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