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A Guide to the Workers Compensation System in NSW. For Union Organisers, Delegates & Activists. Authorised Officers. What are their powers? What are certificates of currency? What to look for in an employers policy?. Workers Compensation. What is workers compensation? Who pays for it ? - PowerPoint PPT Presentation
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http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
A Guide to the Workers Compensation System in NSW
For Union Organisers, Delegates & Activists.
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Authorised Officers
• What are their powers?
• What are certificates of currency?
• What to look for in an employers policy?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Workers Compensation
• What is workers compensation?
• Who pays for it ?
• How are premiums calculated?
• What effects premiums?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Self Insurers
• What are their obligations?• Are there any differences in insurance
arrangements?• Does it impact on my workers comp?• What are the licensing arrangements?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Workers Compensation
• When and how are you covered? • What about journey claims?• Recess claims• Trade Union Training Meeting• Strike Meeting• Do you have to prove fault?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Workers Compensation (continued)
• When and how are you covered? • What about journey claims?• Recess claims• Trade Union Training Meeting• Strike Meeting• Do you have to prove fault?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Workers Comp claims• Who is entitled to claim?
– Employees– Casuals– Deemed employees
• When and what for?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Injuries Outside NSW
• Conduct of a worker.
• Aggravation of an injury or illness
Wilful Misconduct • Self-inflicted injury
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
What to do if you are injured at work
• Notifying injuries
• Employers obligation to report injuries
• Significant Injury
• Putting in a claim
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Workers Compensation • What is a notification number?
• What are provisional liability payments?
• When do payments commence?
• Are self insurers any different?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Medical and Hospital Treatment
• What about medical or hospital treatment?
• Can I still choose my own doctor?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Rules for Paying Claims• What is a “reasonable” excuse
– Must send a letter detailing the exact reasons for not paying the claim
• What next?– Invite a claim– Contact union/CAS
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
What the injured worker must be told
• The insurance company has decided to pay – what happens next?
• What if the insurance company decides to not pay within 7 days?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
BenefitsTotal Incapacity
Partial Incapacity
Suitable Duties
Fit for suitable duties but not at work
First 26 weeks
CWWR
After 26 weeks
Statutory Rate
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Definition of ‘First 26 Weeks’ for the avoidance of doubt:
The first 26 weeks is calculated on periods where any weekly compensation benefit is paid.
For example:? - off work 2 weeks; back 3
months. Do not count the 3 months unless being paid make-up ?
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Benefits - Total Incapacity
• First 26 weeks
• After 26 weeks
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Casuals
• What rate are they paid?
• How is this determined?
• What benefits are they entitled to?
• Two contracts of employment
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Partial Incapacity (1)
• Back at work on suitable duties
• First 26 weeks
• After 26 weeks
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Partial Incapacity (2)
• No Suitable Duties available
• First 26 weeks
• 26 weeks to 52 weeks
(section S 38)
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Reviews / Assessment
• One Year (Sec 40 Fit for Suitable Job Assessment)
• Two year (52 Review)
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Benefits
Statutory RateAfter 26 weeks
CWWRFirst 26 weeks
No Suitable duties available
Suitable Duties
Partial Incapacity
Total Incapacity
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
IR Act 1996 – Protection of Injured Workers
• A worker cannot be terminated because they are not fit for work due to injury within six (6) months. Sec 99 (1) (a)
• If the worker has an entitlement under a Commonwealth or State Industrial Instrument for “accident pay” then the period during which they cannot be dismissed increases to the period during which they are entitled to “accident pay”.
• sec 99( 1) ( b)
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Reinstatement Of Injured Workers
• If a worker becomes fit within 2 years of being terminated the union apply for reinstatement
• Worker must produce medical evidence – fit for prior job.
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Leave Entitlements
• Annual Leave• Sick Leave or Accident Pay• Public Holidays• Long Service Leave• Maternity Leave
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Medical Benefits
• Hospital and Medical Treatment
• Chiropractor
• Physician
• Rehabilitation, ie: workplace assessment
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Miscellaneous Benefits
• Property Damage
• Travel Property
• Domestic Care
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Permanent Impairment
• New Guides for assessing permanent injury
• New Formula @ = $ amount max is $200,000. For 75%+• 6%+ threshold for hearing loss• 15% to access psy & psy injuries
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Permanent Impairment (2)
• Injuries not previously entitled to lump sum - now covered.– Respiratory– Internal organs– Psychological and Psychiatric– Cardiovascular
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Pain & Suffering
• Entitled to an additional lump sum / maximum $50,000
• Threshold is 10% or more to access this benefit
• 75%+ receive maximum lump sum
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Common Law
• Must have 15% whole of body impairment • Applies to all claims beyond 27/11/01 • Disputes for 15 % threshold referred to the
Commission• Commission issues certificate – binding and
conclusive
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Common Law (2)• Claim for economic loss- income loss only • All other entitlements i.e. lump sum for pain
and suffering etc - under stat scheme• Worker’s entitlements to weekly and medical
benefits no longer continue until the claim is settled
• All benefits cease after settlement
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Commutations/Lump Sum Buy Out
• 15% threshold whole of body
• On compensation for 2 years
• All Rehabilitation and return to work options have been exhausted
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Disputes Module
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Dispute Resolution
• Workers Compensation Commission
• Role of the Workers Compensation Court
• What claims will be dealt with by the Commission and the Court
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
PresidentPresident
Deputy PresidentsDeputy Presidents Deputy PresidentsDeputy Presidents
RegistrarRegistrar
Arbitrators & Medical AssessorsArbitrators & Medical Assessors
Expedited DisputesExpedited Disputes Medical Medical AssessmentsAssessments
Legal Legal
DisputesDisputes
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
How will the New Commission Operate?
• Disputes fall into categories:– Expedited – provisional liability– Return to Work– Medical– Complex
• Liability causation• 52A• Section 40
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
The New Dispute Resolution
• Expedited Assessments - Provisional Liability
• Return to Work
• Complex Legal Disputes
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Interim Payment Directions
• No decision with required timeframe
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Suitable Duties
• Unions can pursue these disputes in the new Workers Compensation Commission
• Employer fails to provide suitable duties • Union/delegate identify suitable duties • Employer continues to refuse • Union files dispute in the Commission
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Banning and Great Lakes Council 18.3.02 -IRCNSW- Harrison DP
•Relief unfair dismissal
•Dismissal due to injury
• Contravention of S99-Dismissal less than 6 months form first becoming unfit for employment
•Rehabilitation policy not followed.
• Held dismissal harsh, unreasonable and unjust.
• Reinstatement ordered, costs to Banning
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Medical Disputes
• S 66 – Permanent Impairment
• S 67 – Pain & Suffering
• Stabilisation of a injury
• Other Medical Disputes
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Appeals Against Medical Assessment
• A dispute is referred to AMS
• AMS opinion conclusive
• Workers have 4 grounds for appeal:
• Deterioration of condition
• Further information becomes available, ie: CTScan
• Assessment made on incorrect criteria
• Medical Assessment contains a demonstrable error
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Medical Assessment Appeals
• Appeal panel 2 Doctors (AMS) & Arbitrator
• Hear appeal from binding decisions
• Worker represented by an Advocate
• Worker able to tell their story
• Pain & Suffering-Section 67 – dealt with separately
http://council.labor.net.au
Labor
Counci
l of
Labor
Counci
l of
NSW
NSW
Complex Legal Disputes
• Liability denied weekly benefits medical, ie: physician
• S40 Assessment – 12 month benefit assessment
• S52 – 2 year benefit assessment