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Workers compensation bulletin - issue 60

In this edition: Dispute resolution changes set to improve the system in 2019, new pathways for enquiries and complaints, the pathway for disputes, new requirements for insurer claims administration and conduct, SIRA shutdown and best wishes for the holiday season.

Dispute resolution changes set to improve the system in 2019

The improved NSW workers compensation dispute resolution system commences on 1 January 2019.

After consulting widely with stakeholders, the Government has designed a system that seeks to make the process simpler and clearer, with more consistent outcomes for workers, employers, insurers and other providers.

The changes are designed to reduce disputes by streamlining the system so everyone can get the information they need to resolve issues early on.

When disputes do occur, the improved system positions the Workers Compensation Commission (WCC) as the central body for workers compensation dispute resolution.

There are also changes to the management of enquiries and complaints with the Workers Compensation Independent Review Office (WIRO) being responsible for managing all enquiries and complaints from workers about the conduct of their claim by the insurer. These pathways are outlined in the below article New pathways for enquiries and complaints.

The enhanced system includes new Workers compensation guidelines, gazetted today, which take effect 1 January 2019. The guidelines explain what insurers, workers, employers and other stakeholders must do in relation to claims under NSW workers compensation legislation.

Standards of practice have also been published today, which outline new expectations for the handling of workers compensation claims and insurer conduct, with effect from 1 January 2019. Further details are available in the below article: New requirements for insurer claims administration and conduct.

The guidelines and standards complete the initial package of reforms following the commencement of the Workers Compensation Amendment Regulation 2018 and the proclamation of certain schedules of the Workers Compensation Legislation Amendment Act 2018 on Friday, 14 December 2018.

Overview of changes

In the improved workers compensation system, from 1 January 2019:

  • Insurers will provide single decision notices which must be clear and communicated simply so workers can understand the impacts on their entitlements and the reasons for the decision.
  • Insurers will be required to issue, as part of a decision notice: a summary in the approved form detailing the effect of the decision; the worker’s rights for a review; the procedure for requesting a review; and the support available to a worker.
  • Employers will have the flexibility to display legally required information about workers compensation and return to work programs on their websites, including intranets. This new digital display option supports innovation and reflects modern workplace environments, and the rising trend of remote working.
  • The WCC will be able to award permanent impairment compensation without an approved medical specialist, allowing disputes to be resolved faster so the worker can remain focused on their return to work and wellbeing.
  • Amended commutation provisions will mean that workers who meet the criteria of a catastrophic injury, entitling them to medical and related treatment and services under the National Injury Insurance Scheme (NIIS), will not be able to commute their compensation for medical, hospital and rehabilitation under the workers compensation legislation.  However, these workers will still retain the right to commute their entitlement to weekly payments. This aligns the NSW workers compensation system with the NIIS.

The final component of the workers compensation amendments is the simplification of a worker's pre-injury average weekly earnings (PIAWE) calculation, and is expected to commence later in 2019.

PIAWE has been identified as a key contributor to disputes in the existing system, due to the complexity of the calculation framework. Under the improved workers compensation dispute resolution system, the simplified PIAWE calculation will be more transparent, enabling insurers, employers and workers to understand and explain the process more clearly.

For more information about the amendments, visit our Workers compensation dispute resolution reforms page.

New pathways for enquiries and complaints

From 1 January 2019, there are new pathways for anyone who has been unable to resolve their workers compensation issue with the insurer in the first instance.

WIRO, through its Solutions Group, will handle:

  • enquiries by (or on behalf of) injured workers
  • complaints about the conduct of the insurer regarding the handling of their claim

SIRA will continue to assist:

  • injured workers who have a complaint about their employer or a provider (for example, a treatment provider)
  • employers and other stakeholders who have an enquiry or a complaint related to workers compensation.

The pathway for disputes

A key change for the system is the clear positioning of the Workers Compensation Commission (WCC) as the central body for resolving all workers compensation disputes.

All work capacity decisions made by the insurer on or after 1 January 2019 will have the new dispute pathway through the WCC.

Work capacity decisions made by an insurer before 1 January 2019 will continue to have the existing dispute pathway until the six-month 'transitional review period' is complete. From 1 July 2019, all work capacity disputes will be managed by the WCC, regardless of the decision date.

Workers should get advice from their union, a lawyer or the Workers Compensation Independent Review Office (WIRO) immediately if they are unsure about what the decision notice means, or would like to challenge (dispute) the decision. WIRO has a list of approved lawyers who can give advice which may be at no cost to the worker. This list is available on the WIRO website wiro.nsw.gov.au or workers may call WIRO on 13 94 76 or email complaints@wiro.nsw.gov.au

If a worker disagrees with all or part of the insurer's decision, they have the right to a review of the decision. A worker can:
ask for an optional review by the insurer (by a different person within the insurer), or  
lodge a dispute with the WCC as the independent tribunal for workers compensation disputes. A worker can go to them directly, with assistance from their lawyer (if the worker has one), or after an insurer review if they still disagree with the insurer's decision.
For more information about the new pathways read the fact sheet.

New requirements for insurer claims administration and conduct

SIRA has created new standards of practice and guidelines for insurers to improve outcomes in the workers compensation system.

The Standards of practice, Workers compensation guidelines and Workers compensation medical dispute assessment guidelines, were published today (21 December) and will take effect on 1 January 2019.

The standards of practice will support and encourage insurers to have effective claims management practices to help deliver positive experiences and outcomes for workers, employers and the people of NSW.  

They are supported by streamlined and consolidated Workers compensation guidelines which have been published in the Government Gazette on the NSW Legislation website today.

The workers compensation guidelines replace the:

  • Guidelines for claiming workers compensation (1 August 2016)
  • Guidelines on injury management consultants (27 September 2012)
  • Guidelines on independent medical examinations and reports (13 March 2012).

Workers compensation medical dispute assessment guidelines have also been gazetted. They replace the WorkCover medical assessment guidelines 2006 and complement reforms to the dispute resolution process.

The WorkCover interim payment direction guidelines 2009 have been revoked. Instead, stakeholders should refer to the Workers Compensation Commission's practice direction no. 10 Interim payment directions for weekly payment of compensation or medical expenses compensation (30 October 2018).

Visit SIRA's claims handling requirements webpage for more information about the standards and guidelines. This page also has information about the online platform SIRA is building to improve access to information about workers compensation claims management.

SIRA shutdown

SIRA will be closed over the holiday period, from Monday 24 December 2018 to Friday 4 January 2019.

To support stakeholders to respond to incidents throughout the Christmas and New Year period, SIRA has developed an Operational Response Plan (ORP).

Should the need arise, the ORP team will respond to a serious incident involving a participant in the NSW workers compensation system, or a significant risk to either your or SIRA's operations.

The plan will be in operation from 5 pm Friday 21 December 2018 to 8 am 7 January 2019.

The SIRA Operational Response Team will be on call 24 hours a day during this time on (02) 4321 5015. Please use this number only in the event of a serious incident.

Should you have any questions regarding the ORP, please email us at: ORPCoordinator@sira.nsw.gov.au

Best wishes for the holiday season

From all of us at SIRA, we would like to wish you an enjoyable and safe festive season, and a happy new year.