There is strong evidence that work promotes recovery and reduces the risk of long term disability and work loss. The focus of the NSW workers compensation system is to support workers to recover at/return to work following a work related injury.
Section 53 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) allows the State Insurance Regulatory Authority (SIRA) to develop, administer and coordinate vocational rehabilitation schemes for workers.
The SIRA equipment and workplace modifications program provides funding for workplace equipment or modifications that may assist a worker to remain at work with their pre-injury employer or to commence work with a new employer.
A worker is eligible if:
- at the time of program commencement, they are receiving, or are entitled to receive, weekly payments under the Workers Compensation Act 1987 (1987 Act)
- a commutation or work injury damages settlement has not been accepted.
An application for equipment and/or workplace modifications must address the following principles:
- It is not an item that should be provided by the employer as part of their obligations under the Work Health and Safety Act 2011 (WHS Act).
- The cost is reasonable and other alternatives have been explored and considered to be inappropriate.
- It will be used for a reasonable period of time and is solely or mainly for the use of the worker.
- The existing equipment or lack of the required item was not a contributing factor to the initial injury (where the worker is returning to the pre-injury employer).
- It is essential to allow the worker to return to or remain at work, or to commence a new work role e.g. tools of the trade such as a basic toolkit.
- Workplace modifications are particular and specific to the worker’s functional requirements in allowing them to return to work.
Preparing an application
A worker’s return to work coordinator, insurer, or approved workplace rehabilitation provider (provider) may prepare an application.
The person developing the application must determine whether a worker has an entitlement to new employment assistance (under section 64B of the 1987 Act)1. It may be appropriate to confirm this with the insurer. Where the worker is entitled to claim such assistance, this entitlement must be exhausted before accessing funding under the SIRA equipment and workplace modifications program.
A worker who has an entitlement to new employment assistance may be eligible for funding under the SIRA equipment and workplace modifications program where:
- they have exhausted their entitlement to new employment assistance (this includes where an application exceeds $1,000), or
- the insurer disputes liability for the new employment assistance (including where the insurer does not notify the worker of a decision within the required time period).
A combined new employment assistance and equipment and/or workplace modifications application may be developed where costs required exceed $1,000. In this instance, it will be necessary to demonstrate the application meets the requirements for both a new employment assistance claim and the SIRA equipment and workplace modifications program.
If any requirements cannot be met, justification must be provided outlining why the proposal is necessary to assist the worker to recover at or return to work.
A SIRA equipment and/or workplace modifications application is submitted using the vocational program - details form together with:
- evidence addressing the relevant principles (this may be within a workplace assessment report completed by a suitably qualified professional or other appropriate documentation)
- confirmation that the intervention and associated costs are reasonable
- confirmation that the strategy is appropriate for the worker’s needs and functional capacity
- evidence that the employer has agreed to the installation of the proposed equipment/modification and ongoing maintenance.
SIRA does not prescribe an application form for new employment assistance.
Figure 1 below aims to guide decision making concerning the development of an application.
Assessing an application
Applications $500 or less
A provider can assess applications that are $500 or less. The provider must follow their service provision and internal quality assurance processes to confirm the application meets the SIRA equipment and workplace modifications requirements and relevant principles.
The provider can arrange supply of equipment and/or workplace modifications without seeking formal approval from the insurer. However, the provider must inform the insurer in writing of the specific costs relating to the application.
Applications above $500
Nominal Insurer scheme agent
When the worker’s claim is with a Nominal Insurer scheme agent, the agent will assess applications that are above $500.
The agent will write to the worker and the person submitting the application, advising their decision to approve or decline the request and the reason for their decision within 14 days.
If the application is not approved, the agent must advise the worker of the SIRA appeal process.
SICorp insurance agent, self-insurer or specialised insurer
When the worker’s claim is with a SICorp insurance agent2, the agent will assess applications for funding that cost more than $500 but less than $10,000.
When the worker’s claim is with a self or specialised insurer3, the insurer will assess applications for funding that cost more than $500 but less than $2,000.
The agent/insurer will write to the worker and the person submitting the application, advising their decision to approve or decline the request and the reasons for their decision within 14 days.
If the application is not approved, the agent/insurer must advise the worker of the SIRA appeal process.
If the application exceeds the cost a SICorp insurance agent, or self or specialised insurer may approve, the application must be sent via email to SIRA at firstname.lastname@example.org within 14 days.
The application must include the insurer’s opinion on whether they support the equipment and/or workplace modifications application with reference to the equipment and workplace modifications principles.
SIRA will then assess the application for funding in light of the insurer’s recommendation. The insurer will be advised of the outcome of the assessment in writing within 10 working days of receiving a complete application. The insurer will advise the worker of the outcome of the assessment, and the SIRA application appeal process if the application is not approved.
A completed vocational program – claim for payment form and relevant invoices or receipts must be submitted to facilitate payment.
Up to $300 may be paid in advance (where appropriate) for travel and when a minimum of 10 days’ notice is given.
Nominal Insurer scheme agent
When the claim is with a Nominal Insurer scheme agent, the agent is responsible for administering payment of vocational program expenses.
SICorp insurance agent
When the claim is with a SICorp insurance agent, the agent is responsible for administering payment of vocational program expenses less than $10,000.
Self-insurer or specialised insurer
When the claim is with a self or specialised insurer, the insurer is responsible for administering payment of vocational program expenses less than $2,000.
When the claim is with a SICorp insurance agent, self-insurer or specialised insurer and the costs exceed the amounts above, SIRA will make payments.
These payments will be processed when a vocational program – claim for payment form, copy of the vocational program – details form and relevant invoices or receipts are received at email@example.com.
NOTE: A minimum of 10 working days is required to enable processing and payment of approved costs.
Insurers seeking reimbursement for expenses should submit a claim for payment and relevant receipts to SIRA within six months from the date the expenses were incurred.
Following approval, the person who developed the application is responsible for confirming:
- the equipment or workplace modifications are installed correctly
- the worker (and employer where relevant) has been adequately trained to use the equipment or modifications
- the original need for equipment or workplace modifications has been addressed.
Ownership and maintenance
If the equipment is small, customised or movable, it will belong to the worker. Larger items, such as permanent fixtures or modifications to the workplace, will be owned by the employer – however they may be asked to contribute to the cost where appropriate.
If the worker is re-employed elsewhere within the first six months and still requires the equipment, SIRA may cover reasonable and necessary transport costs to relocate the equipment to a new workplace.
The employer will be responsible for normal maintenance, repairs and insurances in line with obligations under the WHS Act which requires an employer to provide and maintain a work environment that is without risks to health and safety.
When equipment is no longer required
If equipment is no longer required within six months of the date of issue and the provider is still in contact with the worker, re-issue of the equipment to another worker may be negotiated. If the worker is no longer in contact with the provider, the worker should contact SIRA on 13 10 50.
If there is disagreement about eligibility or use of the SIRA equipment and workplace modifications program prior to submission of an application, the worker and/or provider should try to resolve the matter directly with the insurer in the first instance.
If the problem cannot be resolved, contact SIRA on 13 10 50 or email firstname.lastname@example.org.
Where a vocational program – details form has been submitted to the insurer and they have not signed the form indicating program approval, the worker can request an internal review by the insurer.
If agreement has not been obtained following an internal insurer review, an appeal can be lodged with SIRA by writing to: Director, Claimant Outcomes, State Insurance Regulatory Authority (SIRA), Locked Bag 2906, Lisarow NSW 2250 or email@example.com.
The appeal must outline the reasons a review is requested and provide information/evidence to support the request. SIRA may ask for additional information from the worker, person submitting the application, and/or the insurer.
SIRA will notify the worker and the insurer of the outcome of the appeal within 10 working days of receiving an appeal and all the necessary supporting information.
Vocational rehabilitation programs resources are available:
- Vocational program - details form
- Vocational program - claim for payment
- Work trial guidance material
- Transition to work guidance material
- JobCover placement program guidance material
- Workplace Injury Management and Workers Compensation Act 1998 section 53 – vocational rehabilitation programs
- Workers Compensation Act 1987 section 64B – new employment assistance
- Workers Compensation Amendment (Return to Work Assistance) Regulation 2016
- Guidelines for claiming workers compensation
- Refer to the Guidelines for claiming workers compensation – B4.1 Return to work assistance (new employment assistance).
- SICorp provides workers compensation insurance to most public sector employers except those who are self-insurers. SICorp contracts insurance agents to manage policies and claims on its behalf.
- Self-insurers are employers approved by SIRA to manage their own workers compensation claims. Specialised insurers hold a restricted licence to provide workers compensation insurance for a specific industry or class of business or employers.