Workers compensation guidelines, April 2020
SIRA aims to ensure that the insurance and support systems we steward are easy to deal with and deliver protection, recovery and restoration entitlements and good outcomes at an affordable price and in a sustainable way.
SIRA has been adapting and responding to the impacts of COVID-19, and have made minor changes to the Workers Compensation Guidelines designed to:
- reduce regulatory barriers, or
- provide additional clarity for insurers and other stakeholders regarding their approach to arranging work capacity assessment appointments, and / or independent medical examinations.
The table below provides a summary of key changes, the reason for the change, and any relevant additional information for the Guidelines.
About these guidelines
Updated page 5 to reflect that these Guidelines replace the October 2019 Guidelines.
The amendments reflect the replacement of the October 2019 Guidelines by the 2020 Guidelines.
Part 4: Compensation for medical, hospital, and rehabilitation expenses
Minor amendments to Table 4.1 Reasonably necessary treatments and services available without pre-approval from the insurer on page 15.
The changes now provide:
Nominated Treating Doctor
Consultation or case-conferencing for the injury, apart from home visits.
If referred by the nominated treating doctor, any consultation and treatment during consultations for the injury. Referrals for diagnostic tests must meet the Medicare Benefits Schedule criteria.
The changes remove the requirement to obtain pre-approval for telehealth. The October 2019 version of the Guidelines provided:
Nominated Treating Doctor
Consultation or case-conferencing for the injury, apart from telehealth and home visits
If referred by the nominated treating doctor, any consultation and treatment during consultations for the injury (apart from telehealth). Referrals for diagnostic tests must meet the Medicare Benefits Schedule criteria.
Part 5: Work capacity assessments
Minor changes to 5.3 Requirement to attend appointments at page 21, including:
These changes ensure:
Part 7: Independent medical examinations and reports
Part 7: Independent medical examinations and reports (continued)
Minor changes to 7.4 Special Requirements at page 26 to clarify that in limited or special circumstances, examination by video consultation may be appropriate.
Minor changes to 7.7 Unreasonable Request at page 29 to include a requirement that the insurer must consider whether the requirement to attend an IME is reasonable in the circumstances, and that this includes consideration of amendments to existing laws and public health orders made in response to COVID-19.
Provides clarity that a pandemic, such as COVID-19 in Australia, would be considered a special circumstance for the purposes of Part 7.
This change ensures that the insurer actively considers relevant laws or public health orders. For instance, these will impact a worker’s ability to leave their place of residence and travel to an appointment.