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Workers compensation regulation bulletin - Issue 66 (July 2019)

In this edition: Have your say: Customer service conduct principles, Uninsured employers put on notice, The dispute resolution transitional review period has ended, Helpful tool for small business to understand their responsibilities, Guidance for workers reaching the end of the medical entitlement period, Submissions to the Compliance and Performance Review of the Nominal Insurer close.

Have your say: Customer service conduct principles

We are seeking feedback on the proposed Customer Service Conduct principles for insurers dealing with workers compensation, motor accidents (compulsory third party), and home building compensation claims in NSW.

Under our proposed Customer Service Conduct principles, insurers will be required to attest to compliance at regular intervals that they meet these five principles:

  1. Be efficient and easy to engage
  2. Act fairly, with empathy and respect
  3. Resolve customer concerns quickly, respect customers’ time and be proactive
  4. Have systems in place to identify and address customer concerns
  5. Be accountable for actions and honest in interactions with customers.

The principles aim to ensure policy holders and people who experience injury and loss are provided with fair, timely, respectful, inclusive and appropriate services, and the opportunity to provide feedback on the service they receive.

To read the consultation paper and make a submission visit the online consultation page. Submissions are invited by 19 August 2019.

Uninsured employers put on notice

We have recouped more than $1 million in unpaid premiums and issued more than 50 fines to employers for not having the right workers compensation insurance in recent months.

Employers who have not met their workers compensation obligations have been targeted, particularly those who deliberately avoided paying workers compensation insurance.

Uninsured employers may be subject to fines and enforcement action ranging from $750 up to six months imprisonment.

We encourage all employers to take out appropriate workers compensation insurance and do the right thing by their workers.

The dispute resolution transitional review period has ended

The improved workers compensation dispute resolution system provided that from 1 January 2019, the Workers Compensation Commission (Commission) is the central body for resolving workers compensation disputes.

Transitional review period 

The transitional arrangements related to work capacity decisions came to an end on 1 July 2019.

The transitional review period required work capacity decisions made by the insurer before 1 January 2019 to be resolved through the previous dispute resolution pathway. This involved a three-staged review process including an internal review by the insurer, a merit review by SIRA, and a procedural review by the Workers Compensation Independent Review Office (WIRO).

From 1 July 2019, workers who have a work capacity decision notice dated before 1 January 2019, and who have not already requested an internal review by the insurer before 30 June 2019, have the option to either:

  • ask for an optional review of their work capacity decision by the insurer (by a different person within the insurance organisation), or
  • lodge a dispute directly with the Commission.

Workers who have a work capacity decision dated before 1 January 2019, who have requested an internal review by the insurer before 30 June 2019, can visit the SIRA web site for more information about their options.

Decision notice summary 

We have also updated the workers compensation decision notice summary following feedback from stakeholders. Insurers should now be using Version 1.1. of the updated decision notice summary (July 2019).

Further information

Workers can contact the Workers Compensation Independent Review Office (WIRO) if they have an enquiry or complaint. WIRO can help workers obtain independent legal advice about work capacity decisions made by insurers at no cost to the worker.

Visit the reforms page for more information on the workers compensation dispute resolution reforms.

Helpful tool for small business to understand their responsibilities

A new online tool is making it easier for small business to learn about their workers compensation obligations and find out what to do when a worker is injured.

Our Small Business Assist tool has step-by-step information to help time-poor employers understand the requirements after taking out a workers compensation policy.

It explains how to record and report an injury and help someone recover and return to work, and the employer’s role in the claims and recovery process.

There’s also information about the support available, how to maintain a safe workplace, and links to other resources.

Guidance for workers reaching the end of the medical entitlement period

Some workers will soon reach the end of the entitlement period to claim medical benefits from the NSW workers compensation system.

We have developed information and resources to encourage workers, health providers and insurers to work together to plan smooth transitions to alternative treatments and supports.

Under section 59A of the Workers Compensation Act 1987, workers can claim medical, hospital, and rehabilitation expenses for:

  • two years after weekly payments stop, where their degree of permanent impairment is 10 per cent or less
  • five years after weekly payments stop, where their degree of permanent impairment is 11 to 20 per cent.

Workers with greater than 20 per cent permanent impairment are entitled to medical treatment, service or assistance for life.

Some workers are expected to start reaching their medical entitlement limits from September 2019.

Read more and access the resources

Submissions to the Compliance and Performance Review of the Nominal Insurer close

The Compliance and Performance Review of the Workers Compensation Nominal Insurer has attracted significant interest from employers, workers and industry stakeholders.

More than 150 submissions were received during the extended public consultation period which ended on Friday, 5 July.

A summary of the themes in the submissions will be made publicly available.

The Nominal Insurer, which is managed by icare, is the largest insurer in the NSW workers compensation system and accounts for approximately 65% of total active claims. It provides workers compensation cover for more than 320,000 employers, collects $2.3 billion in premiums, and pays out approximately $1.97 billion in claim related costs per year.

The Independent Reviewer, Ms Janet Dore, has met with individuals and representatives from more than 30 stakeholders including workers, employers, self and specialised insurers, industry associations and unions.

She has also held meetings in Tamworth, Wagga Wagga, Orange, Newcastle and Wollongong.

We expect to publish a final report by the end of 2019.