Insurers - COVID and workers compensation
Insurers are to ensure that workers impacted by the COVID-19 pandemic continue to receive weekly payment entitlements without delay or interruption.
COVID-19 presumption for certain workers
Amendments to the workers compensation act 1987 in 2020 introduced a presumption that workers in prescribed employment who contract COVID-19, are automatically presumed to have contracted it in the course of their employment (unless the contrary is established).
The presumption makes it easier for those workers who contract COVID-19 to receive workers compensation entitlements to support their recovery.
The Workers Compensation Amendment (Consequential COVID-19 Matters) Regulation 2020 commenced on 24 July 2020. The Regulation sets out the medical tests and results for these workers, how the presumption applies, and types of prescribed employment.
Eligible workers are also presumed to be incapable of work until 21 days from the date of injury, or if the worker still has COVID-19 at this date, until the date marking the end of the worker’s incapacity on the worker’s certificate of capacity.
SIRA expects insurers to apply a proactive and pragmatic approach to managing COVID-19 workers compensation claims that promotes the intent of the presumptive legislation.
SIRA provides further guidance and expectations for insurers when managing COVID claims in the claims management guide and standard of practice 32.
Certificates of capacity
The legislation allows certificates of capacity to be issued for periods greater than 28 days where special reasons exist, and that second and subsequent certificates may be obtained from their treating physiotherapist or psychologist (SIRA would consider the COVID-19 pandemic to be a ‘special reason’ for the purposes of section 44B(4) of the Workers Compensation Act 1987).
If the person giving the certificate states the special reasons for the longer period and the insurer is satisfied that, for the special reasons stated, the certificate should be accepted, then a certificate may cover a period greater than 28 days (see section 44B of the Workers Compensation Act 1987).
Longer certificates reduce the risk for workers and GPs potentially being exposed to COVID-19.
Insurers are encouraged to proactively discuss longer certificates with workers and providers where appropriate.