates the outcome to WorkCover.

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     assisting Your injured worker’s return to work

 CGU's case management of injured workers claims is based on:
 ◗ Delivering the best possible return-to-work outcome for you and
   the worker.
 ◗ Identifying the worker’s needs early and coordinating services in a
   cost-effective and efficient manner.
 ◗ Satisfying all legislative requirements.
 To achieve these objectives it is vital that we are notified of an injury
 as early as possible and there is a coordinated effort by all parties to
 work towards a successful return to work.

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 responsiBilities of the people involved

 CGU case manager
 The CGU case manager is responsible for the overall management
 of the case from start to finish. They are supported by technical
 and health professional staff within our organisation with specialist
 knowledge about the management of claims and injuries.

 You, the employer
 It is your legislative responsibility to assist the injured worker to
 return to work in a safe, timely and durable manner. This means
 providing alternative work duties if reasonably practicable.
 You must develop a RTW Program for your organisation, and, in the
 event of injury, assist us in developing an Injury Management Plan
 (see p16) and RTW Plan if the injured worker returns to work in a
 restricted capacity.

 Injured worker
 Is expected to take an active role in their recovery and make every
 effort to return to suitable employment. Research tells us that your
 worker will require less time away from work if you stay in touch
 with him or her while they are absent from the workplace.

 Return To Work Coordinator
 If you employ 20 or more workers, you must appoint a RTW
 Coordinator, responsible for identifying suitable duties and assisting
 workers to return to work. This role may be shared among your
 employees or outsourced.
 The person(s) you appoint must have completed the WorkCover               TIP: We offer this course and an
 course ‘Introduction to RTW Coordination’.                                ‘Advanced RTW Coordination’
 If your company does not need a RTW Coordinator, you are still            course for our customers at a
                                                                           reduced rate. For further
 encouraged to be actively involved in developing a RTW Plan. We
                                                                           information, please refer to the
 will help you and may refer you to an Occupational Rehabilitation         course guide on the CGU website
 Provider for assistance.                                                  at or contact
                                                                           CGU Safety and Risk Services on
                                                                           1300 138 601.
 Occupational Rehabilitation Provider
 Occupational rehabilitation providers are accredited by WorkCover to
 assist employers and workers in the return-to-work process. They can
 assess your workplace to identify suitable duties, help formulate a
 RTW Plan and provide ongoing assistance.                                  TIP: CGU has a panel of preferred
                                                                           occupational rehabilitation
                                                                           providers who understand the
 Nominated Treating Doctor (NTD)                                           needs of small businesses.
                                                                           Alternatively, you and the injured
 The injured worker is required to nominate a doctor who is prepared       worker both have the right to
 to participate in the injury management and return-to-work process.       nominate an accredited provider
 The NTD provides WorkCover medical certificates which will specify        of your choosing.
 the worker's capacity for work and any restrictions. You can contact
 the doctor to ask about these restrictions and discuss suitable duties.

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 responsiBilities of the people involved continued

 Other health professionals
 Other service providers such as a medical specialists, physiotherapists
 or psychologists may be involved in providing treatment. We will
 coordinate all parties in this process.

 Injury Management Consultant (IMC)
 An IMC is a registered medical practitioner who assists with return-
 to-work issues when there is a difference of opinion between the          TIP: CGU has a panel of medical
                                                                           assessment organisations providing
 NTD, employer, injured worker and/or CGU. IMCs are appointed by
                                                                           IMC, IME and WPI services to
 WorkCover.                                                                ensure high-quality service
 An IMC may:                                                               provision.
 ◗ review the worker’s file then liaise with the NTD and other parties
   regarding return-to-work management; and/or
 ◗ assess the worker and then liaise with the NTD and other parties
   regarding return-to-work management.

 Independent Medical Examiner (IME)
 An independent medical examination is an impartial assessment
 based on the best-available evidence, undertaken by an
 appropriately qualified and experienced medical practitioner (who
 is not in a treating relationship with the worker) for the purpose of
 providing information to assist with workers compensation injury
 and claims management.
 An IME can be appointed only in the instance when information
 from the worker’s treating medical practitioner(s) is either
 ◗ inadequate,
 ◗ unavailable,
 ◗ inconsistent,
 or when the case manager is unable to resolve matters directly with a
 NTD or treating practitioner(s).
 An IME may be appropriate when the information required relates
 to such matters as diagnosis, the contribution of work to that
 injury, whether the current symptoms still result from the injury,
 recommendations and/or need for treatment, fitness for work,
 timeframe for recovery and assessment of whole person impairment

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 what is the injurY management plan (imp)

 The case manager develops an IMP if your employee is likely to be, or
 is away from, his/her normal job for seven (7) days or more.
 It details:
 ◗ responsibilities of all parties
 ◗ plan objectives
 ◗ penalties or actions should any party fail to comply
 We develop the IMP in consultation with you, the worker, the NTD
 and treating professionals within 20 days of being notified of a
 significant injury.

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 what is the rtw plan

 You develop a RTW Plan when, following injury, your worker can
 perform some work but is unable to return to normal duties. In these
 cases, the NTD certifies the worker fit for suitable duties and you
 have an obligation to provide these duties in accordance with the
 restrictions indicated on the current WorkCover medical certificate.
 Suitable duties are defined as employment for which the injured
 worker is suited, having regard to the injury, the worker’s incapacity
 and pre-injury employment in addition to the details given in the
 worker’s medical certificate. Suitable duties may include the same job
 modified slightly or for less hours, duties at a different site, training
 opportunities or different duties.
 You are obliged to provide suitable duties if an injured worker who
 is totally or partially incapacitated for work as a result of an injury is
 able to return to work and the injured worker has requested suitable
 employment. The work you must provide should be both suitable
 and the same as, or equivalent to, the employment in which the
 injured worker was performing at the time of the injury, unless it
 is not reasonably practicable to provide equivalent employment in
 accordance with this section.                                                eXCePTION: Employers do not
                                                                              have to provide suitable duties in
                                                                              the following circumstances:
 NOTe: The injured worker has a responsibility to accept a reasonable         1. the worker voluntarily resigns;
 offer of suitable duties as outlined in his/her IMP. Failure to do so           or
 may compromise the worker’s entitlements to weekly benefits.                 2. the worker's employment
                                                                                 is terminated for justifiable
                                                                                 reasons. The justifiable reason
 You must complete the RTW Plan prior to the injured worker                      must not be related to the injury
 returning to work in a restricted capacity (i.e. on suitable duties             or the worker's fitness for work.
 or restricted hours). The plan is updated whenever the WorkCover
 medical certificate restrictions and/or duties change and must be
 signed by the worker, you and the NTD.

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 what is the rtw plan continued

 An example of a RTW Plan
                                                                          Joe Smith
 This Return to Work Plan has been developed for __________________________________________________________
                                                                       (injured worker’s name)

 The purpose of this plan is to outline the suitable duties to be undertaken while the abovementioned worker
 recovers from his/her injury. It is expected that these duties will be temporary.
 Claim number ___________________________________                                      12/07/2007
                                                          Date plan developed________________________________
 Initial Return To Work Plan ✔                            Progress Return To Work Plan


     Joe Smith to return to normal duties as a kitchen installer with JK
     Kitchens by 12/10/2007

 Normal job
                      Kitchen installer
 Job title ________________________________________________________________________________________________
                   Workshop in Auburn and on site (various locations)
 Work location __________________________________________________________________________________________
                 Bill Aoun
 Supervisor ______________________________________________________________________________________________

 Suitable Duties
 Current restrictions (as specified on current WorkCover medical certificate)

     No walking on uneven ground
     Lifting up to 7kg
     Avoid kneeling
                                                               Sales and office assistant
 Job title (for duration of the Return To Work Plan) _________________________________________________________
                                                              Workshop/office in Auburn
 Work location (for duration of the Return To Work Plan ____________________________________________________
                                                         Beverley White
 Supervisor (for duration of the Return To Work Plan) ______________________________________________________
 Description of duties (for duration of the Return To Work Plan)

 Date Return To Work Plan / suitable duties to be reviewed ____________________________

 Return To Work Plan agreed to:
                             J Smith
 Injured worker __________________________________________________                        12/07/2007
                                                                                Date ___________________________
                     Bill Aoun
 Employer _______________________________________________________                        12/07/2007
                                                                                Date ___________________________
            B White (Sales Manager)
 Other __________________________________________________________                          12/07/2007
                                                                                Date ___________________________

18        BACk TO CONTeNTS
 what if Your worker is unaBle to return
 to the same joB

 We try and identify these cases as soon as possible but sometimes it
 is unclear if a worker will have permanent restrictions until the injury
 has stabilised.
 If this situation occurs, there are several options:
 ◗ Maintain the worker in his/her normal job with some
   modifications to accommodate medical restrictions.
 ◗ Transfer the worker to a different job within your organisation.
 ◗ Transfer the worker to a different job with a different employer.

 The decision to terminate a worker’s employment
 At some stage (but not within six (6) months of being notified of
 the injury) you may need to consider terminating your worker's
 This can be difficult and can involve:
 ◗ Replacement costs and delays.
 ◗ A possible insurance premium impact.
 ◗ Potential for an unfair dismissal or unlawful termination claim by
   the worker.
 ◗ Direct and indirect costs from losing a skilled and experienced worker.

 NOTe: We can provide information regarding the potential impact
 on your insurance premium but the decision to terminate a worker’s
 employment is yours.

 Once you terminate a worker, we will continue to keep you informed
 about the case if you wish via updated IMPs. We ensure the worker
 receives assistance to obtain alternative employment as quickly as
 possible. The worker will be formally advised that their benefits may
 be suspended if they do not actively seek alternative work.

 Workers compensation and industrial relations
 There are times when these issues overlap. For further information:
 ◗ NSW Office of Industrial Relations (unincorporated businesses)
   - 131 628
 ◗ Commonwealth Department of Employment and Workplace
   Relations (incorporated businesses)
   - WorkChoices Infoline 1300 363 264
 ◗ NSW WorkCover Authority (Workers Compensation and
   Occupational Health and Safety issues)
   - WorkCover Assistance Service 13 10 50
 ◗ Your employer association (e.g. Australian Industry Group,
   Australian Business Limited, Employers First)
 ◗ Your legal adviser

19        BACk TO CONTeNTS
 Benefits paYaBle

 The worker's entitlements depend on the type, nature and severity of
 the injury and include:

 Wage replacement
 Wage replacement benefits should be paid to the worker in the
 normal pay run wherever possible. In certain circumstances we are able
 to pay this benefit directly to you but it is your responsibility to pass
 the payment on to the worker with the appropriate tax deducted.

 When the worker is certified totally unfit for work
 This is known as ‘incapacity’.

 For the first 26 weeks following incapacity, you should
 continue to pay the worker's current weekly wage (example award
 rate/current individual agreement) or 80 % of the average weekly
 wage if there is no applicable award or agreement. This payment
 should not include loadings for shift work, overtime or other

 After 26 weeks following incapacity, you should commence
 paying the statutory rate gazetted by WorkCover. Additional
 amounts are paid if the worker has a dependent spouse and/or
 children, however, there may be exceptions.

 If you anticipate any difficulties in meeting the requirement to
 continue paying your worker whilst he/she recovers, contact your
 case manager.

 When the worker is certified fit to perform
 suitable duties
 If the worker returns to work on suitable duties and is earning less
 than before the injury (e.g. working fewer hours or at a lower pay
 rate), we pay make-up pay.
 Make-up pay is calculated as the difference between the worker’s
 pre-injury average earnings (including overtime, shift allowances, etc,
 calculated over a 12-month period) and their actual weekly earnings
 (i.e. the value of the duties worked).
 Make-up pay is capped at the amount the worker would normally be
 paid if unfit for the first 26 weeks of incapacity. Beyond the first 26
 weeks the amount is capped at the statutory rate.

 NOTe: If despite all efforts you are unable to offer suitable duties or
 the worker’s employment has been terminated, the worker will be
 assisted in job seeking for a maximum of 52 weeks. This may change
 if the NTD’s certificate changes to reflect reduced work capacity.

20        BACk TO CONTeNTS
 Benefits paYaBle continued

 Maximum weekly benefits
 All weekly benefits paid to workers are capped at a maximum rate.
 This rate is set and gazetted by WorkCover and is indexed every six (6)

 Treatment and rehabilitation payments
 CGU can only pay for ‘reasonably necessary’ treatment and services,
 determined by:
 ◗ Appropriateness: will the service reduce the effects of the injury?
 ◗ Alternatives: have other types of treatment been considered?
 ◗ Cost: is the service cost effective?
 ◗ effectiveness: can the service reduce the consequences of
   the injury?
 ◗ Acceptance: is the treatment generally accepted by the medical
   profession (or other appropriate professional group)?

 Permanent impairment – Sections 66 and
 Section 67 payments
 Sometimes an injury may result in a permanent loss or impairment. In
 these cases the worker is entitled to an additional payment known as
 a section 66 payment.
 If the permanent impairment is medically assessed as being over a
 certain threshold, there is a further payment for pain and suffering.
 This is known as a section 67 payment. We can only make this
 payment once the injury has stabilised. The worker’s employment
 status does not impact on the amount paid.
 These additional payments do not affect a worker’s entitlement to other
 types of benefits such as treatment and wage reimbursement. Sections
 66 and 67 payments do not impact on return-to-work planning.

 NOTe: If you receive a claim from the worker for compensation
 for permanent impairment and/or pain and suffering, forward the
 paperwork to us as soon as possible.

 Travel costs
 The worker is entitled to reasonable travel costs to/from:
 ◗ medical treatment
 ◗ medical consultations requested by us
 ◗ other appointments requested by us
 Travel is reimbursed at the rate paid for public transport (upon
 production of receipts), or at 42 cents per km travelled by private
 vehicle. Travel via taxi needs to be pre-approved by your case manager.

21        BACk TO CONTeNTS
 dispute resolution

 Sometimes the parties involved in a workers compensation claim do
 not agree on the course of action to be taken. At these times we
 may request further dialogue with the worker’s NTD and/or treating
 specialist. If this communication fails to resolve the matter, we may
 call upon medical experts relevant to the worker’s condition to assist
 in negotiating an outcome.
 If it is not possible to resolve an issue with your case manager, you
 may request an internal review by a CGU team leader or senior claims
 The following more formal avenues are also available:

 CGU Customer Feedback Policy and Procedure
 You are encouraged to raise any concerns with your CGU case
 manager and/or their team leader. If you are not satisfied or wish
 to provide more formal feedback regarding our services, we have a
 customer feedback process.
 If you have concerns with the way a claim is being managed, this is
 best resolved by contacting us directly by:
 ◗ Telephoning our toll-free Customer Feedback hotline on                 MORe INFO: A full copy of our
   1800 801 241.                                                          policy is available on request or can
                                                                          be found at
 ◗ Faxing our Customer Feedback Coordinator on (02) 9088 9688.
 ◗ Emailing us on
 ◗ Completing our online Customer Feedback form at
 ◗ Writing to CGU Workers Compensation (NSW), Customer Feedback
   Coordinator, PO Box 9960, Sydney, NSW 2001.
 Complaints and queries directed to us by the WorkCover Claims
 Assistance Service (CAS) are also dealt with via this formal process.

 WorkCover NSW
 WorkCover's CAS can be reached by telephoning 13 10 50.
 This service assists employers and injured workers when there are
 delays or problems with workers compensation claims.

 Workers Compensation Commission (WCC)
 The WCC deals mainly with disputes about liability, treatment,
 entitlement to benefits and work capacity. These matters are             TIP: It is best to attempt to resolve
 normally lodged by the worker or representative.                         any disagreements through other
 The WCC provides a formal dispute resolution process which may           channels before lodging a dispute
                                                                          with the WCC. Further information
 involve a conciliation hearing or arbitration.
                                                                          about the WCC is at www.wcc.

22       BACk TO CONTeNTS
 how we calculate Your premium

 CGU must calculate premiums in accordance with the formula and
 rules set out in the legislation.
 We are not permitted to adjust the premium outside the formula.

 WorkCover Industry Classification (WIC)
 Each industry in NSW is classified according to the WIC system. A WIC
 rate is determined by assessing the predominant business activity of
 an employer.

 On taking out a workers compensation insurance policy, you are
 required to provide us with an estimate of the gross wages you
 expect to pay over the next 12 months.

 Premium calculation specific to small employers
 Unless otherwise stated, premium is calculated over a period of
 12 months. Cover commences immediately from the date nominated
 in the policy or when we receive a written or verbal request from an
 As a small employer the main component of the premium calculation
 is the basic tariff premium which is calculated by multiplying annual
 wages by the WIC rate.
 Effective 31/12/2006 the Apprentice Incentive Scheme was introduced
 to encourage employers to take on apprentices by deducting the
 apprentice wages from the end of the premium calculation.
 Dust disease and mine safety levies and GST are also included. For
 more information please call your CGU case manager.
                                                                         Effective 31/12/2006 the Apprentice
 Claims costs used in the premium calculation reflect the total cost
                                                                         Incentive Scheme commenced to
 of each claim. This includes any amount paid on a claims plus any       encourage employers to take on
 amount we have placed in reserve for future costs. This is limited to   apprentices, as such apprentice
 $150,000 per claim.                                                     wages will not be taken into
                                                                         consideration when your premium
                                                                         is calculated.

 NOTe: ‘Wages’ do not include directors’ fees paid to non-working
 directors or compensation benefits paid to injured workers under the
 Workers Compensation Act 1987.

23       BACk TO CONTeNTS
 how we calculate Your premium continued

 In regards to premium calculation, wages include:
 ◗ Salary.
 ◗ Overtime, shift work and over-award payments.
 ◗ Bonuses and commissions.
 ◗ Employer superannuation contributions (including the
   superannuation guarantee levy).
 ◗ Grossed-up value of fringe benefits (i.e. value of the fringe
   benefit multiplied by the ATO fringe benefit formula).
 ◗ Payments to working directors (including directors’ fees).
 ◗ Payments for public and annual holidays (including leave
 ◗ Payments for sick leave and long service leave.
 ◗ Payments for terminations.
 ◗ Value of board and lodging provided by the employer for
   the worker.
 ◗ Payments made by trusts or companies in lieu of wages.
 ◗ Any other amounts awarded to the worker under a contract
   of service.

 How your claims experience will impact
 For some employers, additional premium is payable over and above
 the basic tariff premium to take into account the frequency/severity
 of workers compensation claims and the cost of these claims.
 For any new or renewed policies commencing after 31 December
 2005, the following applies:

 If you are a small employer
 That is, you pay a basic tariff premium of $10,000 or less, or annual
 wages equal to or less than $300,000, the cost of claims will not
 impact your premium.

 If you are a medium employer
 That is, you pay a basic tariff premium of between $10,000 and
 $500,000, with an annual wage bill of more than $300,000, the cost
 of claims will have an impact but the impact is limited depending on
 your basic tariff premium. See below for where you can obtain more
 specific information.

24       BACk TO CONTeNTS
 how we calculate Your premium continued


 Your employer claims excess (equivalent to the first week of benefits
 paid) is waived if CGU receives notice of a workplace injury within
 five (5) days of it being reported to you.

 Journey claims
 Claims cost related to injuries sustained as a result of an accident
 which occurred in a journey to or from the workplace are not
 included in the experience premium calculation. These are known as
 journey claims.

 Recess claims
 Claims costs related to injuries sustained during an authorised
 break away from the workplace are not included in the experience
 premium calculation. These are known as recess claims.

 Further information on your premium
 For further information about your premium, contact CGU Workers
 Compensation on (02) 9088 9000 or 1300 666 506 (toll free), or go to
 Alternatively, you can contact WorkCover NSW on 13 10 50 or at, or speak to your insurance broker.
 Your CGU case manager can provide you with specific information
 about the estimated cost of your claims.

25        BACk TO CONTeNTS
 how cgu can assist You to reduce the cost
 of injuries at work and improve Your ohs

 The impact of workplace injuries in your organisation can mean much
 more than just the direct costs of treating an injured worker. The
 hidden costs of workplace injuries can include lost productivity, high    TIP: Under the workers
 staff turnover, absenteeism and the effects of low morale.                compensation scheme, a small
                                                                           business can receive a $500 rebate
                                                                           for safety improvements they make.

                                                                           For more info:
 NOTe: To assist you meet your OH&S legislative requirements and           http://www.workcover.nsw.
 reduce the hidden costs of injuries at work, CGU Safety and Risk
 Services offers a comprehensive range of preventative services.           MediaReleases/2007 and click on
                                                                           the press release dated 2/19/2007.

  Most workplaces have some level of safety and environmental risks.
 This means your workers may be exposed to: hazardous chemicals,
 back injuries, overuse of muscles, sustained and difficult postures and
 conditions of high levels of anxiety and stress, to name a few. Our
 team of highly qualified and experienced professionals understand
 the needs of small employers. Our services can include visiting your
                                                                           MORe INFO: Please contact us by
 workplace, assessing your needs with you and discussing how to meet       phoning 1300 138 601 or email
 your health and safety requirements.                             to find
 We understand that you need prompt, effective advice and action           out other ways we can assist you
 which will also be cost effective. To assist with this, CGU Safety and    in preventing injuries to your
                                                                           workers. See also
 Risk Services has developed online training and risk profiling tools.
  As part of being insured with CGU Workers Compensation you can
 contact us anywhere in Australia on 1300 138601 or send an email to for a no obligation discussion about your
 individual circumstances.

26       BACk TO CONTeNTS
 need more information

 CGU contact details

 CITY                                     CLAIMS                                      POLICY

 388 George Street                        T 1300 666 506                              T 1300 666 506
 Sydney NSW 2000                          F 1300 666 406                              F (02) 9088 9709
 GPO Box 9960
 Sydney NSW 2001                  
 GPO Box 3995                             T (02) 8895 0581
 Parramatta NSW 2124                      F (02) 8895 0938

 Level 1                                  T (02) 6767 2360
 155-157 Marius Street                    F (02) 6767 2381
 Tamworth NSW 2340
 GPO Box 593
 Tamworth NSW 2340
 133 King Street                          T (02) 4907 5200
 Newcastle NSW 2300                       F (02) 4907 5299
 PO Box 834
 Newcastle NSW 2300
 243-249 Crown Street                     T (02) 4298 2000
 Wollongong NSW 2500                      F (02) 4226 5937
 PO Box 1759
 Wollongong NSW 2500

 CGU Safety and Risk Services T 1300 138 601

 WorkCover contact details
 HEAD OFFICE                     POSTAL ADDRESS                      SWITCHBOARD                        CLAIMS ASSISTANCE
 92-100 Donnison Street,         WorkCover NSW                       T (02) 4321 5000                   SERvICE (CAS)
 GOSFORD NSW 2250                Locked Bag 2906                     F (02) 4325 4145                   T 13 10 50
 Australia                       Lisarow, NSW 2252                                                      F (02) 9287 5491
 Office Hours                                                                                           Hours: 8:30am - 5:00pm
 8:30am - 5:00pm                                                                                        Monday to Friday
 Monday to Friday

               CGU Workers Compensation (NSW) Limited Agent for the NSW WorkCover Authority ABN 83 564 379 108/007

                           Insurance Australia Limited ABN 11 000 016 722 trading as CGU Safety and Risk Services

27        BACk TO CONTeNTS

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