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.
If a worker and employer meet SIRA’s eligibility criteria and program requirements, the worker and employer’s use of the program will be accepted and the insurer will administer the program costs.
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.
The application must include a detailed description of how the equipment and / or workplace modifications addresses 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 recover at, or return to work, or to commence a new work role e.g. tools of the trade such as a basic toolkit.
- Workplace modifications are 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 check whether a worker has an entitlement to new employment assistance (under section 64B of the 1987 Act) - note this does not apply to exempt workers. 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.
An agent for icare Insurance for NSW, self-insurer or specialised insurer
When the worker’s claim is with an agent for icare Insurance for NSW2, 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 an agent for icare Insurance for NSW, 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.
Payments should be made in line with the amount(s) approved. Payment should only be made where there is evidence of cost/expenditure (e.g. purchase order, tax invoice, receipts or record of travel such as a travel log or fares).
The insurer / agent must have controls in place to prevent duplicate payments being made and claimed.
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.
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.
Agent for icare Insurance for NSW
When the claim is with an agent for icare Insurance for NSW, 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 an agent for icare Insurance for NSW, 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.
Insurer / agent reimbursement
Insurers and agents can request reimbursement from SIRA for program costs. Insurers and agents are to ensure that all claims for reimbursement can be substantiated. Substantiated means programs are approved and supported by appropriate evidence of the expenses.
Self and specialised insurers
Reimbursements from SIRA can be claimed within six months of the costs being incurred by submitting a claim for payment, evidence of payment and relevant receipts.
Nominal insurer and agent for icare Insurance for NSW
Reimbursements from SIRA can be claimed by a tax invoice. The invoice should be accompanied by an itemised breakdown by claim and program type of the costs incurred.
For more information about making a claim for reimbursement contact firstname.lastname@example.org.
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 equipment and workplace modifications program, the worker should try to resolve the matter with the insurer in the first instance.
For information on what to do when a request to use a SIRA funded program has not been approved, find out how to request a review of a program decision.
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
- Workers compensation guidelines
- An agent for icare Insurance for NSW provides workers compensation insurance to most public sector employers except those who are self-insurers. icare Insurance for NSW 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.