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A Guide to the Workers Compensation System in NSW

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 ?

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A Guide to the Workers Compensation System in NSW

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  1. A Guide to the Workers Compensation System in NSW For Union Organisers, Delegates & Activists. http://council.labor.net.au

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

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

  4. 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

  5. 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

  6. 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

  7. Workers Comp claims • Who is entitled to claim? • Employees • Casuals • Deemed employees • When and what for? http://council.labor.net.au

  8. Injuries Outside NSW • Conduct of a worker. • Aggravation of an injury or illness • WilfulMisconduct • Self-inflicted injury http://council.labor.net.au

  9. 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

  10. 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

  11. Medical and Hospital Treatment • What about medical or hospital treatment? • Can I still choose my own doctor? http://council.labor.net.au

  12. 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

  13. 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

  14. Benefits http://council.labor.net.au

  15. 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

  16. Benefits - Total Incapacity • First 26 weeks • After 26 weeks http://council.labor.net.au

  17. 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

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

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

  20. Reviews / Assessment • One Year (Sec 40 Fit for Suitable Job Assessment) • Two year (52 Review) http://council.labor.net.au

  21. Total Incapacity Partial Incapacity Suitable Duties No Suitable duties available First 26 weeks CWWR After 26 weeks Statutory Rate Benefits http://council.labor.net.au

  22. 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

  23. 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

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

  25. Medical Benefits • Hospital and Medical Treatment • Chiropractor • Physician • Rehabilitation, ie: workplace assessment http://council.labor.net.au

  26. Miscellaneous Benefits • Property Damage • Travel Property • Domestic Care http://council.labor.net.au

  27. 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

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

  29. 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

  30. 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

  31. 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

  32. 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

  33. Disputes Module http://council.labor.net.au

  34. 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

  35. http://council.labor.net.au

  36. 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

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

  38. Interim Payment Directions • No decision with required timeframe http://council.labor.net.au

  39. 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

  40. 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

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

  42. 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

  43. 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

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

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