Questions & Answers

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OVERVIEW

What changes have been introduced by the reform package?

The NSW Parliament has passed legislation that delivers a fairer, more sustainable and more customer-centric workers compensation system.

The reform package has three elements:

  • Enhanced benefits for injured workers
  • Premium discounts for employers with good safety and return to work records
  • Three new simplified organisations to regulate and operate the State’s insurance schemes and work health and safety.

How did these reforms come about?

The NSW Government committed to immediately reviewing the financial position of the NSW Workers Compensation Scheme following the 2015 election and made the following commitment:

“….out of that review, of every dollar above minimum surplus to keep the Scheme sustainable, two thirds will be invested in supporting injured workers and getting them back to work. The balance will be returned to business as lower premiums.”

Various reviews and stakeholders have contributed to the development of these reforms. The Government considered the views of all stakeholders who took the time to contribute to these important processes in developing these new legislation.

Why are these changes being made?

The restoration of the Scheme’s financial sustainability provides the opportunity to enhance benefits for injured workers and further improve return to work opportunities.

The benefit enhancements introduced by the Government aim to:

  • Help workers with the highest needs
  • Assist people to return to work, which all the evidence tells us is the best outcome for injured workers.
  • Making sure that all changes to benefits will not compromise the financial sustainability of the Scheme.

What are the new organisations?

  • SafeWork NSW – a new risk-based regulator for work health and safety
  • State Insurance Regulatory Authority (SIRA) – a new independent regulator overseeing all State insurance schemes
  • Insurance & Care NSW (icare) – a highly customer-focused organisation delivering insurance and care services

What is the point of creating three separate organisations?

The Government responded to one of the main criticisms that came through from various reports and inquiries into WorkCover, namely the inbuilt conflict between the regulatory and operational service delivery functions. The new structure will be far more transparent and accountable and will lead to better outcomes for injured workers.

What will the structural reforms achieve?

Combining like-for-like functions across all the insurance schemes in NSW will result in improved outcomes for injured workers.

The separation of the insurance operator and regulator will also eliminate conflicts of interest between insurance functions and regulatory functions, and will ensure capability gaps in management and industry expertise are met.

Combining the regulatory functions of insurance in NSW will allow the Government to capitalise on joint knowledge and processes to improve efficiency and services to customers. For example, combining agencies helps with managing service providers and reduces duplication.

BENEFIT REFORMS

How will injured workers benefit from these reforms?

The benefit enhancements mean that:

  • Cover is extended for artificial aids such as prostheses, crutches, and hearing aids, as well as home and vehicle modifications for life, regardless of the level of permanent impairment.
  • The cap for medical expenses, previously 12 months from when weekly payments stop (or date of claim where no weekly payments were made) has doubled to two years after weekly payments cease for all injured workers and to five for those with 11-20% permanent impairment.
  • If you have 21% or greater permanent impairment, medical expenses are payable for life.
  • The maximum lump sum compensation payable for injury resulting in greater than 10% permanent impairment has been increased to a maximum of $577,050 depending on your level of permanent impairment.
  • If you have more than 21% permanent impairment and have some work capacity, you no longer have to work a minimum of 15 hours a week to get weekly payments after 130 weeks (2.5 years).
  • If you have more than 30% permanent impairment, a safety net has been introduced of $788.32 per week. Where your income (made up of weekly payments and any earnings) falls below $788.32, your insurer will increase your weekly payments so you don’t receive any less than this amount to support yourself. This amount will be indexed to CPI.
  • All injured workers who return to work with a new employer will get return to work assistance of up to $1,000 to assist with the transition.
  • Education and retraining grants of up to $8,000 will be provided for workers who have been receiving weekly benefits for 78 weeks (18 months) or more to improve the opportunity to return to work.
  • Families of deceased have access to an increased death benefit of $750,000 – up substantially from the previous $528,400. These benefits will soon also apply to specific classes of workers who were exempt from the 2012 amendments – police, fire fighters and paramedics.
  • The maximum amount that will be payable for funeral expenses of a deceased worker has increased from $9,000 to $15,000.
  • The 2014 regulations have been extended to include workers who made a claim after 1 October 2012 to:
    • Make a claim for secondary surgery
    • Suspend a work capacity decision by the insurer while it is under review (e.g. weekly payments cannot be reduced during this time)
    • Receive weekly payments for up to 12 months after reaching retiring age
    • Make a claim for medical expenses for life for those with more than 20% permanent impairment
    • Make a claim for aids and modifications for life
  • The Government is also consulting with stakeholders to develop a regulation to allow legal practitioners to provide legal advice on work capacity decisions.

How many injured workers will benefit from the new legislation?

More than 14,450 injured workers will get a further 12 months of medical expenses for treatments such as physiotherapy and 4,440 will get up to an extra four years. Around 1,000 of these injured workers are approaching the end of their 12 month entitlement to medical expenses in the next month (as at August 2015). More than:

  • 18,000 injured workers will have lifetime access to artificial aids (prosthesis, hearing aids etc), home and vehicle modifications.
  • 11,500 injured workers will be eligible for up to $1,000 to help with return to work costs (tools, clothes etc)
  • Almost 4,000 injured workers will become eligible for retraining and education assistance of up to $8000
  • 1,700 injured workers will be able to claim second surgery if needed
  • 250 injured workers with high needs that would stop receiving weekly benefits because they aren’t working 15 hours a week will continue to receive benefits
  • 616 injured workers will continue to receive weekly benefits for an extra 12 months past retiring age
  • Around 2,260 injured workers will have access to lifetime medical expenses
  • 119 injured workers with the highest needs will receive an increase in their weekly payment to $788.32. The difference between current weekly benefits and the new minimum payment will be back payed to September 2012.

When can injured workers expect to receive the additional or enhanced benefits?

Some benefits commenced in October 2015 and others on 4 December 2015. For more information including dates, go to Benefits for workers.

Will the benefit reforms be retrospective?

All of the changes that extended the 2014 Regulation will apply retrospectively to all claimants. These include:

  • Extension to medical entitlements
  • Artificial aids and home and vehicle modifications for life
  • Claims for secondary surgery
  • Lifelong medical expenses for workers with high needs
  • Stay of a work capacity decision while a review is underway
  • Minimum weekly payments for workers with highest needs
  • Minimum working hours removed for workers with high needs

Other reforms vary in terms of their application time frames and conditions. For example the death benefit lump sum increases apply to deaths from the date the bill was introduced into Parliament, which was 5 August 2015.

See individual benefit reforms for further details. Your insurer will be able to advise you further.

How will I be reimbursed for retrospective medical expenses?

Your insurer will require receipts for any out of pocket expenses for any medical treatment you received. The insurer will need to determine the medical treatment or services were reasonably necessary. If the insurer determines the medical expense was not reasonably necessary, they will not be able to reimburse the expense incurred.

The insurer may contact Medicare to determine if the expense was covered under that scheme, if so you will only be entitled to receive out of pocket expenses.

Some of the usual requirements for payment of medical expenses will be waived for retrospective payments. Including:

  • maximum amounts set for treatment and services will not apply. For example, a worker who paid more for their own treatment will not be disadvantaged by this usual requirement
  • pre-approval by insurer will not apply as the treatment or service has already been provided.

Is an assessment for permanent impairment required to be eligible for medical benefits?

All workers are entitled to a further two years of medical benefits from the date their weekly payments ceased or the date of injury (whichever is the latter). An assessment for permanent impairment is not required for this benefit.

If these changes are only possible because the NSW workers compensation scheme is in surplus, will they be removed if the scheme goes into deficit?

No, these benefit enhancements will be an ongoing part of the system.

How do I find out more about the benefits?

Your insurer should be the first point of contact for any inquiries. Further information is also available elsewhere on this website insurancereforms.nsw.gov.au or you can call the SIRA Customer Contact Centre on 13 10 50.

 Return to work benefits

How does the up to $1,000 return to work assistance operate?

A return to work assistance payment of up to $1,000 will be made available for workers who return to work with a new employer. The purpose of the assistance is to provide support with back-to-work transition for injured workers.

An injured worker who has found employment with a new employer has most likely been on benefits for 6 months. By this point, workers may require assistance with work clothing, tools, or transport and/or childcare costs until they receive a regular wage.

A regulation will need to be developed to define how this assistance will be delivered. SIRA is currently consulting with stakeholders to inform the development of the regulation. Submissions are open from 12 November 2015 to 10 December 2015. To make a submission, go to www.workcover.nsw.gov.au/about-us/have-your-say.

How does the up to $8,000 retraining and education assistance work?

An education and retraining assistance payment of up to $8,000 is being introduced for injured workers with greater than 20% permanent impairment who have reached 78 weeks (2.5 years) of entitlement to weekly payments.

These workers are likely to require a higher level of retraining or education to enter a new vocation and re-join the workforce. This assistance is in keeping with the Government’s philosophy of providing injured workers with the support and incentive to return to work.

The payment will be made to a provider of tertiary education or vocational training.

A regulation will need to be developed to define how this assistance will be delivered. SIRA is currently consulting with stakeholders to inform the development of the regulation. Submissions are open from 12 November 2015 to 10 December 2015. To make a submission, go to www.workcover.nsw.gov.au/about-us/have-your-say.

Aids and modifications

What types of prostheses and aids are being extended from retirement to life?

Prostheses and aids available for life will include: crutches, artificial limbs, hearing aids and batteries, eyes or teeth, spectacles and other artificial aids. Home and vehicle modifications are being made available on the same basis.

BENEFITS COMMENCING 16 OCTOBER 2015

Lump sum compensation benefit and funeral expenses

Why are these benefits back-dated to 5 August 2015?

This was the date that the draft bill, the Workers Compensation Amendment Bill 2015, was introduced into Parliament. The Bill was passed on 13 August, but the Government decided to go with the earlier date.

Retiring age and weekly benefits

What has changed for workers injured at retiring age? And why?

Previously, depending on when a person was injured, weekly payments may have stopped at retiring age. All eligible workers are now entitled to up to 12 months of weekly payments of compensation after reaching retiring age. This benefit ensures equity for all workers approaching retiring age.

My weekly payments were stopped when I reached retiring age, what do I do now?

The insurer managing your claim will endeavour to identify all claims affected by the changes and contact you if you have an entitlement to weekly payments of compensation. You may also contact your insurer for information about the changes and how they may apply to you.

What evidence will I need to provide to my insurer to show I continued to be incapacitated as a result of my injury after reaching retiring age?

You will need to provide a certificate of capacity to your insurer which is completed by your nominated treating doctor. You will also need to complete the declaration that is attached to the certificate and send that to the insurer at the same time. Ordinarily a certificate of capacity cannot cover a period of more than 90 days before the date of the certificate. The NSW Government has changed the law to enable workers who have an entitlement because of this reform to have a certificate that covers a period of time of more than 90 days ago.

What happens if I am now on the aged pension?

Contact the insurer who managed your workers compensation claim to discuss the process required to claim your weekly payments of compensation.

If I have already started my aged pension who needs to contact Centrelink if my workers compensation weekly payments recommence?

Once it is agreed you have an entitlement, your insurer will contact Centrelink to advise them of your entitlement, including the gross amount per week you will receive and the period you will receive it for.

What happens to my other benefits attached to my aged pension if my weekly payments of compensation start again?

You will need to contact Centrelink to discuss what will happen to any other benefits related to your aged pension that you are receiving for the time you will receive weekly payments of compensation.

If my weekly payments were stopped almost three years ago do I get the weekly payments reinstated up to 1 October 2015?

No. You will only be entitled to weekly payment of compensation under your workers compensation claim for a maximum period of 12 months after you reached retiring age.

Will I be entitled to medical expenses?

You would have been entitled to reasonably necessary medical expenses for the 12 month period after your weekly payments previously ceased. You will also be entitled to payment for reasonably necessary medical expenses for the 12 month period after your reinstated weekly payments cease.

What happens if I have already paid my medical expenses? Will I able to be reimbursed?

You will be entitled to reimbursement for reasonably necessary medical expenses incurred during the 12 month period after weekly payments ceased. You will need to provide evidence that you incurred the expense as a result of your injury.

What happens if the insurer has not contacted me yet?

Your insurer will endeavour to review all claims where workers weekly payments of compensation ceased at retiring age and to contact those workers. This may take some time as case managers search their databases for workers who are eligible, determine what entitlements they should get under the new regulation, and contact each worker in this situation. Your patience during this time is appreciated, however, you may contact your insurer as your first point of contact for any enquiries.

STRUCTURAL REFORM

What is SafeWork NSW?

SafeWork NSW is the State’s workplace health and safety regulator.

It focuses on harm prevention and improving the safety culture in New South Wales workplaces.

SafeWork NSW will also include the establishment of a centre of excellence for work, health and safety in New South Wales.

What is Insurance & Care NSW (icare)?

Insurance & Care NSW (icare) is a new service delivery organisation focused on better health and return to work outcomes as opposed to rigid claims processing. It will be more supportive and there will be fewer forms and less bureaucracy. Injured workers will have greater say in their treatment and return-to-work pathway. icare will use new technologies and customer-friendly initiatives to make the system more accessible and predictable, and easier to use.

How will the process be simplified in future under Insurance & Care NSW (icare)?

icare is dedicated to the provision of services to injured workers and with a customer-centred charter.

The amount and complexity of paperwork for injured workers, employers and medical providers will be simplified so it will be easier for people to receive their benefits, be treated as quickly as possible, and return to work.

Injured people will find it much easier to find out the progress of a claim and who to contact with a query. A range of online and other tools, including mobile apps, will be rolled out to make the customer’s journey simpler and more transparent.

What benefits can be expected for employers from icare?

icare is a new organisation dedicated to the provision of services to injured workers and with a customer-centred charter.

We are simplifying the amount and complexity of paperwork for injured workers, employers and medical providers so it will be easier for people to receive their benefits, be treated as quickly as possible, and return to work. The system will be more supportive, more predictable and far more transparent in terms of the status of claims.

The premium changes being introduced – focused on simplicity, fairness, transparency and return to work outcomes – are completely in keeping with the ethos that will underpin icare.

Who will run icare?

icare reports to the Minister for Finance, Services and Property, Dominic Perrottet. It is governed by an independent board of directors, which includes the Chief Executive and up to eight non-executive Directors. Michael Carapiet is the Chair of icare and Michael Pratt is the Deputy Chair. The Chief Executive of icare is Vivek Bhatia, former CEO of SRWS.

What is the State Insurance Regulatory Authority (SIRA)?

The State Insurance Regulatory Authority (SIRA) assumes the regulatory functions of WorkCover NSW in relation to workers compensation insurance, the Motor Accidents Authority in relation to Compulsory Third Party (CTP) insurance as well as regulatory functions relating to Sporting Injuries Compensation and Home Building Compensation.

This will eliminate conflict and achieve efficiencies in the delivery of key outcomes.

SIRA will focus on ensuring key public policy outcomes are being achieved in relation to service delivery to injured people, affordability, and the effective management and sustainability of the insurance schemes.

Who runs SIRA?

Anthony Lean, Deputy Secretary, Better Regulation, Department of Finance Services and Innovation, is the Chief Executive of SIRA. He has carriage of day-to-day business. The Board determines the strategic direction.

Who is on the board of SIRA?

The Board for SIRA was announced on 20 November 2015. The SIRA Board appointments include Chair, Mr Trevor Matthews, who is a long time insurance industry professional with extensive experience both in Australia and overseas; Deputy Chair, Ms Nancy Milne, OAM a highly credentialed lawyer with experience that includes the insurance and risk management sectors; and three board members, Dr Abby Bloom an adjunct professor at the Menzies Centre for Health Policy and experienced company director, the Secretary of the Department of Finance, Services and Innovation, Martin Hoffman and the Chief Executive of SIRA, Anthony Lean. Read here for more information on the Board.

What will happen within Safety Return to Work and Support (SRWS)?

We have created three organisations from SRWS, each with its own focused role and contribution to the care, insurance and regulation of NSW workers, businesses and road users. The Safety Return to Work and Support Board has been abolished.

icare will deliver customer-centred services to those currently served by WorkCover, Lifetime Care & Support Authority, Dust Diseases Authority, SICorp and Sporting Injuries Compensation.

It will be a centre of excellence for long-term care needs, care for people with the highest needs, helping people return to work and improving quality of life outcomes.

The State Insurance Regulatory Authority (SIRA) is a principles and risk-based insurance regulator, covering workers compensation and compulsory third party insurance for motor accidents and home building compensation. SIRA will focus on ensuring key public policy outcomes are being achieved in relation to service delivery to injured people, affordability, and the effective management and sustainability of the insurance schemes.

SafeWork NSW is the State’s workplace health and safety regulator. It will focus on harm prevention and improving the safety culture in NSW workplaces. SafeWork NSW will include the establishment of a centre of excellence for work health and safety in NSW.

What will happen to SRWS employees?

Employees have been directly transferred to the new entities. There will also be new roles and opportunities that employees will be eligible to apply for.

There is no change to the employment of staff who work within the State Insurance Regulatory Authority (SIRA) or SafeWork NSW. They continue to be employed by the Department of Finance, Services and Innovation (formerly Office of Finance and Services).

Employees who have moved to icare are employed by that entity under the same entitlements and terms and conditions as their current arrangements.

How many public servants are going to lose their jobs as a consequence of these reforms?

There are no job losses as a consequence of these changes. There are no plans to relocate any staff from Gosford and other regional areas.

What will happen to the recommendations from the Allegations of bullying in WorkCover NSW (Inquiry)?

The supported recommendations will be implemented across all three entities.

The Dust Diseases Authority (DDA)

What changes have been made to the Dust Diseases Board?

The Workers’ Compensation Dust Diseases Board (the agency) is now the Workers Compensation Dust Diseases Authority or the Dust Diseases Authority (DDA), with all existing functions, expertise and staff.

Services are being provided to the Dust Diseases Authority by the new entity icare. icare is also the service provider for the Workers Compensation Nominal Insurer,  Lifetime Care and Support Authority and the Self Insurance Corporation (SICorp).

A Chief Executive of the Dust Diseases Authority will be appointed.

A Dust Diseases Board comprising a broader range of stakeholder representatives will be established to authorise grants for research into the prevention, diagnosis and treatment of dust diseases and to support the activities of groups who provide support to sufferers of dust diseases and their families.

Claims will be approved by the Dust Diseases Authority within strict timeframes to ensure sufferers of dust diseases receive the earliest possible access to their entitlements.

What is the role of the Dust Diseases Authority (DDA)?

  • The DDA supports people with work related dust diseases and their dependants.
  • Staff employed to administer the Dust Diseases scheme undertake all the assessment activities related to determining the application including arranging to obtain medical reports and work histories of applicants.
  • All applications for compensation must firstly be considered by the Medical Assessment Panel before being approved by the DDA.
  • The Medical Assessment Panel determines if an applicant has a compensable dust disease.
  • The DDA formally approves an award of compensation if satisfied the applicant is a worker in NSW. In the vast majority of cases, the issue of worker status is not in question.

What is the role of the Dust Diseases Board?

The former Dust Diseases Board consisted of seven members, three representing employer groups; three representing employer groups (unions) and one independent chair (CEO, SRWS).  Board members other than the Chair receive an annual payment of $11,330.

A new Dust Diseases Board comprising a broader range of stakeholder representatives will be established to authorise grants for research into the prevention, diagnosis and treatment of dust diseases and to support the activities of groups who provide support to sufferers of dust diseases and their families.

Why will clients be better off under the new structure?

Workers with dust diseases can expect faster access to compensation benefits and medical expenses and greater peace of mind.