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Workers compensation bulletin - issue 18

In this edition: vocational programs and forms, the new workers compensation guide for allied health practitioners, the AHRR, Section 39 special provisions, work capacity decisions legal costs, the 2017 medical and allied health Fees Orders, and training and evaluation of permanent impairment.

Updates to SIRA vocational programs and forms

SIRA has updated the guidance material and forms for a number of its vocational programs.

SIRA vocational programs help workers recover at/return to work following a work related injury or illness. The programs offer financial support, incentives and assistance to workers and employers because we know it is better for everyone when a worker returns to work following an injury or illness.

The guidance material for the SIRA training, JobCover placement, and Equipment and workplace modification programs has been amended to allow workers to complete the program even if their weekly payments stop while the program is underway.

JobCover and Work trial guidance material has also been updated to align with recent changes to the SIRA training, Equipment and workplace modifications, and Transition to work guidance material. These updates incorporate the new return to work assistance benefits, improve readability, and reflect current SIRA branding.

The JobCover placement program – agreement [PDF] and the JobCover placement program – employer incentive payment claim form [PDF] have also been modified to improve user experience and functionality.

The new guidance material and forms can be found at www.sira.nsw.gov.au. If you have any questions or feedback regarding these documents, please contact claims.design@sira.nsw.gov.au.

New workers compensation guide for allied health practitioners

We are pleased to announce the release of the workers compensation guide for allied health practitioners.

Developed after extensive consultation with stakeholders across the workers compensation system, the guide provides allied health practitioners with essential information for the delivery of treatment services in the NSW workers compensation system.

Allied health recovery request update

We have updated our suite of supporting documents for practitioners using the allied health recovery request (AHRR).

The new documents include a webinar and step-by-step guide, as well as examples of completed AHRRs for both physical and psychological fields.

All of these resources can be found on our AHRR webpage.

Section 39 special provisions for existing recipients of weekly payments

From 16 December 2016, two new transitional provisions will be introduced in the Workers Compensation Regulation 2016. These special provisions will enable eligible workers to access ongoing entitlement to weekly payments beyond five years (260 weeks).

The provisions apply to workers in receipt of weekly payments immediately before 1 October 2012 (‘existing recipients’).

They provide that certain injured workers may be excluded from the five-year cap on weekly payments. Specifically, where the worker’s injury has resulted in permanent impairment and:

  • an assessment of the degree of permanent impairment is pending and has not been made because an approved medical specialist has declined to make the assessment on the basis that maximum medical improvement has not been reached and the degree of permanent impairment is not fully ascertainable, or
  • the insurer is satisfied that the degree of permanent impairment is likely to be more than 20 per cent (whether or not the degree of permanent impairment has previously been assessed).

Additionally, these workers are able to undergo a further assessment of the degree of permanent impairment for the purposes of determining the worker's entitlement to certain benefits.

The Workers Compensation Amendment (Transitional Arrangements for weekly payments) Regulation 2016 has been published on the Government legislation website

Legal costs for the review of a work capacity decision

Effective from 16 December 2016, a new provision has commenced which allows a legal practitioner to be paid for providing legal advice to a worker in connection with an application for a merit review of a work capacity decision.

A worker is now eligible to access paid legal advice:

  • after an internal review of a work capacity decision by the insurer has been conducted and the worker has been notified of the decision of the insurer, or
  • if the insurer has not completed the internal review of the work capacity decision within 30 days after the worker made an application for the internal review.

Legal costs will be payable where the original work capacity decision date is on or after 16 December 2016.

The Commencement Proclamation under the Workers Compensation Amendment Act 2015 and the Workers Compensation Amendment (Legal Costs) Regulation 2016 have been published on the NSW Government Legislation website.

2017 medical and allied health Fees Orders now available

11 Fees Orders were gazetted on 9 December 2016 and apply to services provided on or after 1 January 2017.

The Fees Orders are:

Most of the rates have been indexed in line with either the Wage Price Index or the Australian Medical Association’s List of Medical Services and Fees (1 November 2016).

Section 61 (2) of the Workers Compensation Act 1987 and Section 339 of the Workplace Injury Management and Workers Compensation Act 1998 provides that, in respect of medical and related treatment, an employer is not liable to pay in excess of an amount fixed by SIRA and published in the Gazette.

Timetable for implementation

These fees are payable for services delivered on or after 1 January 2017.

Access to the Fees Orders

All Medical and Allied Health Fees Orders will be available on the SIRA website prior to 1 January 2017.

Please direct any queries you have about the Fees Orders to contact@sira.nsw.gov.au.

Breakdown of the major changes in 2017 Fees Orders

Amendments include:

  • the introduction of item numbers for existing services (Surgeons and Orthopaedic Surgeons Fee Orders):
  • “Out of hours consultation” -  WCO007
  • “Out of hours loading” -  WCO008
  • “Opinion on file request”-  WCO009
  • clarification of out of hours loading calculation. To be calculated at 20 per cent of the total procedure fee. Item must be reflected in the invoice as a separate entry against code WCO008 (Surgeons and Orthopaedic Surgeons Fee Orders)
  • clarification that code WCO002 is to be used when billing 'telephone requests including case conferences' (Surgeons and Orthopaedic Surgeons Fee Orders)
  • removal of schedule 5 'Rates of Senior Approved Medical Specialists' (Independent Medical Examinations Fees Order)
  • modified rate for 'Travel for assessment/consultation at the worker’s place of work' to an hourly rate of $326.80 per hour (Injury Management Consultants Fees Order)
  • provision for flying allowance (applicable to schedules 2, 3 and 4 of Medical Examination and Reports Fees Order). This fee only applies when the IME is required to fly to a location they (or the medico-legal company they contract to) do not usually service (Medical Examination and Reports Fees Order)
  • the introduction of item number PSY007 for trauma focused psychological treatment (provided to an Emergency service worker employed by a Treasury Managed Fund member agency who has been diagnosed with a work related post-traumatic stress disorder (Psychology & Counselling Fees Order)
  • an increase of fee for completion of initial allied health recovery request (AHRR) from $25 to $35.60 ('Psychology and Counselling', 'Accredited Exercise Physiology' and 'Physiotherapy, Chiropractic and Osteopathy' Fees Orders).

Training in the evaluation of permanent impairment

We are pleased to announce Solutions Plus Training (trading as AMA Training) as the new provider for training in the evaluation of permanent impairment in the NSW workers compensation system. Training will commence in early 2017.

Solutions Plus Training is AMA Victoria’s education and training business unit who will be partnering with AMA NSW to deliver the training.

In the last decade, Solutions Plus Training have trained over 1300 Australian doctors to become accredited impairment assessors.

For more information or to register for training please contact Solutions Plus Training on 03 9280 8722 or amatraining@amavic.com.au.

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