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
◗ 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
◗ 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
*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.
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
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
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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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
◗ 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. www.wcc.nsw.gov.au.
3. Return to Work
◗ You will arrange a suitable person to explain Reference:
the return-to-work process to the injured www.workcover.nsw.gov.au 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
THE INJURED WORKER’S
THE INJURED WORKER’S
The employer develops an
CGU develops an individual
individual RTW Plan for
plan for 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
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. firstname.lastname@example.org
How to notify us workerscompensation.live
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
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
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.
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
◗ Date and time of injury.
◗ Type of injury and cause.
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
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
• 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
• 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.
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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
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
• 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 www.cgu.com.au.
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.
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
◗ 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
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 www.cgu.com.au 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
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
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.
◗ 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
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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
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
Job title ________________________________________________________________________________________________
Workshop in Auburn and on site (various locations)
Work location __________________________________________________________________________________________
Current restrictions (as specified on current WorkCover medical certificate)
No walking on uneven ground
Lifting up to 7kg
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 ____________________________________________________
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:
Injured worker __________________________________________________ 12/07/2007
Employer _______________________________________________________ 12/07/2007
B White (Sales Manager)
Other __________________________________________________________ 12/07/2007
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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
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
◗ 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
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The worker's entitlements depend on the type, nature and severity of
the injury and include:
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
When the worker is certified fit to perform
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.
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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,
◗ 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
◗ 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.
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.
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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 www.cgu.com.au.
◗ Faxing our Customer Feedback Coordinator on (02) 9088 9688.
◗ Emailing us on email@example.com.
◗ 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'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.
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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
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
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.
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how we calculate Your premium continued
In regards to premium calculation, wages include:
◗ 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
◗ Payments made by trusts or companies in lieu of wages.
◗ Any other amounts awarded to the worker under a contract
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
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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.
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
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
www.workcover.nsw.gov.au, or speak to your insurance broker.
Your CGU case manager can provide you with specific information
about the estimated cost of your claims.
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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 gov.au/MediaResources/
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. firstname.lastname@example.org 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
email@example.com for a no obligation discussion about your
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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
WCNSWenquiries@cgu.com.au WCNSWclaims@cgu.com.au WCNSWpolicy@cgu.com.au
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 www.cgu.com.au/safety
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
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