1.7 - Section 53 Vocational re-education programs: requirements for insurers
Learn more about requirements for insurers under 1.7 - Section 53 Vocational re-education programs.
We institute, administer and/or coordinate vocational re education and rehabilitation schemes for injured workers. This information outlines the administration, management and reporting of s53 vocational re education and rehabilitation programs.
Schemes for vocational re education, rehabilitation and retraining of injured workers
Section 53 of the Workplace Injury Management and Workers Compensation Act 1998 No 86 (WIMWC Act) provides for us to institute, administer or coordinate vocational re education and rehabilitation schemes for injured workers. These schemes include:
- financial assistance for the rehabilitation and retraining of injured workers, including formal training and on the job experience with a host employer such as work trials or return to work assistance for micro-employers
- financial incentives for the provision of equipment or workplace modifications to employers who retain their injured workers or employers who offer new employment to unemployed injured workers
- financial assistance to employers who offer new employment to unemployed injured workers, eg JobCover placement program
- financial assistance to injured workers to address any immediate, short term barrier or need preventing them accepting employment in a new work role ie transition to work payment
Costs associated with these programs are funded from the Workers Compensation Operational Fund. The payments are to be recorded against a claim but are excluded from an employer’s experience adjusted premium.
Quality assurance process
The insurer is required to utilise an internal quality assurance process for the review of all program proposals, prior to notification of a decision to all parties. All decisions including those regarding high cost proposals should be made in accordance with the quality assurance process and the relevant vocational program guidance material.
Review of applications
Where the insurer does not approve a vocational program, the insurer is required to provide a decision in writing to the worker. The worker, workplace rehabilitation provider or employer can ask us to review the decision.
Administration and payment:
The insurer will administer and make payment for the costs as outlined in each program's guidance material except where the guidance material indicates SIRA will administer the payment.
Premium calculation
The cost of s53 programs are not to be included in the cost of claim for premium setting purposes in the same way as interpreter fees are excluded from premium setting.
The insurer is requested to be mindful of the need to exclude such costs from employers whose premium is experience rated.
Reporting
Financial reporting
Disclosure of all costs paid by the insurer associated with vocational re-education programs are required to be reported in the insurance agent's monthly claim submission and monthly financial reporting returns.
These costs are for SIRA vocational programs including
- work trials
- training
- equipment and workplace modifications
- financial incentives (JobCover placement program)
- transition to work
- return to work assist for micro-employers (travel costs only)
The transactional level data must correspond to the amounts disclosed on the monthly financial reporting returns and are subject to audits (both financial and process).
Transactional data reporting
To ensure transactional level data is reported against each claim in the insurer's monthly claim submission for all vocational programs, the following claims technical manual reporting requirements are to be used.
Claims Technical Manual reporting requirements
When a vocational program has been approved for an injured worker, the following information will need to be supplied against the claim at certain times, to satisfy the reporting requirements of the Claims Technical Manual.
It is important to note that this is current practice in the Claims Technical Manual, no changes have been made.
Vocational programs
We require information identifying the type of vocational program approved on a claim, eg work trial, JobCover, equipment, training or transition to work), as well as the relevant dates for the program.
Depending on the type of vocational rehabilitation program approved, one of the two possible events will be triggered. These are either vocational program event or work trial event.
Vocational rehabilitation program event
This event is required at the beginning of each approved program and then at the end to capture the completion date (where it is not the same as the start date).
The vocational rehabilitation program event is triggered when the service provision type (C: 2.4.8) is equal to ‘02’ vocational rehabilitation program and the service provision sub type (C: 2.4.9) is equal to '02', '03', '04' or '05'.
Data Item Number | Data Item Name |
---|---|
C:2.4.8 | Service provision type |
C:2.4.9 | Service provision sub type |
C:2.4.6 | Service provision start date |
C:2.4.7 | Service provision end date |
C:2.4.10 | Service provision null date |
Work trial event
This event is required at the beginning of each work trial and then at the end of the work trial to capture the completion date.
The work trial event is triggered when the service provision type (C: 2.4.8) is equal to ‘02’ vocational rehabilitation program and the service provision sub type (C: 2.4.9) is equal to ‘01’ – work trial.
Data Item Number | Data Item Name |
---|---|
C:2.4.5 | Rehabilitation provider code |
C:2.4.8 | Service provision type |
C:2.4.9 | Service provision sub type |
C:2.4.6 | Service provision start date |
C:2.4.7 | Service provision end date |
C:2.4.10 | Service provision null date |
C:2.4.11 | Work trial host employer ABN |
Processing payments
To make a payment for costs associated with an approved vocational rehabilitation program against a claim, a payment classification code from the following suite of codes must be used:
- VWT001 – work trial equipment
- VWT002 – work trial travel expenses, also to be used for return to work assist travel expenses
- VJC002 – JobCover employer incentive instalment 1
- VJC003 – JobCover employer incentive instalment 2
- VJC004 – JobCover employer Incentive instalment 3
- VEQ001 – equipment
- VRE001 – retraining course costs
- VRE002 – retraining stationary allowance
- VRE003 – retraining travel expenses
- VRE004 – retraining accommodation
- VTP001 – transition to work using these codes will trigger the ‘other payments’ event.
Other payments event
This event is triggered when the payment classification number (C:2.5.17) is not equal to WPT001, WPT002, WPT003, WPT004, WPP001, WPP002, WPP003, WPP004 or DEC003. The complete data set required to report a payment successfully is as follows:
Data Item Number | Data Item Name |
---|---|
C:2.1.22 | Claimants language code |
C:2.5.5 | Payment transaction date |
C:2.5.6 | Adjustment transaction flag |
C:2.5.7 | Payment and/or recovery amount |
C:2.5.15 | Payee identification |
C:2.5.16 | Service provider identification |
C:2.5.17 | Payment classification number |
C:2.5.18 | Date of service |
Return to work assist program for micro employers
This program is to be recorded using the same process for a work trial event as described above (also refer Claims Technical Manual 6.4.19) to enable use of VWT002 for payment of a worker’s travel costs. Travel costs are to be reimbursed to ensure the worker is not disadvantaged financially given the worker will be receiving weekly payments at 95% of pre-injury average weekly earnings during the program and not their full pre-injury earnings.
Estimates event
This estimates event is triggered when the liability status code (C:2.2.9) is equal to 02, 05, 07, 08, 10, 11 and the claim closed flag (C:2.2.5) is equal to ‘N’.
To ensure an anticipated vocational program is estimated against a claim properly, an estimate type and amount must be entered.
When using the estimate type 64 estimate on liabilities, the estimate to be excluded from cost of claims calculations is to be used in data item estimate type (C:2.6.5) to ensure that vocational program costs are not included in the cost of claims calculations
The complete data set required to report this successfully is as follows:
Data Item Number | Data Item Name |
---|---|
C:2.2.5 | Claim closed flag |
C:2.6.4 | Estimate type |
C:2.6.5 | Estimate amount |
C:2.6.6 | Estimated future weeks off work for total incapacity |
Examples
1. Work trial
A work trial for an injured worker for 8 weeks, is due to commence 12/7/2011 to 3/9/2011. It is anticipated that travel expenses of $250.00 (40 days at $6.25/day return train fare) as well as a telephone headset at $325.00 will be required.
This information is to be reported to us in your claim submission file as follows:
Estimate event (if not already captured)
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.2.5 | Claim closed flag | N |
C:2.6.4 | Estimate type | 64 |
C:2.6.5 | Estimate amount | $575.00 |
C:2.6.6 | Estimated future weeks off work for total incapacity | As estimated for the claim |
Work trial event
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.4.5 | Rehabilitation provider code | NNNN |
C:2.4.8 | Service provision type | 02 |
C:2.4.9 | Service provision sub type | 01 |
C:2.4.6 | Service provision start date | 20110712 |
C:2.4.7 | Service provision end date | 00000000 |
C:2.4.10 | Service provision null date | 00000000 |
C:2.4.11 | Work trial host employer ABN | NNNNNNNN |
Note: When the service provision is complete, this event must be supplied to us again to provide the service provision end date (C:2.4.7). This date must be reported as the actual end date of the service (refer to the last section of this example). Additionally, if an error is made on this service provision record, the record details are to be reported again with a date in the service provision null date (C:2.4.10).
Other payments event
Payment is only to be made once a Claim for Payment form and an Invoice or travel receipts are provided.
Telephone headset payment
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.1.22 | Claimants language code | As per claim detail |
C:2.5.5 | Payment transaction date | Actual date payment was made |
C:2.5.6 | Adjustment transaction flag | N |
C:2.5.7 | Payment and/or recovery amount | $325.00 |
C:2.5.15 | Payee identification | ABN of company being paid |
C:2.5.16 | Service provider identification | ABN of supplier |
C:2.5.17 | Payment classification number | VWT001 |
C:2.5.18 | Date of service | Invoice date |
Travel reimbursement – week 1 (12/7/2011 to 15/07/2011)
Where there are multiple services for travel expenses within the same reimbursement claim, the aggregate value for the payments is reported as one transaction for the claim number, one weeks travel rolled up to 1 payment as shown below.
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.1.22 | Claimants language code | As per claim detail |
C:2.5.5 | Payment transaction date | Date payment was made |
C:2.5.6 | Adjustment transaction flag | N |
C:2.5.7 | Payment and/or recovery amount | $31.25 |
C:2.5.15 | Payee identification | REIMB |
C:2.5.16 | Service provider identification | NOABN |
C:2.5.17 | Payment classification number | VWT002 |
C:2.5.18 | Date of service | 20110715 |
Note: In some cases a prepayment of travel of up to $300 may be approved. In this example if a pre payment was approved the change to the above would be the following 2 data items:
- Payment and recovery amount (C:2.5.7) $250.00
- Date of service (C:2.5.18) 20110712
Work trial event
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.4.5 | Rehabilitation provider code | NNNN |
C:2.4.8 | Service provision type | 02 |
C:2.4.9 | Service provision sub type | 01 |
C:2.4.6 | Service provision start date | 20110712 |
C:2.4.7 | Service provision end date | 20110903 |
C:2.4.10 | Service provision null date | 00000000 |
C:2.4.11 | Work trial host employer ABN | NNNNNNNNNNN |
2. JobCover placement program
An Agreement has been signed and lodged for the JobCover Placement Program for an injured worker. The employment commences on 1 August 2011 and the employer incentive for each instalment has been agreed as it is anticipated that the worker’s wages will exceed the weekly wage rate of the incentive.
Estimate event (if not already captured)
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.2.5 | Claim closed flag | N |
C:2.6.4 | Estimate type | 64 |
C:2.6.5 | Estimate amount | $27,400.00 |
C:2.6.6 | Estimated future weeks off work for total incapacity | As estimated for the claim |
Vocational rehabilitation program event
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.4.8 | Service provision type | 02 |
C:2.4.9 | Service provision sub type | 04 |
C:2.4.6 | Service provision start date | 20110801 |
C:2.4.7 | Service provision end date | 00000000 |
C:2.4.10 | Service provision null date | 00000000 |
Other payments event
Payment is only to be made once the JobCover placement program claim for payment form and required evidence has been received and accompanied by a completed JobCover placement program agreement.
Employer incentive – instalment 1 (wage period 1/8/11 to 21/10/2011)
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.1.22 | Claimants language code | As per claim detail |
C:2.5.5 | Payment transaction date | Actual date payment is made (ie post Date of Service) |
C:2.5.6 | Adjustment transaction flag | N |
C:2.5.7 | Payment and/or recovery amount | $4,800.00 |
C:2.5.15 | Payee identification | ABN of company being paid |
C:2.5.16 | Service provider identification | ABN of company being paid |
C:2.5.17 | Payment classification number | VJC002 |
C:2.5.18 | Date of service | 20111021 |
Note: Date of service (C:2.5.18) is the actual end date of the Instalment period
Employer incentive – instalment 2 (wage period 24/10/11 to 27/01/2012)
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.1.22 | Claimants language code | As per claim detail |
C:2.5.5 | Payment transaction date | Actual date payment is made (ie post Date of Service) |
C:2.5.6 | Adjustment transaction flag | N |
C:2.5.7 | Payment and/or recovery amount | $7,000.00 |
C:2.5.15 | Payee identification | ABN of company being paid |
C:2.5.16 | Service provider identification | ABN of company being paid |
C:2.5.17 | Payment classification number | VJC003 |
C:2.5.18 | Date of service | 20120127 |
Note: Date of Service (C:2.5.18) is the actual end date of the Instalment period
Employer incentive – instalment 3 (wage period 30/01/12 to 29/07/2012)
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.1.22 | Claimants language code | As per claim detail |
C:2.5.5 | Payment transaction date | Actual date payment is made (ie post Date of Service) |
C:2.5.6 | Adjustment transaction flag | N |
C:2.5.7 | Payment and/or recovery amount | $15,600.00 |
C:2.5.15 | Payee identification | ABN of company being paid |
C:2.5.16 | Service provider identification | ABN of company being paid |
C:2.5.17 | Payment classification number | VJC004 |
C:2.5.18 | Date of service | 20120729 |
Note: Date of service (C:2.5.18) is the actual end date of the Instalment period
Note: When the service provision is complete, this event must be entered again to provide the service provision end date (C:2.4.7). This date must be reported as the actual end date of the service (refer to the last section of this example). Additionally, if an error is made on this service provision record, the record details are to be reported again with a date in the service provision null date (C:2.4.10).
Vocational Rehabilitation Program Event
Data Item Number | Data Item Name | Information to be reported |
---|---|---|
C:2.4.8 | Service provision type | 02 |
C:2.4.9 | Service provision sub type | 04 |
C:2.4.6 | Service provision start date | 20110801 |
C:2.4.7 | Service provision end date | 20120729 |
C:2.4.10 | Service provision null date | 00000000 |
Further information
Workplace Injury Management and Workers Compensation Act 1998
SIRA training program guidance material
SIRA equipment and workplace modifications guidance material
JobCover placement program guidance material
SIRA transition to work program guidance material
Return to work assist program for micro-employers guidance material