Although workers compensation is a statutory insurance it is not managed or controlled by the federal government, but is instead governed by each state or territory, which has its own legislation, regulations and systems. For national employers this means that you will need to place insurance, and manage your claims with up to 8 different regulators, agents and insurers operating under these environments. There has been an approach however, to develop Work Health and Safety (WHS) standards that act in co-operation with the state and territory governing bodies to harmonise WHS laws. This implementation is driven through Safe Work Australia.
Workers compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment. This insurance generally relinquishes the employee’s right to sue his or her employer for the tort of negligence.
Should an employee’s injury exceed certain impairment thresholds, depending upon the jurisdiction, they do have the right however to claim for common law damages. This occurs when a worker injured in circumstances involving the negligence of the employer, or of fellow workers for which the employer is liable, may have a claim for common law damages. There may also be a claim against a third party such as the occupier of premises where a worker is injured.
The workers compensation regulators for each of the states and territories are as follows:-
- Australian Capital Territory – Work Safe Act
- New South Wales – Work Cover NSW
- Northern Territory – NT Work Safe
- Queensland – The Workers’ Compensation Regulator (formerly Q-COMP)
- South Australia – ReturnToWork SA (from 1st July 2015)
- Tasmania – WorkCover Tasmania
- Victoria – WorkSafe Victoria
- Western Australia – WorkCover WA
How can we add value?
Work Health Options (WHO) constantly places workers compensation insurance cover for employers in all jurisdictions. Our national team can provide all the advice you require including:
- Understanding your business and structure
- Reviewing your classifications in all States and Territories
- Premium projections
- Advising of liability exposures
- Setting up national insurance programmes and agent/insurer tenders
- Negotiating rates in risk states (WA, NT, TAS & ACT)
- Minimising premiums in managed fund states (NSW, VIC, SA & QLD)
- Education and training on premium calculations
- Wages Definition
- How claims decisions impact premiums
- Providing advice on the impacts as your business grows and develops
- Impacts of acquisitions and mergers
- Premium funding
- WorkCover appeals and retrospective adjustments
- Self-Insurance and Retro Paid Loss advice
Injury management and early intervention is vital to the health, safety and welfare of employees and subsequently reduces employers’ cost base in terms of direct and indirect expenses.
WHO currently works with clients to implement effective injury management protocol which includes communication and a pro-active approach to claims management starting with early intervention. Combined with the adherence to detailed service standards, this delivers an earlier return to work hence cost saving.
Without continuity of these ideals, WHO believes that the complete injury management process will falter. We believe that claims management is imperative, but only a part of the injury management process, hence this is why we need to manage your claims both effectively and efficiently.
WHO establishes productive policies, procedures and effectively assist our clients in managing their responsibilities. WHO puts forward recommendations to help continuously improve the current operations of the organisation.
It is crucial that an injury is managed correctly, and is just as important that the agent/insurer has developed an injury management programme. The programme should be aimed at assisting our clients and injured workers in returning to work at the earliest possible opportunity. WHO assists our clients by maintaining the insurer achieves the above initiatives by;
- Developing and implementing injury management strategies using an evidence-based approach
- Keep up to date with the latest research on effective injury management approaches
- Ensure that costs on the claim are justified by proven results
- Assist with legislative requirements
- Encouraging and facilitating early reporting of injuries;
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- A claims streaming process that enables them to manage and enhance their resources effectively and efficiently (e.g. high/low risk claims management)
- The development of injury management plans for injured workers
- Managing the claim with effective case conferencing principles – we currently attend and represent the employer as there are a number of clients where we act on their behalf
- The regular monitoring of treatment and other costs
- Early and appropriate referral to rehabilitation
A Return To Work (RTW) Co-ordinator is an employee nominated by an employer whose principal purpose is to assist injured workers to return to work in a safe and durable manner. The RTW Co-ordinator ensures the policy and procedures in an employer’s return to work programme are followed. WHO currently acts for clients as their National RTW Co-ordinator involving all key stakeholders in the process.
WHO focuses on effective rehabilitation which plays a major role in injury management and minimises the economic and social costs of work related injury and illness. Our approach is based on the philosophy that rehabilitation commences at the time of the injury.
The development of rehabilitation programmes are supported by medical updates, claims personnel, technical advice and resources provided by our preferred agents’/insurers’ team.
WHO believes that rehabilitation should be:
- Industry based
- Function orientated
- Based on early intervention
- Multi-disciplinary
- Based around a shared responsibility of all stakeholders (workers/employers, WHO and professionals)
WHO constantly works with their clients’ on varying degrees of psychological claims. These are a sensitive issue for any employer; hence we maintain that there is support from WHO’s preferred agents’/insurers’ dedicated claims management team to ensure that all necessary steps are taken. Each case is outcome focused utilising a number of disciplines and techniques.
WHO’s aim is to work with clients and become an extension of their human resources, industrial relations and work health and safety teams. We work with managers/staff from these division as well as business owners utilising our four key areas which underpins our business model and exclusive networks including;
- Return to Work & Injury Management
- Claims Management
- Broking Services
- Health & Wellbeing