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Workers compensation insurer data reporting requirements

The Workers Compensation Insurer Data Reporting Requirements (Requirements) describes the rules and the process workers compensation insurers must follow to submit their workers compensation insurance data. The Requirements take effect from 31 May 2019.

The Requirements replace the:

  • the Claims technical manual nominal insurer V 4.14
  • the Claims technical manual self and specialised insurers V 5.10
  • the Payment classification booklet (published in 2013)

General introduction

The Workers Compensation Insurer Data Reporting Requirements (Requirements) describes the rules and the process workers compensation insurers must follow to submit their workers compensation insurance data.

Purpose of the Requirements

The Requirements support delivery of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) and the Workers Compensation Regulation 2016 by establishing clear processes and procedures around the submission of claims data to SIRA.

The accurate and timely collection of notification of injuries and claims data is essential to assist in the service delivery to people with a work-related injury, affordability and the effective management and sustainability of the system.

The data collected is used by SIRA in achieving its function as the regulator for example: ensure stakeholders comply with legislation and guidelines and to monitor their performance, identify areas of high risk and the publication of reports.

For the purposes of these Requirements, a notification of injury and a claim are hereinafter referred to as a claim, unless otherwise specified.

Publication notes

These Requirements are published by the State Insurance Regulatory Authority (SIRA) and replace the following documents:

  • Claims technical manual nominal insurer V 4.14 (published in 2016)
  • Claims technical manual self and specialised insurers V 5.10 (published in 2016)

An independent agency located within the NSW Customer Service Cluster, the Authority is constituted under the State Insurance and Care Governance Act 2015 and is responsible for regulating workers compensation insurance, motor accidents compulsory third party (CTP) insurance and home building compensation insurance in NSW.

Replacement and transition

The following publications are repealed:

  • the Claims technical manual nominal insurer V 4.14
  • the Claims technical manual self and specialised insurers V 5.10

and are replaced by these Requirements.

These Requirements apply to all claims data submitted by workers compensation insurers.

Legislative framework

The data described in these Requirements is collected under:

  • the conditions of the insurer’s licence and/or in accordance with Section 23(1)(m) and Section 40C of the 1998 Act and
  • Section 40B of the 1998 Act

Requirement making power

These Requirements are made under Section 40C of the 1998 Act.

Interpretation of the Requirements

These Requirements should be interpreted in a manner that supports the achievement of the objectives and general functions of SIRA under the workers compensation legislation as described in section 22 of the 1998 Act.

In order of hierarchy, if there is any conflict between the claims technical manual, guidance specification and the relevant legislation, the legislation takes precedence.

Commencement of the Requirements

The Workers compensation claims technical manual (WCIDRR01) is published by SIRA on 31 May 2019.

The Workers compensation claims data item guidance specification (WCIDRR02) is published by SIRA on 31 May 2019.

These Requirements are effective from the publication date until SIRA amends, revokes or replaces them in whole or in part. These Requirements supersede the previous requirements which were in place until 31 May 2019.

Parts of the Requirements

The Requirements are divided into the following parts:

Part 1: Claims technical manual: details the technical requirements for submitting workers compensation data

Part 2: Claims data item guidance specification: helps to explain how the data needs to be reported to SIRA.

Reference Data

Part 3: Claims technical manual claims state and events reference: details which data items are mandatory to report, which data items are optional to report, and when the data item must be reported.

Part 4: Claims technical manual validations reference: provides a validation matrix which lists all validations, their severity and the data items impacted.

Part 5: Claims technical manual code set reference: details all codes and code sets applicable to specific data items and provides a detailed description of each code and its use.

Part 6: Claims technical manual payment classification reference: provides a simplified list of payment classifications that can be reported by insurers.

Part 7: Claims technical manual payment classification and estimates reference, details:

  • all payment classifications that can be reported by insurers
  • the revised list of Medical services and fees published by the Australian Medical Association (AMA) payable to medical practitioners, providing medical or related treatment under the Workers Compensation Act 1987, and
  • a list of all estimate types and their descriptions.

Compliance with the Requirements

SIRA will monitor and review compliance with the Requirements. Compliance and enforcement will be undertaken in accordance with SIRA’s Compliance and enforcement policy (July 2017)

Penalties for not meeting reporting requirements

It is the responsibility of the insurer to ensure the accuracy, quality and timeliness of the data provided.

Failure to comply with these Requirements may result in regulatory sanctions being imposed including imposition of penalties, civil penalties or loss of licence if applicable.

Requirement identifiers

Each requirement component has been allocated a unique identifier (for example: WCIDRR01-01) to make it traceable. This will assist when:

  • searching for a requirement
  • linking requirements
  • advising relevant stakeholders when a requirement has been revised, and
  • to assist insurers when they request advice or suggest improvements.

Part 1: Claims technical manual

A pdf version is also available.

Data submission

SIRA assistance

WCIDRR01-01        For queries, suggested changes or enhancements about any aspect of these requirements, please contact the Data Quality and Exchange Team on ph: (02) 4321 5703 or email: data.information@sira.nsw.gov.au

Insurer types

WCIDRR01-02       These are allocated by SIRA and advised to the insurers. Insurers are to provide data in accordance with their allocated insurer type.

Data submission

WCIDRR01-03       In preparing a claim submission, insurers must report all new claims and all activity on a claim since its last successful report.

WCIDRR01-04       SIRA may validate claims data submissions prior to loading to ensure compliance with reporting requirements.

WCIDRR01-05       A claim is considered to have been successfully reported when the data submitted does not trigger any critical errors.

Record descriptions

WCIDRR01-06       The submitted file contains the following record types.

WCIDRR01-06.1     Header record

Record Set 1. Must be the first record on the submission. There must only be one of these in the submission.

WCIDRR01-06.2     Submission trailer record

Record Set 9. Must be the last record on the submission. There must only be one of these in the submission.

WCIDRR01-06.3     Basic claim detail record (1) & (2)

The Basic claim detail records 1 and 2 are considered part of the same record and must not be submitted in isolation.

Record Set 2 - Record Identifier 1. There can be at most one of these for each claim. This record must be reported for every new claim. This record must always be accompanied by a Basic claim detail record (2). If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

Record Set 2 - Record Identifier 7. There can be at most one of these for each claim. This record must be reported for every new claim. This record must always be accompanied by a Basic claim detail record (1). If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

WCIDRR01-06.4    Claim activity record

Record Set 2 - Record Identifier 2. This record must be reported for every new claim and every time there is a change in Liability status code (C: 2.2.9) on a claim. When there is no change in Liability status code and any other data item in the record is different to last successful report then only one record is to be reported with the latest data available as at Submission end date (C: 1.6).

If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

WCIDRR01-06.5     Time lost record

Record Set 2 - Record Identifier 3. There can be at most one of these for each claim reported. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

If the worker has not resumed employment as at the submission end date (C: 1.6) then this record must be reported to update the Number of days off work (C: 2.3.8).

WCIDRR01-06.6    Service provision record

Record Set 2 - Record Identifier 4. There can be any number of these for each claim reported. A service referral must only be reported once unless required to update any of the data describing that service referral, e.g. reporting the Service provision end date (C: 2.4.7).

WCIDRR01-06.7     Compensation payment and recovery record

Record Set 2 - Record Identifier 5. There can be any number of these for each claim reported.

WCIDRR01-06.8     Estimate record

Record Set 2 - Record Identifier 6. Required for open claim only. There must be only one record per applicable estimate type for each claim reported.

WCIDRR01-06.9    Work capacity record

Record Set 2 - Record Identifier 8. There can be any number of these for each claim reported. The Original decision date (C: 2.8.4) and work capacity decision type (C: 2.8.5) are used to identify a unique decision.

WCIDRR01-06.10   Claim control record

Record Set 2 - Record Identifier 9. There must be one of these for each claim reported.

Record dependencies

WCIDRR01-07       The first time a claim is reported, it must as a minimum include:

  • Basic claim detail record (1)
  • Basic claim detail record (2)
  • Claim activity record
  • Claim control record.

An Estimate record must also be reported if the claim is open and the Liability status code (C: 2.2.9) is not 01 (Notification of work related injury).

Submission record sorting

WCIDRR01-08.1     The submission records must be sorted in ascending sequence on the first 31 ASCII characters in each record.

WCIDRR01-08.2     In addition, work capacity records have a secondary sort in order of work capacity activity date (C: 2.8.8) from oldest activity date to latest activity date.

Submission frequency

WCIDRR01-09       Unless otherwise directed by SIRA each insurer must provide a minimum of one acceptable submission per month on or before the required delivery date. If there is no activity in a month, a Null submission, i.e. a header and trailer record only, must be submitted.

Insurer Type Required delivery date

Specialised                               15th calendar day of the month

Group-self                                15th calendar day of the month

Self-Insurer                               15th calendar day of the month

TMF (Treasury Managed Fund)  15th calendar day of the month

UL (Uninsured Liability)             15th calendar day of the month

NI (Nominal Insurer)                  6th business day of the month

Submission characteristics

WCIDRR01-010      The records in the submission must have the following characteristics:

  • ASCII format. Refer to table below.
  • All fields must be fixed length (zero or space filled as appropriate)
  • All records are fixed length of 900 characters
  • The submission file name must be formatted as
    CLMnnn.WCA where nnn is the insurer number allocated
    by SIRA.
  • The submission must be zipped prior to upload.

WCIDRR01-010.1              Acceptable ASCII characters

Decimal

Character

Hex

Decimal

Character

Hex

Decimal

Character

Hex

32

space

20

64

@

40

96

`

60

33

!

21

65

A

41

97

a

61

34

"

22

66

B

42

98

b

62

35

#

23

67

C

43

99

c

63

36

$

24

68

D

44

100

d

64

37

%

25

69

E

45

101

e

65

38

&

26

70

F

46

102

f

66

39

'

27

71

G

47

103

g

67

40

(

28

72

H

48

104

h

68

41

)

29

73

I

49

105

i

69

42

*

2a

74

J

4a

106

j

6a

43

+

2b

75

K

4b

107

k

6b

44

,

2c

76

L

4c

108

l

6c

45

-

2d

77

M

4d

109

m

6d

46

.

2e

78

N

4e

110

n

6e

47

/

2f

79

O

4f

111

o

6f

48

0

30

80

P

50

112

p

70

49

1

31

81

Q

51

113

q

71

50

2

32

82

R

52

114

r

72

51

3

33

83

S

53

115

s

73

52

4

34

84

T

54

116

t

74

53

5

35

85

U

55

117

u

75

54

6

36

86

V

56

118

v

76

55

7

37

87

W

57

119

w

77

56

8

38

88

X

58

120

x

78

57

9

39

89

Y

59

121

y

79

58

:

3a

90

Z

5a

122

z

7a

59

;

3b

91

[

5b

123

{

7b

60

<

3c

92

\

5c

124

|

7c

61

=

3d

93

]

5d

125

}

7d

62

>

3e

94

^

5e

126

~

7e

63

?

3f

95

_

5f

   

Submission structure

WCIDRR01-011       This section gives the size and structure for the data items contained in each record of a submission.

WCIDRR01-011.1              Claim header record

Data Item

From

To

Size

Type

C: 1.1 Record Set

1

1

1

Number

C: 1.2 Insurer number

2

4

3

Number

C: 1.3 Submission type

5

10

6

Text

C: 1.4 Claims system release number

11

12

2

Number

C: 1.5 Submission start date

13

20

8

Date

C: 1.6 Submission end date

21

28

8

Date

Filler

29

900

871

Text

WCIDRR01-011.2              Basic claim detail No. 1 record

Data Item

From

To

Size

Type

Claim identification data

    

C: 2.1.1 Record Set

1

1

1

Number

C: 2.1.2 Claim Identifier

2

20

19

Text

C: 2.1.3 Record identifier

21

21

1

Number

C: 2.1.4 No longer in use

22

40

19

Text

C: 2.1.5 Shared claim code

41

41

1

Number

C: 2.1.6 Error report target

42

48

7

Text

C: 2.1.7 Insurer branch

49

68

20

Text

C: 2.1.8 Date claim entered on insurer's system

69

76

8

Date

C: 2.1.9 Date claim made

77

84

8

Date

Employer data

    

C: 2.1.10 Policyholder identification number

85

103

19

Text

C: 2.1.11 Period commencement date

104

111

8

Date

C: 2.1.12 Tariff rate number

112

114

3

Number

C: 2.1.13 Employer name

115

189

75

Text

C: 2.1.14 Employer ACN or ARBN

190

198

9

Number

Claimant data

    

C: 2.1.15 No longer in use

199

238

40

Text

C: 2.1.16 Worker’s address - Street information

239

358

120

Text

C: 2.1.17 Worker’s address - Locality name

359

388

30

Text

C: 2.1.18 Worker’s address – Postcode

389

392

4

Number

C: 2.1.19 Worker's gender code

393

393

1

Text

C: 2.1.20 Worker's date of birth

394

401

8

Date

C: 2.1.21 No longer in use

402

405

4

Number

C: 2.1.22 Worker's language code

406

409

4

Number

C: 2.1.23 No longer in use

410

410

1

Text

C: 2.1.24 Worker's occupation code

411

414

4

Number

C: 2.1.25 Worker's dependent children

415

416

2

Number

C: 2.1.26 Worker's other dependants

417

418

2

Number

C: 2.1.27 No longer in use

419

419

1

Number

C: 2.1.28 Permanent employment code

420

420

1

Number

C: 2.1.29 Training status code

421

421

1

Number

C: 2.1.30 Hours worked per week

422

425

4

Number

C: 2.1.31 Pre-injury average weekly earnings/ Current weekly wage rate

426

433

8

Value

Accident data

    

C: 2.1.32 Duty status code

434

434

1

Number

C: 2.1.33 Workplace address - Street information

435

554

120

Text

C: 2.1.34 Workplace address - Locality name

555

584

30

Text

C: 2.1.35 Workplace address - Postcode

585

588

4

Number

C: 2.1.36 Workplace industry (ASIC)

589

592

4

Number

C: 2.1.37 Workplace industry (ANZSIC)

593

596

4

Number

C: 2.1.38 Workplace size

597

601

5

Number

C: 2.1.39 Incident location code

602

603

2

Number

C: 2.1.40 Incident location description

604

723

120

Text

C: 2.1.41 Incident locality name

724

753

30

Text

C: 2.1.42 Incident location postcode

754

757

4

Number

Injury data

    

C: 2.1.43 Date of injury

758

765

8

Date

C: 2.1.44 Time of injury

766

769

4

Number

C: 2.1.45 Nature of injury/disease code

770

772

3

Number

C: 2.1.46 Bodily location of injury/disease code

773

775

3

Number

C: 2.1.47 TOOCS Mechanism

776

777

2

Number

C: 2.1.48 Breakdown agency

778

780

3

Number

C: 2.1.49 Result of injury code

781

781

1

Number

C: 2.1.50 Date deceased

782

789

8

Date

C: 2.1.51 Employer ABN (Australian Business Number)

790

800

11

Number

C: 2.1.52 Workers Compensation Industry Classification (WIC) code

801

806

6

Number

C: 2.1.53 No longer in use

807

825

19

Text

C: 2.1.54 Agency of injury/disease

826

828

3

Number

C: 2.1.55 Significant injury date

829

836

8

Date

C: 2.1.56 Contact complete date

837

844

8

Date

C: 2.1.57 No longer in use

845

852

8

Number

C: 2.1.58 Worker (Home) telephone number

853

866

14

Text

C: 2.1.59 TOOCS Breakdown agency

867

870

4

Number

C: 2.1.60 TOOCS Agency of injury/disease

871

874

4

Number

Filler

875

900

26

Text

WCIDRR01-011.3              Claim activity record

Data Item

From

To

Size

Type

C: 2.2.1 Record Set

1

1

1

Number

C: 2.2.2 Claim identifier

2

20

19

Text

C: 2.2.3 Record identifier

21

21

1

Number

C: 2.2.4 Liability status date

22

29

8

Date

C: 2.2.5 Claim closed flag

30

30

1

Text

C: 2.2.6 Date claim closed

31

38

8

Date

C: 2.2.7 Date claim re-opened

39

46

8

Date

C: 2.2.8 Reason for re-opening claim code

47

47

1

Number

C: 2.2.9 Liability status code

48

49

2

Number

C: 2.2.10 No longer in use

50

51

2

Number

C: 2.2.11 Date of claim review

52

59

8

Date

C: 2.2.12 No longer in use

60

61

2

Number

C: 2.2.13 Work status code

62

63

2

Number

C: 2.2.14 No longer in use

  

0

 

C: 2.2.15 Second injury claim flag

64

64

1

Text

C: 2.2.16 Initial notifier code

65

66

2

Number

C: 2.2.17 Reasonable excuse code

67

68

2

Number

C: 2.2.18 No longer in use

69

76

8

Number

C: 2.2.19 No longer in use

77

78

2

Number

C: 2.2.20 Action date section 66

79

86

8

Date

C: 2.2.21 Action type section 66

87

88

2

Number

C: 2.2.22 Common law action date

89

96

8

Date

C: 2.2.23 Initial notifier name

97

136

40

Text

C: 2.2.24 Initial notifier telephone number

137

150

14

Text

C: 2.2.25 Description of incident

151

350

200

Text

C: 2.2.26 Description of Injury/illness

351

550

200

Text

C: 2.2.27 Work status date

551

558

8

Date

C: 2.2.28 Type of dispute

559

560

2

Number

C: 2.2.29 Date of claim screening

561

568

8

Date

C: 2.2.30 Claim screening action code

569

570

2

Number

C: 2.2.31 Result of the permanent impairment assessment (PI %).

571

573

3

Number

C: 2.2.32 Date claim recovery action commenced

574

581

8

Date

C: 2.2.33 Percentage of estimated recovery

582

584

3

Number

C: 2.2.34 Recovery investigation indicator

585

586

2

Number

C: 2.2.35 SIRA NSW Certificate of Capacity period start date

587

594

8

Date

C: 2.2.36 SIRA NSW Certificate of Capacity period end date

595

602

8

Date

C: 2.2.37 SIRA NSW Certificate of Capacity fitness

603

604

2

Number

C: 2.2.38 WCC matter number

605

612

8

Text

C: 2.2.39 Section 52A code

613

614

2

Number

C: 2.2.40 Common law action type

615

616

2

Number

C: 2.2.41 Common law action outcome

617

618

2

Number

C: 2.2.42 Work capacity transition date

619

626

8

Date

C: 2.2.43 Work capacity transition outcome

627

628

2

Number

C: 2.2.44 Estimated permanent impairment (EPI%)

629

630

2

Number

C: 2.2.45 Assessed percentage of permanent impairment for paid S66 benefits

631

633

3

Number

Filler

634

900

267

Text

WCIDRR01-011.4              Time lost record

Data Item

From

To

Size

Type

C: 2.3.1 Record Set

 

1

1

Number

C: 2.3.2 Claim identifier

2

20

19

Text

C: 2.3.3 Record identifier

21

21

1

Number

C: 2.3.4 Date ceased work

22

29

8

Date

C: 2.3.5 Estimated date fit to resume employment

30

37

8

Date

C: 2.3.6 No longer in use

38

45

8

Date

C: 2.3.7 Actual date resumed work

46

53

8

Date

C: 2.3.8 Number of days off work

54

58

5

Number

Filler

59

900

842

Text

WCIDRR01-011.5              Service provision record

Data Item

From

To

Size

Type

C: 2.4.1 Record Set

1

1

1

Number

C: 2.4.2 Claim identifier

2

20

19

Text

C: 2.4.3 Record identifier

21

21

1

Number

C: 2.4.4 No longer in use

22

24

3

Number

C: 2.4.5 Rehabilitation provider code

25

28

4

Number

C: 2.4.6 Service provision start date

29

36

8

Date

C: 2.4.7 Service provision end date

37

44

8

Date

C: 2.4.8 Service provision type

45

46

2

Number

C: 2.4.9 Service provision sub type

47

48

2

Number

C: 2.4.10 Service provision null date

49

56

8

Date

C: 2.4.11 Work trial host employer ABN

57

67

11

Number

Filler

68

900

833

Text

WCIDRR01-011.6              Compensation payment and recovery record

Data Item

From

To

Size

Type

C: 2.5.1 Record Set

1

1

1

Number

C: 2.5.2 Claim identifier

2

20

19

Text

C: 2.5.3 Record identifier

21

21

1

Number

C: 2.5.4 No longer in use

22

23

2

Number

C: 2.5.5 Payment transaction date

24

31

8

Date

C: 2.5.6 Adjustment transaction flag

32

32

1

Text

C: 2.5.7 Payment/
recovery amount

33

43

11

Value

C: 2.5.8 Payment period start date

44

51

8

Date

C: 2.5.9 Payment period end date

52

59

8

Date

C: 2.5.10 Hours paid for total incapacity

60

66

7

Number

C: 2.5.11 Hours paid for partial incapacity

67

73

7

Number

C: 2.5.12 Reimbursement schedule code

74

75

2

Number

C: 2.5.13 No longer in use

76

83

8

Number

C: 2.5.14 No longer in use

84

85

2

Number

C: 2.5.15 Payee ID

86

105

20

Text

C: 2.5.16 Service provider ID

106

125

20

Text

C: 2.5.17 Payment classification number

126

140

15

Text

C: 2.5.18 Date of service

141

148

8

Date

C: 2.5.19 Determined weekly benefit amount

149

156

8

Value

C: 2.5.20 Invoice number

157

176

20

Text

C: 2.5.21 Hours lost

177

183

7

Number

C: 2.5.22 Earnings

184

194

11

Value

C: 2.5.23 Deductibles

195

205

11

Value

Filler

206

900

695

Text

WCIDRR01-011.7              Estimate record

Data Item

From

To

Size

Type

C: 2.6.1 Record Set

1

1

1

Number

C: 2.6.2 Claim identifier

2

20

19

Text

C: 2.6.3 Record identifier

21

21

1

Number

C: 2.6.4 Estimate type

22

23

2

Number

C: 2.6.5 Estimate amount

24

35

12

Value

C: 2.6.6 Estimated future weeks off employment

36

41

6

Number

Filler

42

900

859

Text

WCIDRR01-011.8              Basic claim detail no 2 record

Data Item

From

To

Size

Type

C: 2.7.1 Record Set

1

1

1

Number

C: 2.7.2 Claim identifier

2

20

19

Text

C: 2.7.3 Record identifier

21

21

1

Number

C: 2.7.4 Worker’s surname

22

41

20

Text

C: 2.7.5 Worker’s given name/s

42

61

20

Text

C: 2.7.6 Accident location - Street information

62

181

120

Text

C: 2.7.7 Worker (Mobile) telephone number

182

195

14

Text

C: 2.7.8 Worker (Work) telephone number

196

209

14

Text

C: 2.7.9 Ordinary earnings

210

217

8

Value

C: 2.7.10 Shift allowance

218

225

8

Value

C: 2.7.11 Overtime

226

233

8

Value

C: 2.7.12 Worker's email address

234

487

254

Text

Filler

488

900

413

Text

WCIDRR01-011.9              Work Capacity Record

Data Item

From

To

Size

Type

C: 2.8.1 Record Set

1

1

1

Number

C: 2.8.2 Claim identifier

2

20

19

Text

C: 2.8.3 Record identifier

21

21

1

Number

C: 2.8.4 Original decision date

22

29

8

Date

C: 2.8.5 Work capacity decision type

30

31

2

Number

C: 2.8.6 Work capacity review stage

32

33

2

Number

C: 2.8.7 Work capacity date type

34

35

2

Number

C: 2.8.8 Work capacity activity date

36

43

8

Date

C: 2.8.9 Work capacity outcome

44

45

2

Number

Filler

46

900

855

Text

WCIDRR01-011.10    Claim Control Record

Data Item

From

To

Size

Type

C: 2.9.1 Record Set

1

1

1

Number

C: 2.9.2 Claim identifier

2

20

19

Text

C: 2.9.3 Record identifier

21

21

1

Number

C: 2.9.4 Claim payments to date

22

33

12

Value

C: 2.9.5 Claim recoveries to date

34

45

12

Value

C: 2.9.6 Total claim estimated liability

46

57

12

Value

C: 2.9.7 Total claim estimated recoveries

58

69

12

Value

C: 2.9.8 Hours paid total incapacity to date

70

78

9

Value

C: 2.9.9 No longer in use

79

87

9

Text

C: 2.9.10 No longer in use

88

90

3

Number

C: 2.9.11 Decreasing adjustment on settlement payments

91

102

12

Value

C: 2.9.12 Input tax credit on non-settlement payments

103

114

12

Value

C: 2.9.13 Estimate of decreasing adjustment

115

126

12

Value

C: 2.9.14 Estimated input tax credits

127

138

12

Value

C: 2.9.15 Hours lost to date

139

147

9

Value

Filler

148

900

753

Text

WCIDRR01-011.11    Claim submission trailer record

Data Item

From

To

Size

Type

C: 9.1 Record Set

1

1

1

Number

C: 9.2 Basic claim detail (1) record count

2

8

7

Number

C: 9.3 Claim activity record count

9

15

7

Number

C: 9.4 Time lost record count

16

22

7

Number

C: 9.5 Service provision record count

23

29

7

Number

C: 9.6 Compensation payment and recovery record count

30

36

7

Number

C: 9.7 Estimate record count

37

43

7

Number

C: 9.8 Claim control record count

44

50

7

Number

C: 9.9 Total payment/recovery amount

51

65

15

Value

C: 9.10 Basic claim detail record 2 record count

66

72

7

Number

C: 9.11 Work capacity record count

73

79

7

Number

Filler

80

900

821

Text

Data quality

Data Acceptance Criteria

WCIDRR01-012      There are 3 classes of validation rules applied across 4 data acceptance validation layers. The 3 classes of validations are:

  • Abort – if triggered the entire submission will be rejected
  • Critical – A claim triggering a critical error will not be loaded
  • Suspect – if triggered the claim will be loaded if it did not trigger   any critical errors

WCIDRR01-013      SIRA may add, remove or revise validations as required to ensure the quality of data provided.

WCIDRR01-014      For a list of all current validations, refer to the SIRA Workers Compensation Claims Technical Manual Validations Reference.

Validation Layer 1 - Abort

WCIDRR01-015      This validation layer will identify if the submission is formatted correctly and acceptable for further validation criteria. If an Abort error is identified, further validation layers will not be run on the submission. The submission will be rejected and the insurer will be required to correct and re-submit.

Validation Layer 2 – Critical – Data Completeness

WCIDRR01-016      This validation layer will review the claims records; identify triggered claim states and events and reject claims that have incomplete data reported for that state or event.  Critical error number C5000 will identify all data completeness errors for an individual claim.  If a claim triggers data completeness errors, further validation layers will not be run for that claim and the associated claims data will be rejected.

WCIDRR01-017      Any data items included in the submission that do not fall within a triggered claim state or event will not be validated or loaded.

Validation Layer 3 – Critical – Technical Errors

WCIDRR01-018      This validation layer will review the content in the individual data fields and ensure the format is correct. Critical error number C6000 will identify all technical errors for an individual claim.  If technical errors are triggered, the claim will be rejected and further validation layers will not be run for that claim. The technical errors include:

Data Field type

Format of Value Required

Text

Left justified, space filled

Date

YYYYMMDD

All dates supplied must be after 1 Jan 1900 and before submission end date plus fifty years.

Value

Right justified, defined decimal places, leading sign, zero filled

Number

Right justified, zero filled

Time

The HH component must be in range 00 to 23

The MM component must be in the range 00 to 59

Validation Layer 4 – Critical and Suspect -Business Rules

WCIDRR01-019      This validation layer will review the data that passed validation layer 1, 2 and 3 and report on all triggered critical and suspect errors.

Reporting

WCIDRR01-020     SIRA produces several reports resulting from the validation or load of a data submission:

  • CLM401: Claims Submission Validation Report – Layer 1 – Submission Abort (PDF)
  • CLM402: Claims Submission Validation Report – Layer 2 – Data Completeness errors in the submission (CSV)
  • CLM402CUM: Claims Submission Validation Report – Layer 2 – All outstanding Data Completeness errors (CSV)
  • CLM403: Claims Submission Validation Report – Layer 3 – Technical Errors in the submission (CSV)
  • CLM403CUM: Claims Submission Validation Report – Layer 3 – All outstanding Technical Errors (CSV)
  • CLM404: Claims Submission Validation Report – Layer 4 – Business Errors in the submission (CSV)
  • CLM404CUM: Claims Submission Validation Report – Layer 4 – All outstanding Business Errors (CSV)
  • CLM406: Claims Submission Validation Financial & Process Statistics (PDF)
  • CLM407: Claims Submission Validation Error Analysis

WCIDRR01-021      The following file format is applied to all generated reports:

  • nnn_333333_CLM4##_YYYYMMDD_val.pdf where
  • nnn – Insurer Number
  • 333333 – Submission number
  • 4## – Report number (EG: 401 or 406)
  • YYYYMMDD – Date that the submission file was run
  • Validation reports end with ‘val’
  • Load report submission names end with ‘ld’

Claim states and events

WCIDRR01-022     Claim states and events have been developed based on the life cycle of a claim.

WCIDRR01-023     Refer to Workers compensation claims technical manual claims state and events reference for a list of the mandatory and optional data items applicable to claim state or event for each insurer type.  It is important to note that some data items are not applicable to all insurer types.

WCIDRR01-024     Only when the conditions for a claim to be made have been met is the Date claim made (C: 2.1.9) data item to be populated with a date.  This will trigger the claim made state.

WCIDRR01-025     The absence of a Date claim made indicates a notification of injury.

WCIDRR01-026     Additional data is reported progressively as the claim moves through its life cycle and triggers events.

WCIDRR01-027     Any data item reported that is not part of a triggered claim state, liability status or other event is ignored.  This means that the data is not validated or loaded.

WCIDRR01-028     SIRA may add, remove or revise claim states and events as required to ensure the quality and completeness of the data provided.

Claims data definitions

WCIDRR01-029     This section details each data item required. The data items are documented in record and reference number order. Each data item includes most of the following metadata where applicable, but some data items have unique information.

  • Reference Number: The reference number allocated to the data item by SIRA.
  • Description: A textual description of the data item that expresses the essential nature of the data item.
  • Record Set: The record that the data item appears within the submission structure.
  • Start Position: The position of the first character of the data item in the record structure.
  • End Position: The position of the last character of the data item in the record structure.
  • Length: The number of characters allocated to the data item in the record structure.
  • Size: The minimum number of characters to be completed for the data item.
  • Applies To: The insurer type/s that must provide this data in their submission. The value can be one of the following:
    • All
    • Specialised
    • Group-self
    • Self-Insurer
    • TMF (Treasury Managed Fund)
    • UL (Uninsured Liability)
    • NI (Nominal Insurer)
  • Representational Layout: The layout of characters in a data item expressed by a character string representation.
    • Number

fill with leading zeros OR all zeros if not applicable OR a ‘No longer in use’ numeric data item

Hour numbers are represented as hours and minutes e.g. HHMM

  • Text

fill with ending spaces OR all spaces if not applicable OR a ‘No longer in use’ text data item

  • Date

YYYYMMDD OR all zeros if not applicable OR a ‘No longer in use’ date data item

  • Value

must have a leading sign + if zero or positive or – for negative values

fill with leading zeros after the sign where appropriate OR all zeros after sign if not applicable OR a ‘No longer in use’ value data item

Hour values are represented as hours and minutes e.g. HHMM

Dollar values have an implied decimal before last two digits

  • Representational Format: The format of presentation for the data item: Number, Text, Date, Value
  • Code Value Set: The code values and their applicable descriptions for the data item.
  • Statutory Legislation: The specific piece of legislation, Act OR SIRA issued guideline that this data item relates to.
  • Notes: Notes applicable to the data item.

Record Set 1  WCIDRR01-030     Claim Header Record

Header record: Must be the first record on the submission. There can be only one of these on the submission. The Submission start date (C: 1.5) in this record must be one day later than the Submission end date (C: 1.6) of the last successfully loaded submission.

This record contains:

  • C: 1.1 Record Set
  • C: 1.2 Insurer number
  • C: 1.3 Submission type
  • C: 1.4 Claims system release number
  • C: 1.5 Submission start date
  • C: 1.6 Submission end date

C: 1.1         Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Claim Header"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '1' for a Submission Header Record.

C: 1.2        Insurer number

Description

A unique three-digit number allocated by SIRA used to identify an insurer or the insurer’s data provider

Record set

"Claim Header"

Start position

2

End position

4

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Number

Notes

C: 1.3                Submission type

Description

Identifies the type of data in the submission as either claims or policy.

Record set

"Claim Header"

Start position

5

End position

10

Length

6

Size

6

Applies to

All

Representational Layout

Spaces

Representational Format

Text

Notes

Must contain the word 'Claims'.

C: 1.4        Claims system release number

Description

Identifies the version of the claims system under which the data are being submitted to SIRA

Record set

"Claim Header"

Start position

11

End position

12

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Number

Notes

Claims system release number must be

04 for the Nominal insurer (NI) excluding UL

05 for all other insurers including UL

C: 1.5                Submission start date

Description

The start date (or from date) of the submission period

Record set

"Claim Header"

Start position

13

End position

20

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

C: 1.6                Submission end date

Description

The end date of the submission period.

Record set

"Claim Header"

Start position

21

End position

28

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Record set 2 WCIDRR01-031 Record Identifier 1: Basic Claim Detail No. 1 Record

There can only be one Basic Claim Detail No. 1 record for each claim reported on the submission. This record must be reported for every new claim. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

This record contains:

  • C: 2.1.1 Record Set
  • C: 2.1.2 Claim Identifier
  • C: 2.1.3 Record identifier
  • C: 2.1.4 No longer in use
  • C: 2.1.5 Shared claim code
  • C: 2.1.6 Error report target
  • C: 2.1.7 Insurer branch
  • C: 2.1.8 Date claim entered on insurer's system
  • C: 2.1.9 Date claim made
  • C: 2.1.10 Policyholder identification number
  • C: 2.1.11 Period commencement date
  • C: 2.1.12 Tariff rate number
  • C: 2.1.13 Employer name
  • C: 2.1.14 Employer ACN or ARBN
  • C: 2.1.15 No longer in use
  • C: 2.1.16 Worker’s address - Street information
  • C: 2.1.17 Worker’s address - Locality name
  • C: 2.1.18 Worker’s address - Postcode
  • C: 2.1.19 Worker's gender code
  • C: 2.1.20 Worker's date of birth
  • C: 2.1.21 No longer in use
  • C: 2.1.22 Worker's language code
  • C: 2.1.53 No longer in use
  • C: 2.1.54 Agency of injury/disease
  • C: 2.1.55 Significant injury date
  • C: 2.1.56 Contact complete date
  • C: 2.1.57 No longer in use
  • C: 2.1.58 Worker (Home) telephone number
  • C: 2.1.59 TOOCS Breakdown agency
  • C: 2.1.60 TOOCS Agency of injury/disease
  • C: 2.1.23 No longer in use
  • C: 2.1.24 Worker's occupation code
  • C: 2.1.25 Worker's dependent children
  • C: 2.1.26 Worker's other dependents
  • C: 2.1.27 No longer in use
  • C: 2.1.28 Permanent employment code
  • C: 2.1.29 Training status code
  • C: 2.1.30 Hours worked per week
  • C: 2.1.31 Pre-injury average weekly earnings/ Current weekly wage rate
  • C: 2.1.32 Duty status code
  • C: 2.1.33 Workplace address - Street information
  • C: 2.1.34 Workplace address - Locality name
  • C: 2.1.35 Workplace address - Postcode
  • C: 2.1.36 Workplace industry (ASIC)
  • C: 2.1.37 Workplace industry (ANZSIC)
  • C: 2.1.38 Workplace size
  • C: 2.1.39 Incident location code
  • C: 2.1.40 Incident location description
  • C: 2.1.41 Incident locality name
  • C: 2.1.42 Incident location postcode
  • C: 2.1.43 Date of injury
  • C: 2.1.44 Time of injury
  • C: 2.1.45 Nature of injury/disease code
  • C: 2.1.46 Bodily location of injury/disease code
  • C: 2.1.47 TOOCS Mechanism
  • C: 2.1.48 Breakdown agency
  • C: 2.1.49 Result of injury code
  • C: 2.1.50 Date deceased
  • C: 2.1.51 Employer ABN (Australia Business Number)
  • C: 2.1.52 Workers Compensation Industry Classification (WIC) code

C: 2.1.1      Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Basic Claim Detail No. 1"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.1.2     Claim identifier

Description

The identifier allocated to the claim by the insurer.

Record set

"Basic Claim Detail No. 1"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

The Claim identifier reported on the insurers submission must be identical to that used by the insurer in all correspondence.

The following is applicable to the Nominal Insurer only (this excludes UL):

The Claim identifier must not be changed once reported to SIRA.

The last 3 digits of the Claim identifier must be the unique number used to identify the Insurer number (C: 1.2) that first registered the claim.

C: 2.1.3     Record identifier

Description

The identifier code of the record within the data submission

Record set

"Basic Claim Detail No. 1"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '1'

C: 2.1.5     Shared claim code

Description

Identifies whether the financial responsibility for a claim is being shared with another insurer

Record set

"Basic Claim Detail No. 1"

Start position

41

End position

41

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.1.6     Error report target

Description

The insurer’s reference that allows error reports to be aggregated for a particular person or office

Record set

"Basic Claim Detail No. 1"

Start position

42

End position

48

Length

7

Size

7

Applies to

All

Representational Format

Text

Notes

If not applicable set to NA.

C: 2.1.7     Insurer branch

Description

Insurer branch responsible for handling the claim

Record set

"Basic Claim Detail No. 1"

Start position

49

End position

68

Length

20

Size

20

Applies to

All

Representational Format

Text

Notes

Must be supplied for all claims.

C: 2.1.8     Date claim entered on insurer's system

Description

The date the claim was first entered into the insurer's computer system

Record set

"Basic Claim Detail No. 1"

Start position

69

End position

76

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.1.9     Date claim made

Description

The date that a claim is made with the insurer in accordance with the SIRA Guidelines for claiming workers compensation.

Record set

"Basic Claim Detail No. 1"

Start position

77

End position

84

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

SIRA Guidelines

Notes

If not applicable set to 00000000.

C: 2.1.10    Policyholder identification number

Description

A unique identification number for each policyholder (employer) in NSW.

Record set

"Basic Claim Detail No. 1"

Start position

85

End position

103

Length

19

Size

19

Applies to

Specialised, TMF, UL and NI

Representational Format

Text

Notes

Identifies the policy against which the claim is made.

C: 2.1.11     Period commencement date

Description

The period commencement date of the policy term covering the claim.

Record set

"Basic Claim Detail No. 1"

Start position

104

End position

111

Length

8

Size

8

Applies to

Specialised

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.1.12    Tariff rate number

Description

The relevant tariff industry rate number covering the claim for the appropriate policy renewal year.

Record set

"Basic Claim Detail No. 1"

Start position

112

End position

114

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Statutory Legislation

Workers compensation market practice and premiums guidelines

Notes

Only applicable to claims with a Date of injury (C: 2.1.43) prior to 4pm 30/6/2001 (Self and Group Self Insurers)

For specialised insurers, only applicable to Policy period commencement date (2.1.11) prior to 4pm 30/6/2001. If not applicable set to 000.

Where the policy activity is classified by the NSW Workers Compensation Industry Classification (WIC) code (C: 2.1.52), this field must be set to zero.

C: 2.1.13    Employer name

Description

The legal name of the employer

Record set

"Basic Claim Detail No. 1"

Start position

115

End position

189

Length

75

Size

75

Applies to

Specialised, TMF and UL

Representational Format

Text

Notes

C: 2.1.14    Employer ACN or ARBN

Description

The Australian Company Number or Australian Registered Body Number of the employer.

Record set

"Basic Claim Detail No. 1"

Start position

190

End position

198

Size

9

Applies to

Group Self

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes

If not applicable, set to 000000000

C: 2.1.16    Worker’s address - Street information

Description

The street details of the worker’s current residential address.

Record set

"Basic Claim Detail No. 1"

Start position

239

End position

358

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

For overseas addresses report the full address in this street information item.

Do not report the locality or postcode in this field unless it is an overseas address.

C: 2.1.17    Worker’s address - Locality name

Description

The locality or suburb of the worker’s current residential address

Record set

"Basic Claim Detail No. 1"

Start position

359

End position

388

Length

30

Size

30

Applies to

All

Representational Format

Text

Notes

For overseas addresses specify "OS" as the locality name.

C: 2.1.18    Worker’s address – Postcode

Description

The postcode of the locality or suburb of the worker’s current residential address

Record set

"Basic Claim Detail No. 1"

Start position

389

End position

392

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

Enter ‘0000’ for overseas addresses, i.e. addresses where the Worker’s address - Locality name (C: 2.1.17) is specified as ‘OS’. This is the only case where ‘0000’ will be accepted as a postcode.

C: 2.1.19    Worker's gender code

Description

The gender of the worker

Record set

"Basic Claim Detail No. 1"

Start position

393

End position

393

Length

1

Size

1

Applies to

All

Representational Format

Code

C: 2.1.20   Worker's date of birth

Description

The date of birth of the worker

Record set

"Basic Claim Detail No. 1"

Start position

394

End position

401

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Notes

May be reported as 00000000 on an initial notification where date of birth is unknown.

C: 2.1.22   Worker's language code

Description

The language spoken at home by the worker

Record set

"Basic Claim Detail No. 1"

Start position

406

End position

409

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

If not applicable set to 0000.

C: 2.1.24   Worker's occupation code

Description

The occupation of the worker at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

411

End position

414

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

Optional for claims reported prior to 30 June 1988, when Classification and Classified List of Occupations (CCLO) was the classification used.  CCLO codes must not be reported in this field.

If not applicable set to 0000.

C: 2.1.25   Worker's dependent children

Description

The number of dependent children.

Record set

"Basic Claim Detail No. 1"

Start position

415

End position

416

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Number

Statutory Legislation

Section 3 (1A), 25, 29, 30, 31, 32, 37(1)(c) Workers Compensation Act 1987 No 70

Notes

Set to 00 if no dependants.

C: 2.1.26   Worker’s other dependants

Description

The number of dependants other than children

Record set

"Basic Claim Detail No. 1"

Start position

417

End position

418

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Number

Statutory Legislation

Section 3, 25, 29, 30, 31, 32, 37(1)(b) Workers Compensation Act 1987 No 70

Notes

Set to zero (00) if no dependants.

C: 2.1.28   Permanent employment code

Description

The worker’s type of employment at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

420

End position

420

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.1.29   Training status code

Description

The worker’s training status at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

421

End position

421

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

C: 2.1.30   Hours worked per week

Description

The worker’s weekly ordinary hours or average weekly hours at the date of injury

Record set

"Basic Claim Detail No. 1"

Start position

422

End position

425

Length

4

Size

4

Applies to

All

Representational Layout

HHMM

Representational Format

Number

Statutory Legislation

s44H Workers Compensation Act 1987 and s42 Workers Compensation Act 1987 prior to the 2012 Legislative Reform.

Notes

C: 2.1.31    Pre-injury average weekly earnings/  Current weekly wage rate

Description

The average weekly earnings as calculated in accordance with the legislation for exempt and non-exempt workers.

Record set

"Basic Claim Detail No. 1"

Start position

426

End position

433

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Worker: sections 44C to 44I of the Workers
Compensation Act 1987 in addition to schedule 3

Exempt worker: Section 42 of the Workers Compensation Act 1987 (prior to 2012 legislative reform)

Notes

The Defined limit can be sourced from the Workers Compensation Benefits Guide (refer to Maximum weekly payment section)

C: 2.1.32   Duty status code

Description

The worker’s duty status
at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

434

End position

434

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Statutory Legislation

Workers Compensation Act 1987

Section 10 Journey Claims

Section 11 Recess Claims

Section 9A Employment must be a substantial contributing factor

Notes

C: 2.1.33   Workplace address - Street information

Description

The street address of the employer’s base of operations for the worker at the date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

435

End position

554

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

C: 2.1.34   Workplace address - Locality name

Description

The locality or suburb of the employer’s base of operations for the worker at the date of injury

Record set

"Basic Claim Detail No. 1"

Start position

555

End position

584

Length

30

Size

30

Applies to

All

Representational Format

Text

Notes

For overseas addresses specify 'OS' as the locality name.

C: 2.1.35   Workplace address – Postcode

Description

The postcode of the employer’s base of operations for the worker at the date of injury

Record set

"Basic Claim Detail No. 1"

Start position

585

End position

588

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

C: 2.1.36   Workplace industry (ASIC)

Description

The primary industry activity undertaken at the employer’s base of operation for the worker at the date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

589

End position

592

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Code Value Set

Coded according to the Australian Standard Industrial Classification, ABS Catalogue No. 1201.0

Notes

C: 2.1.37   Workplace industry (ANZSIC)

Description

The primary industry activity undertaken at the employer’s base of operations for the worker at the date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

593

End position

596

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

C: 2.1.38   Workplace size

Description

The employer's estimate of the number of employees normally working at the employer’s base of operations for the worker at date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

597

End position

601

Length

5

Size

5

Applies to

All

Representational Layout

NNNNN

Representational Format

Number

Notes

Zero can be reported where Workplace Size is not known and claim is in the Initial Claim state.

C: 2.1.39   Incident location code

Description

The type of incident location

Record set

"Basic Claim Detail No. 1"

Start position

602

End position

603

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

C: 2.1.40   Incident location description

Description

A description of the incident location in circumstances where the worker was away from their normal workplace or base of operations.

Record set

"Basic Claim Detail No. 1"

Start position

604

End position

723

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

Set to NA if the accident occurred at the worker's normal place of work or base of operations (Incident location code C: 2.1.39 = 01) or if Date claim entered on insurer’s system is prior to 1 Jan 1998 (Incident location code C: 2.1.39 = 00).

For overseas address, report 'OS'.

C: 2.1.41    Incident locality name

Description

The locality or suburb of the incident location.

Record set

"Basic Claim Detail No. 1"

Start position

724

End position

753

Length

30

Size

30

Applies to

All

Representational Format

Text

Notes

Must be a valid locality or suburb as specified by Australia Post.

C: 2.1.42   Incident location postcode

Description

The postcode of the incident location.

Record set

"Basic Claim Detail No. 1"

Start position

754

End position

757

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Code Value Set

See Australia Post address standards

Notes

Set to '0000' if the accident occurred at the worker's normal place of work or base of operations (Incident location code C: 2.1.39 = 01) or if Date claim entered insurer system (C: 2.1.8) is prior to 1 January 1998 (Incident location code C: 2.1.39 = 00).

C: 2.1.43   Date of injury

Description

The date of the injury or disease

Record set

"Basic Claim Detail No. 1"

Start position

758

End position

765

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Workers Compensation Act 1987 and Workplace Injury Management and Workers Compensation Act 1998

Notes

C: 2.1.44   Time of injury

Description

The time of the injury or disease.

Record set

"Basic Claim Detail No. 1"

Start position

766

End position

769

Length

4

Size

4

Applies to

All

Representational Layout

HHMM

Representational Format

Time

Notes

To be specified according to the 24-hour clock

The HH component must be in the range 00 to 23

The MM component must be in the range 00 to 59

C: 2.1.45   Nature of injury/disease code

Description

Identifies the most serious injury or disease type of the worker.

Record set

"Basic Claim Detail No. 1"

Start position

770

End position

772

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

C: 2.1.46   Bodily location of injury/disease code

Description

Identifies the part of the body affected by the most serious injury or disease

Record set

"Basic Claim Detail No. 1"

Start position

773

End position

775

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

C: 2.1.47   TOOCS Mechanism

Description

Identifies the action, exposure or event that triggered the incident/injury.

Record set

"Basic Claim Detail No. 1"

Start position

776

End position

777

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

C: 2.1.48   Breakdown agency

Description

Identifies the object, substance or circumstance that was principally involved in causing the incident.

Record set

"Basic Claim Detail No. 1"

Start position

778

End position

780

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

C: 2.1.49   Result of injury code

Description

A code to indicate the result of the injury

Record set

"Basic Claim Detail No. 1"

Start position

781

End position

781

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.1.50   Date deceased

Description

The date of death of the worker where the death arises from the incident.

Record set

"Basic Claim Detail No. 1"

Start position

782

End position

789

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Required where the result of injury indicates death (fatality).

C: 2.1.51    Employer ABN (Australian Business Number)

Description

The Australian Business Number (ABN) issued to the employer by the Australian Business Register.

Record set

"Basic Claim Detail No. 1"

Start position

790

End position

800

Length

11

Size

11

Applies to

All except NI

Representational Layout

NNNNNNNNNNN

Representational Format

Number

Notes

When reporting this field, you must not include any spaces.

C: 2.1.52   Workers Compensation Industry Classification (WIC) code

Description

The relevant NSW Workers Compensation Industry Classification (WIC) code covering the claim for the appropriate policy renewal year

Record set

"Basic Claim Detail No. 1"

Start position

801

End position

806

Length

6

Size

6

Applies to

All

Representational Layout

NNNNNN

Representational Format

Code

Statutory Legislation

Workers compensation market practice and premiums guidelines or relevant Insurance Premiums Order

Notes

Required for all claims where the commencement date of the policy is greater than or equal to 30 June 2001.

If not applicable, set to 000000.

C: 2.1.54  Agency of injury/disease

Description

Identifies the object, substance or circumstance directly involved in causing the most serious injury or disease

Record set

"Basic Claim Detail No. 1"

Start position

826

End position

828

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

For claims with a Date entered insurer's system prior to 1 July 2002, and after 30 June 2011, report this code to '000'.

C: 2.1.55 Significant injury date

Description

The date on which the insurer first becomes aware of the likelihood of the worker being incapacitated for a continuous period of more than 7 days.

Record set

"Basic Claim Detail No. 1"

Start position

829

End position

836

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Chapter 3 of Workplace Injury Management & Workers Compensation Act 1998

Notes

C: 2.1.56   Contact complete date

Description

The date the insurer completes initial contact with the worker, the employer and treating doctor (if required).

Record set

"Basic Claim Detail No. 1"

Start position

837

End position

844

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Chapter 3 of Workplace Injury Management & Workers Compensation Act 1998

Notes

If not applicable set to 00000000.

C: 2.1.58   Worker (Home) telephone number

Description

The contact Home telephone number of the worker

Record set

"Basic Claim Detail No. 1"

Start position

853

End position

866

Length

14

Size

14

Applies to

All

Representational Format

Text

Notes

For Australian landline report only area code and phone number only. Do not include international codes.

International telephone numbers require the international country code included.

If not applicable set to NA

C: 2.1.59   TOOCS Breakdown agency

Description

Identifies the object, substance or circumstance that was principally involved causing the incident.

Record set

"Basic Claim Detail No. 1"

Start position

867

End position

870

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

For claims with a date entered insurer's system prior to 1 July 2011, report this code as '0000'.

This code may need to be updated if there is a change in coding for the Nature of injury/disease code (C: 2.1.45).

C: 2.1.60   TOOCS Agency of injury/disease

Description

Identifies the object, substance or circumstance directly involved in causing the most serious injury or disease.

Record set

"Basic Claim Detail No. 1"

Start position

871

End position

874

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

For claims with a date entered insurer's system prior to 1 July 2011, report this code as '0000'.

Record Set 2 WCIDRR01-032 Record Identifier 2: Claim Activity Record

There can be any number of these records in a submission if there has been any activity in the reporting period. This record must be reported along with the Basic claim detail record (1) and (2) for every new claim.

Each change of liability status must be reported unless they occur in the same day.

If there is activity since the time the claim was successfully reported but no change to the liability status then only one record is to be reported.

If two or more sets of data are processed on one claim on the same day (that is with the same liability status date), only the latest set of data for that day is to be reported. If more than one set of data is sent for the same claim, with the same liability status date, the claim will be rejected. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

This record contains:

  • C: 2.2.1 Record Set
  • C: 2.2.2 Claim identifier
  • C: 2.2.3 Record identifier
  • C: 2.2.4 Liability status date
  • C: 2.2.5 Claim closed flag
  • C: 2.2.6 Date claim closed
  • C: 2.2.7 Date claim re-opened
  • C: 2.2.8 Reason for re-opening claim code
  • C: 2.2.9 Liability status code
  • C: 2.2.10 No longer in use
  • C: 2.2.11 Date of claim review
  • C: 2.2.12 No longer in use
  • C: 2.2.13 Work status code
  • C: 2.2.14 No longer in use
  • C: 2.2.15 Second injury claim flag
  • C: 2.2.16 Initial notifier code
  • C: 2.2.17 Reasonable excuse code
  • C: 2.2.18 No longer in use
  • C: 2.2.19 No longer in use
  • C: 2.2.20 Action date Section 66
  • C: 2.2.21 Action type Section 66
  • C: 2.2.22 Common law action date
  • C: 2.2.23 Initial notifier name
  • C: 2.2.24 Initial notifier telephone number
  • C: 2.2.25 Description of incident
  • C: 2.2.26 Description of Injury/illness
  • C: 2.2.27 Work status date
  • C: 2.2.28 Type of dispute
  • C: 2.2.29 Date of claim screening
  • C: 2.2.30 Claim screening action code
  • C: 2.2.31 Result of the permanent impairment assessment (PI %).
  • C: 2.2.32 Date claim recovery action commenced
  • C: 2.2.33 Percentage of estimated recovery
  • C: 2.2.34 Recovery investigation indicator
  • C: 2.2.35 SIRA NSW Certificate of Capacity period start date
  • C: 2.2.36 SIRA NSW Certificate of Capacity period end date
  • C: 2.2.37 SIRA NSW Certificate of Capacity fitness
  • C: 2.2.38 WCC matter number
  • C: 2.2.39 Section 52A code
  • C: 2.2.40 Common law action type
  • C: 2.2.41 Common law action outcome
  • C: 2.2.42 Work capacity transition date
  • C: 2.2.43 Work capacity transition outcome
  • C: 2.2.44 Estimated permanent impairment (EPI%)
  • C: 2.2.45 Assessed percentage of permanent impairment for paid S66 benefits

C: 2.2.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Claim Activity"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.2.2    Claim identifier

Description

The identifier allocated to the claim by the insurer.

Record set

"Claim Activity"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

C: 2.2.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Claim Activity"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim activity record.

C: 2.2.4    Liability status date

Description

The date of the Liability Status decision.

Record set

"Claim Activity"

Start position

22

End position

29

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.5    Claim closed flag

Description

A flag to indicate if the claim is closed.

Record set

"Claim Activity"

Start position

30

End position

30

Length

1

Size

1

Applies to

All

Representational Format

Code

C: 2.2.6    Date claim closed

Description

The most recent date that the claim was closed

Record set

"Claim Activity"

Start position

31

End position

38

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.7    Date claim re-opened

Description

The most recent date that the claim was re-opened

Record set

"Claim Activity"

Start position

39

End position

46

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

If not applicable, set to 00000000

C: 2.2.8    Reason for re-opening claim code

Description

Identifies why the insurer has re-opened the claim

Record set

"Claim Activity"

Start position

47

End position

47

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.2.9    Liability status code

Description

The current status of liability for a notification or claim, as determined by the insurer.

Record set

"Claim Activity"

Start position

48

End position

49

Length

2

Min Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Workers Compensation Act 1987 & Workplace Injury Management & Workers Compensation Act 1998

Notes

C: 2.2.11    Date of claim review

Description

The date of the latest claim review conducted by the insurer.

Record set

"Claim Activity"

Start position

52

End position

59

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.13   Work status code

Description

The current work status of the worker.

Record set

"Claim Activity"

Start position

62

End position

63

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

s48 and s49 Workplace Injury Management and Workers Compensation Act 1998. s32A, 36, 37, 38, 39, of Workers Compensation Act 1987.

Notes

C: 2.2.15   Second injury claim flag

Description

A flag indicating if the claim is a second injury claim as defined under section 54 of the Workplace Injury Management and Workers Compensation Act 1998

Record set

"Claim Activity"

Start position

64

End position

64

Length

1

Size

1

Applies to

All

Representational Format

Code

Statutory Legislation

s54 Workplace Injury Management & Workers Compensation Act 1998.

Notes

C: 2.2.16   Initial notifier code

Description

Identifies the category of the initial notifier of an injury

Record set

"Claim Activity"

Start position

65

End position

66

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

May be set to 00 where date of first notification is less than 1 January 2002.

C: 2.2.17   Reasonable excuse code

Description

The reason for not commencing provisional payments.

Record set

"Claim Activity"

Start position

67

End position

68

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

C: 2.2.20  Action date Section 66

Description

The date the insurer made a reasonable offer of settlement or disputed liability for lump sum compensation.

Record set

"Claim Activity"

Start position

79

End position

86

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Refer to Section 281 of the Workplace Injury Management and Workers Compensation Act 1998 No 86.

Notes

If not applicable, set to 00000000

C: 2.2.21   Action type Section 66

Description

Identifies the type of action taken by the insurer in response to a lump sum compensation claim.

Record set

"Claim Activity"

Start position

87

End position

88

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Refer to Section 281 of the Workplace Injury Management and Workers Compensation Act 1998 and SIRA Guidelines for claiming workers compensation.

Notes

If not applicable set to 00

Must not be specified if Action date - Section 66 is not specified.

C: 2.2.22  Common law action date

Description

The date a statement of claim for a Common Law Claim is filed with the Court or the date the insurer receives a pre-filing statement for the recovery of Work Injury Damages.

Record set

"Claim Activity"

Start position

89

End position

96

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Workers Compensation Act 1987 Part 5

Workplace Injury Management and Workers Compensation Act 1988

Part 3 - Division 4 and Part 6

SIRA Guidelines for claiming workers compensation

Notes

C: 2.2.23  Initial notifier name

Description

The name of the person who first notified the insurer of the incident.

Record set

"Claim Activity"

Start position

97

End position

136

Length

40

Size

40

Applies to

All

Representational Format

Text

Notes

If date of first notification is less than 01 September 2003 set to NA.

C: 2.2.24  Initial notifier telephone number

Description

The contact telephone number of the person who first notified the Insurer of the incident

Record set

"Claim Activity"

Start position

137

End position

150

Length

14

Size

14

Applies to

All

Representational Format

Text

Notes

For Australian landline report only area code and phone number only. Do not include International codes.

International telephone numbers require the international country code included.

If not applicable set to NA

C: 2.2.25  Description of incident

Description

A clear and concise description of how the incident occurred.

Record set

"Claim Activity"

Start position

151

End position

350

Length

200

Size

200

Applies to

All

Representational Format

Text

Notes

Must not be NA if Date of first notification is equal to or greater than 01/09/2003

C: 2.2.26  Description of Injury/illness

Description

A description of all the injuries/illnesses and parts of the body affected.

Record set

"Claim Activity"

Start position

351

End position

550

Length

200

Size

200

Applies to

All

Representational Format

Text

Notes

Must not be NA if Date of first notification is equal to or greater than 01/09/2003.

C: 2.2.27  Work status date

Description

The date when the worker’s work status changed.

Record set

"Claim Activity"

Start position

551

End position

558

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.28  Type of dispute

Description

Identifies the reason why an insurer disputes a claim.

Record set

"Claim Activity"

Start position

559

End position

560

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

If not applicable set to 00

When the dispute is resolved, reset to 00

C: 2.2.29  Date of claim screening

Description

The date a claim is screened by the insurer to assess whether an Injury management plan (IMP) is required, or the date of a review of an Injury management plan.

Record set

"Claim Activity"

Start position

561

End position

568

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.30  Claim screening action code

Description

Describes the action taken by the insurer about an Injury management plan following the screening of a claim.

Record set

"Claim Activity"

Start position

569

End position

570

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.31   Result of the permanent impairment assessment (PI %)

Description

Result of the most recent permanent impairment assessment (PI %).

Record set

"Claim Activity"

Start position

571

End position

573

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Number

Statutory Legislation

s66 Workers Compensation Act 1987

s263 & s322A Workplace injury management and workers compensation Act 1998

Notes

This is the greater of either:

a) the worker’s level of permanent  
impairment in the:

complying agreement, or

Medical Assessment Certificate, or

outcome of the Medical
Assessment Panel

b) the worker’s level of permanent impairment where the assessment was undertaken for threshold purposes.

C: 2.2.32  Date claim recovery action commenced

Description

The date that claim recovery action is commenced against the other liable party/Insurer

Record set

"Claim Activity"

Start position

574

End position

581

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYDDMM

Representational Format

Date

Notes

C: 2.2.33  Percentage of estimated recovery

Description

The estimated percentage of recovery

Record set

"Claim Activity"

Start position

582

End position

584

Length

3

Size

3

Applies to

NI

Representational Layout

NNN

Representational Format

Number

Notes

C: 2.2.34  Recovery investigation indicator

Description

Indicates if a claim has been investigated for recovery payments potential

Record set

"Claim Activity"

Start position

585

End position

586

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.35  SIRA NSW Certificate of Capacity period start date

Description

The start date for the period covered by a SIRA Certificate of Capacity/ certificate of fitness

Record set

"Claim Activity"

Start position

587

End position

594

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Accuracy Level % 100

Notes

If not applicable, set to 00000000. For example, payment classification codes WPT003, WPT004 WPP003 or WPP004.

C: 2.2.36  SIRA NSW Certificate of Capacity period end date

Description

The end date for the period covered by a SIRA Certificate of Capacity/certificate of fitness.

Record set

"Claim Activity"

Start position

595

End position

602

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

If not applicable set to 00000000.

C: 2.2.37  SIRA NSW Certificate of Capacity/ fitness

Description

Capacity for work as specified on the SIRA Certificate of Capacity/certificate of fitness

Record set

"Claim Activity"

Start position

603

End position

604

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Accuracy Level % 100

Notes

If not applicable, set to 00.

C: 2.2.38  WCC matter number

Description

The Workers Compensation Commission reference number allocated for a dispute

Record set

"Claim Activity"

Start position

605

End position

612

Length

8

Size

8

Applies to

All

Representational Format

Text

C: 2.2.39  Section 52A code

Description

The reason for discontinuation of weekly payments for partial incapacity after 2 years.

Record set

"Claim Activity"

Start position

613

End position

614

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.40  Common law action type

Description

Identifies the legislative basis upon which a claim for work injury damages (WID) has been made.

Record set

"Claim Activity"

Start position

615

End position

616

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.41   Common law action outcome

Description

The outcome of the Work Injury Damages or Common Law action.

Record set

"Claim Activity"

Start position

617

End position

618

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.42  Work capacity transition date

Description

The date that a work capacity transition outcome was made.

Record set

"Claim Activity"

Start position

619

End position

626

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Section 43 Workers Compensation Act 1987

Notes

C: 2.2.43  Work capacity transition outcome

Description

The outcome of a work capacity transition assessment conducted by the insurer.

Record set

"Claim Activity"

Start position

627

End position

628

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Refer to Subdivision 3 of Workers Compensation Act 1987

Notes

C: 2.2.44  Estimated permanent impairment (EPI%)

Description

The insurers estimate of the permanent impairment (PI%) of the worker based on available information.

Record set

"Claim Activity"

Start position

629

End position

630

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

s66 Workers Compensation Act 1987

s263 & 322a WIMWCA Act 1998

Notes

C: 2.2.45  Assessed percentage of permanent impairment for paid S66 benefits

Description

The permanent impairment assessment (PI%) applicable to the payment of permanent impairment compensation.

Record set

"Claim Activity"

Start position

631

End position

633

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Number

Statutory Legislation

s66 Workers Compensation Act 1987

Notes

Record Set 2 WCIDRR01-033 Record Identifier 3: Time Lost Record

There can be at most one of these for each claim reported on the submission. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

If the worker has not resumed work as at the submission end date then the time lost record is to be reported so that the Number of days off work (C: 2.3.8) is updated.

Rules:

  1. If worker has no capacity, then a Time lost record must be reported
  2. If worker has current capacity but is not working (ie suitable employment not performed), then a Time lost record must be reported

If a worker has only been in the following situations, then a time lost record must not be reported:

  1. If worker has current capacity and is working (ie suitable employment) pre- injury hours and days
  2. If worker has current capacity and is working (ie suitable employment) reduced hours or reduced days.

This record contains:

  • C: 2.3.1 Record Set
  • C: 2.3.2 Claim identifier
  • C: 2.3.3 Record identifier
  • C: 2.3.4 Date ceased work
  • C: 2.3.5 Estimated date fit to resume employment
  • C: 2.3.6 No longer in use
  • C: 2.3.7 Actual date resumed work
  • C: 2.3.8 Number of days off work

C: 2.3.1     Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Time Lost"

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.3.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Time Lost"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C 2.3.3     Record identifier

Description

The identifier code of the record within the data submission

Record set

"Time Lost"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '3' for a time lost record.

There must be no more than one time lost record for any claim in the submission. Note if there is more than one period of time lost since the last report, only the latest information is required.

C: 2.3.4 Date ceased work

Description

The date of the last day the worker attended work prior to commencing their first period of absence from the workplace due to their work capacity.

Record set

"Time Lost"

Start position

22

End position

29

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Must be specified if a time lost record is reported.

C: 2.3.5    Estimated date fit to resume employment

Description

The date when it is expected that the worker will resume work in any capacity, as at the submission end date

Record set

"Time Lost"

Start position

30

End position

37

Length

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

If at the Submission end date, the worker has resumed work, or is deemed fit to resume work, enter 00000000 in this item.

If the worker is not expected to have any future work capacity for any employment then report the expected date of cessation of weekly payments.

C: 2.3.7 Actual date resumed work

Description

The date the worker resumed work in any capacity with any employer.

Record set

"Time Lost"

Start position

46

End position

53

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Report 00000000 if claimant has not resumed work.

C: 2.3.8    Number of days off work

Description

The total number of days, measured in whole calendar days (including holidays and weekend days) that the worker has been off work due to the injury/ illness.

Record set

"Time Lost"

Start position

54

End position

58

Length

5

Size

5

Applies to

All

Representational Layout

NNNNN

Representational Format

Number

Notes

Record Set 2 WCIDRR01-034 Record Identifier 4: Service Provision Record

There can be any number of these for each claim reported on the submission. Any service referral must only be reported once to SIRA, unless the insurer is changing some of the data describing that service referral, e.g. reporting the service provision end date (C: 2.4.7).

This record contains:

  • C: 2.4.1 Record Set
  • C: 2.4.2 Claim identifier
  • C: 2.4.3 Record identifier
  • C: 2.4.4 No longer in use
  • C: 2.4.5 Rehabilitation provider code
  • C: 2.4.6 Service provision start date
  • C: 2.4.7 Service provision end date
  • C: 2.4.8 Service provision type
  • C: 2.4.9 Service provision sub type
  • C: 2.4.10 Service provision null date
  • C: 2.4.11 Work trial host employer ABN

Notes

Service Provision records are required for claims where the claimant is undergoing a vocational rehabilitation program or referred to an approved workplace rehabilitation provider for workplace rehabilitation.

Each service provision record is considered unique by the following data items:

  • Workplace Rehabilitation Event

­ C: 2.4.5 Rehabilitation provider code

­ C: 2.4.6 Service provision start date

­ C: 2.4.8 Service provision type

  • Vocational rehabilitation program Event

­ C: 2.4.6 Service provision start date

­ C: 2.4.8 Service provision type

­ C: 2.4.9 Service provision sub type

  • Work Trial Event

­ C: 2.4.5 Rehabilitation provider code

­ C: 2.4.6 Service provision start date

­ C: 2.4.8 Service provision type

­ C: 2.4.9 Service provision sub type

C: 2.4.1     Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Service Provision"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.4.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Service Provision"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.4.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Service Provision"

Start position

21

End position

21

Length

1

Min Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '4' for a Service provision record.

C: 2.4.5    Rehabilitation provider code

Description

The approved workplace rehabilitation provider number as specified by SIRA

Record set

"Service Provision"

Start position

25

End position

28

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

C: 2.4.6    Service provision start date

Description

The commencement date of a vocational rehabilitation program OR the insurer approval date for workplace rehabilitation.

Record set

"Service Provision"

Start position

29

End position

36

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

s52 and s53 of the Workplace Injury Management and Workers Compensation Act 1998

Notes

C: 2.4.7    Service provision end date

Description

The end date of the workplace rehabilitation referral OR the vocational rehabilitation program.

Record set

"Service Provision"

Start position

37

End position

44

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

s52 and s53 Workplace Injury Management & Workers Compensation Act 1998

Notes

C: 2.4.8    Service provision type

Description

Identifies the type of rehabilitation service.

Record set

"Service Provision"

Start position

45

End position

46

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Workplace Injury Management and Workers Compensation Act 1998

Notes

C: 2.4.9    Service provision sub type

Description

Identifies the category of vocational rehabilitation program.

Record set

"Service Provision"

Start position

47

End position

48

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Workplace Injury Management and Workers Compensation Act 1998

Notes

Only applicable when Service provision type (C: 2.4.8) of '02', vocational rehabilitation program is reported.

C: 2.4.10   Service provision null date

Description

The date the service provision record was identified as being reported in error.

Record set

"Service Provision"

Start position

49

End position

56

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

s52 and s53 Workplace Injury Management and Workers Compensation Act 1988

Notes

If not applicable set to 00000000.

C: 2.4.11    Work trial host employer ABN

Description

The ABN of the work trial host employer

Record set

"Service Provision"

Start position

57

End position

67

Length

11

Size

11

Applies to

All

Representational Layout

NNNNNNNNNNN

Representational Format

Number

Notes

For employers without an ABN set this item to ‘00000000000’. Note that this includes foreign owned companies who do not hold an ABN or are not entitled to an ABN.

When reporting this field, you must not include any spaces.

Record Set 2 WCIDRR01-035 Record Identifier 5: Compensation Payment and Recovery Record

There will be one of these for each payment or recovery transaction for each claim reported on the submission. Insurers must ensure that a transaction is only reported once to SIRA.

This record contains:

  • C: 2.5.1 Record Set
  • C: 2.5.2 Claim identifier
  • C: 2.5.3 Record identifier
  • C: 2.5.4 No longer in use
  • C: 2.5.5 Payment transaction date
  • C: 2.5.6 Adjustment transaction flag
  • C: 2.5.7 Payment/recovery amount
  • C: 2.5.8 Payment period start date
  • C: 2.5.9 Payment period end date
  • C: 2.5.10 Hours paid for total incapacity
  • C: 2.5.11 Hours paid for partial incapacity
  • C: 2.5.12 Reimbursement schedule code
  • C: 2.5.13 No longer in use
  • C: 2.5.14 No longer in use
  • C: 2.5.15 Payee ID
  • C: 2.5.16 Service provider ID
  • C: 2.5.17 Payment classification number
  • C: 2.5.18 Date of service
  • C: 2.5.19 Determined weekly benefit amount
  • C: 2.5.20 Invoice number
  • C: 2.5.21 Hours lost
  • C: 2.5.22 Earnings
  • C: 2.5.23 Deductibles

C: 2.5.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Compensation Payment and Recovery"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.5.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Compensation Payment and Recovery"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.5.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Compensation Payment and Recovery"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Notes

Must contain '5' for a compensation payment and recovery record.

C: 2.5.5    Payment transaction date

Description

The date the insurer makes the payment or receives a recovery payment.

Record set

"Compensation Payment and Recovery"

Start position

24

End position

31

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.6    Adjustment transaction flag

Description

A flag to indicate, for weekly payments, that the transaction being submitted is an adjustment to a previously submitted transaction

Record set

"Compensation Payment and Recovery"

Start position

32

End position

32

Length

1

Size

1

Applies to

All

Representational Format

Code

Notes

C: 2.5.7    Payment/recovery amount

Description

The amount of the payment or recovery transaction, inclusive of GST

Record set

"Compensation Payment and Recovery"

Start position

33

End position

43

Length

11

Size

11

Applies to

All

Representational Layout

+/-NNNNNNNNNN

Representational Format

Value

Notes

Where an amount is being recovered it should be reported as a positive amount.

Alterations to previously reported payment or recovery transactions can be reported as positive or negative as appropriate.

When an adjustment to an existing weekly payment is being reported, the Adjustment transaction flag (C: 2.5.6) must be set to 'Y'.

C: 2.5.8    Payment period start date

Description

The start date of the period of incapacity for the weekly payment.

Record set

"Compensation Payment and Recovery"

Start position

44

End position

51

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.9    Payment period end date

Description

The end date of the period of incapacity for the weekly payment.

Record set

"Compensation Payment and Recovery"

Start position

52

End position

59

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.10   Hours paid for total incapacity

Description

The hours paid for total incapacity, within the payment period.

Record set

"Compensation Payment and Recovery"

Start position

60

End position

66

Length

7

Size

7

Applies to

All

Representational Layout

+/-HHHHMM

Representational Format

Value

Statutory Legislation

S36, 37 Workers Compensation Act 1987

Notes

The figure in this field must be reported in hours and minutes.

The layout cannot be more than 7 digits and if it is, the insurer must split down the payment transactions into multiple transactions and allocate the relevant hours across the relevant transactions.

C: 2.5.11    Hours paid for partial incapacity

Description

The hours paid for partial incapacity, within the payment period.

Record set

"Compensation Payment and Recovery"

Start position

67

End position

73

Length

7

Size

7

Applies to

All

Representational Layout

+/-HHHHMM

Representational Format

Value

Statutory Legislation

S 38 and 40 Workers Compensation Act 1987

Notes

The layout cannot be more than 7 digits and if it is, the insurer must split down the payment transactions into multiple transactions and allocate the relevant hours across the relevant transactions.

C: 2.5.12   Reimbursement schedule code

Description

Identifies the wage payment agreement between an insurer and employer OR an insurer and worker

Record set

"Compensation Payment and Recovery"

Start position

74

End position

75

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

If not applicable or no reimbursement schedule exists, enter 00

C: 2.5.15   Payee ID

Description

This identifies the entity receiving payment for services provided.

Record set

"Compensation Payment and Recovery"

Start position

86

End position

105

Length

20

Size

20

Applies to

All

Representational Format

Text

Notes

When reporting this field, you must not include any spaces.

C: 2.5.16   Service provider ID

Description

Identifies the entity that provided the service.

Record set

"Compensation Payment and Recovery"

Start position

106

End position

125

Length

20

Size

20

Applies to:

All

Representational Format

Text

Notes

When reporting this field, you must not include any spaces.

C: 2.5.17   Payment classification number

Description

Identifies the type of payment being made by an insurer.

Record set

"Compensation Payment and Recovery"

Start position

126

End position

140

Length

15

Size

15

Applies to:

All

Representational Format

Text

Code Value Set

AMA SIRA allocated number including legal cost regulation

Notes

C: 2.5.18   Date of service

Description

The date the service was provided.

Record set

"Compensation Payment and Recovery"

Start position

141

End position

148

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.19   Determined weekly benefit amount

Description

The maximum weekly benefit entitlement amount for one week relating to the payment period.

Record set

"Compensation Payment and Recovery"

Start position

149

End position

156

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Divisions 1, 2, 3 and 4, particularly sections 34, 35, 36, 37, 38, 39, 40, 41, 42, 44C and 44G of the Workers Compensation Act 1987 No70.

Notes

C: 2.5.20  Invoice number

Description

The unique identifier on the tax invoice or receipt for reimbursements.

Record set

"Compensation Payment and Recovery"

Start position

157

End position

176

Length

20

Size

20

Applies to

NI

Representational Format

Text

Notes

If not reported, set to NA.

C: 2.5.21   Hours lost

Description

The number of hours and minutes in the weekly benefit payment period during which the worker was absent from work.

Record set

"Compensation Payment and Recovery"

Start position

177

End position

183

Length

7

Size

7

Applies to

All

Representational Layout

+/-HHHHMM

Representational Format

Value

Statutory Legislation

s36, 37, 38 Workers Compensation Act 1987

Notes

The figure in this field must be reported in hours and minutes.

Where Hours Lost (C: 2.5.21) is zero, report as +000000

C: 2.5.22  Earnings

Description

The worker’s earnings or deemed earnings in the weekly benefit payment period.

Record set

"Compensation Payment and Recovery"

Start position

184

End position

194

Length

11

Size

11

Applies to

All

Representational Layout

+/-NNNNNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44l of the Workers Compensation Act 1987.

Notes

Where the earnings are determined to be an amount of zero, report as +0000000000.

C: 2.5.23  Deductibles

Description

The monetary value that a worker receives as ‘payment in kind’ in the weekly benefit payment period.

Record set

"Compensation Payment and Recovery"

Start position

195

End position

205

Length

11

Size

11

Applies to

All

Representational Layout

+/-NNNNNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44C, 44D, 44E, 44F, 44G and 44H of the Workers Compensation Act 1987

Notes

Where the deductibles are determined to be an amount of zero, report as +0000000000.

Record Set 2 WCIDRR01-036     Record Identifier 6: Estimate Record

There will be an estimate record for each applicable estimate type within each claim where an estimate is required. This is reported on the submission. Estimate amounts do not carry forward from previous submissions. Where an estimate amount has not changed from a previous submission, the same value must be reported. Estimate records are not to be reported for closed claims.

This record contains:

  • C: 2.6.1 Record Set
  • C: 2.6.2 Claim identifier
  • C: 2.6.3 Record identifier
  • C: 2.6.4 Estimate type
  • C: 2.6.5 Estimate amount

C: 2.6.6 Estimated future weeks off employment

Notes

Estimate data is provided as at the submission end date. Report all estimates for each claim on the submission.  If they haven’t changed since the previous submission they must still be reported if the claim is otherwise reported (i.e. for changes in some other data).

Estimates represent the estimate of outstanding liability and shouldn’t include payments already made.  Similarly, estimated recoveries represent the estimated amount to be recovered and shouldn’t include recoveries already made.

The sum of the estimates of outstanding liability and estimated recoveries reported on estimate records for a claim will be checked against the total estimate figure and total estimated recovery figure respectively, reported in the claim control record. Any inconsistency will cause the claim to be rejected.

Do not report zero estimate values.  Where zero is reported in the total estimate figure and total estimated recovery figure reported in the claim control record then there must not be any estimate or estimated recovery records for that claim on the submission.

There must be only one estimate record for each estimate type applicable to a claim.

Estimate records should not be reported where the Liability Status Code is equal to 01, 06, 09, or 12.

C: 2.6.1    Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Estimate"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.6.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Estimate"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.6.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Estimate"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '6' for an estimate record.

C: 2.6.4    Estimate type

Description

Identifies the type of estimate of future liability.

Record set

"Estimate"

Start position

22

End position

23

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

C: 2.6.5    Estimate amount

Description

The amount of the estimate, reported in dollars and cents.  Reported as at the submission end date

Record set

"Estimate"

Start position

24

End position

35

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

Where an estimate type is not reported, the value for that estimate type is deemed as being zero.

C: 2.6.6    Estimated future weeks off employment

Description

The number of future weeks that the worker is expected to have off work

Record set

"Estimate"

Start position

36

End position

41

Length

6

Size

6

Applies to

All

Representational Layout

+/-NNNNN

Representational Format

Value

Accuracy Level % 100

Notes

Report weeks to one decimal place, e.g. 1 day is 0.2 weeks and reported as +00002.

If not applicable set to 000000.

Record Set 2  WCIDRR01-037 Record Identifier 7: Basic Claim Detail No 2 Record

There can only be one Basic claim detail No. 2 record for each claim reported on the submission. This record must be reported for every new claim. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

This record contains:

  • C: 2.7.1 Record Set
  • C: 2.7.2 Claim identifier
  • C: 2.7.3 Record Identifier
  • C: 2.7.4 Worker’s surname
  • C: 2.7.5 Worker’s given name/s
  • C: 2.7.6 Accident location - Street information
  • C: 2.7.7 Worker (mobile) telephone number
  • C: 2.7.8 Worker (work) telephone number
  • C: 2.7.9 Ordinary earnings
  • C: 2.7.10 Shift allowance
  • C: 2.7.11 Overtime
  • C: 2.7.12 Worker's email address

C: 2.7.1      Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Basic Claim Detail No 2"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for claim

C: 2.7.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Basic Claim Detail No 2"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.7.3    Record Identifier

Description

The identifier code of the record within the data submission

Record set

"Basic Claim Detail No 2"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '7' for a Basic Detail (2).

C: 2.7.4    Worker’s surname

Description

The surname of the worker.

Record set

"Basic Claim Detail No 2"

Start position

22

End position

41

Length

20

Size

20

Applies to

All

Representational Format

Text

Notes

Full Surname required.

Must not be spaces or zeros.

'Care of' names are not to be included.

No digits are to be included.

Special characters (for example: hyphens, apostrophes) that form part of the names must be included; no other special characters are to be recorded in the name field.

C: 2.7.5    Worker’s given name/s

Description

The given names of the worker.

Record set

"Basic Claim Detail No 2"

Start position

42

End position

61

Length

20

Applies to

All

Representational Format

Text

Notes

Full Given Names required.

Title is not to be supplied.

Multiple given names must only be separated by a single space.

No digits are to be included.

Special characters (for example: hyphens, apostrophes) that form part of the names must be included; no other special characters are to be recorded in the name field.

C: 2.7.6    Incident location - Street information

Description

Incident location - street information

Record set

"Basic Claim Detail No 2"

Start position

62

End position

181

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

Where the injury occurred at the normal workplace, set to NA.

C: 2.7.7    Worker (Mobile) telephone number

Description

The worker's mobile telephone number.

Record set

"Basic Claim Detail No 2"

Start position

182

End position

195

Length

14

Size

14

Applies to

All

Representational Format

Text

Notes

Mobile number must be reported as NA where worker does not have mobile phone.

C: 2.7.8    Worker (Work) telephone number

Description

The worker's work (place of employment) telephone number.

Record set

"Basic Claim Detail No 2"

Start position

196

End position

209

Length

14

Applies to

All

Representational Format

Text

Notes

For Australian landline report only the area code and phone number. Do not include International codes.

International telephone numbers require the international country code included.

If not applicable set to NA

C: 2.7.9    Ordinary earnings

Description

The average of the worker's ordinary earnings before the injury expressed as a weekly sum.

Record set

"Basic Claim Detail No 2"

Start position

210

End position

217

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, sections 44C, 44E, 44F, 44G, 44H and Schedule 3 of the Workers Compensation Act 1987

Notes

C: 2.7.10   Shift allowance

Description

Shift allowance paid or payable before the injury, expressed as a weekly sum.

Record set

"Basic Claim Detail No 2"

Start position

218

End position

225

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44C of the Workers Compensation Act 1987

Notes

This data item is not to be set to zero or removed once the first 52 weeks of payable weekly payments has occurred.

Where the Shift Allowance is determined to be an amount of zero, report as +0000000.

C: 2.7.11    Overtime

Description

Overtime paid or payable to the worker, expressed as a weekly.

Record set

"Basic Claim Detail No 2"

Start position

226

End position

233

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44C of the Workers Compensation Act 1987

Notes

This data item is not to be set to zero or removed once the first 52 weeks of payable weekly payments has occurred.

Where the Overtime is determined to be an amount of zero, report as +0000000.

C: 2.7.12   Worker's email address

Description

The worker's email address

Record set

"Basic Claim Detail No 2"

Start position

234

End position

487

Length

256

Applies to

All

Representational Format

Text

Notes

If not applicable leave blank

Record Set 2 WCIDRR01-038     Record Identifier 8: Work Capacity Record

There can be multiple Work Capacity Decision records reported on a claim, with the Original decision date (C: 2.8.4) and Work capacity decision type (C: 2.8.5) being the key to identifying a unique decision.

There may be multiple Work capacity decisions reported for each Work capacity decision type (C: 2.8.5). The different Original decision date (C: 2.8.4) identifies each decision set as unique.

Where multiple records (set) exist in a submission for the same claim then after the first 31 characters have been sorted, the records must be in order of activity with the last in the set displaying the latest view of that decision.

This record contains:

  • C: 2.8.1 Record Set
  • C: 2.8.2 Claim identifier
  • C: 2.8.3 Record identifier
  • C: 2.8.4 Original decision date
  • C: 2.8.5 Work capacity decision type
  • C: 2.8.6 Work capacity review stage
  • C: 2.8.7 Work capacity date type
  • C: 2.8.8 Work capacity activity date
  • C: 2.8.9 Work capacity outcome

C: 2.8.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Work Capacity"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record

C: 2.8.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Work Capacity"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

C: 2.8.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Work Capacity"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '8' for a work capacity record.

C: 2.8.4    Original decision date

Description

The date the insurer issued the original decision notice to the worker.

Record set

"Work Capacity"

Start position

22

End position

29

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Section 43 Workers Compensation Act 1987

Notes

C: 2.8.5    Work capacity decision type

Description

Identifies the type of Work Capacity Decision.

Record set

"Work Capacity"

Start position

30

End position

31

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 43 Workers Compensation Act 1987

Notes

C: 2.8.6   Work capacity review stage

Description

Identifies the stage of the work capacity decision.

Record set

"Work Capacity"

Start position

32

End position

33

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 43 Workers Compensation Act 1987

C: 2.8.7    Work capacity date type

Description

Type of activity that relates to the date reported

Record set

"Work Capacity"

Start position

34

End position

35

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 44A Workers Compensation Act 1987

Notes

C: 2.8.8   Work capacity activity date

Description

The date the work capacity activity occurs

Record set

"Work Capacity"

Start position

36

End position

43

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Section 44B Workers Compensation Act 1987

Notes

C: 2.8.9    Work capacity outcome

Description

The result of the work capacity assessment or work capacity assessment review

Record set

"Work Capacity"

Start position

44

End position

45

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 44B Workers Compensation Act 1987

Notes

Record Set 2 WCIDRR01-039     Record Identifier 9: Claim Control Record

There must be one Claim control record for each claim reported on the submission.

This record contains:

  • C: 2.9.1 Record Set
  • C: 2.9.2 Claim identifier
  • C: 2.9.3 Record identifier
  • C: 2.9.4 Claim payments to date
  • C: 2.9.5 Claim recoveries to date
  • C: 2.9.6 Total claim estimated liability
  • C: 2.9.7 Total claim estimated recoveries
  • C: 2.9.8 Hours paid total incapacity to date
  • C: 2.9.9 No longer in use
  • C: 2.9.10 No longer in use
  • C: 2.9.11 Decreasing adjustment on settlement payments
  • C: 2.9.12 Input tax credit on non-settlement payments
  • C: 2.9.13 Estimate of decreasing adjustment
  • C: 2.9.14 Estimated input tax credits
  • C: 2.9.15 Hours lost to date

C: 2.9.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Claim Control"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.9.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Claim Control"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

C: 2.9.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Claim Control"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '9' for a claim control record.

C: 2.9.4    Claim payments to date

Description

The total payments on the claim as at the submission end date.

Record set

"Claim Control"

Start position

22

End position

33

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.5    Claim recoveries to date

Description

The total amount of recoveries on the claim as at the submission end date.

Record set

"Claim Control"

Start position

34

End position

45

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.6    Total claim estimated liability

Description

The total of estimates of outstanding liability on the claim as at the submission end date.

Record set

"Claim Control"

Start position

46

End position

57

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

Where there are no estimates on a claim, insurer's must enter zero in this field.

C: 2.9.7    Total claim estimated recoveries

Description

The total of estimated recoveries on the claim as at the submission end date.

Record set

"Claim Control"

Start position

58

End position

69

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

Where there are no estimated recoveries on a claim, insurer's must enter 000000000000 in this field.

C: 2.9.8    Hours paid total incapacity to date

Description

The total of hours paid for total incapacity on the claim as at the submission end date.

Record set

"Claim Control"

Start position

70

End position

78

Length

9

Size

9

Applies to

All

Representational Layout

+/-HHHHHHMM

Representational Format

Value

Notes

C: 2.9.11    Decreasing adjustment on settlement payments

Description

The total amount of decreasing adjustment payments that the insurer has claimed against settlement payments on the claim at the submission end date.

Record set

"Claim Control"

Start position

91

End position

102

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.12   Input tax credit on non-settlement payments

Description

The total amount of all input tax credits that the insurer has claimed against non-settlement payments on the claim at the submission end date.

Record set

"Claim Control"

Start position

103

End position

114

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.13   Estimate of decreasing adjustment

Description

The estimate of the decreasing adjustment which will be claimed on the GST which will be paid on the Outstanding Liabilities relating to the settlement of the claim.

Record set

"Claim Control"

Start position

115

End position

126

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

C: 2.9.14   Estimated input tax credits

Description

An estimate of the Input Tax Credits that will be claimed for the GST which will be paid on the Outstanding Liabilities relating to non-settlement (or management costs) of the claim.

Record set

"Claim Control"

Start position

127

End position

138

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes:

C: 2.9.15   Hours lost to date

Description

The total sum of hours lost on the claim as at the submission end date.

Record set

"Claim Control"

Start position

139

End position

147

Length

9

Size

9

Applies to

All

Representational Layout

+/-HHHHHHMM

Representational Format

Value

Notes

The figure in this field must be reported in hours and minutes.

Record Set 9 WCIDRR01-040     Claim Submission Trailer Record

Must be the last record on the submission.

This record contains:

  • C: 9.1 Record Set
  • C: 9.2 Basic claim detail (1) record count
  • C: 9.3 Claim activity record count
  • C: 9.4 Time lost record count
  • C: 9.5 Service provision record count
  • C: 9.6 Compensation payment and recovery record count
  • C: 9.7 Estimate record count
  • C: 9.8 Claim control record count
  • C: 9.9 Total payment/recovery amount
  • C: 9.10 Basic claim detail record 2 record count
  • C: 9.11 Work capacity record count

C: 9.1                Record set

Description

Identifies the record as a Submission Trailer Record

Record set

"Claim Submission Trailer"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '9' for a Submission Trailer Record.

C: 9.2       Basic claim detail (1) record count

Description

The count of the number of the Basic claim detail records (Record Set 2 - Record identifier 1) on the submission

Record set

"Claim Submission Trailer"

Start position

2

End position

8

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

Notes

Must be the count of the number of Basic claim detail records (Record Set 2 - Record identifier 1) on the submission.

C: 9.3       Claim activity record count

Description

The count of the number of claim activity records (Record Set 2 - Record identifier 2) on the submission

Record set

"Claim Submission Trailer"

Start position

9

End position

15

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

Notes

Must be the count of the number of claim activity records (Record Set 2 - Record identifier 2) on the submission.

C: 9.4       Time lost record count

Description

The count of the number of time lost records (Record Set 2 - Record identifier 3) on the submission

Record set

"Claim Submission Trailer"

Start position

16

End position

22

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.5       Service provision record count

Description

The count of the number of Service provision records (Record Set 2 - Record identifier 4) on the submission

Record set

"Claim Submission Trailer"

Start position

23

End position

29

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.6       Compensation payment and recovery record count

Description

The count of the number of compensation and recovery records (Record Set 2 - Record identifier 5) on the submission

Record set

"Claim Submission Trailer"

Start position

30

End position

36

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.7       Estimate record count

Description

The count of the number of estimate records (Record Set 2 - Record identifier 6) on the submission

Record set

"Claim Submission Trailer"

Start position

37

End position

43

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.8       Claim control record count

Description

The count of the number of claim control records (Record Set 2 - Record identifier 9) on the submission

Record set

"Claim Submission Trailer"

Start position

44

End position

50

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.9       Total payment/recovery amount

Description

The total of all the payment/recovery amounts specified in all the compensation payment and recovery records on the submission

Record set

"Claim Submission Trailer"

Start position

51

End position

65

Length

15

Size

15

Applies to

All

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

C: 9.10 Basic claim detail record 2 record count

Description

The count of the number of the Basic claim detail 2 records (Record Set 2 - Record identifier 7) on the submission

Record set

"Claim Submission Trailer"

Start position

66

End position

72

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.11       Work capacity record count

Description

The count of the number of the Work capacity records (Record Set 2 - Record Identifier 8) on the submission.

Record set

"Claim Submission Trailer"

Start position

73

End position

79

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

Reference data

WCIDRR01-041      SIRA relies on externally and internally sourced reference data to verify the information submitted by insurers and stored in the SIRA Corporate Data Repository. Insurers and SIRA will be required to collaboratively utilise the same reference data to ensure consistent data quality and content in related systems.

WCIDRR01-042     Reference data can be regarded as tables that provide a valid source of information that can be used to validate information gathered and maintained within the system. Some form of reference data will be available to insurers for population into their own claims and policy system. SIRA will verify data reported by insurers with these reference tables.

WCIDRR01-043     The application of reference data can be found within the reporting requirements section of this document.

WCIDRR01-044     The following table is an example of the reference data; the rationale and responsibilities involved for successful implementation and ongoing management.

Agency/ Data source

Type of data

Data Elements and descriptions

Rationale for use

Expected Frequency

Responsibility

SIRA NSW

Allied Health

Professional

Service Provider ID’s

Provider Number for; Chiropractors

Physiotherapists

Osteopaths

Rehab Providers

Remedial Massage

Exercise Physiologists

SIRA will utilise the codes to monitor stakeholder behaviours.

Monthly

SIRA will be responsible for ensuring SIRA produced codes are made available to insurers, including the maintenance and updates in a timely manner. It is the insurer’s responsibility to ensure version control and the timeliness of the physical load to their database.

Australian

Medical

Association

(AMA)

Medical service provided codes

AMA Service Provided Codes

The AMA codes are maintained and updated by the Australian Medical Association. These codes have been included as part of the “SIRA Payment Classification System”.

Theses codes will be used to assist managing transactional level data and provide information to target key result areas.

Annually

SIRA will be responsible for ensuring SIRA AMA codes are made available to insurers, including the maintenance and updates in a timely manner.

It is the insurer’s responsibility to ensure version control and the timeliness of the physical load to their database.

SIRA NSW

A register of company names and addresses

Employer ABN

Employer Legal Name

Employer ACN

The ABN and Employer legal name reported by insurers will be validated against the ABR by SIRA.

Monthly

Insurers will be required to source the information directly from the ATO and load into their database.

Australia Post

The formal Australian register of addresses.

Street address, suburbs and postcodes

Address details provided by insurers are consistent with those held on the Australian Post Code register.

To be used to verify the postcode against locality for Employer Address, Worker’s Address, Workplace Address and Accident Location.

6 Monthly

SIRA will be responsible for coordinating the timeliness of loading new versions however insurers will be required to source the information directly from Australia Post and load into their database.

ABS

(Australian

Bureau of

Statistics)

Claim related codes.

National wage rates Hours people work Language codes ASCO 2nd Edition catalogue number 1220.

ASCO 1st Edition Cat 1223.0

ANZSIC Cat 1292.0

ASIC Cat 1201.0

Country and language have been condensed, so not all codes are applicable

ASCCS 1269.0

ASCL 1267.0

Utilised in claim definitions.

As Required

SIRA will be responsible for issuing and coordinating the timeliness of loading new versions.

It is the Insurer’s responsibility to ensure version control and the timeliness of the physical load to their database.

SIRA

Calculations for premium rates.

WIC Rates

IPO

Utilised in premium determination as per current solution.

Annually

SIRA will be responsible for issuing & coordinating the timeliness of loading new versions.

It is the Insurer’s responsibility to ensure version control and the timeliness of the physical load to their database.

Work Safe

Australia

Injury coding,

(TOOCS)

Nature of Injury/disease code/Disease code, Mechanism of injury/disease code,

Breakdown Agency.

TOOCS 1st Edition

TOOCS 2nd Edition revised (2.1)

TOOCS 3rd Edition revised (3.1)

Utilised in injury classification as per current solution.

Annually

SIRA will be responsible for issuing and coordinating the timeliness of loading new versions. It is the insurer’s responsibility to ensure version control and the timeliness of the physical load to their database.

SIRA

Valid, Invalid Cross Code validation combinations

(TOOCS)

SIRA NSW Cross Code Valid invalid combinations

Utilised in injury classification as per current solution

As Required

SIRA will be responsible for issuing and coordinating the timeliness of loading new versions. It is the insurer’s responsibility to ensure version control and the timeliness of the physical load to their database.

Part 2 : Claims data item guidance

A pdf version is also available.

Data item guidance

SIRA assistance

WCIDRR02-01         For queries, suggested changes or enhancements about any aspect of these requirements, please contact the Data Quality and Exchange Team on ph: (02) 4321 5703 or email: data.information@sira.nsw.gov.au

WCIDRR02-02        SIRA will be reconciling this data and if any discrepancy occurs, insurers will be asked to resolve, correct and, if appropriate, resubmit data.

WCIDRR02-03        SIRA will also use the data that is submitted by insurers for audit purposes in the event the Compliance, Enforcement and Investigation unit are made aware of potential fraud by a worker’s compensation insurer.

WCIDRR02-04        SIRA will use the data submitted to respond to complaints regarding work capacity decisions, permanent impairment and medical disputes, liability disputes, injury management disputes and premium disputes.

WCIDRR02-05        SIRA will use the data for monitoring insurer performance and for ensuring compliance with their licensing conditions.

WCIDRR02-06        SIRA may use the data for any other purpose in accordance with its legislative powers.

Data Item

WCIDRR02-07        This section details what additional information is relevant for each data item to assist in its reporting. Where nothing appears in the ‘Notes/ Comments’ column, it is considered that the data item needs no further explanation.

WCIDRR02-07.1      Claim Header Record

Data Item

Description

Notes/ Comments

C: 1.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 1.2 Insurer number

A unique three-digit number allocated by SIRA used to identify an insurer or the insurer's data provider

 

C: 1.3 Submission type

Identifies the type of data in the submission as either claims or policy.

 

C: 1.4 Claims system release number

Identifies the version of the claims system under which the data are being submitted to SIRA

 

C: 1.5 Submission start date

The start date (or from date) of the submission period

 

C: 1.6 Submission end date

The end date of the submission period.

The date should be the actual as at date (or close-off date) of the submission.

WCIDRR02-07.2    Basic Claim Detail No. 1 Record

Data Item

Description

Notes/ Comments

Claim identification data

  

C: 2.1.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 2.1.2 Claim identifier

The identifier allocated to the claim by the insurer

The Claim identifier must not be changed once reported to SIRA.

C: 2.1.3 Record identifier

The identifier code of the record within the data submission

 

C: 2.1.5 Shared claim code

Identifies whether the financial responsibility for a claim is being shared with another insurer

 

C: 2.1.6 Error report target

The insurer's reference that allows error reports to be aggregated for a particular person or office

This item is the responsibility of the insurer.

C: 2.1.7 Insurer branch

Insurer branch responsible for handling the claim

The precise nature of the identifier will be developed in conjunction with insurers so that it allows matching to the Insurer Branch set up as recorded in SIRA's computer system. Insurers must notify SIRA when new Branches are created.

C: 2.1.8 Date claim entered on insurer's system

The date the claim was first entered into the insurer's computer system

New claims should be reported to SIRA on the first submission following the entry of the claim on the insurer's system.

This date must not be changed from the original date first reported on the claim.

For claims first reported prior to 1 January 1998, when only a YYYYMM date was required, report the actual day (if known) as the DD component of the date, otherwise report '01' as the DD component of the date.

Date entered insurer's system must be equal to or later than Date of Injury (C: 2.1.43).

Non-converted claims are claims with a Date entered insurer’s system on or after 1 January 1998.

Converted claims are claims that were reported to SIRA prior to 1 January 1998.

C: 2.1.9 Date claim made

The date that a claim is made with the insurer in accordance with the SIRA Guidelines for claiming workers compensation.

Refer to the Guidelines for claiming workers compensationwhich specifies what information is required to make a claim and how the claim is made.

For the purpose of reporting in the data submission to SIRA, the Date claim made is the date that all information required to meet the “claim made” data set has been received by the insurer. This information may or may not be received on a claim form.

Employer data

  

C: 2.1.10 Policyholder identification number

A unique identification number for each policyholder (employer) in NSW.

 

C: 2.1.11 Period commencement date

The period commencement date of the policy term covering the claim.

Period commencement date must represent the policy term in which the injury occurred.

C: 2.1.12 Tariff rate number

The relevant tariff industry rate number covering the claim for the appropriate policy renewal year

Identifies the tariff rate number, and therefore the policy activity, that the claim is being attributed to.

The number specified must be a valid number for the particular policy renewal year as specified in the Insurance Premiums Order or Market Practice Premiums Guideline.

The number specified must exist as an activity of the policy, as reported on the policy data provided to SIRA for the particular renewal year.

The worker must be allocated to the same tariff rate number that the wages were counted against on the policy or in the deemed premium calculation.

C: 2.1.13 Employer name

The legal name of the employer

Must be the correct legal name of the employer. Where the legal name of the employer changes, this field must be updated. Acronyms should not be used unless they form part of the full legal name of the employer.

For example,: BT (for Bankers Trust) is not acceptable

Comments must not be recorded in the Employer legal name field.

For example, Expired on 30 June 1992 is not acceptable

Title words such as 'The' and 'and' which form part of an employer name should be included in their logical order in the name string.

For example, The Rocking Horse Shop but not Rocking Horse Shop, The

Commas, brackets, numerals and any other special characters, which form part of an employer legal name, should be included in their logical position in the name.

For example: 7-Eleven Stores Pty Ltd; The Boots Company (Australia) Pty Ltd

In those cases where the ACN forms part of the employer’s trading name, it is acceptable to supply it in the Employer Legal name field in the following format:

For example, ACN 001950380 Pty Ltd

‘Care of’ (c/o) or ‘Attention’ names are not to be recorded in the Employer Legal Name.

For example: Westmorley Company, C/o Penn and Jones Solicitors; Employer Legal Name: Westmorley Company

Asterisks must not be used in the Employer Legal Name field.

For example, **Null Policy** is not acceptable.

If the employer is an individual use the combination of Entity Name Given Name, Entity Name Other Given Names, Entity Name Family Name AND Entity Name Suffix with a space between each field.

For example, James Ferdinand Poulson.

The name must be entered in the order that the people would use to introduce themselves.

For example, Alison Gray, but not Gray, Alison.

For partnerships, the Given name and other names are to be reported in full, with a space between the Given name and Surname. Each partners name is to be separated by an ampersand

For example, Mary Jones and Brian Smith would be reported as Mary Jones & Brian Smith.

If the employer is an ‘Other partnership’, then each of the partners must be listed in alphabetical order rather than the name of the partnership. (generally, applies to accountancy and legal firms)

For example, A Apple & B Baker & C Charlie rather than AppleBakerCharlie.

Where two companies are in partnership, the name of both companies is to be provided. If more than 2 companies are involved in the partnership provide as much information as possible.

If the employer is a superannuation fund then the employer legal name can contain ‘Proprietary Limited’, ‘Pty Ltd’ or ‘Proprietary Ltd’

If the employer is an Australian private company, limited partnership or other incorporated entity then the employer legal name can contain ‘Proprietary Limited’, ‘Pty Ltd’ or ‘Proprietary Ltd’

For all Australian public and private companies, the name registered with ASIC is what should be reported.

Strata Title - only requires the words Strata Plan and the number. All other information (e.g. managing agent names, proprietor names, property names) must be omitted.

For example: Strata Plan No. 1234356 to be reported as Strata Plan 1234356; and The Proprietors of Strata Plan 9835343 to be reported as Strata Plan 9835343.

Trustee name - supply the full name of the Trustee or Trustees. Address details must not be recorded in the same fields as Trustee name.

Trusts and Trustees (sometimes identified by T/for or T/Tee for) must be reported as follows:

For example, R Citizen for the Citizen Family trust.

C: 2.1.14 Employer ACN or ARBN

The Australian Company Number or Australian Registered Body Number of the employer.

 

Claimant data

  

C: 2.1.16 Worker’s address - Street information

The street details of the worker's current residential address

Address details must be specified in line with Australia Post Standards.

C: 2.1.17 Worker’s address - Locality name

The locality or suburb of the worker's current residential address

See section Address format rules for examples and rules as to how to specify addresses.

C: 2.1.18 Worker’s address - Postcode

The postcode of the locality or suburb of the worker's current residential address

 

C: 2.1.19 Worker's gender code

The gender of the worker

 

C: 2.1.20 Worker's date of birth

The date of birth of the worker

 

C: 2.1.22 Worker's language code

The language spoken at home by the worker

If Date claim entered on insurer’s system (C: 2.1.8) is greater than or equal to 1 January 1998 AND before 1 July 2011, use Australian Standard Classification of Languages (ABS Cat No. 1267.0 1997).

If Date claim entered on insurer’s system (C: 2.1.8) is greater than or equal to 1 July 2011, use Australian Standard Classification of Languages (ABS Cat No. 1267.0 2005-2006).

Must be reported as a current valid code or zeros, for claims with a Date claim entered on insurer's system (C: 2.1.8) prior to 1 January 1998.

Where interpreter payments have been reported, must be a valid value.

C: 2.1.24 Worker’s occupation code

The occupation of the worker at the date of the injury

If Date claim entered on insurer's system (C: 2.1.8) is prior to 1 July 2002, use Australian Standard Classification of Occupations (ASCO), 1st Edition, ABS Catalogue No 1222.0.

If Date claim entered on insurer's system (C: 2.1.8) is after 1 July 2002 AND before 1 July 2011, use Australian Standard Classification of Occupations (ASCO), 2nd Edition (ABS Cat. No. 1220.0, 1997).

If Date claim entered on insurer's system (C: 2.1.8) is after 30 June 2011, use Australian and New Zealand Standard Classification of Occupations (ANZSCO), (ABS Cat. No. 1220.0, 2006)

Claims must be coded to the 4-digit (i.e. Unit Group) level.

C: 2.1.25 Worker's dependant - children

The number of dependent children.

This is only to be reported for death claims or Police Officers, Paramedics, Firefighters or Coal workers.

C: 2.1.26 Worker’s other dependants

The number of dependants other than children

Should be updated during the life of the claim if the number of dependent children changes.

Number of dependants includes partial dependants as defined in s26 Workers Compensation Act 1987.

C: 2.1.28 Permanent employment code

The worker's type of employment at the date of the injury

 

C: 2.1.29 Training status code

The worker's training status at the date of the injury.

 

C: 2.1.30 Hours worked per week

The worker's weekly ordinary hours or average weekly hours at the date of injury

 

C: 2.1.31 Pre-injury average weekly earnings/ Current weekly wage rate

The average weekly earnings as calculated in accordance with the legislation for exempt and non-exempt workers.

Where the pre-injury average weekly earnings change as a result of indexation or other factors, this data item must be updated.

Accident data

  

C: 2.1.32 Duty status code

The worker's duty status at the date of injury

 

C: 2.1.33 Workplace address - Street information

The street address of the employer's base of operations for the worker at the date of injury

Address details must be specified in line with Australia Post Standards.

Report the normal workplace address, or base of operations, as at the time of the injury.

C: 2.1.34 Workplace address - Locality name

The locality or suburb of the employer's base of operations for the worker at the date of injury

See section: Address format rules for examples and rules on how to specify addresses.

Report the normal workplace address, or base of operations, as at the time of the injury.

C: 2.1.35 Workplace address - Postcode

The postcode of the employer's base of operations for the worker at the date of injury

Report the normal workplace address, or base of operations, as at the time of the injury.

C: 2.1.36 Workplace industry (ASIC)

The primary industry activity undertaken at the employer's base of operations for the worker at the date of injury

Only to be specified for claims with a Date claim entered on insurer’s system (C: 2.1.8) prior to 1 July 1997.

Claims with a Date claim entered insurer’s system (C: 2.1.8) on or after 1 July 1997 must have this field set to ‘0000’. The Workplace industry (ANZSIC) code (C: 2.1.37) must be specified for these claims.

C: 2.1.37 Workplace industry (ANZSIC)

The primary industry activity undertaken at the employer's base of operations for the worker at the date of injury

If Date claim entered on insurer's system (C: 2.1.8) is after 1 July 1997 AND before 1 July 2011, use Australian and New Zealand Standard Industrial Classification (ANZSIC), (ABS Cat No 1292.0, 1993).

If Date claim entered on insurer's system (C: 2.1.8) is after 1 July 2011, use Australian and New Zealand Standard Industrial Classification (ANZSIC), (ABS Cat No 1292.0, 2006).

Required for claims with a Date entered Insurer's system (C: 2.1.8) on or after 1 July 1997

Claims with a Date claim entered on insurer's system (C: 2.1.8) prior to 1 July 1997 must have this field set to '0000'.  The ASIC code (C: 2.1.36 Workplace Industry ASIC) must be specified for these claims.

Must be the primary industry of the workplace address reported in C: 2.1.33, C: 2.1.34 and C: 2.1.35.

C: 2.1.38 Workplace size

The employer's estimate of the number of employees normally working at the employer's base of operations for the worker at date of injury.

Must be specified for claims with a Date claim entered on insurer's system (C: 2.1.8) on or after 1 January 1998 and before 1 January 2002.

Can be set to zero if Date entered Insurer's system (C: 2.1.8) is less than 1 January 1998.

Do not provide the total number of employees of the business (unless they are all employed at the one location).

It must be the number of employees at the workplace address specified in items C: 2.1.33, C: 2.1.34 and C: 2.1.35.

If the worker is working from a temporary or mobile workplace, specify the size of the base of operations or permanent workplace of the worker.

C: 2.1.39 Incident location code

The type of incident location

 

C: 2.1.40 Incident location description

A description of the incident location in circumstances where the worker was away from their normal workplace or base of operations.

Provide a description of the location of the incident where the worker was injured away from the normal workplace.

Locality name and postcode of the incident location should be provided in separate fields (Incident locality name C: 2.1.41 & Incident postcode C: 2.1.42)

Examples

Accident happened at a construction site.

Incident location description: House construction site.

A cleaner was injured at a school.

Incident location description: School grounds at North Parramatta Public School.

A truck driver was involved in a traffic accident on a public road.

Incident location description: On M1 near Gosford exit.

A council worker was injured in a park.

Incident location description: On the footpath at Ryde Park.

C: 2.1.41 Incident Locality name

The locality or suburb of the incident location

For overseas addresses specify Locality name as OS

C: 2.1.42 Incident postcode

The postcode of the incident location

For overseas addresses specify Postcode as 0000

Injury data

  

C: 2.1.43 Date of injury

The date of the injury or disease.

For personal injury arising out of or in the course of employment, report the date it occurred.

For diseases of gradual process, report the most appropriate date, that is:

at the time of the worker’s death or first incapacity; OR

if death or incapacity has not resulted from the injury – at the time the worker makes a claim for compensation for the injury

For loss, or further loss of hearing, report the most appropriate date, that is:

where the worker was employed in employment that caused the injury, the date the notice was given; OR

where the worker was not employed in employment that caused the injury, on the last day the worker was employed in employment that caused the injury.

C: 2.1.44 Time of injury

The time of the injury or disease.

For illnesses or diseases of gradual onset set this item to 0000

If an Injury occurred at midnight then time of injury = 23.59

C: 2.1.45 Nature of injury/disease code

Identifies the most serious injury or disease type of the worker.

If Date claim entered on insurer’s system (C: 2.1.8) is after 1 July 1991 AND before 1 July 2002, use the Nature of injury/ disease classification, Type of Occurrence Classification System (TOOCS), version 1.

If Date claim entered on insurer’s system (C: 2.1.8) is on or after 1 July 2002 AND before 1 July 2011, use the Nature of injury/ disease classification, Type of Occurrence Classification System (TOOCS), version 2.1.

Claims with a Date claim entered on insurer’s system (C: 2.1.8) after 30 June 2011, use the Nature of injury/disease classification, Type of Occurrence Classification System (TOOCS), version 3.1.

C: 2.1.46 Bodily location of injury/disease code

Identifies the part of the body affected by the most serious injury or disease

If Date claim entered on insurer’s system (C: 2.1.8) is after 1 July 1991 AND before 1 July 2002, use the Bodily location of injury/disease classification, Type of Occurrence Classification System (TOOCS), version 1.

If Date claim entered on insurer’s system (C: 2.1.8) is on or after 1 July 2002 AND before 1 July 2011, use the Bodily location of injury/disease classification, Type of Occurrence Classification System (TOOCS), version 2.1.

Claims with a Date claim entered on insurer’s system (C: 2.1.8) after 30 June 2011, use the Bodily location of injury/disease classification, Type of Occurrence Classification System (TOOCS), version 3.1.

C: 2.1.47 TOOCS Mechanism

Identifies the action, exposure or event that triggered the incident/injury.

If Date claim entered on insurer’s system (C: 2.1.8) is on or after 1 July 1991 AND before 1 July 2002, use the Mechanism of injury/disease classification, Type of Occurrence Classification System (TOOCS), version 1.

If Date claim entered on insurer’s system (C: 2.1.8) is on or after 1 July 2002 AND before 1 July 2011, use the Mechanism of injury/disease classification, Type of Occurrence Classification System (TOOCS), version 2.1.

Claims with a Date claim entered on insurer’s system (C: 2.1.8) after 30 June 2011, use the Mechanism of Incident classification, Type of Occurrence Classification System (TOOCS), version 3.1.

C: 2.1.48 Breakdown agency

Identifies the object, substance, or circumstance that was principally involved in causing the incident.

If Date claim entered on insurer’s system (C: 2.1.8) is after 1 July 1991 AND before 1 July 2002, use the Breakdown agency classification, Type of Occurrence Classification System (TOOCS), version 1.

If Date claim entered on insurer’s system (C: 2.1.8) is on or after 1 July 2002 AND before 1 July 2011, use the Breakdown agency classification, Type of Occurrence Classification System (TOOCS), version 2.1.

For example, if the injured worker had tripped over a chair and hit their knee on the table, the breakdown agency of the injury/disease would be the chair. The chair caused the accident. The table on the other hand caused the harm and would be the Agency of the injury/disease (C: 2.1.54).

C: 2.1.49 Result of injury code

A code to indicate the result of the injury

 

C: 2.1.50 Date deceased

The date of death of the worker where the death arises from the incident.

Do not report the date of death where the death is unrelated to the claim.

C: 2.1.51 Employer ABN (Australian Business Number)

The Australian Business Number (ABN) issued to the employer by the Australian Business Register.

 

C: 2.1.52 Workers Compensation Industry Classification (WIC) code

The relevant NSW Workers Compensation Industry Classification (WIC) code covering the claim for the appropriate policy renewal year

For underwriters, this is the WIC specified in the relevant policy term.

For other insurers, this is the WIC of the employer at the date of injury.

C: 2.1.54 Agency of injury/disease

Identifies the object, substance or circumstance directly involved in causing the most serious injury or disease

If Date claim entered on insurer’s system (C: 2.1.8) is on or after 1 July 2002 AND before 1 July 2011, use the Agency classification, Type of Occurrence Classification System (TOOCS), version 2.1.

For example, if the injured worker had tripped over a chair and hit their knee on the table, the agency of the injury/disease would be the table. The table caused the harm. The chair on the other hand caused the accident and would be the breakdown agency of the injury/disease (C: 2.1.48).

C: 2.1.55 Significant injury date:2

The date on which the insurer first becomes aware of the likelihood of worker being incapacitated for a continuous period of more than 7 days.

 

C: 2.1.56 Contact complete date

The date the insurer completes initial contact with the worker, the employer and treating doctor (if required).

 

C: 2.1.58 Worker (Home) telephone number

The contact Home telephone number of the worker

Examples:

NSW landline

02########                  where # is the digit

Australian mobile

04#######                   where # is the digit

UK

+44##########            where # is the digit

C: 2.1.59 TOOCS Breakdown agency

Identifies the object, substance, or circumstance that was principally involved causing the incident.

Claims with a Date claim entered on insurer’s system (C: 2.1.8) after 30 June 2011, use the Breakdown agency classification, Type of Occurrence Classification System (TOOCS), Version 3.1.

For example, if the injured worker had tripped over a chair and hit their knee on the table, the breakdown agency of the injury/disease would be the chair. The chair caused the accident. The table on the other hand caused the harm and would be the TOOCS Agency of injury/disease (C: 2.1.60).

C: 2.1.60 TOOCS Agency of injury/disease

Identifies the object, substance or circumstance directly involved in causing the most serious injury or disease.

Claims with a Date claim entered on insurer’s system (C: 2.1.8) after 30 June 2011, use the Agency of injury/disease classification, Type of Occurrence Classification System (TOOCS), Version 3.1.

For example, if the injured worker had tripped over a chair and hit their knee on the table, the agency of the injury/disease would be the table. The table caused the harm. The chair on the other hand caused the accident and would be the TOOCS Breakdown agency (C: 2.1.59).

WCIDRR02-07.3     Claim Activity Record

Data Item

Description

Notes/ Comments

C: 2.2.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 2.2.2 Claim identifier

The identifier code of the claim by the insurer

The Claim identifier must not be changed once reported to SIRA.

C: 2.2.3 Record identifier

The identifier code of the record within the data submission

 

C: 2.2.4 Liability status date

The date of the Liability Status decision.

Liability status date must only be changed where there has been a change to the Liability status or when correcting a previously reported Liability status date.

C: 2.2.5 Claim closed flag

A flag to indicate if the claim is closed

 

C: 2.2.6 Date claim closed

The most recent date that the claim was closed

 

C: 2.2.7 Date claim re-opened

The most recent date that the claim was re-opened

 

C: 2.2.8 Reason for re-opening claim code

Identifies why the insurer has re-opened the claim

 

C: 2.2.9 Liability status code

The current status of liability for a notification or claim, as determined by the insurer.

 

C: 2.2.11 Date of claim review

The date of the latest claim review conducted by the insurer

 

C: 2.2.13 Work status code

The current work status of the worker.

This item indicates if the worker is currently Working or Not Working.

Work status code must be actively reviewed and updated to reflect the current work status of the worker.

C: 2.2.15 Second injury claim flag

A flag indicating if the claim is a second injury claim as defined under section 54 of the Workplace Injury Management and Workers Compensation Act 1998

 

C: 2.2.16 Initial notifier code

Identifies the category of the initial notifier of an injury

 

C: 2.2.17 Reasonable excuse code

The reason for not commencing provisional payments.

 

C: 2.2.20 Action date section 66

The date the insurer made a reasonable offer of settlement or disputed liability for lump sum compensation.

 

C: 2.2.21 Action type section 66

Identifies the type of action taken by the insurer in response to a lump sum compensation claim.

 

C: 2.2.22 Common law action date

The date a statement of claim for a Common Law Claim is filed with the Court or the date the insurer receives a pre-filing statement for the recovery of Work Injury Damages.

 

C: 2.2.23 Initial notifier name

The name of the person who first notified the insurer of the incident

Report the name of the person as indicated by the Initial notifier code (C: 2.2.16).

Preferred format is:

- Title Given Names Surname.

- Title is optional

- Full Given Names are preferred; Initials must only be given when the full name is not known

C: 2.2.24 Initial notifier telephone number

The contact telephone number of the person who first notified the Insurer of the incident

Examples:

NSW landline

02########                  where # is the digit

Australian mobile

04#######                   where # is the digit

UK

+44##########           where # is the digit

C: 2.2.25 Description of incident

A clear and concise description of how the incident occurred.

Due to the size limitation in this field, the description should be captured in a concise manner and include:

  • worker   activity
  • equipment/object/person/circumstance   that caused the incident
  • equipment/object/person/circumstance   that caused the injury
  • type   of mechanism for example: fall, motor vehicle accident

Example

Walking through warehouse, worker tripped over timber on the floor.

Driving taxi, stopped at red traffic light. Rear ended by a bus. Struck head on steering wheel.

C: 2.2.26 Description of Injury/illness

A description of all the injuries/ diseases and parts of the body affected.

Due to the size limitation in this field, the description should be captured in a concise manner and include

  • injures   and parts of the body affected in order of severity

Example

Torn ligament to right ankle.

Concussion and multiple cuts to the forehead.

C: 2.2.27 Work status date

The date when the worker's work status changed.

Indicates the date the worker’s Work Status changed, not the date the code was updated.

C: 2.2.28 Type of dispute

Identifies the reason why an insurer disputes a claim.

 

C: 2.2.29 Date of claim screening

The date a claim is screened by the insurer to assess whether an Injury management plan (IMP) is required, or the date of a review of an Injury management plan.

 

C: 2.2.30 Claim screening action code

Describes the action taken by the insurer about an Injury management plan following the screening of a claim.

 

C: 2.2.31 Result of the permanent impairment assessment (PI %).

Result of the most recent permanent impairment assessment (PI %).

This value can be greater than the value in Assessed percentage of permanent impairment for paid S66 benefits (C: 2.2.45) where a subsequent assessment has taken place.

C: 2.2.32 Date claim recovery action commenced

The date that claim recovery action is commenced against the other liable party/Insurer

Recovery action is considered to commence from the date a letter of demand is sent to the third party indicating the intention to recover costs. This may include an initial schedule of payments.

C: 2.2.33 Percentage of estimated recovery

The estimated percentage of recovery

To be calculated only on claims that have been identified as being Recovery claims.

C: 2.2.34 Recovery investigation indicator

Indicates if a claim has been investigated for recovery payments potential

 

C: 2.2.35 SIRA NSW Certificate of Capacity period start date

The start date for the period covered by a SIRA Certificate of capacity/certificate of fitness.

As specified on the latest SIRA NSW Certificate of Capacity/Fitness.

C: 2.2.36 SIRA NSW Certificate of Capacity period end date

The end date for the period covered by a SIRA Certificate of capacity/certificate of fitness.

As specified on the latest SIRA NSW Certificate of Capacity/Fitness.

C: 2.2.37 SIRA NSW Certificate of Capacity fitness

Capacity for work as specified on the SIRA Certificate of capacity/ certificate of fitness

As specified on the latest SIRA NSW Certificate of Capacity/Fitness.

C: 2.2.38 WCC matter number

The Workers Compensation Commission reference number allocated for a dispute

Where there is more than one dispute, then report the most recent.

C: 2.2.39 Section 52A code

The reason for discontinuation of weekly payments for partial incapacity after 2 years.

 

C: 2.2.40 Common law action type

Identifies the legislative basis upon which a claim for work injury (WID) damages has been made.

 

C: 2.2.41 Common law action outcome

The outcome of the work injury damages or common law action.

 

C: 2.2.42 Work capacity transition date

The date that a work capacity transition outcome was made.

This data item is to record the work capacity decision date for transitioning a claim from old 1987 act to the current 1987 act.

C: 2.2.43 Work capacity transition outcome

The outcome of a work capacity transition assessment conducted by the insurer.

This data item is to record the work capacity decision outcome for transitioning a claim from old 1987 act to the current 1987 act.

C: 2.2.44 Estimated permanent impairment (EPI%)

The insurers estimate of the permanent impairment (PI%) of the worker based on available information.

The estimate must be updated on receipt of additional information including when an assessment takes place.

C: 2.2.45 Assessed percentage of permanent impairment for paid S66 benefits

The permanent impairment assessment (PI%) applicable to the payment of permanent impairment compensation.

The permanent impairment percentage applicable to the sum of all sect 66 payments reported.

WCIDRR02-07.4     Time Lost Record

Data Item

Description

Assortment of Notes/ Comments

C: 2.3.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 2.3.2 Claim identifier

The identifier allocated to the claim by the insurer

The Claim identifier must not be changed once reported to SIRA.

C: 2.3.3 Record identifier

The identifier code of the record within the data submission

 

C: 2.3.4 Date ceased work

The date of the last day the worker attended work prior to commencing their first period of absence from the workplace due to their work capacity.

This item should not be updated to reflect date/s ceased work after the original date ceased work.

If the worker dies during the incident do not report a time lost record.

If the worker is injured on the way home from work, and is absent from the workplace as a result, the date ceased work is the same as the Date of injury (C: 2.1.43).

If a worker is injured on the way to work, and is absent from the workplace as a result, the date ceased work is the previous day, i.e. the Date of injury (C: 2.1.43) minus 1 day.

Rules:

  1. If worker has no capacity, then Date   ceased work (C: 2.3.4) must be reported
  2. If worker has current capacity but is not   working (i.e. suitable employment not performed),   then Date ceased work (C: 2.3.4) must be reported

C: 2.3.5 Estimated date fit to resume employment

The date when it is expected that the worker will resume work in any capacity, as at the submission end date

 

C: 2.3.7 Actual date resumed work

The date the worker resumed work in any capacity with any employer.

If after resuming work the worker has a further period of time off work, the Actual date resumed work (C: 2.3.7) must be reset to zero.

Where the worker has ceased work and does not resume work due to death, the Actual date resumed work (C: 2.3.7) is reported with the same date as the date of death to stop the number of days off work incrementing.

Where the worker has ceased work and will not resume work due to situations such as retirement or commutation, report the Actual date resumed work (C: 2.3.7) the same as the date of retirement or the date that the commutation was determined.

C: 2.3.8 Number of days off work

The total number of days, measured in whole calendar days (including holidays and weekend days) that the worker has been off work due to the injury/illness

Where the worker has part of a day off work, that day is not counted unless the time lost is for part of one day only.

Minimum number of days off work is 1. Where multiple periods off work occur, these must be added together.

If the worker has not resumed work, calculate as at the Submission end date (C: 1.6).

Examples

If Date ceased work = 12 March 2018 and Date resumed work = 13 March 2018 then Number of days off work = 1

If Date ceased work = 12 March 2018 and Date resumed work = 15 April 2018 then Number of days off work = 33

(15 April 2018 less 12 March 2018 - 1)

If Date ceased work = 12 March 2018 and the submission end date (C: 1.6) is 30 April 2018 and the claimant has not resumed work, then the Number of days off work for the April submission = 49 (30 April 2018 minus 12 March 2018)

WCIDRR02-07.5     Service Provision Record

Data Item

Description

Notes/ Comments

C: 2.4.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 2.4.2 Claim identifier

The identifier allocated to the claim by the insurer

The Claim identifier must not be changed once reported to SIRA.

C: 2.4.3 Record identifier

The identifier code of the record within the data submission

 

C: 2.4.5 Rehabilitation provider code

The approved workplace rehabilitation provider number as specified by SIRA.

 

C: 2.4.6 Service provision start date

The commencement date of a vocational rehabilitation program OR the insurer approval date for workplace rehabilitation.

Service provision type is '01' Workplace Rehabilitation Services.

Must be the date the insurer approved commencement of workplace rehabilitation services not the date of service. If the worker is referred to a workplace rehabilitation provider more than once, each date must be reported on a separate Service Provision Record.

Service provision type is '02' Vocational Rehabilitation Program.

For retraining, work trial or JobCover Placement, the service provision start date is the date the course or work commences.

Where a piece of equipment has been approved, the service provision start date is the date the equipment is supplied.

For transition to work, the service provision start date is the date the first service is delivered.

C: 2.4.7 Service provision end date

The end date of the workplace rehabilitation referral OR the vocational rehabilitation program.

A Service Provision End Date is only to be reported once the service/program is completed. Zeroes must be reported in this data item when a Service Provision Record is being reported and the service/program is underway.

If the record is being Nulled, set this date to zeroes.

Service provision type '01' Workplace Rehabilitation Services

The date must be the last date of rehabilitation service and be the same as reported by the workplace rehabilitation provider in their closure report to the insurer.

Service provision type '02' Vocational Rehabilitation Services

Where a worker’s retraining, work trial or JobCover placement ends, the last date of the program/course is to be reported as the service provision end date.

Where it is a piece of equipment or transition to work payment, the date the last service is provided is to be reported as Service provision end date.  In some cases, the Service provision start date and Service provision end date may be the same.

For transition to work, the service provision end date is the date the last service is delivered.

C: 2.4.8 Service provision type

The type of rehabilitation service.

 

C: 2.4.9 Service provision sub type

Identifies the category of vocational rehabilitation program.

Only applicable when service provision type '02' vocational rehabilitation program is reported.

C: 2.4.10 Service Provision Null date

The date the service provision record was identified as being reported in error.

 

C: 2.4.11 Work trial host employer ABN

The ABN of the work trial host employer

 

WCIDRR02-07.6     Compensation Payment and Recovery Record

Refer to the Payment classification reference for examples of reporting payment transactions.

Data Item

Description

Notes/ Comments

C: 2.5.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 2.5.2 Claim identifier

The identifier allocated to the claim by the insurer

The claim identifier must not be changed once reported to SIRA.

C: 2.5.3 Record identifier

The identifier code of the record within the data submission

 

C: 2.5.5 Payment transaction date

The date the insurer makes the payment or receives a recovery payment.

Payments that have been pre-approved or scheduled for future action are only to be reported as each payment or recovery is made during that submission period.

C: 2.5.6 Adjustment transaction flag

A flag to indicate, for weekly payments, that the transaction being submitted is an adjustment to a previously submitted transaction

Adjustment transaction flag of ‘Y’ is only applicable to weekly payments.

Other payment types must have the adjustment transaction flag set to 'N'.

C: 2.5.7 Payment/recovery amount

The amount of the payment or recovery transaction, inclusive of GST

Weekly benefit payments are inclusive of PAYG.

C: 2.5.8 Payment period start date

The start date of the period of incapacity for the weekly payment.

Must also be specified for adjustments.

C: 2.5.9 Payment period end date

The end date of the period of incapacity for the weekly payment.

Must also be specified for adjustments.

C: 2.5.10 Hours paid for total incapacity

The hours paid for total incapacity within the payment period.

Applicable to Payment classification number (C: 2.5.17) WPT001, WPT002, WPT003 and WPT004.

WPT005, WPT006 and WPT007 are only to be reported with this data item where an adjustment is being made to a weekly payment transaction reported prior to 1 January 2015.

Alterations to previously reported payment transactions can be reported as positive or negative as appropriate.

C: 2.5.11 Hours paid for partial incapacity

The hours paid for partial incapacity within the payment period.

Applicable to Payment classification number (C: 2.5.17) WPP001, WPP002, WPP003 and WPP004.

Only report the hours not being worked where the worker is working reduced hours as a result of the injury.

Alterations to previously reported payment transactions can be reported as positive or negative as appropriate.

C: 2.5.12 Reimbursement schedule code

Identifies the wage payment agreement between an insurer and employer OR an insurer and worker

 

C: 2.5.15 Payee ID

This identifies the entity receiving payment for services provided.

Reporting of REIMB

Where the payment is a reimbursement to the worker or employer (e.g. Pharmacy expenses), report REIMB.

Reporting of NA

Where the Payment classification number (C: 2.5.17) is for one of the following groups, report NA:

COM, CLP, DEC, DOA, PAS, PDO, RCL, RES, RFD, ROP, RPE, RSC, SCP, TRA002, TRA003, WPI.

Reporting of ABN or NOABN

If REIMB or NA is not applicable, report the ABN of the payee (note: If an ABN is reported, it must meet the minimum data requirements IE: 11 characters in length)

If the provider has no ABN, report NOABN.

C: 2.5.16 Service provider ID

Identifies the entity that provided the service.

Reporting of NA

Where the Payment classification number (C: 2.5.17) is in one of the following groups, report NA:

- COM, CLP, DEC, DOA, PAS, PDO, RCL, RES, RFD, ROP, RPE, RSC, SCP, WPI, WPP, WPT, VRE002, VRE003, VRE004, VWT002, TRA002, TRA003

HIC Provider Number

Where the Payment classification number (C: 2.5.17) is in one of the following code groups, report the HIC provider number:

- All AMA (Australian Medical Association) codes

And

- the following SIRA Medical Service codes:

IIN105, IIN106, IIN107, IIN108, IIN109, IMG, IMS, WCO, WIG, WIS

Where Medicare has declined to issue a HIC, report the ABN of the Service Provider

Approved SIRA Provider

Where the Payment classification number (C: 2.5.17) is in one of the following code groups, report the provider number:

- AID, CHA, COU, EPA, OR, OSA, PSY, PTA or RMA

Use provider code REV0000 when cancelling a payment where a provider code has not previously been reported on a payment. Only to be used for the following payment classification code groups:

-AID, CHA, COU, EPA, OSA, PSY, PTA

Reporting of ABN or NOABN

If HIC, Approved SIRA provider or NA is not applicable, report the ABN of the service provider.

If the provider has no ABN, report NOABN.

C: 2.5.17 Payment classification number

Identifies the type of payment being made by an insurer.

Refer to the Payment classification reference for a comprehensive list of the codes and code values. For examples of reporting payment transactions refer to the Payment reporting rules section of this document.

C: 2.5.18 Date of service

The date the service was provided.

Date of Service

Where the Payment classification number (C: 2.5.17) is for one of the following code groups, the Date of service is not to be supplied:

- COM, DEC, PAS, PDO, RCL, RES, ROP, RPE, RSC, SCP, TRA002, WPI, WPP, WPT, VWT002.

Service provided for more than one day

Where the service provided is conducted over a period of time, report the last day as the date of service

C: 2.5.19 Determined weekly benefit amount

The maximum weekly benefit entitlement amount for one week relating to the payment period.

SIRA Defined Limit $3000

C: 2.5.20 Invoice number

The unique identifier on the invoice provided by a service provider

If there is no invoice, this field can be left blank.

C: 2.5.21 Hours lost

The number of hours and minutes in the weekly benefit payment period during which the worker was absent from work.

 

C: 2.5.22 Earnings

The worker’s earnings or deemed earnings in the weekly benefit payment period.

Not applicable for Police Officers, Paramedics, Firefighters or Coal Workers as per exempt classes in the 2012 Legislative Reform.

C: 2.5.23 Deductibles

The monetary value that a worker receives as ‘payment in kind’ in the weekly benefit payment period.

Not applicable for Police Officers, Paramedics, Firefighters or Coal Workers as per exempt classes in the 2012 Legislative Reform.

WCIDRR02-07.7     Estimate Record

Data Item

Description

Notes/ Comments

C: 2.6.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 2.6.2 Claim identifier

The identifier allocated to the claim by the insurer

The claim identifier must not be changed once reported to SIRA.

C: 2.6.3 Record identifier

The identifier code of the record within the data submission

 

C: 2.6.4 Estimate Type

Identifies the type of estimate of future liability.

 

C: 2.6.5 Estimate Amount

The amount of the estimate, reported in dollars and cents. Reported as at the submission end date

If estimate type 64 ‘Estimate on liabilities - Estimates to be excluded from cost of claims calculations’ is used, the estimate amount is not included in the cost of claims calculations but is still included in reporting values.

For example, future costs of vocational programs, Workplace Injury Management and Workers Compensation Act 1998 expenses and interpreter expenses are excluded. Please refer to Exclusions from premium calculations on page 48 for examples.

C: 2.6.6 Estimated future weeks off employment

The number of future weeks that the worker is expected to be not working.

Only applicable to Estimate type (C: 2.6.4) 50 - Estimates on liabilities – weekly


WCIDRR02-07.8     Basic Claim Detail No. 2 Record

Data Item

Description

Notes/ Comments

C: 2.7.1 Record Type

Identifies the type of data in the record as either claims or policy.

 

C: 2.7.2 Claim identifier

The identifier allocated to the claim by the insurer.

The claim identifier must not be changed once reported to SIRA.

C: 2.7.3 Record Identifier

The identifier code of the record within the data submission.

 

C: 2.7.4 Worker surname

The surname of the worker.

Only name information is to be included in the Surname field.

Titles, address details and comments are not to be recorded in this field.

C: 2.7.5 Worker’s given name/s

The given names of the worker.

Only name information is to be included in the Given Name field.

Titles, address details and comments are not to be recorded in this field.

C: 2.7.6 Incident location - Street information

Incident location - street information.

For overseas addresses report the full address.

Do not report the locality or postcode in this field unless it is an overseas address.

Report NA if the incident occurred at the worker's normal place of work or base of operations (Incident location code (C: 2.1.39 = 01)) or if Date claim entered on insurer’s system (C: 2.1.8) is prior to 1 January 1998 (Incident location code (C: 2.1.39 = 00)).

C: 2.7.7 Worker (Mobile) telephone number

The worker's mobile telephone number.

Examples

Australian mobile

04#######                   where # is the digit

C: 2.7.8 Worker (Work) telephone number

The worker's work (place of employment) telephone number.

Examples:

NSW landline

02########                  where # is the digit

UK

+44##########           where # is the digit

C: 2.7.9 Ordinary Earnings

The average of the worker's ordinary earnings before the injury expressed as a weekly sum.

 

C: 2.7.10 Shift Allowance

Shift allowance paid or payable before the injury, expressed as a weekly sum.

 

C: 2.7.11 Overtime

Overtime paid or payable to the worker, expressed as a weekly sum.

 

C: 2.7.12 Worker's email address

The worker’s email address.

 

WCIDRR02-07.9     Work Capacity Record

Data Item

Description

Notes/ Comments

C: 2.8.1 Record Type

Identifies the type of data in the record as either claims or policy.

 

C: 2.8.2 Claim identifier

The identifier allocated to the claim by the insurer.

The claim identifier must not be changed once reported to SIRA.

C: 2.8.3 Record identifier

The identifier code of the record within the data submission.

 

C: 2.8.4 Original decision date

The date the insurer issued the original decision notice to the worker.

 

C: 2.8.5 Work capacity decision type

Identifies the type of work capacity decision.

Note: only adverse decisions need to be reported.

C: 2.8.6 Work capacity review stage

Identifies the stage of the work capacity decision.

 

C: 2.8.7 Work capacity date type

Type of activity that relates to the date reported.

 

C: 2.8.8 Work capacity activity date

The date the work capacity activity occurs.

 

C: 2.8.9 Work capacity outcome

The result of the work capacity assessment or work capacity assessment review.

 

WCIDRR02-07.10    Claim Control Record

Data Item

Description

Notes/ Comments

C: 2.9.1 Record type

Identifies the type of data in the record as either claims or policy.

 

C: 2.9.2 Claim identifier

The identifier allocated to the claim by the insurer

The Claim identifier must not be changed once reported to SIRA.

C: 2.9.3 Record identifier

The identifier code of the record within the data submission

 

C: 2.9.4 Claim payments to date

The total payments on the claim as at the submission end date.

 

C: 2.9.5 Claim recoveries to date

The total amount of recoveries on the claim as at the submission end date.

 

C: 2.9.6 Total claim estimated liability

The total of estimates of outstanding liability on the claim as at the submission end date.

 

C: 2.9.7 Total claim estimated recoveries

The total of estimated recoveries on the claim as at the submission end date.

 

C: 2.9.8 Hours paid total incapacity to date

The total of hours paid for total incapacity on the claim as at the submission end date.

 

C: 2.9.11 Decreasing adjustment on settlement payments

The total amount of decreasing adjustment payments that the insurer has claimed against settlement payments on the claim at the submission end date.

Must be zeroes if the employer’s entitlement to input tax credits is 100%.

C: 2.9.12 Input tax credit on non-settlement payments

The total amount of all input tax credits that the insurer has claimed against non-settlement payments on the claim at the submission end date.

 

C: 2.9.13 Estimate of decreasing adjustment

The estimate of the decreasing adjustment which will be claimed on the GST which will be paid on the Outstanding Liabilities relating to the settlement of the claim.

 

C: 2.9.14 Estimated Input Tax Credits

An estimate of the Input Tax Credits that will be claimed for the GST which will be paid on the Outstanding Liabilities relating to non-settlement (or management costs) of the claim.

 

C: 2.9.15 Hours lost to date

The total sum of hours lost on the claim as at the submission end date.

 

WCIDRR02-07.11     Claim Submission Trailer Record

Data Item

Description

Notes/ Comments

C: 9.1 Record type

Identifies the record as a Submission Trailer Record

 

C: 9.2 Basic claim detail (1) record count

The count of the number of the Basic claim detail records (Record type 2 - Record identifier 1) on the submission

 

C: 9.3 Claim activity record count

The count of the number of claim activity records (Record type 2 - Record identifier 2) on the submission

 

C: 9.4 Time lost record count

The count of the number of time lost records (Record type 2 - Record identifier 3) on the submission

 

C: 9.5 Service provision record count

The count of the number of Service provision records (Record type 2 - Record identifier 4) on the submission

 

C: 9.6 Compensation payment and recovery record count

The count of the number of compensation and recovery records (Record type 2 - Record identifier 5) on the submission

 

C: 9.7 Estimate record count

The count of the number of estimate records (Record type 2 - Record identifier 6) on the submission

 

C: 9.8 Claim control record count

The count of the number of claim control records (Record type 2 - Record identifier 9) on the submission

 

C: 9.9 Total payment/recovery amount

The total of all the payment/recovery amounts specified in all the Compensation payment and recovery records on the submission

 

C: 9.10 Basic claim detail record 2 record count

The count of the number of the Basic claim detail 2 records (Record type 2 - Record identifier 7) on the submission

 

C: 9.11 Work capacity record count

The count of the number of the work capacity records (Record type 2 - Record Identifier 8) on the submission.

 

Address format rules

WCIDRR02-08        The formats contained in this section are to assist you in achieving the level of data quality that SIRA requires for the specification of addresses. The Data Quality and Exchange team at SIRA will continue to monitor data quality levels and work with insurers to meet these standards.

Street and locality rules

WCIDRR02-09        Rule 1: DX (document exchange) addresses are not acceptable.

WCIDRR02-10         Rule 2: Post office (PO) box addresses are not acceptable.

WCIDRR02-11          Rule 3: Property names must be contained in single quotes so that they can be distinguished from street and locality names.

WCIDRR02-12         Rule 4: Each component of the street details (e.g. house numbers, property or building names, street names and street types) must be separated from each other by commas.

WCIDRR02-13         Rule 5: Property details such as Unit, Flat, Suite, Level, Floor, Factory, Shop must be written in full.

WCIDRR02-14         Rule 6: House or building number ranges must be separated by a dash.

WCIDRR02-15         Rule 7: Where a unit number, suite number, shop number has a prefix or suffix, the components must be kept together, not separated by spaces or brackets.

WCIDRR02-16         Rule 8: Where there are two or more shops in the address, they are to be joined by an ampersand. Commas must not be used.

WCIDRR02-17         Rule 9: Shopping centre addresses must contain a street name where known.

WCIDRR02-18         Rule 10: Large properties (e.g. universities, hospitals, airports and some shopping centres) that have no street details must report the Street information field as spaces.

WCIDRR02-19         Rule 11: Street names must be written in full.

WCIDRR02-20        Rule 12: Street type indicators (Street, Road, Highway, Lane etc) must be included. The preference is for street type indicators to be abbreviated.

WCIDRR02-21         Rule 13: For corner addresses, use only the abbreviation ‘cnr’. Do not spell ‘corner’ in full

WCIDRR02-22        Rule 14: Road Side Delivery (RSD) and Roadside Mail Box (RMB) address must be entered in the Street information field.

WCIDRR02-23        Rule 15: Overseas addresses are identified by having ‘OS’ as the locality name. The full address must be supplied in the street information and the postcode field must be set to ‘0000.’

WCIDRR02-24        Rule 16: State/Territory is not required and is not to be recorded in the Locality name field.

WCIDRR02-25        Rule 17: The locality name must not be abbreviated and if required truncated to 30 characters.

WCIDRR02-26        Examples:

Rule

Type

Example

How data should be reported

3

Property names

The Gateway Plaza, Shop 6, Old Northern Road

Street information:          Shop 6, ‘Gateway Plaza’, Old Northern Rd

4

Comma separation

Suite 1 Level 2 63 Church Street

Street information:          Suite 1, Level 2, 63 Church St

5

No property abbreviations

F 5

Fl 5

S1A

Street information:          Flat 5

Street information:          Floor 5

Street information:          Shop 1A

6

Use of dashes

Level 6, 213 to 217 King Street

Street information:          Level 6, 213 - 217 King St

7

Keep street number prefix/ suffix together

13 A Smith St

Street information:          13A Smith St

8

Ampersand rules

Shop 5 and 6

Street information:          Shop 5&6

9

Large property addresses

Westfield Parramatta

Street information:          Shop 82, ‘Westfield Shopping Centre’, Church St

10

Properties with their own postcode

Block H, Level 7, Macquarie University, North Ryde

Street information:          ‘Block H’, Level 7

Locality name:                 Macquarie University

Postcode: 2109

11

Street names written in full

E’trn Valley Way

Street information:          Eastern Valley Way

12

Street type indicators

Road

Avenue

Crescent

Rd

Ave

Cres

13

Corner streets

Corner of George and Wellington Streets

Street information:          Cnr George St and Wellington St

14

RSD or RMB

Dalkeith RMB 265, Mangrove Rd, Cowan

Street information:          RMB 265, ‘Dalkeith’, Mangrove Rd

Locality:                         Cowan

15

Overseas addresses

14 Main St, Denver, Colorado

Street information field:   14 Main St, Denver,                                       Colorado, USA

Locality name field:          OS

Postcode field:                0000

17

No locality abbreviations

P’matta

Locality name field:         Parramatta

Service provision reporting rules

WCIDRR02-27        Rule 1: Each rehabilitation provider referral must be reported in a separate service provision.

WCIDRR02-28        Rule 2: Each vocational rehabilitation program must be reported in a separate service provision record.

WCIDRR02-29        Rule 3: Service provision end date (C: 2.4.7) is only to be reported when the rehabilitation provider referral or vocational rehabilitation program has ended.

SIRA Funded recovery at work programs (vocational programs) reporting rules

WCIDRR02-30        Disclosure of all costs paid by the insurer associated with vocational re-education programs are required to be reported in the insurance agent's monthly claim submission and monthly financial reporting returns.

WCIDRR02-31         These costs are for SIRA vocational programs including:

  • work trials
  • training
  • equipment and workplace modifications
  • JobCover placement program
  • transition to work
  • return to work assist for micro-employers (travel costs only)
  • Community Connect.

WCIDRR02-32        The transactional level data must correspond to the amounts disclosed on the monthly financial reporting returns and are subject to audits (both financial and process).

Exclusions from premium calculations

SIRA Funded recovery at work programs (vocational programs)

WCIDRR02-33       The cost of s53 programs are not to be included in the cost of claim for premium setting purposes.

Interpreter costs

WCIDRR02-34        The cost of interpreter fees is not to be included in the cost of claim for premium setting purposes.

Vocational Program Examples

1. Work trial

WCIDRR02-35        A work trial for an injured worker for 8 weeks, is due to commence 12/7/2018 to 3/9/2018. It is anticipated that travel expenses of $250.00 (40 days at $6.25/day return train fare) as well as a telephone headset at $325.00 will be required.

This information is to be reported to us in your claim submission file as follows:

WCIDRR02-36        Estimate event (if not already captured)

Data Item

Description

Information to be reported

C: 2.2.5

Claim closed flag

N

C: 2.6.4

Estimate type

64

C: 2.6.5

Estimate amount

$575.00

C: 2.6.6

Estimated future weeks off work for total incapacity

As estimated for the claim

WCIDRR02-37        Work trial event

Data Item

Description

Information to be reported

C: 2.4.5

Rehabilitation provider code

NNNN

C: 2.4.6

Service provision start date

20180712

C: 2.4.7

Service provision end date *

00000000

C: 2.4.8

Service provision type

02

C: 2.4.9

Service provision sub type

01

C: 2.4.10

Service provision null date

0000000000

C: 2.4.11

Work trial host employer ABN

NNNNNNNN

*Zeroes reported where the end date has not been reached. See below where the end date has been reached.

WCIDRR02-38        Other payments event

Payment is only to be made once a Claim for Payment form and an Invoice or travel receipts are provided.

WCIDRR02-39        Telephone headset payment

Data Item

Description

Information to be reported

C: 2.1.22

Claimants language code

As per claim detail

C: 2.5.5

Payment transaction date

Actual date payment was made

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Payment and/or recovery amount

$325.00

C: 2.5.15

Payee identification

ABN of company being paid

C: 2.5.16

Service provider identification

ABN of supplier

C: 2.5.17

Payment classification number

VWT001

C: 2.5.18

Date of service

Invoice date

WCIDRR02-40        Travel reimbursement – week 1 (12/7/2018 to 15/07/2018)

Where there are multiple services for travel expenses within the same reimbursement claim, the aggregate value for the payments is reported as one transaction for the claim identifier, one week’s travel rolled up to one payment as shown below.

Data Item

Description

Information to be reported

C: 2.1.22

Claimants language code

As per claim detail

C: 2.5.5

Payment transaction date

Date payment was made

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Payment and/ or recovery amount

$31.25

C: 2.5.15

Payee identification

REIMB

C: 2.5.16

Service provider identification

NOABN

C: 2.5.17

Payment classification number

VWT002

C: 2.5.18

Date of service

20180715

Note: In some cases, a pre-payment of travel of up to $300 may be approved. In this example if a pre-payment was approved the change to the above would be the following 2 data items:

  • Payment and recovery amount (C:2.5.7)         $250.00
  • Date of service (C:2.5.18)                               20180712

WCIDRR02-41                 Work trial event

Data Item

Description

Information to be reported

C: 2.4.5

Rehabilitation provider code

NNNN

C: 2.4.6

Service provision start date

20180712

C; 2.4.7

Service provision end date

20180903

C: 2.4.8

Service provision type

02

C: 2.4.9

Service provision sub type

01

C: 2.4.10

Service provision null date

00000000

C: 2.4.11

Work trial host employer ABN

NNNNNNNNNNN

2.  JobCover placement program

WCIDRR02-42        An Agreement has been signed and lodged for the JobCover Placement Program for an injured worker. The employment commences on 1 August 2017 and the employer incentive for each instalment has been agreed as it is anticipated that the worker’s wages will exceed the weekly wage rate of the incentive.

WCIDRR02-43        Estimate event (if not already captured)

Data Item

Description

Information to be reported

C: 2.2.5

Claim closed flag

N

C: 2.6.4

Estimate type

64

C: 2.6.5

Estimate amount

$27,400.00

C: 2.6.6

Estimated future weeks off work for total incapacity

As estimated for the claim

WCIDRR02-44        Vocational rehabilitation program event

Data Item

Description

Information to be reported

C: 2.4.6

Service provision start date

20170801

C: 2.4.7

Service provision end date

00000000

C: 2.4.8

Service provision type

02

C: 2.4.9

Service provision sub type

04

C: 2.4.10

Service provision null date

0000000000

WCIDRR02-45        Other payments event

Payment is only to be made once the JobCover placement program claim for payment form and required evidence has been received and accompanied by a completed JobCover placement program agreement.

WCIDRR02-46        Employer incentive – instalment 1 (wage period 1/8/2017 to 21/10/2017)

Data Item

Description

Information to be reported

C: 2.1.22

Claimants language code

As per claim detail

C: 2.5.5

Payment transaction date

Actual date payment is made (i.e.: post Date of service)

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Payment and/ or recovery amount

$4,800.00

C: 2.5.15

Payee identification

ABN of company being paid

C: 2.5.16

Service provider identification

ABN of company being paid

C: 2.5.17

Payment classification number

VJC002

C: 2.5.18

Date of service

20171021

Note: Date of service (C: 2.5.18) is the actual end date of the Instalment period


WCIDRR02-47        Employer incentive – instalment 2 (wage period 24/10/2017 to 27/01/2018)

Data Item

Description

Information to be reported

C: 2.1.22

Claimants language code

As per claim detail

C: 2.5.5

Payment transaction date

Actual date payment is made (i.e.: post Date of service)

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Payment and/ or recovery amount

$7,000.00

C: 2.5.15

Payee identification

ABN of company being paid

C: 2.5.16

Service provider identification

ABN of company being paid

C: 2.5.17

Payment classification number

VJC003

C: 2.5.18

Date of service

20180127

Note: Date of Service (C: 2.5.18) is the actual end date of the Instalment period

WCIDRR02-48        Employer incentive – instalment 3 (wage period 30/01/2018 to 29/07/2018)

Data Item

Description

Information to be reported

C: 2.1.22

Claimants language code

As per claim detail

C: 2.5.5

Payment transaction date

Actual date payment is made (i.e.: post Date of service)

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Payment and/ or recovery amount

$15,600.00

C: 2.5.15

Payee identification

ABN of company being paid

C: 2.5.16

Service provider identification

ABN of company being paid

C: 2.5.17

Payment classification number

VJC004

C: 2.5.18

Date of service

20180729

Note: Date of service (C: 2.5.18) is the actual end date of the Instalment period


WCIDRR02-49        Vocational rehabilitation program event

Data Item

Description

Information to be reported

C: 2.4.6

Service provision start date

20170801

C: 2.4.7

Service provision end date

20180729

C: 2.4.8

Service provision type

02

C: 2.4.9

Service provision sub type

04

C: 2.4.10

Service provision null date

0000000000

Nulling a Service provision record

WCIDRR02-50        To null a Service provision record, report the original data items reported in the record and report a Service provision null date (C: 2.4.10). Where a Service provision end date (C: 2.4.7) has previously been specified, set to zeroes. The Service provision null date (C: 2.4.10) must be the date the record is identified as erroneous.

WCIDRR02-51         1. Example of nulling a Service provision record reported with an incorrect Rehabilitation provider code (C: 2.4.5)

Sample of original record

Data Item

Description

Information reported

C: 2.4.5

Rehabilitation provider code

0123

C: 2.4.6

Service provision start date

20180803

C: 2.4.7

Service provision end date

00000000

C: 2.4.8

Service provision type

01

C: 2.4.9

Service provision sub type

00

C: 2.4.10

Service provision null date

00000000

 

Submission end date

20180831


Sample of null and corrected record

Null record

Data Item

Description

Information reported

C: 2.4.5

Rehabilitation provider code

0123

C: 2.4.6

Service provision start date

20180803

C: 2.4.7

Service provision end date

00000000

C: 2.4.8

Service provision type

01

C: 2.4.9

Service provision sub type

00

C: 2.4.10

Service provision null date

20180907

 

Submission end date

20180831

Corrected record

Data Item

Description

Information reported

C: 2.4.5

Rehabilitation provider code

0789

C: 2.4.6

Service provision start date

20180803

C: 2.4.7

Service provision end date

00000000

C: 2.4.8

Service provision type

01

C: 2.4.9

Service provision sub type

00

C: 2.4.10

Service provision null date

00000000

 

Submission end date

20180831


WCIDRR02-52        2. Example of nulling a Service provision record reported that should never have been reported

Sample of original record

Data Item

Description

Information reported

C: 2.4.5

Rehabilitation provider code

0123

C: 2.4.6

Service provision start date

20180803

C: 2.4.7

Service provision end date

00000000

C: 2.4.8

Service provision type

01

C: 2.4.9

Service provision sub type

00

C: 2.4.10

Service provision null date

00000000

 

Submission end date

20180831

Sample of null record

Data Item

Description

Information reported

C: 2.4.5

Rehabilitation provider code

0123

C: 2.4.6

Service provision start date

20180803

C: 2.4.7

Service provision end date

00000000

C: 2.4.8

Service provision type

01

C: 2.4.9

Service provision sub type

00

C: 2.4.10

Service provision null date

20180907

 

Submission end date

20180930

Interstate allied health practitioners

WCIDRR02-53        The service provider number that must be reported on invoices from interstate allied health practitioners is INT0000.


Payment reporting rules

WCIDRR02-54        Rule 1: Each invoice item must be reported as an individual transaction unless the payment classification is

PHS001 – Pharmaceutical services – items can be rolled up into one transaction per Date of service (C: 2.5.18).

WCIDRR02-55        Rule 2: Each weekly benefit must be reported as an individual transaction where there is a break in the period or a change of entitlement to weekly compensation.

WCIDRR02-56        Rule 3: Weekly benefit payments can only be adjusted where the payment period start and end dates are not changing.

WCIDRR02-57        Rule 4: Corrections to payment transactions. Reverse the original transaction and report the corrected record.

Examples

  • PHS001 - Pharmaceutical services

WCIDRR02-58        Where there are multiple pharmaceutical services with the same date of service, the aggregate value for each date of service is reported.

Sample submission of data

Data Item

Description

Information reported

C: 2.5.7

Amount

$58.15

C: 2.5.15

Payee ID

REIMB

C: 2.5.16

Service provider ID

ABN of provider

C: 2.5.17

Payment classification number

PHS001

C: 2.5.18

Date of service

20180702

Data Item

Description

Information reported

C: 2.5.7

Amount

$74.80

C: 2.5.15

Payee ID

REIMB

C: 2.5.16

Service provider ID

ABN of provider

C: 2.5.17

Payment classification number

PHS001

C: 2.5.18

Date of service

20180705

  • Reporting weekly benefits

WCIDRR02-59        The following example outlines when a single period of absence is to be reported as more than one record. Worker has no capacity from injury for a period of 14 weeks with a PIAWE of $1,000

Sample of record

Data Item

Description

Information reported

C: 2.5.5

Transaction date

20180724

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Amount

$12350

C: 2.5.8

Payment period start date

20180409

C: 2.5.9

Payment period end date

20180708

C: 2.5.17

Payment classification number

WPP005

C: 2.5.19

Determined weekly benefit amount

$950

Data Item

Description

Information reported

C: 2.5.5

Transaction date

20180724

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Amount

$950

C: 2.5.8

Payment period start date

20180709

C: 2.5.9

Payment period end date

20180715

C: 2.5.17

Payment classification number

WPP006

C: 2.5.19

Determined weekly benefit amount

$950


  • Adjusting a previously reported weekly benefit

WCIDRR02-60        The Adjustment transaction flag (C: 2.5.6) must be set to Y. Payment period start date (C: 2.5.8) and Payment period end date (C: 2.5.9) must be reported and matched to a previous record.

Sample of original record

Data Item

Description

Information reported

C: 2.5.5

Transaction date

20180724

C: 2.5.6

Adjustment transaction flag

N

C: 2.5.7

Amount

$900

C: 2.5.8

Payment period start date

20180702

C: 2.5.9

Payment period end date

20180706

C: 2.5.17

Payment classification number

WPP005

Sample of adjustment record

Data Item

Description

Information reported

C: 2.5.5

Transaction date

20180807

C: 2.5.6

Adjustment transaction flag

Y

C: 2.5.7

Amount

$50

C: 2.5.8

Payment period start date

20180702

C: 2.5.9

Payment period end date

20180706

C: 2.5.17

Payment classification number

WPP005


  • Reversing a payment

WCIDRR02-61         The following example outlines when a payment is reversed.

Sample of original record

Data Item

Description

Information reported

C: 2.5.5

Transaction date

20180724

C: 2.5.7

Amount

$58.15

C: 2.5.15

Payee ID

REIMB

C: 2.5.16

Service Provider ID

ABN of provider

C: 2.5.17

Payment classification number

PHS001

C: 2.5.18

Date of service

20180702

Sample of reversal record

Data Item

Description

Information reported

C: 2.5.5

Transaction date

20180808

C: 2.5.7

Amount

-$58.15

C: 2.5.15

Payee ID

REIMB

C: 2.5.16

Service Provider ID

ABN of provider

C: 2.5.17

Payment classification number

PHS001

C: 2.5.18

Date of service

20180702

WCIDRR02-62 For the following Payment Classification numbers, please note the following specific rules.

Where the Date of Service (C: 2 5.18) is less than 1st April 2014 and a reversal is submitted on payments with the PTX, OSX or CHX prefix, then the applicable validation rules will still apply. Payment Classification numbers with the PTX, OSX or CHX prefix were retired on/ after the 1st April 2014.

Work capacity reporting methods

WCIDRR02-63 Rule 1: where the correction is in the same reporting period, only report the corrected record.

1. Correction to a previously reported record without nulling

WCIDRR02-64        In the example below, an internal review was reported with an outcome date of 22 August 2018 instead of the correct date 21 August 2018. The decision is re-reported the following month with the Original decision date (C: 2.8.4) and work capacity decision type (C: 2.8.5) remaining the same but with a change for the Work capacity activity date (C: 2.8.8).

Sample of original record

Data Item

Description

Information reported

C: 2.8.4

Original decision date

20180723

C: 2.8.5

Decision type

02 – s43 (1)(a)

C: 2.8.6

Review stage

02 – Date Internal Review Application received

C: 2.8.7

Date type

01 – Date of work capacity outcome

C: 2.8.8

Activity date

20180822

C: 2.8.9

Work capacity outcome

23 – Different decision – better or worker – no new information

 

Submission end date

20180831

Sample of corrected record

Data Item

Description

Information reported

C: 2.8.4

Original decision date

20180723

C: 2.8.5

Decision type

02 – s43 (1)(a)

C: 2.8.6

Review stage

02 – Date Internal Review Application received

C: 2.8.7

Date type

01 – Date of work capacity outcome

C: 2.8.8

Activity date

20180821

C: 2.8.9

Work capacity outcome

23 – Different decision – better or worker – no new information

 

Submission end date

20180930

2. Nulling one record within a work capacity data set where the unique identifier has changed (Original decision date (C: 2.8.4) or Work capacity decision type (C: 2.8.5))

WCIDRR02-65        Note: where the correction is in the same submission period, only report the corrected record. In the example below a work capacity decision was reported with a decision type of 02. The decision type should have been reported as 03.

WCIDRR02-66 The original work capacity decision is reported again with the outcome marked as 99 Null and the correct record with decision type 03 is reported separately.

Sample of original record

Data Item

Description

Information reported

C: 2.8.4

Original decision date

20180802

C: 2.8.5

Decision type

02 – s43 (1)(a)

C: 2.8.6

Review stage

01 – Original insurer decision

C: 2.8.7

Date type

01 – Date of work capacity outcome

C: 2.8.8

Activity date

20180802

C: 2.8.9

Work capacity outcome

11 – Work capacity decision notice issued

 

Submission end date

20180831

Sample of nulling single record

Data Item

Description

Information reported

C: 2.8.4

Original decision date

20180802

C: 2.8.5

Decision type

02 – s43 (1)(a)

C: 2.8.6

Review stage

01 – Original insurer decision

C: 2.8.7

Date type

01 – Date of work capacity outcome

C: 2.8.8

Activity date

20180802

C: 2.8.9

Work capacity outcome

99 null record

 

Submission end date

20180831

Data Item

Description

Information reported

C: 2.8.4

Original decision date

20180802

C: 2.8.5

Decision type

03 – s43 (1)(c)

C: 2.8.6

Review stage

01 – Original insurer decision

C: 2.8.7

Date type

01 – Date of work capacity outcome

C: 2.8.8

Activity date

20180802

C: 2.8.9

Work capacity outcome

11 – Work capacity decision notice issued

 

Submission end date

20180930

3. Removing a work capacity decision record when the record should have not been reported at all.

WCIDRR02-67        Where a work capacity decision has been reported with an incorrect value in a previous submission period, the data should be re reported in a subsequent submission as a Null record.

WCIDRR02-68 The only change is reporting the work capacity outcome as 99 ‘Null record’.

WCIDRR02-69        Do not report either record if the correction has been applied to the insurers system in the same submission reporting period.

WCIDRR02-70 A record with a Date Type of 99 is only required once regardless of how many unique work capacity records have been reported, for this combination.

Sample of original record

Data Item

Description

Information reported

C: 2.8.4

Original decision date

20180802

C: 2.8.5

Decision type

02 – s43 (1)(b)

C: 2.8.6

Review stage

01 – Original insurer decision

C: 2.8.7

Date type

01 – Date of work capacity outcome

C: 2.8.8

Activity date

20180802

C: 2.8.9

Work capacity outcome

11 – Work capacity decision notice issued

 

Submission end date

20180831

Sample of nulling record set

Data Item

Description

Information reported

C: 2.8.4

Original decision date

20180802

C: 2.8.5

Decision type

02 – s43 (1)(b)

C: 2.8.6

Review stage

01 – Original insurer decision

C: 2.8.7

Date type

01 – Date of work capacity outcome

C: 2.8.8

Activity date

20180802

C: 2.8.9

Work capacity outcome

99 null record

 

Submission end date

20180930

Valid combinations

WCIDRR02-71         This table provide high level information on some of the possible combinations.

Work capacity review stage

C: 2.8.6

Possible allowable Date types

C: 2.8.7

Valid Work capacity outcome

C: 2.8.9

01 Original insurer decision

01 Date of work capacity outcome

99 Null date

11

99

02 Insurer internal review

01 Date of work capacity outcome

02 Date internal review application received

05 Date of acknowledgement of Application for insurer internal review

99 Null date

All except 11

03 WorkCover merit review

01 Date of work capacity outcome

03 Date merit review application received

06 Date of reply to application for a merit review

99 Null date

All except 11

04 Judicial review

01 Date of work capacity outcome

04 Date notified of judicial review

99 Null date

11

99

05 Procedural Review

(WIRO)

01 Date of work capacity outcome

07 Date notified of Procedural review

99 Null date

31

32

99

06 Revised WC Decision

01 Date of work capacity outcome

04 Date notified of judicial review

99 Null date

11

99

Nulling of a claim

WCIDRR02-72 Where an insurer identifies the submission of a claim should not have been made, the following data items need to be reported to null the claim or notification:

Data Item

Description

Information reported

C: 2.2.5

Claim closed flag

Y

C: 2.2.9

Liability status code

06

C: 2.2.22

Common law action date

00000000

C: 2.9.4

Claim payments to date

000000000000

C: 2.9.5

Claim recoveries to date

000000000000

C: 2.9.6

Total claim estimated liability

000000000000

C: 2.9.7

Total claim estimated recoveries

000000000000

WCIDRR02-73        The previously reported payments must be reversed so the above totals will sum to zero.

WCIDRR02-74        Some examples of when a claim is to be nulled are:

  • Claim has been duplicated
  • Claim has been raised in error

Request for critical error removal/ error suppression

WCIDRR02-75        All requests for critical error removal and suppressions must be submitted separately in the correct format as an email attachment and sent to: data.information@sira.nsw.gov.au

WCIDRR02-76        To ensure the request is easily recognised, the Subject heading of the email is to be in the following format:

  • <Insurer number><Insurer Name>, Claim Fatal Error Removal Request for <Month><Year>
  • <Insurer number><Insurer Name>, Claim Suppression Request for <Month><Year>

WCIDRR02-77        All requests received will be acknowledged by email the next business day. The Data Quality and Exchange team will review the request to determine if it is appropriate to remove the critical error or apply the suppression.

WCIDRR02-78        An email notification will be provided on the outcome of a request and will advise of any errors that were not eligible for removal or suppression and the reason.

Timeframe

WCIDRR02-79        Insurers should endeavour to provide their critical error removal and suppression requests to the Data Quality and Exchange team five working days before the end of the month. This should allow sufficient time for the Data Quality and Exchange team to review and action the requests. Late requests may not be actioned before processing of the insurer’s next submission.

Critical error removal file layout

WCIDRR02-80 Details of claim critical errors to be removed are to be included in a CSV file. The following naming convention is to be used:

  • <Insurer number><Insurer Name>, Claim Fatal Error Removal Request<Date>.csv

Please note the previously used terminology of ‘Fatal’ appears in the file name

File format

WCIDRR02-81         There are four columns of data to be provided in the CSV file:

Insurer number, Claim Identifier, Error Number, Reason (max 100 characters)

WCIDRR02-82 All values must be provided in double quotes (same as supplied in the csv error reports).

Example

“165”, “02864”, “C0663”, “time lost record should not have been submitted”

Suppression request file layout

WCIDRR02-83 The details of the Claim error suppressions are to be included in a CSV file. The following naming convention is to be used:

  • <Insurer number><Insurer Name>, Claim Error Suppression Request<Date>.csv

WCIDRR02-84        A suspect error can be set as a one-off suppression or an ongoing future suppression. Setting an error as a future suppression means the error will never appear again for the relevant Claim unless cancelled by the Data Quality and Exchange team.

File format

WCIDRR02-85        There are five columns of data to be provided in the CSV file:

Insurer number, Claim Identifier, Error Number, Suppression Type, Reason for suppression (max 100 characters)

WCIDRR02-86        All values must be provided in double quotes (same as supplied in the csv error reports).

WCIDRR02-87        Suppression type is either N for single suppression or Y for future suppression.

Example

“165”, “984814165”, “C4031”, “Y”, “WCC Award no medical certificate required”

Part 3: Claims technical manual claims state and events reference

Download the Claims technical manual claims state and events reference (xls file, 140 kb)

Part 4: Claims technical manual validations reference

Download the Claims technical manual validations reference (xls file, 495 kb)

Part 5: Claims technical manual code set reference

Download the Claims technical manual code set reference (xls file, 29 kb)

Part 6 : Payment classification reference

A pdf version is also available.

General introduction

The Workers Compensation Insurer Data Reporting Requirements (Requirements) describes the rules and the process workers compensation insurers must follow to submit their workers compensation insurance data.

Purpose of the Requirements

The Requirements support delivery of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) and the Workers Compensation Regulation 2016 by establishing clear processes and procedures around the submission of claims data to SIRA.

The accurate and timely collection of notification of injuries and claims data is essential to assist in the service delivery to injured people, affordability, and the effective management and sustainability of the system.

The data collected is used to ensure insurers comply with legislation and guidelines and to monitor their performance. The data is also used for the detection of fraud and the publication of reports.

For the purposes of these Requirements, a notification of injury and a claim are hereinafter referred to as a claim, unless otherwise specified.

Publication notes

These Requirements are published by the State Insurance Regulatory Authority (SIRA) and replaces the following document:

  • Payment classification booklet – (published in 2013)

An independent agency located within the NSW Customer Service Cluster, the Authority is constituted under the State Insurance and Care Governance Act 2015 and is responsible for regulating workers compensation insurance, motor accidents compulsory third party (CTP) insurance and home building compensation insurance in NSW.

Replacement and transition

The following publications are repealed:

  • Payment classification booklet – (published in 2013)
  • The Payment Classification section within the old Claims technical manual Nominal insurer V 4.14
  • The Payment Classification section within the old Claims technical manual self and specialised insurers V 5.10

and are replaced by these Requirements.

Legislative framework

The data described in these Requirements is collected under:

  • the conditions of the insurer’s licence and/or in accordance with Section 23(1)(m) and Section 40C of the 1998 Act and
  • Section 40B of the 1998 Act

Requirement making power

These Requirements are made under Section 40C of the 1998 Act.

Interpretation of the Requirements

These Requirements should be interpreted in a manner that supports the achievement of the objectives and general functions of SIRA under the workers compensation legislation as described in section 22 of the 1998 Act.

In order of hierarchy, if there is any conflict between the claims technical manual, guidance specification and the relevant legislation, the legislation takes precedence.

Commencement of the Requirements

The Workers compensation payment classification reference (WCIDRR06) is published by SIRA on 31 May 2019.

These Requirements are effective from the publication date until SIRA amends, revokes or replaces them in whole or in part. These Requirements supersede the previous requirements which were in place until 31 May 2019.

Parts of the Requirements

The information described in this document will assist insurers to improve the quality and timeliness of their data:

The Requirements are divided into the following parts:

Part 1: Claims technical manual: details the technical requirements for submitting workers compensation data

Part 2: Claims data item guidance specification: helps to explain how the data needs to be reported to SIRA.

Reference Data

Part 3: Claims technical manual claims state and events reference: details which data items are mandatory to report, which data items are optional to report, and when the data item must be reported.

Part 4: Claims technical manual validations reference: provides a validation matrix which lists all validations, their severity and the data items impacted.

Part 5: Claims technical manual code set reference: details all codes and code sets applicable to specific data items and provides a detailed description of each code and its use.

Part 6: Claims technical manual payment classification reference: provides a simplified list of payment classifications that can be reported by insurers.

Part 7: Claims technical manual payment classification and estimates reference, details:

  • all payment classifications that can be reported by insurers
  • the revised list of Medical services and fees published by the Australian Medical Association (AMA) payable to medical practitioners, providing medical or related treatment under the Workers Compensation Act 1987, and
  • a list of all estimate types and their descriptions.

Compliance with the Requirements

SIRA will monitor and review compliance with the Requirements. Compliance and enforcement will be undertaken in accordance with SIRA’s Compliance and enforcement policy (July 2017)

Penalties for not meeting reporting requirements

It is the responsibility of the insurer to ensure the accuracy, quality and timeliness of the data provided.

Failure to comply with these Requirements may result in regulatory sanctions being imposed including imposition of penalties, civil penalties or loss of licence if applicable.

Requirement identifiers

Each requirement component has been allocated a unique identifier (for example: WCIDRR06-01) to make it traceable. This will assist when:

  • searching for a requirement
  • linking requirements
  • advising relevant stakeholders when a requirement has been revised, and
  • to assist insurers when they request advice or suggest improvements.

SIRA payment classification system

Background

WCIDRR06-01                       To assist SIRA and insurers to better manage and evaluate system performance including service providers and health professionals, insurers are required to report payments at a transactional level.

WCIDRR06-02                       Where a service provider issues an invoice for services conducted over a period of time, insurers are required to report each service as an individual item.

SIRA assistance

WCIDRR06-03                       For queries, suggested changes or enhancements about any aspect of these requirements, please contact the Data Quality and Exchange Team on ph: (02) 4321 5703 or email: data.information@sira.nsw.gov.au

WCIDRR06-04                       The classification system includes payment for all services and benefits made against the claim that will be reported by the insurers.

The hierarchical classification system produces a 6-character code forming a unique identifier for each service/benefit type.

Weekly payments

WCIDRR06-05            Weekly payments – total incapacity

WPT001                                 Section 36 - weekly payments during total incapacity, first 26 weeks

The weekly payments of compensation to a worker in respect of any period of total incapacity for work, during the first twenty six weeks of incapacity.

Inclusions/exclusions:

  • Weekly payment amounts to be reported as single gross figure, before PAYG tax deducted.
  • Includes payments to Centrelink where a Notice of Charge has been issued.
  • Includes payments to a garnishee such as a child support agency.
  • Excludes weekly payments made to dependants of the deceased worker.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act.

WPT002                                 Section 37 - weekly payments during total incapacity, after 26 weeks

The weekly payment of compensation to a worker in respect of any period of total incapacity for work - (not being a period during the first 26 weeks of incapacity).

Inclusions/exclusions:

  • Weekly payment amounts to be reported as single gross figure, before PAYG tax deducted.
  • Includes payments to Centrelink where a notice of Charge has been issued.
  • Includes payments to a garnishee such as a child support agency. Excludes weekly payments made to dependants of the deceased worker.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act.

WPT003                                 Section 36 - Weekly payments for total incapacity, first 26 weeks court or commission award

The weekly payment of compensation for total incapacity to a worker where the payment is pursuant to an award from the Workers Compensation Commission or the Workers Compensation Court.

Inclusions/exclusions:

  • Weekly payment amounts to be reported as single gross figure, before PAYG tax deducted.
  • Excludes weekly payments made to dependants of the deceased worker.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act.

WPT004                                 Section 37 - Weekly payments for total incapacity - after 26 weeks Court or Commission Award

The weekly payment of compensation for total incapacity to a worker (not being a period during the first 26 weeks of incapacity) where the payment is pursuant to an award from the Workers Compensation Commission or the Workers Compensation Court.

Inclusions/exclusions:

  • Weekly payment amounts to be reported as single gross figure, before PAYG tax deducted.
  • Excludes weekly payments made to dependants of the deceased worker.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act'

WCIDRR06-06 Weekly payments – total incapacity  (applicable to claims post 2012)

WPT005                                 Section 36 - Weekly payments no current work capacity, first 13 weeks

The weekly payment of compensation to which, a worker who has no current work capacity is entitled during the first aggregate period (whether or not consecutive) of 13 weeks.

WPT006                                 Section 37 - Weekly payments no current work capacity, 14 - 130 weeks

The weekly payment of compensation to which, a worker who has no current work capacity is entitled during the second entitlement period (whether or not consecutive) of 117, after the expiry of the first entitlement period (13 weeks).

WPT007                                 Section 38 - Weekly payments no current work capacity, greater than 130 weeks

The weekly payment of compensation to which, a worker, who has no current work capacity, is entitled to after 130 weeks.

WCIDRR06-07            Weekly payments – partial incapacity

WPP001                                 Section 38 - payments for partially incapacitated workers not suitably employed and special initial payments while seeking employment

The payments of compensation to a worker in respect of any period where a worker is partially incapacitated for work as a result of injury and the worker is not suitably employed and seeking employment during any period of that partial incapacity for work.

Inclusions/exclusions:

  • Weekly payment amounts to be reported as single gross figure, before PAYG tax deducted.
  • Includes payments to Centrelink where a Notice of Charge has been issued.
  • Includes payments to a garnishee such as a child support agency.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act.

WPP002                                 Section 40 - Weekly payments during partial incapacity - general

The weekly payments of compensation to a worker in respect of any period of partial incapacity.

Inclusions/exclusions:

  • Weekly payment amounts to be reported as single gross figure, before PAYG tax deducted.
  • Includes payments to Centrelink where a Notice of Charge has been issued.
  • Includes payments to a garnishee such as child support agency.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act.

WPP003                                 Section 38 - payments for partially incapacitated workers not suitably employed - court or commission award

The weekly payment of compensation for partial incapacity to a worker where the payment is pursuant to an award from the Workers Compensation Commission or the Workers Compensation Court.

Inclusions/exclusions:

  • Weekly payment amounts to be reported as single gross figure, before PAYG tax deducted.
  • Excludes weekly payments made to dependants of the deceased worker.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act

WPP004                                 Section 40 - Weekly payments during partial incapacity – court or commission award

The weekly payments of compensation to a worker in respect of any period of partial incapacity pursuant to an award from the Workers Compensation Commission or the Workers Compensation Court.

Inclusions/exclusions:

  • Weekly payment amounts to be reported as a single gross figure, before PAYG tax deducted.

Applies to exempt workers:

  • Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classes in the 2012 Legislative Reform or pre-1987 Act.

WPP005                                 Section 36 - Weekly Payments, first 13 weeks

The weekly payment of compensation to which a worker is entitled during the first aggregate period (whether or not consecutive) of 13 weeks.

WPP006                                 Section 37(2) - Weekly Payments, 14 - 130 weeks

The weekly payments of compensation to a worker for any period of partial incapacity.

WPP007                                 Section 37(1) & (3) - weekly payments, 14 - 130 weeks

The weekly payments of compensation to a worker in respect of any period of partial incapacity.

WPP008                                 Section 38 - Weekly payments, greater than 130 weeks

The weekly payments of compensation to a worker for any period of partial incapacity.

Medical services

WCIDRR06-08            AMA list of medical services and fees

WCIDRR06-09                       The AMA list of medical service fees contains the AMA item number, medical category and sub category, description of the medical service, fee and Medical Benefits Schedule (MBS) item number, where applicable.

WCIDRR06-10                       Electronic versions of the AMA list are available from the AMA.

WCIDRR06-11                       SIRA also gazettes fees for specific workers compensation medical services.

WCIDRR06-12            Professional medical - SIRA specific medical services

WCIDRR06-13                       Refer to the Workers compensation (medical practitioner, surgeons and orthopaedic surgeons fees) orders for service definitions.

WCO001                                SIRA certificate of capacity (medical certificate)

WCO002                                Report/case conference

WCO003                                Instrument fee - for surgeons only

WCO004                                Other medical items

WCO005                                Providing copies of clinical notes and medical records

WCO006                                Extended initial consultation and report

WCO007                                Out of hours consultation

WCO008                                Out of hours loading

WCO009                                Opinion on file request

Pharmaceutical services

WCIDRR06-14            Pharmaceutical services

PHS001                                  Pharmaceutical services

Payments are only to be made for pharmaceutical services (medicines) given at the direction of a medical practitioner.

Inclusions/exclusions:

  • Includes prescription medicines and non-prescription medicines such as analgesics and Chinese herbal medicine, as directed by a medical practitioner.

Allied health services

WCIDRR06-15                       For the following payment classification numbers, please note the following specific rules.

WCIDRR06-16                       Where the date of service (C: 2.5.18) is before 1 April 2014 and a reversal is submitted on payments with the PTX, OSX or CHX prefix, then the applicable validation rules still apply. Payment classification numbers with the PTX, OSX or CHX prefix were retired on/after 1 April 2014.

All SIRA-approved allied health practitioners must use an allied health recovery request form to seek prior approval for treatment and services.

To provide the initial allied health recovery request, use OAS003. All other allied health recovery request submissions do not attract a fee.

WCIDRR06-17                       To provide copies of clinical notes and medical records, use WCO005.

WCIDRR06-18  Counselling Services

WCIDRR06-19                       Refer to the Workers Compensation (Psychology and Counselling Fees) Order for service definitions.

Inclusions/exclusions:

  • Includes payments to:
  • SIRA-approved counsellors
  • Interstate counsellors
  • Non-approved counsellors for exempt categories of workers

COU002                                 Initial Consultation

COU003                                 Standard Consultation

COU004                                 Report Writing

COU005                                 Case Conferencing

COU006                                 Travel

COU007                                 Group

WCIDRR06-20  Chiropractic services – SIRA-approved

WCIDRR06-21                       Refer to the Workers compensation (physiotherapy, chiropractic and osteopathy fees) order for service definitions.

Inclusions/exclusions:

  • Includes payments to:
  • SIRA approved chiropractors,
  • interstate chiropractors,
  • non-approved chiropractors for exempt categories of workers.

CHA001                                 Initial consultation and treatment

CHA002                                 Standard consultation

CHA031                                  Initial consultation and treatment of 2 distinct areas

CHA032                                  Standard consultation and treatment of 2 distinct areas

CHA033                                  Complex treatment

CHA004                                  Spine X-rays performed by the chiropractor

CHA010                                  Group/class intervention

CHA005                                 Home visit - initial consultation and treatment

CHA006                                 Home visit - standard consultation and treatment

CHA071                                  Home visit - initial consultation and treatment of 2 distinct areas

CHA072                                  Home visit - standard consultation and treatment of 2 distinct areas

CHA073                                 Home visit - complex treatment

CHA081                                  Case conference and report writing

CHA082                                  Work related activity assessment, consultation and treatment

CHA009                                  Travel

WCIDRR06-22  Chiropractic services – non-SIRA approved

WCIDRR06-23                       These codes are only available for payments related to dates of service that precede 31 March 2016.

CHX001                                  Initial consultation and treatment that take place in consulting rooms

CHX002                                  Standard consultation

CHX031                                  Initial consultation and treatment of 2 distinct areas

CHX032                                  Standard consultation and treatment of 2 distinct areas

CHX033                                  Complex treatment

CHX010                                  Group/class visit

CHX004                                  Spine x-rays performed by the chiropractor

CHX005                                  Home visit - initial consultation and treatment

CHX006                                  Home visit - standard consultation and treatment

CHX071                                  Home visit - initial consultation and treatment of 2 distinct areas

CHX072                                  Home visit - standard consultation and treatment of 2 distinct areas

CHX073                                  Home visit - complex treatment

CHX081                                  Case conference and report writing

CHX082                                  Report writing

CHX009                                 Travel

WCIDRR06-24            Accredited exercise physiologists - SIRA-approved

WCIDRR06-25                       Refer to the Workers compensation accredited exercise physiologists order for service definitions.

Inclusions/exclusions:

  • Includes payments to:
  • SIRA approved Exercise Physiologists,
  • Interstate Exercise Physiologists,
  • Non-approved Exercise Physiologists for exempt categories of workers
  • EPA001                                  Initial consultation and treatment

    EPA002                                  Standard consultation and treatment

    EPA003                                  Reduced supervision treatment

    EPA004                                  Group rate

    EPA005                                  Incidental expenses

    Excludes

  • External facility fees – should be coded as OTT007 external facilities fees
  • EPA006                                  Case conference

    EPA007                                  Report writing

    EPA008                                  Travel

WCIDRR06-26  Osteopathy services – SIRA-approved

WCIDRR06-27                       Refer to the Workers compensation (physiotherapy, chiropractic and osteopathy fees) order for service definitions.

Inclusions/exclusions:

  • Includes payments to:
  • SIRA approved Osteopaths,
  • Interstate Osteopaths,
  • Non-approved Osteopaths for exempt categories of workers

OSA001                                  Initial consultation and treatment

OSA002                                  Standard consultation and treatment

OSA003                                  Initial consultation and treatment of 2 distinct areas

OSA004                                  Standard consultation and treatment of 2 distinct areas

OSA005                                  Complex treatment

OSA006                                  Group/class intervention

OSA007                                  Home visit - initial consultation and treatment

OSA008                                  Home visit - standard consultation and treatment

OSA009                                  Home visit - initial consultation and treatment of 2 distinct areas

OSA010                                  Home visit - standard consultation and treatment of 2 distinct areas

OSA011                                  Home visit - complex treatment

OSA012                                  Case conference and report writing

OSA013                                  Work related activity assessment, consultation and treatment

OSA014                                  Travel

WCIDRR06-28            Osteopathy services – non-approved

WCIDRR06-29                       These codes are only available for payments related to dates of service that precede 31 March 2016.

OSX001                                  Initial consultation and treatment

OSX002                                  Standard consultation and treatment

OSX003                                 Initial consultation and treatment of 2 distinct areas

OSX004                                  Standard consultation and treatment of 2 distinct areas

OSX005                                 Complex treatment

OSX006                                  Group/class service

OSX007                                  Home visit - initial consultation and treatment

OSX008                                  Home visit - standard consultation and treatment

OSX009                                  Home visit - initial consultation and treatment of 2 distinct areas

OSX010                                  Home visit - standard consultation and treatment of 2 distinct areas

OSX011                                  Home visit - complex treatment

OSX012                                  Case conference

OSX013                                  Report writing

OSX014                                  Travel

WCIDRR06-30            Physiotherapy services - approved

WCIDRR06-31                       Refer to the Workers compensation (physiotherapy, chiropractic and osteopathy fees) order for service definitions.

Inclusions/exclusions:

  • Includes payments to:
  • SIRA approved physiotherapists,
  • interstate physiotherapists,
  • non-approved physiotherapists for exempt categories of workers

PTA001                                  Initial consultation and treatment

PTA002                                  Standard consultation and treatment

PTA003                                  Initial consultation and treatment of 2 distinct areas

PTA004                                  Standard consultation and treatment of 2 distinct areas

PTA005                                  Complex treatment

PTA006                                  Group/class service

PTA007                                  Home visit - initial consultation and treatment

PTA008                                  Home visit - standard consultation and treatment

PTA009                                  Home visit - initial consultation and treatment of 2 distinct areas

PTA010                                  Home visit - standard consultation and treatment of 2 distinct areas

PTA011                                  Home visit - complex treatment

PTA012                                  Case conference and report writing

PTA013                                  Work related activity assessment, consultation and treatment

PTA014                                  Travel

WCIDRR06-32  Physiotherapy services – non-approved

WCIDRR06-33                       These codes are only available for payments related to dates of service that precede 31 March 2016.

PTX001                                  Initial consultation and treatment

PTX002                                  Standard consultation and treatment

PTX003                                  Initial consultation and treatment of 2 distinct areas

PTX004                                  Standard consultation and treatment of 2 distinct areas

PTX005                                  Complex treatment

PTX006                                  Group/class service

PTX007                                  Home visit - initial consultation and treatment

PTX008                                  Home visit - standard consultation and treatment

PTX009                                  Home visit - initial consultation and treatment of 2 distinct areas

PTX010                                  Home visit - standard consultation and treatment of 2 distinct areas

PTX011                                  Home visit - complex treatment

PTX012                                  Case conference and report writing

PTX013                                  Report writing

PTX014                                  Travel

WCIDRR06-34  Psychological services

WCIDRR06-35                       Refer to the Workers compensation (psychology and counselling fees) order for service definitions.

Inclusions/exclusions:

  • Includes payments to:
  • SIRA approved psychologists
  • interstate psychologists.
  • non-approved psychologists for exempt categories of workers

PSY001                                  Initial consultation

PSY002                                  Standard consultation

PSY003                                  Report writing

PSY004                                  Case conference

PSY005                                  Travel

PSY006                                  Group

PSY007                                  Trauma focused psychological treatment (for a worker who has been diagnosed with a work-related post-traumatic-stress disorder)

WCIDRR06-36                       Remedial massage therapy

RMA001                                 Consultation and treatment (60 minutes in duration)

RMA002                                 Consultation and treatment (45 minutes in duration)

RMA003                                 Consultation and treatment (30 minutes in duration)

WCIDRR06-37  Other therapies and treatments

OTT001                                  Acupuncture

Payments for treatments provided by a registered medical practitioner or an acupuncture practitioner accredited with the Australian Traditional Chinese Medicine Practitioner Accreditation Board.

OTT002  Speech pathology

Payments for services provided by speech pathologists to assist with communication for workers with neurological conditions. For example an acquired brain injury.

OTT004  Assessment and management of persistent pain

Services provided to workers with, or at high risk of, persistent pain.

Services must be:

  • multidisciplinary, including medical services such as neuromodulation and drug rationalisation and withdrawal, intensive physical and psychological therapies which focus on functional improvements and return to work
  • incorporate a biopsychological approach
  • based on a management plan.

OTT005 Case coordination services for catastrophic injuries and medically intensive

Payments for case management services provided to workers with catastrophic injuries or workers requiring monitoring whilst medically intensive

Catastrophic injury is defined in part 9.1 of the Workers compensation guidelines

OTT006 Other therapies or treatments that have not been classified elsewhere

Therapies and treatments not elsewhere classified.

Inclusions/exclusions:

Include reasonable necessary treatment services which are not elsewhere classified. For example, podiatry.

Exclude physiotherapy, chiropractic, osteopathy, psychology, counselling, exercise, physiology, remedial massage therapy, acupuncture, occupational therapy, nurse practitioners, dental services and speech pathology.

OTT007                                  External facilities fees

The fee for worker entry into an external facility such as a gymnasium or pool.

External facility fees only apply to the cost for the worker’s entry.

No entry fee is payable where the facility is owned or operated by the treatment practitioner or the treatment practitioner contracts their services to the facility.

Fees payabe for the entry of the practitioner are a business cost and cannot be charged to the insurer.

WCIDRR06-38  Allied services not elsewhere classified

OAS001                                  Nurse practitioners

Payments for services provided by a Nurse Practitioner as authorised by the Nurses Registration Board.

Inclusions/exclusions:

  • Exclude nursing care at home services - code to NUR001.

OAS002                                  Occupational therapists

Payments for services provided by an Occupational Therapist. For example assessments for domestic assistance and home or vehicle modifications.

OAS003                                  Submission of an initial allied health recovery request (AHRR) only

An Allied Health Recovery Request is the form used by practitioners to request prior approval for treatment and services.

Inclusions/exclusions:

  • Include only payments for the initial allied health recovery request which is the first allied health recovery request completed and submitted to the insurer.
  • Exclude all other allied health recovery requests submitted.

Assistance at home

WCIDRR06-39  Personal care

PCA001                                  Personal care

Payments for services for personal care including:

  • assistance with and/or supervision of transfers and mobility
  • assistance with and/or supervision of showering, bathing, dressing, grooming, eating, drinking
  • planning of daily activity such as planning/arranging outings
  • assistance/supervision provided with community activities (for example, shopping, library)
  • assisting with use of diary/calendar, correspondence, assisting with telephone calls
  • preparing for and attending medical/therapy appointments.

WCIDRR06-40  Nursing care at home

NUR001                                 Nursing care at home

Payments for services provided by a registered nurse such as regulation/management of, and/or advice to carers regarding bowel/bladder care, skin care, wound care, chest care, medication, temperature, nutrition and blood pressure.

WCIDRR06-41 Domestic assistance

DOA001                                 Domestic assistance

Payments for domestic assistance such as household cleaning (internal and external), meal preparation, shopping, laundry, lawn or garden care, simple essential home maintenance.

DOA002                                 Domestic assistance (gratuitous assistance)

When care provided by family member and paid as gratuitous assistance in accordance with gazetted guidelines.

Aids and modifications

WCIDRR06-42  Hearing aids

AID002                                   Hearing aid assessments

This is the payment for the hearing needs assessment, fitting and maintenance of an aid by a Hearing Service Provider.

Hearing aid repairs, payable only if a copy of manufacturer’s invoice for repairs is provided.

AID003                                   Hearing aids (including batteries)

This is for purchase of a hearing aid for a worker.

This covers the supply of a hearing aid (including remote control) and 12 months supply of hearing aid batteries.

WCIDRR06-43            Home and motor vehicle purchases and  modifications

HVM001                                 Home modifications

Payments for modifications to the worker’s place of residence and cost of reasonably necessary architectural and building fees.

HVM002                                 Motor vehicle modifications

Payments for reasonably necessary modifications to the worker’s motor vehicle.

HVM003                                 Home purchase

Payments to purchase a home and associated payments for legal, building and architectural fees.

HVM004                                 Motor vehicle purchase

The repair or replacement costs of quad bike or motor vehicle.

WCIDRR06-44  Mobility aids

MOB001                                 Mobility aids excluding motor vehicles

The original purchase costs, repair or replacement costs of mobility aids such as wheelchair, crutches, walking frame, artificial limb, brace, or foot orthotics that have been provided as a result of a workplace injury.

Inclusions/exclusions:

  • Exclude repair or replacement of mobility aids as part of a property damage claim under sections 74 or 75 (Refer to code PDO001).

WCIDRR06-45  Optometry & visual aid services

Inclusions/exclusions:

OPT001                                  Optometry services

Payments for services provided by optometrists registered with the NSW Optometrists Registration Board.

Inclusions/exclusions:

  • Excludes Ophthalmologists (these are medical services - refer to AMA Codes).

OPT002                                  Spectacles

This is for the purchase, repair or replacement of spectacles or contact lenses, required as a result of the workplace injury.

  • Exclude repair or replacement of spectacles as part of a property damage claim under sections 74 and 75 (Refer to code PDO001).

OPT003                                  Artificial eye

OPT004                                  Visual mobility aids / services

Guide dog, cane, sonar device, mobility training, and vision aids.

WCIDRR06-46  Aids not elsewhere classified

Refer to the Workers compensation (psychology and counselling fees) order for service definition of incidental expenses.

Refer to the Workers compensation (physiotherapy, chiropractic and osteopathy fees) order for service definition of incidental expenses

Refer to the Workers compensation (accredited excercise physiologist fees) order for service definition of incidental expenses

OAD001                                 Aids not elsewhere classified

The purchase or replacement costs of aids such as a back rest, strapping, tape, theraband, exercise putty, communication devices and aids not elsewhere classified, that are required as a result of the injury.

Transport

WCIDRR06-47  Ambulance and travel expenses

TRA001                                  Ambulance services

The amounts paid for paramedic service to a worker and the conveyance of a worker to or from a medical practitioner or hospital.

Inclusions/exclusions:

Excludes:

  • treatment at the scene of the accident or transport for hospital admission for workers injured in a motor vehicle accident. These are to be paid by the Motor Accidents Insurance Regulation (MAIR) Bulk Billing arrangement.
  • conveyance of a worker by taxis, public transport or private vehicle to or from a medical practitioner or hospital or from one public hospital to another.

TRA002                                  Injured worker related travel and accommodation expenses

The amounts paid for a worker to attend treatment initiated by the worker, excluding ambulance services.

Inclusions/exclusions:

  • Includes:
  • conveyance of a worker by taxis, public transport, private vehicle to or from a health  practitioner or hospital
  • conveyance of a worker for court hearings, etc not provided by an ambulance service
  • accommodation where the worker is required to attend court hearings, etc. (including meals). Costs are reimbursed to the worker or paid to the accommodation provider.

TRA003                                  Injured worker time lost for attending independent medical examination

The amount paid to or on behalf of a worker for reimbursement of time lost where a worker attends a medical examination arranged by the insurer or the workers representative.

  • Inclusions/exclusions:

Exclude payments for any conveyance of a worker by taxis, public transport or private vehicle, to or from treatment provided by a health practitioner or hospital.

Private hospital services

WCIDRR06-48  Private hospital treatment and service

WCIDRR06-51                       Private hospitals generally adopt the Australian Private Hospital Association (APHA) procedure banding list. It outlines the categories of accommodation, procedures types and fees.

PTH001                                  Advanced surgical patient

Accommodation - overnight bed fees 1-14 days or more than 14 days.

An advanced surgical patient upon admission to hospital is identified by the item number in the MBS which is rendered to the patient at that hospital.

PTH002                                  Surgical patient

Accommodation - overnight bed fees 1-14 days or more than 14 days.

A surgical patient upon admission to hospital is identified by the item number in the MBS which is rendered to the patient at that hospital.

PTH003                                  Psychiatric patient

Accommodation - overnight bed fees 1-21 days, 22-65 days or more than 65 days

A psychiatric patient is a patient in a hospital who is admitted for the purposes of undertaking specific psychiatric treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient's injury.

PTH004                                  Rehabilitation patient

Accommodation - overnight bed fees 1-49 days or more than 49 days.

A rehabilitation patient is a patient in a hospital who is admitted for the purposes of undertaking specific rehabilitation treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient's injury.

PTH005                                  Other patient (medical)

Accommodation - overnight bed fees 1-14 days or more than 14 days.

Other patient is a patient in a hospital who is receiving any treatment that involves part of an overnight stay, but who is not: an advanced surgical patient, a surgical patient, a psychiatric patient or a rehabilitation patient.

PTH006                                  Day patient - day accommodation - including accident and emergency attendance

For non band items, as per national procedure banding schedule, the following band levels apply depending on anaesthetic type and theatre time.

Band 1 - means services not requiring anaesthetic or theatre time.

Band 2 - means procedure (other than band 1) carried out under local anaesthetic with no sedation

Band 3 - means procedure (other than band 1) carried out under general or regional anaesthetic or intravenous sedation where the actual time in theatre is less than 1 hour. Electroconvulsive therapy is to be coded under this band with an additional Band 1 fee under PTH008.

Band 4 - means procedures (other than band 1) carried out under general or regional anaesthetic or intravenous sedation where theatre time is 1 hour or more.

Facility fees include allied health services except where the worker is a rehabilitation patient. For rehabilitation patients, the appropriate allied health fees Order is to be used. Facility fees include the cost of inpatient pharmaceutical items.

Refer to the NSW Ministry of Health for classifications of private hospitals in NSW.

Inclusions/exclusions:

  • Group programs are billed under this code (PTH006) as detailed in the Workers Compensation (Private Hospital Rates) Order for the relevant year.
  • Only pharmaceutical items provided on discharge can be billed separately and are to be coded to PHS001 Pharmaceutical Services.
  • No additional fee is payable for a private room.

PTH007                                  Intensive care unit

Accommodation - overnight bed fees 1-5 days - level 1 or more than 5 days – level 2. Benefit provisions are contained in section 62 of the Workers Compensation Act 1987.

Note: rates are set for all hospital treatment in annual fee orders

PTH008                                  Theatre

Refer to the NSW Ministry of Health for the classification of private hospitals.

As per the national banding schedule the 13 bands refer to a theatre fee determined by the time taken for the service provided, and may include the cost of consumable and disposable items.

Only in exceptional circumstances will an additional fee be payable on justification from the private hospital.

A multiple procedure rule applies for theatre fees. 100% of the fee may be charged for the first procedure, 50% for the second procedure undertaken at the same time as the first, and 20% for the third and subsequent procedures undertaken at the same time as the first.

PTH009                                  Surgical prostheses

For surgically implanted prosthesis, use this payment classification code. A surgically implanted prosthesis is an item of equipment or device used by a medical practitioner, surgeon or treating specialist during a procedure.

Surgical prostheses are to be selected from the Department of Health Prostheses List (in accordance with the Private Health Insurance (Prostheses) Rules (Cth) rate current at the time of service) at the minimum benefit rate.

A prosthesis handling fee is payable at the maximum rate detailed in the Workers compensation (private hospital rates) order for the relevant year.

Public hospital services

WCIDRR06-49                       Refer to the Workers compensation (public hospital rates) order for service definitions.

WCIDRR06-50  Brain injury rehabilitation

WCIDRR06-51                       These codes apply to patients admitted to an inpatient Brain Injury Rehabilitation Program (BIRP) unit, a Transitional Living Unit or to Compensable non-inpatient services.

PBI001                                   Admitted patient services

This includes admitted patient services under the following categories:

Category A patients. That is a patient being assessed for or receiving active rehabilitation for an acquired brain injury.

Category B patients. That is a patient receiving personal and nursing support who is resident in a brain injury rehabilitation program unit.

Category X patients. That is a patient needing an extremely high level of support as a result of an acquired brain injury.

PBI002                                   Admitted patient transitional living unit bed

Transitional living unit bed that is staffed 24 hours a day and is officially approved by NSW Health under the Brain Injury Rehabilitation Program for the accommodation of patients requiring transitional living care services following a brain injury

PBI003                                   Non-admitted patient services

This includes allied health services provided to a non-admitted patient with an acquired brain injury. A non-admitted patient is a patient that has not undergone a formal admission process.

PBI004                                   Out-patient medical clinic appointments

PBI005                                   Group activities

WCIDRR06-52  Public hospital treatment

PUH001                                  Public hospital - acute, emergency department admitted and non-emergency department

PUH002                                  Public hospital – non-acute and sub-acute in-patient

This incorporates the admission of a patient to a public hospital, psychiatric hospital or other public hospital (for example, residential aged care facility), for sub-acute and non-acute services. It also incorporates dialysis treatment.

PUH003                                  Public hospital out-patient occasion of services and emergency department patient services small rural hospital

This incorporates outpatient by a public hospital, public psychiatric hospital, or other public hospital (for example, residential aged care facility). An outpatient is a patient who does not undergo a formal admission process.

Rates chargeable for physiotherapy, psychological and exercise physiology outpatient services are in accordance with SIRA's Fees orders relating to each allied health discipline.

WCIDRR06-53            Public hospital medical reports and  health records

PHR001                                  Public hospital medical reports

This includes the preparation of a report by a treating medical practitioner or health professional appointed or employed by the health institution /hospital supplied in response to a request. Where examination of the patient is required in order to prepare the report, the cost of the examination is included in the fee.

PHR002                                  Public hospital health records

Health records include summary of injuries or copies of clinical notes or medical records supplied in response to a request that is accompanied by a written consent of the injured person.

The charges for health records and medical reports are in accordance with rates set out by NSW Health. refer to www.health.nsw.gov.au for more information if required.

WCIDRR06-54                       Spinal injury rehabilitation

These codes exclusively apply to spinal injury rehabilitation services provided at the Royal Rehabilitation Centre Sydney.

PSI001                                   In-patient spinal injury rehabilitation services

This includes services provided to a patient with a spinal injury at the Royal Rehabilitation Centre, Sydney who  has undergone a formal admission process.

PSI002                                   Out-patient/outreach services

This includes services provided to a patient with a spinal injury at the Royal Rehabilitation Centre, Sydney who has not undergone a formal admission process.

Dental services

WCIDRR06-55  Dental related services

DEN001                                  Dental and dental prosthetist services

Payments for services provided by a dental practitioner registered with the Australian Health Practitioner Regulation Agency.

DEN002                                  Teeth and dental

Repair or replacement costs of teeth or other dental equipment.

Practitioner peer review

WCIDRR06-56  Injury management consultants

WCIDRR06-57                       Refer to the Workers compensation (injury management consultants fees) order for service definitions.

IIN105                                    Injury management consultants

Fees paid for the provision of services by an Injury Management Consultant (IMC) in respect of the provision of any report prepared after a file review and/or examination and discussion for use in connection with a claim for compensation. It also includes the appearance as a witness in proceedings before the Workers Compensation Commission or a court in connection with a claim for compensation or injury damages.

Inclusions/exclusions:

  • Include only Injury Management Consultants approved pursuant to Section 45A, of the Workplace Injury Management and Workers Compensation Act 1998.
  • Include only payments for services instigated by the insurer.
  • Exclude payments for services instigated by the worker or their solicitor.

IIN107                                     Injury management consultant - cancellation with less than 2 days’ notice or non-attendance at scheduled appointment or unreasonably late attendance

IIN108                                   Injury management consultation with interpreter

The interpreter will invoice separately using code INT001

IIN109                                   Injury management consultants - travel for assessment/consultation outside consulting rooms.

Exclude expenses incurred by the worker or their solicitor.

WCIDRR06-58  Independent consultants

WCIDRR06-59                       Refer to the Workers compensation (independent consultants fees) order for service definitions.

IIN110                                     Independent consultation where referral initiated by a party other than the treating practitioner

IIN111                                     Independent consultation where referral initiated by the treating practitioner

IIN112                                     Independent consultation cancellation with 2 working days or less notice, non-attendance at scheduled appointment or unreasonably late attendance by worker or interpreter that prevents full examination being conducted

IIN113                                     Independent consultation travel for assessment/ consultation outside of consulting rooms

WCIDRR06-60  Insurer medical services panel

IIN201                                     Standard file review

Fees for a standard file review and recommendation on a claim undertaken by a medical specialist as part of a medical panel, where the review and provision of the recommendation is less than 1 hour.

Inclusions/exclusions:

  • Includes services provided by a medical panel medical specialist only.
  • Exclude any administrative costs associated with the function of a medical panel.

IIN202                                     Complex file review

Fees for a standard file review and recommendation on a claim undertaken by a medical specialist as part of a medical panel, where the review and provision of the recommendation takes 1 hour or longer.

Inclusions/exclusions:

  • Includes services provided by a medical panel medical specialist only.
  • Exclude any administrative costs associated with the function of a medical panel.

Workplace rehabilitation services

WCIDRR06-61  Workplace rehabilitation services

WCIDRR06-62                       Refer to the NSW Supplement to the Nationally Consistent Approval Framework for Workplace Rehabilitation providers for service definitions.

OR01                                      Single rehabilitation service

OR02                                      Return to work same employer services

OR03                                      Return to work different employer services

OR04                                      Travel

Inclusions/exclusions:

  • Travel costs of the worker are not included within this payment code.

SIRA-funded vocational programs to support recovery at work

WCIDRR06-63                       Refer to the guidance material for SIRA funded vocational programs to support recovery at work

WCIDRR06-64  Recover at Work Assist for Small Business

RAW001                                 Employer assistance payment of up to $400 per week for a combined total of up to 6 weeks

WCIDRR06-65  Work trial

VWT001                                 Equipment

VWT002                                 Travel expenses

Inclusions:

  • Include travel costs provided in connection with the Return to work assist program for micro employers.

WCIDRR06-66 Training

VRE001                                  Course costs

VRE002                                  Stationery allowance

VRE003                                  Travel expenses

VRE004                                  Accommodation

WCIDRR06-67  Equipment

VEQ001                                  Equipment

WCIDRR06-68  Transition to work

VTP001                                  Transition to work expenses tier 2 - suitable employment

VTP002                                  Transition to work tier 1 - job seeking preparation

WCIDRR06-69  Job cover placement program

VJC002                                  Employer incentive payment 1

VJC003                                  Employer incentive payment 2

VJC004                                  Employer incentive payment 3

WCIDRR06-70  Community Connect Program

VCC001                                  Community connect

Return to work assistance

WCIDRR06-71                       Eligible workers may be able to claim two benefits under return to work assistance to provide them with financial assistance for costs and services associated with return to work in accordance with section 64 of the Workers Compensation Act 1987.

WCIDRR06-72  New employment assistance

NEA001                                  New employment assistance payment

Note: Not applicable for exempt categories or workers (police officers, Paramedics, Firefighters or Coal Workers as per exempt classes in the 2012 Legislative Reform or pre 1987 Act.

WCIDRR06-73                       Education or training assistance

WCIDRR06-74                       Note: Not applicable for exempt categories of workers (police officers, paramedics, firefighters or coal workers as per exempt classes in the 2012 Legislative Reform or pre 1987 Act.

ERA001                                  Education or training assistance course costs payment

ERA002                                  Education or training assistance stationery and/ or book costs payment

ERA003                                  Education or training assistance travel costs payment

ERA004                                  Education or training assistance other costs payment

Property damage

WCIDRR06-75  Property damage not elsewhere classified

PDO001                                 Damage to property - section 74 & 75

The amounts paid for the repair to or the replacement of property including, clothing, spectacles, artificial limbs or existing mobility aids.

Lump sum benefits

WCIDRR06-76                       The following dates may be relevant to a workers compensation claim for weekly benefits or lump sum compensation including permanent impairment:

  • 19 June 2012

    New provisions applied for claims for permanent impairment, lump sum compensation and damages for nervous shock. (See payment codes PAS001 and PAS002).
  • 17 September 2012          

    New weekly payment provisions commenced for seriously injured workers.
  • 1 October 2012

    New weekly payment provisions commenced for claims made on or after 1 October 2012. (see payment codes WPT005 - WPT007 and WPP005 - WPP008)
  • 1 January 2013

    New weekly payment provisions commenced for claims made by workers (other than seriously injured workers) who made a claim prior to 1 October 2012. (See transitional arrangements documentation).

WCIDRR06-77  Permanent impairment

WPI001                                  Section 66 - Permanent impairment

The amounts paid to a worker for permanent impairment.

Inclusions/exclusions:

  • Include only payment amounts for permanent impairment pursuant to Section 66, Workers Compensation Act 1987 No. 70 and as provided by the ‘Table of Disabilities’ or whole person impairment (WPI) and ‘Ready-reckoner of Benefits Payable’.

WPI002                                  Section 66 - Permanent impairment – interest

The amount of interest awarded by the Workers Compensation Commission (WCC) as part of a permanent impairment settlement.

Inclusions/exclusions:

  • Include only interest amounts calculated on compensation awarded for permanent impairment pursuant to Section 66, Workers Compensation Act 1987 No. 70.

WCIDRR06-78  Pain and suffering

PAS001                                  Section 67 - Pain and suffering

The amounts paid for pain and suffering of a worker who has permanent impairment of 10 per cent or more.

Note: Only applicable to police officers, paramedics, firefighters or coal workers as per exempt classses in the 2012 Legislative Reform or pre 1987 Act

PAS002                                  Section 67 - Pain and suffering – interest

The amount of interest awarded by the Workers Compensation Commission (WCC) as part of a pain and suffering settlement.

Note: Only applicable to police officers, paramedics, firefighters or coal workers as per exempt classses in the 2012 Legislative Reform or pre 1987 Act.

Commutations

WCIDRR06-79  Commutation

COM001                                Commutation lump sum

The gross amount of commutation awarded or agreed upon. This refers to compensation payments where a commutation between the worker and the insurer has been agreed.

Inclusions/exclusions:

  • If weekly payments have been overpaid, they must not be deducted from the commutation amount but should be shown as recoveries.
  • If a Centrelink payback is to be taken out of the commutation, then the total amount of the commutation must still be shown.

Work injury damages

WCIDRR06-80  Common law payments

CLP001                                  Common law lump sum payment to the worker

The total common law lump sum paid for damages.

Inclusions/exclusions:

  • Excludes common law legal expenses incurred by the worker or insurers or their agents.

Payments in the event of death

WCIDRR06-81  Payments in the event of death

DEC001                                 Lump sum payment to dependants of the deceased worker

The lump sum payments paid to the dependants of the the deceased worker.

Inclusions/exclusions:

  • Excludes weekly payments to dependants and funeral expenses and expenses related to the transportation of deceased worker’s body.

DEC003                                 Weekly payment to child/children of the deceased worker

The weekly payments of compensation to the dependent child or children of the deceased worker.

Note: Only applicable to police officers, paramedics, firefighters or coal miners as per exempt classses in the 2012 Legislative Reform or pre 1987 Act

DEC004                                 Transportation of deceased worker’s body

The expenses equal to the reasonable cost of transporting the body of the worker to (a) what would, in the circumstances, be an appropriate place for its preparation for burial or cremation; or (b) the  usual place of residence, whichever is the lesser cost.

DEC005                                 Funeral expenses

The amounts paid for the funeral expenses of the deceased worker.

Legal services

WCIDRR06-82                       Schedule 6 to the Workers Compensation Amendment (Transitional) Regulation 2012 provides a schedule of costs and upper limits for use by lawyers when providing legal services to both workers and the SIRA Insurer. This regulation is to be used for legal services relating to compensation matters.

WCIDRR06-83                       Payments for legal services are to be reported using codes from the following tables that detail the payment classification codes. The codes are listed in two tables:

  • Insurer Legal Codes
  • Worker Legal Codes

WCIDRR06-84                       If the services have been provided for the insurer, payments for legal services are to be reported from the Insurer Legal Codes that are prefixed with IN. If the services have been provided on behalf of the worker the Worker Legal Codes that are prefixed with WK are to be reported.

WCIDRR06-85                       The codes have been developed using the descriptions for legal services in schedule 6 of the Workers Compensation Amendment (Costs) Regulation 2006 and the (Transitional) Regulation 2012. Refer to the regulations, schedule of codes and the easy reference guide to ensure the correct fees are being applied.

WCIDRR06-86                       The invoice submitted by the legal representative providing the service is to contain the relevant code for each service provided.

WCIDRR06-87            Schedule 6 – Insurer Legal Codes

Code

Detailed description

INS6000

Legal expenses incurred on a claim where a dispute was lodged prior to 1 November 2006. Date of injury must be on or before 31 October 2006. This includes any matter lodged with the Compensation Court

IN0220

Section 67 only - A - resolved before application accepted by WCC

IN0222

Section 67 only - B - Resolved after application accepted by WCC

IN0224

Section 67 only - B - Resolved after application accepted by WCC - where Part 1 cl 6 variation applies

IN0526

Lump sum permanent impairment compensation (liability in issue) dispute – a decision notice issued or referred to arbitrator by Registrar - C - After decision notice issued before matter accepted by WCC or before death claim application accepted by WC

IN0528

Lump sum permanent impairment compensation (liability in issue) dispute – a decision notice issued or referred to arbitrator by Registrar - D - Up to initial teleconference, including consequential settlement

IN0530

Lump sum permanent impairment compensation (liability in issue) dispute – a decision notice issued or referred to arbitrator by Registrar - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN0532

Lump sum permanent impairment compensation (liability in issue) dispute – a decision notice issued or referred to arbitrator by Registrar - F - Following conciliation conference up to & including arbitration hearing

IN0625

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction - C - After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN0627

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction D - Up to initial teleconference, including consequential settlement attendances

IN0629

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN0631

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction F - Following conciliation conference up to & including arbitration hearing

IN0726

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction C - After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN0728

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction D - Up to initial teleconference, including consequential settlement attendances

IN0730

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN0732

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction - F - Following conciliation conference up to & including arbitration hearing

IN0826

Application for termination or reduction of weekly payments compensation – section 55 review - C - After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN0828

Application for termination or reduction of weekly payments compensation – section 55 review-D - Up to initial teleconference, including consequential settlement attendances

IN0830

Application for termination or reduction of weekly payments compensation – section 55 review - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN0832

Application for termination or reduction of weekly payments compensation – section 55 review - F - Following conciliation conference up to & including arbitration hearing

IN1126

Application for increase in weekly payments compensation – section 55 review - C – After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN1128

Application for increase in weekly payments compensation – section 55 review - D - Up to initial teleconference, including consequential settlement attendances

IN1130

Application for increase in weekly payments compensation – section 55 review - E – After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN1132

Application for increase in weekly payments compensation – section 55 review - F – Following conciliation conference up to & including arbitration hearing

IN1225

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) C - After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN1227

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) D - Up to initial teleconference, including consequential settlement attendances

IN1229

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN1231

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) F - Following conciliation conference up to & including arbitration hearing

IN1326

Medical expenses compensation exceeding $7,500 - C - After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN1328

Medical expenses compensation exceeding $7,500 D - Up to initial teleconference, including consequential settlement attendances

IN1330

Medical expenses compensation exceeding $7,500 E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN1332

Medical expenses compensation exceeding $7,500 - F - Following conciliation conference up to & including arbitration hearing

IN1425

Compensation re death of a worker – liability admitted & no dispute re dependency - C – After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN1526

Compensation re death of a worker – liability and/or dependency disputed - C - After decision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

IN1528

Compensation re death of a worker – liability and/or dependency disputed - D - Up to initial teleconference, including consequential settlement attendances

IN1530

Compensation re death of a worker – liability and/or dependency disputed - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN1532

Compensation re death of a worker – liability and/or dependency disputed - F – Following conciliation conference up to & including arbitration hearing

IN1627

Reduction in uninsured employer's liability to reimburse SIRA Authority Fund/Insurance Fund under section 145 by WCC determination or agreement after referral - D - Up to initial teleconference, including consequential settlement attendances

IN1629

Reduction in uninsured employer's liability to reimburse SIRA Authority Fund/Insurance Fund under section 145 by WCC determination or agreement after referral - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

IN1631

Reduction in uninsured employer's liability to reimburse SIRA Authority Fund/Insurance Fund under section 145 by WCC determination or agreement after referral - F – Following conciliation conference up to & including arbitration hearing

IN1733

Special Resolution - A1 - IPD dispute resolved after claimant application accepted by WCC

IN1734

Special Resolution - A2 - Further IPD dispute about the same claim resolved after claimant application accepted by WCC

IN1735

Special Resolution - B1 - WIM dispute resolved after claimant application accepted by WCC

IN1736

Special Resolution B1 - WIM dispute resolved after insurer application accepted by WCC

IN1737

Special Resolution - B2 - Further WIM dispute about the same claim resolved after claimant application accepted by WCC

IN1738

Special Resolution B2 - Further WIM dispute about the same claim resolved after insurer application accepted by WCC

IN1739

Special Resolution - C1 - Resolution of other claimant initiated proceedings commenced by the claimant - as ordered or certified by the WCC

IN1740

Special Resolution - C1 - Resolution of other insurer initiated proceedings - as ordered or certified by the WCC

IN1741

Special Resolution - D1 - Commutation agreement approved by SIRA Authority and registered by WCC - application by claimant

IN1742

Special Resolution - D1 - Commutation agreement approved by SIRA Authority and registered by WCC - application by insurer

IN1744

Special Resolution - F1 - Written advice requested by insurer before the issue of a decision notice and costs not recoverable under Table 1 (subject to Part A cl. 7)

IN7100

Disbursements - Country/interstate loadings (incl travel-accommodation)

IN7200

Disbursements - Conduct money re notice for the production of documents

IN7300

Disbursements - Conduct money re direction for production of documents

IN7400

Disbursements - Treating health service provider's report (whether resolved before or after proceedings commenced)

IN7500

Disbursements - Treating health service provider's report (whether resolved before or after proceedings commenced)

IN7600

Disbursements - Treating health service provider's clinical notes and records

IN7700

Disbursements - Fee for the provision of independent financial advice by a qualified financial adviser for a commutation by agreement that is approved by the Authority and registered with the Commission

IN7800

Disbursements - Reports obtained pursuant to clause 96-

IN7900

Disbursements - Interpreter or translation services

IN8000

Disbursements - Fees imposed by a court or the WCC

IN8001

Dust Diseases Tribunal - All insurer / scheme agent matters in the Dust Diseases Tribunal

IN8002

District Court - Residual Jurisdiction and Special Statutory Compensation Lists - All matters related to the following:

(a) Police Regulation (Superannuation) Act 1906, s 21

(b) Police Act 1990, s 216A

(c) Sporting Injuries Insurance Act 1978, s 29

(d) Workers Compensation (Bush Fire), Emergency and Rescue Services) Act 1987, ss 16 and 30

(e) Workers Compensation (Dust Diseases) Act 1942, s 81.

(f) The Mining List

IN8003

Legal costs for recovery matters - All insurer / scheme agent matters where action has been commenced in an appropriate jurisdiction for recovery of damages from a third party. Legal costs associated with the reimbursement of amounts contained in a notice under S145 of the 1987 Act.

IN8004

Legal cost associated with an appeal to a higher court - All insurer / scheme agent matters involving an appeal where not otherwise identified as payable under schedule 6 or schedule 7 of the Workers Compensation Regulation 2010.

IN8005

Legal costs associated with a legal action from other jurisdictions - All insurer /scheme agent matters where they have become involved and where the matter is not about the provision of NSW Workers Compensation System benefits i.e. provision of benefits or damages from another jurisdiction e.g. MAA, civil liability, cross claim, interstate jurisdictional arguments.

That is, legal costs where not otherwise identified as payable under schedule 6 or schedule 7 of the Workers Compensation Regulation 2010.

IN8100

Disbursements - Travel costs and expense of claimant pursuant to clause 96

IN8200

Disbursements - Witness expenses pursuant to clause 96

IN8300

Disbursements - Part A clause 17 charges for documents from certain public authorities

IN5100

Additional legal services or other factors – 1 Claimant's appeal against an arbitral decision resolved by Presidential member's decision

IN5105

Additional legal services or other factors –1 Insurer's appeal against an arbitral decision resolved by Presidential member’s decision

IN5200

Additional legal services or other factors – 2 Claimant's question of law application – resolved by Presidential member's decision

IN5205

Additional legal services or other factors – 2 Insurer's question of law application - resolved by Presidential member's decision

IN5300

Additional legal services or other factors – 3 Claimant's medical assessment appeal - resolved by Appeal Panel's decision

IN5305

Additional legal services or other factors – 3 Insurer's medical assessment appeal – resolved by Appeal Panel's decision

IN5400

Additional legal services or other factors – 4 Dispute resolved after proceedings commenced - WCC certifies matter as complex and neither multiple respondent nor lead scheme agent loading applies - Commenced by claimant

IN5405

Additional legal services or other factors – 4 Dispute resolved after proceedings commenced and WCC certifies matter as complex & either multiple respondent or lead scheme agent loading applies - Commenced by Insurer

IN5500

Additional legal services or other factors – 5 Dispute resolved after proceedings commenced and WCC certifies matter as complex & either multiple respondent or lead scheme agent loading applies

IN5700

Acting for lead scheme agent if resolved on behalf of multiple scheme agents – not where the above complex matter loading applies (lead scheme agent only – other agents; no costs recoverable)

WCIDRR06-88            Schedule 6 – Worker legal codes

Code

Detailed description

WRK6000

Legal expenses incurred on a claim where a dispute was lodged prior to 1 November 2006. Date of injury must be on or before 31 October 2006. This includes any matter lodged with the Compensation Court

WK0120

Section 66 only – extent of impairment is the only issue or decision noticedecision notice not issued - A - resolved before application accepted by WCC

WK0122

Section 66 only – extent of impairment is the only issue or decision noticedecision notice not issued - B - resolved after application accepted by WCC

WK0220

Section 67 only - A - resolved before application accepted by WCC

WK0222

Section 67 only - B - resolved after application accepted by WCC

WK0320

Section 16 of the 1926 Act - extent of impairment is the only issue or decision noticedecision notice not issued - A - resolved before application accepted by WCC

WK0322

Section 16 of the 1926 Act - extent of impairment is the only issue or decision noticedecision notice not issued - B - resolved after application accepted by WCC

WK0421

Section 66 & 67 - extent of impairment and pain & suffering only at issue or decision noticedecision notice not issued A - resolved before application accepted by WCC

WK0423

Section 66 & 67 - extent of impairment and pain & suffering only at issue or decision noticedecision notice not issued B - resolved after application accepted by WCC

WK0424

Section 66 & 67 - extent of impairment and pain & suffering only at issue or decision noticedecision notice not issued B - resolved after application accepted by WCC - where part A cl 6 variation applies

WK0526

Lump sum permanent impairment compensation (liability in issue) dispute – a decision noticedecision notice issued or referred to arbitrator by Registrar - C - After decision noticedecision notice issued before matter accepted by WCC or before death claim application accepted by WCC

WK0528

Lump sum permanent impairment compensation (liability in issue) dispute – a decision noticedecision notice issued or referred to arbitrator by Registrar - D - Up to initial teleconference, including consequential settlement attendances

WK0530

Lump sum permanent impairment compensation (liability in issue) dispute – a decision noticedecision notice issued or referred to arbitrator by Registrar - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK0532

Lump sum permanent impairment compensation (liability in issue) dispute – a decision noticedecision notice issued or referred to arbitrator by Registrar - F - Following conciliation conference up to & including arbitration hearing

WK0625

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction - C - After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK0627

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction D - Up to initial teleconference, including consequential settlement attendances

WK0629

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK0631

Weekly payment compensation – up to & including 12 weeks excluding Interim Payment Direction F - Following conciliation conference up to & including arbitration hearing

WK0726

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction C - After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK0728

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction D - Up to initial teleconference, including consequential settlement attendances

WK0730

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK0732

Weekly payment compensation – exceeding 12 weeks excluding Interim Payment Direction - F - Following conciliation conference up to & including arbitration hearing

WK0926

Application for termination or reduction of weekly payments compensation – section 55 review - C - After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK0928

Application for termination or reduction of weekly payments compensation – section 55 review - D - Up to initial teleconference, including consequential settlement attendances

WK0930

Application for termination or reduction of weekly payments compensation – section 55 review - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK0932

Application for termination or reduction of weekly payments compensation – section 55 review - F - Following conciliation conference up to & including arbitration hearing

WK1026

Application for increase in weekly payments compensation – section 55 review - C – After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK1028

Application for increase in weekly payments compensation – section 55 review - D - Up to initial teleconference, including consequential settlement attendances

WK1030

Application for increase in weekly payments compensation – section 55 review - E – After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK1032

Application for increase in weekly payments compensation – section 55 review - F – Following conciliation conference up to & including arbitration hearing

WK1225

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) C - After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK1227

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) D - Up to initial teleconference, including consequential settlement attendances

WK1229

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK1231

Medical expenses compensation not exceeding $7,500 (excluding Interim Payment Directions) F - Following conciliation conference up to & including arbitration hearing

WK1326

Medical expenses compensation exceeding $7,500 - C - After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK1328

Medical expenses compensation exceeding $7,500 D - Up to initial teleconference, including consequential settlement attendances

WK1330

Medical expenses compensation exceeding $7,500 E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK1332

Medical expenses compensation exceeding $7,500 - F - Following conciliation conference up to & including arbitration hearing

WK1425

Compensation re death of a worker – liability admitted & no dispute re dependency - C – After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK1526

Compensation re death of a worker – liability and/or dependency disputed - C - After decision noticedecision notice issued and before matter accepted by WCC or before death claim application accepted by WCC

WK1528

Compensation re death of a worker – liability and/or dependency disputed - D - Up to initial teleconference, including consequential settlement attendances

WK1530

Compensation re death of a worker – liability and/or dependency disputed - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK1532

Compensation re death of a worker – liability and/or dependency disputed - F – Following conciliation conference up to & including arbitration hearing

WK1627

Reduction in uninsured employer's liability to reimburse SIRA Authority Fund/Insurance Fund under section 145 by WCC determination or agreement after referral - D - Up to initial teleconference, including consequential settlement attendances

WK1629

Reduction in uninsured employer's liability to reimburse SIRA Authority Fund/Insurance Fund under section 145 by WCC determination or agreement after referral - E - After initial teleconference, up to & including conciliation conference including consequential settlement attendances

WK1631

Reduction in uninsured employer's liability to reimburse SIRA Authority Fund/Insurance Fund under section 145 by WCC determination or agreement after referral - F – Following conciliation conference up to & including arbitration hearing

WK1733

Special Resolution - A1 - IPD dispute resolved after claimant application accepted by WCC

WK1734

Special Resolution - A2 - Further IPD dispute about the same claim resolved after claimant application accepted by WCC

WK1735

Special Resolution B1 - WIM dispute resolved after claimant application accepted by WCC

WK1736

Special Resolution B1 - WIM dispute resolved after insurer application accepted by WCC

WK1737

Special Resolution B2 - Further WIM dispute about the same claim resolved after claimant application accepted by WCC

WK1738

Special Resolution B2 - Further WIM dispute about the same claim resolved after insurer application accepted by WCC

WK1739

Special Resolution - C1 - Resolution of other claimant initiated proceedings commenced by the claimant - as ordered or certified by the WCC

WK1740

Special Resolution - C1 - Resolution of other insurer initiated proceedings - as ordered or certified by the WCC

WK1741

Special Resolution - D1 - Commutation agreement approved by SIRA Authority and registered by WCC - application by claimant

WK1742

Special Resolution - D1 - Commutation agreement approved by SIRA Authority and registered by WCC - application by insurer

WK1743

Special Resolution - E1 - Legal service to claimant before decision noticedecision notice where insurers decision on existing entitlement to weekly payments is varied to the workers benefit by an increase of 5% or more in weekly payments as a consequence of a legal service

WK1745

Special Resolution G1 - Providing independent legal advice to a claimant re a complying agreement proposed by an insurer (subject to Part A cl.7)

WK7100

Disbursements - Country/interstate loadings (incl travel-accommodation)

WK7200

Disbursements - Conduct money re notice for the production of documents

WK7300

Disbursements - Conduct money re direction for production of documents

WK7400

Disbursements - Treating health service provider's report (whether resolved before or after proceedings commenced)

WK7600

Disbursements - Treating health service provider's clinical notes and records

WK7700

Disbursements - Fee for the provision of independent financial advice by a qualified financial adviser for a commutation by agreement that is approved by the Authority and registered with the Commission

WK7800

Disbursements - Reports obtained pursuant to clause 82

WK7900

Disbursements - Interpreter or translation services

WK8000

Disbursements - Fees imposed by a court or the WCC

WK8001

Dust Disease Tribunal - Other party costs where the insurer/scheme agent is required to pay for matters in the Dust Diseases Tribunal.

WK8002

District Court - Residual Jurisdiction List - Other party costs where the scheme insurer is required to pay for all matters related to the following:

(a) Police Regulation (Superannuation) Act 1906, s 21

(b) Police Act 1990, s 216A

(c) Sporting Injuries Insurance Act 1978, s 29

(d) Workers Compensation (Bush Fire), Emergency and Rescue Services) Act 1987, ss 16 and 30

(e) Workers Compensation (Dust Diseases) Act 1942, s 81.

(f) The Mining List

WK8003

Legal costs for recovery matters - Other party costs where the scheme insurer is required to pay for all matters related to the following:

All insurer/scheme agent matters where action has been commenced in an appropriate jurisdiction for recovery of damages from a third party.

Legal costs associated with the reimbursement of amounts contained in a notice under S145 of the 1987 Act

WK8004

Legal cost associated with an appeal to a higher court - Other party costs for all matters related to an appeal where not otherwise identified as payable under schedule 6 or schedule 7 of the Workers Compensation Regulation 2010 and where the scheme insurer is required to pay.

WK8005

Legal costs associated with a legal action from other jurisdictions - Other party costs for all matters, where the matter is not about the provision of NSW Workers Compensation System benefits i.e. provision of benefits or damages from another jurisdiction e.g. MAA, public liability, cross claim, interstate jurisdictional arguments etc. and where the scheme insurer is required to pay. That is, legal costs where not otherwise identified as payable under schedule 6 or schedule 7 of the Workers Compensation Regulation 2010.

WK8100

Disbursements - Travel costs and expense of claimant pursuant to clause 96

WK8200

Disbursements - Witness expenses pursuant to clause 96

WK8300

Disbursements - Part A clause 17 charges for documents from certain public authorities

WK5100

Additional legal services or other factors – 1 Claimant's appeal against an arbitral decision resolved by Presidential member's decision

WK5105

Additional legal services or other factors – 1 Insurer's appeal against an arbitral decision resolved by Presidential member's decision

WK5200

Additional legal services or other factors – 2 Claimant's question of law application – resolved by Presidential member's decision

WK5205

Additional legal services or other factors – 2 Insurer's question of law application - resolved by Presidential member's decision

WK5300

Additional legal services or other factors – 3 Claimant's medical assessment appeal -resolved by Appeal Panel's decision

WK5305

Additional legal services or other factors – 3 Insurer's medical assessment appeal – resolved by Appeal Panel's decision

WK5400

Additional legal services or other factors – 4 Dispute resolved after proceedings commenced - WCC certifies matter as complex and neither multiple respondent nor lead scheme agent loading applies - Commenced by Claimant

WK5405

Additional legal services or other factors – 4 Dispute resolved after proceedings commenced and WCC certifies matter as complex & either multiple respondent or lead scheme agent loading applies - Commenced by Insurer

WK5500

Additional legal services or other factors – 5 Dispute resolved after proceedings commenced and WCC certifies matter as complex & either multiple respondent or lead scheme agent loading applies

WK5600

Additional legal services or other factors – 6 Multiple respondent case resolved with apportionment - not where the above complex matter loading applies.

WK5800

Additional legal services or other factors – 8(a.1) Worker’s lawyer to review file and advise on WCD and on Internal Review.

WK5801

Additional legal services or other factors – 8(a.2) Prepare and submit Internal Review application

WK5802

Additional legal services or other factors – 8(a.3) Review and advise on Internal Review decision from insurer/agent

WK5805

Additional legal services or other factors – 8(b.1) Prepare and submit Merit Review application

WK5806

Additional legal services or other factors – 8(b.2) Review Merit Review Decision and advise worker/claimant of outcome.

WCIDRR06-89            Schedule 7 legal services

WCIDRR06-90                       Schedule 7 to the Workers Compensation Regulation 2010 provides a schedule of codes and definitions for use by lawyers when providing legal services to both workers and SIRA Insurers. This regulation is to be used for legal services relating to work injury damages matters.

WCIDRR06-91                       Before a worker is entitled to claim for work injury damages the degree of permanent impairment must have been assessed to be at least 15 percent and the permanent impairment benefit must have been paid. The assessment of permanent impairment must have been made in accordance with the SIRA Guidelines for the Evaluation of Permanent Impairment.

WCIDRR06-92                       From 19 June 2012, only one claim can be made under the 1987 Act for permanent impairment compensation that results from an injury.

WCIDRR06-93                       Payments for legal services are to be reported using codes from the following tables that detail the payment classification codes. The codes are listed in two tables:

  • Insurer Legal Codes
  • Worker Legal Codes.

WCIDRR06-94                       If the services have been provided for the insurer, payments for legal services are to be reported from the Insurer Legal Codes that are prefixed with INS. If the services have been provided on behalf of the worker the Worker Legal Codes that are prefixed with WRK are to be reported.

WCIDRR06-95                       The codes have been developed using the descriptions for legal services in schedule 7 of the Workers Compensation Regulation 2010. For more detail on each individual code, refer to the Workers Compensation Regulation 2010.

WCIDRR06-96                       The invoice submitted by the legal representative providing the service is to contain the relevant code for each service provided.

WCIDRR06-97            Schedule 7 – Insurer Legal Codes

Code

Table

Stage

Column 1

Column 2

Fee

INS7000

  

Legal expenses incurred on a claim where a dispute lodged prior to 1st April 2002.

Date of injury must be on or before 31 March 2002.

This includes Common Law matters only (refer to C: 2.2.22 Common Law Action Date)

  

INS7101A

A

1

From the acceptance of the retainer to the preparation and service of a claim under section 260 of the 1998 Act (including the provision of all relevant particulars under 281 of that Act)

(a) in the case of a legal practitioner acting for a claimant—$200

$200

INS7102A

A

1

From the acceptance of the retainer to the preparation and service of a claim under section 260 of the 1998 Act (including the provision of all relevant particulars under 281 of that Act)

(b) in the case of a legal practitioner acting for an insurer—nil

 

INS7201A

A

2

From service of the claim under section 260 of the 1998 Act to the preparation and service of the prefiling statement of claim under section 315 of that Act

(a) in the case of a legal practitioner acting for a claimant—$300

$300

INS7202A

A

2

From service of the claim under section 260 of the 1998 Act to the preparation and service of the prefiling statement of claim under section 315 of that Act

(b) in the case of a legal practitioner acting for an insurer—nil

 

INS7301A

A

3

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the prefiling statement of claim and settlement occurs without the commencement of court proceedings

—from service of the pre-filing statement to finalisation of the matter

(a) if the settlement amount is $20,000 or less and the insurer wholly admitted liability for the claim—$500

 

INS7302A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(b) if the settlement amount is $20,000 or less and the insurer wholly or partly denied liability for the claim—

10% of the settlement amount

 

INS7303A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(c) if the settlement amount is more than $20,000 but less than $50,001 and the insurer wholly admitted liability for the claim—$500 plus 12% of the settlement amount over $20,000

 

INS7304A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(d) if the settlement amount is more than $20,000 but less than $50,001 and the insurer wholly or partly denied liability for the claim— $2,000 plus 12% of the settlement amount over $20,000

 

INS7305A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(e) if the settlement amount is $50,001 or more but less than $100,001 and the insurer wholly admitted liability for the claim— $4,100 plus 10% of the settlement amount over $50,000

 

INS7306A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(f) if the settlement amount is $50,001 or more but less than $100,001 and the insurer wholly or partly denied liability for the claim—$5,600 plus 10% of the settlement amount over $50,000

 

INS7307A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(g) if the settlement amount is $100,001 or more and the insurer wholly admitted liability for the claim—$9,100 plus 2% of the settlement amount over $100,000

 

INS7308A

A

3

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(h) if the settlement amount is $100,001 or more and the insurer wholly or partly denied liability for the claim— $10,600 plus 2% of the settlement amount over $100,000

 

INS7401A

A

4

If the matter is referred to mediation and settlement occurs after the issue of a certificate as to the mediation under section 318B of the 1998 Act but without the commencement of court proceedings— from service of the pre-filing statement to finalisation of the matter.

(a) an amount determined, in accordance with stage 3, by reference to the amount of the settlement,

 

INS7402A

A

4

If the matter is referred to mediation and settlement occurs after the issue of a certificate as to the mediation under section 318B of the 1998 Act but without the commencement of court proceedings— from service of the pre-filing statement to finalisation of the matter.

(b) 2% of the amount of the settlement

 

No new code as no payment applicable

A

4A

4A If the matter is referred to mediation and the claim is withdrawn by the claimant after the issue of a certificate as to the mediation under section 318B of the 1998 Act but before the commencement of court proceedings—from service of the pre-filing statement to finalization of the matter.

(a) in the case of a legal practitioner acting for a claimant—nil

 

INS7403A

A

4A

4A If the matter is referred to mediation and the claim is withdrawn by the claimant after the issue of a certificate as to the mediation under section 318B of the 1998 Act but before the commencement of court proceedings—from service of the pre-filing statement to finalization of the matter.

(b) in the case of a legal practitioner acting for an insurer—$12,500

 

INS7501A

A

5

If the matter is referred to mediation and is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

The total of the following:

(a) an amount determined in accordance with stage 4, by reference to the amount of the settlement or award as if that amount were the amount of the settlement referred to in stage 4,

 

INS7502A

A

5

If the matter is referred to mediation and is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

(b) 2% of the amount of the settlement or award

 

INS7601A

A

6

If the matter is not referred to mediation and the matter is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

The total of the following:

(a) an amount determined in accordance with stage 3, by reference to the amount of the settlement or award as if that amount were the amount of the settlement referred to in stage 3

 

INS7602A

A

6

If the matter is not referred to mediation and the matter is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

(b) 2% of the amount of the settlement or award

 

No new code as no payment applicable

A

6A

If the matter is finalised after the commencement of court proceedings other than by settlement or an award of damages—from service of the pre-filing statement to finalisation of the matter.

  

INS7603A

A

6A

If the matter is finalised after the commencement of court proceedings other than by settlement or an award of damages—from service of the pre-filing statement to finalisation of the matter.

  

INS7101B

B

1

Advice on the certificate as to mediation (if the matter is referred to mediation).

$250

 

INS7201B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(a) if the settlement amount or award is $20,000 or less—nil

 

INS7202B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(b) if the settlement amount or award is more than $20,000 but less than $50,001— 10% of the settlement amount or award over $20,000

 

INS7203B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(c) if the settlement amount or award is $50,001 or more but less than $100,001— $3,000 plus 8% of the settlement amount or award over $50,000

 

INS7204B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(d) if the settlement amount or award is $100,001 or more— $7,000 plus 2% of the settlement amount or award over $100,000

 

No new code as no payment applicable

B

3

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter other than by settlement or an award of damages.

(a) in the case of a legal practitioner acting for a claimant—nil

 

INS7303B

B

3

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter other than by settlement or an award of damages.

(b) in the case of a legal practitioner acting for an insurer—in addition to the $250specified for stage 1 (if chargeable)—$12,500

 

INS7301B

Other

1

Costs associated with a dispute under Part 6 of Chapter 7 of the 1998 Act as to whether the degree of permanent impairment of a worker is sufficient for an award of damages (including costs associated with referring the dispute for assessment by an approved medical specialist under Part 7 of that Chapter).

  

INS7401B

Other

2

Costs associated with a dispute under section 317 of the 1998 Act as to whether a pre-filing statement is $200 defective.

  

INS7501B

Other

3

Cost of representation at a mediation under section 318A of the 1998 Act:

(a) flat fee

(a)

$400

INS7502B

Other

3

Cost of representation at a mediation under section 318A of the 1998 Act: (b) additional amount, at the mediator’s discretion, if the conference exceeds 2 hours

(b)

 

INS7601B

Other

4

If the matter was referred to mediation and counsel advised before mediation about settlement:

(a) counsel’s fee for advice about settlement

(a)

$500

INS7602B

Other

4

If the matter was referred to mediation and counsel advised before mediation about settlement:

(b) cost of representation in court, per day, for advocate other than senior counsel

(b)

$1,500

INS7603B

Other

4

If the matter was referred to mediation and counsel advised before mediation about settlement:

(c) cost of representation in court, per day, for senior counsel

(c)

$2,200

INS7701B

Other

4

If the matter was not referred to mediation:

(a) cost of representation in court, per day, for advocate other than senior counsel

(a)

$1,500

INS7702B

Other

4

If the matter was not referred to mediation:

(b) cost of representation in court, per day, for senior counsel

(b)

$2,200

WCIDRR06-98            Schedule 7 – Worker legal code

Code

Table

Stage

Column 1

Column 2

Fee

WRK7000

  

Legal expenses incurred on a claim where a dispute was lodged prior to 1 April 2002. Date of injury must be on or before 31 March 2002. This includes Common Law matters only

  

WRK7101A

A

1

From the acceptance of the retainer to the preparation and service of a claim under section 260 of the 1998 Act (including the provision of all relevant particulars under 281 of that Act).

(a) in the case of a legal practitioner acting for a claimant—$200

$200

WRK7102A

A

1

From the acceptance of the retainer to the preparation and service of a claim under section 260 of the 1998 Act (including the provision of all relevant particulars under 281 of that Act).

(b) in the case of a legal practitioner acting for an insurer—nil

 

WRK7201A

A

2

From service of the claim under section 260 of the 1998 Act to the preparation and service of the prefiling statement of claim under section 315 of that Act.

(a) in the case of a legal practitioner acting for a claimant—$300

$300

WRK7202A

A

2

From service of the claim under section 260 of the 1998 Act to the preparation and service of the prefiling statement of claim under section 315 of that Act.

(b) in the case of a legal practitioner acting for an insurer—nil

 

WRK7301A

A

3

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the prefiling statement of claim and settlement occurs without the commencement of court proceedings —from service of the pre-filing statement to finalisation of the matter

(a) if the settlement amount is $20,000 or less and the insurer wholly admitted liability for the claim—$500

 

WRK7302A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(b) if the settlement amount is $20,000 or less and the insurer wholly or partly denied liability for the claim— 10% of the settlement amount

 

WRK7303A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(c) if the settlement amount is more than $20,000 but less than $50,001 and the insurer wholly admitted liability for the claim—$500 plus 12% of the settlement amount over $20,000

 

WRK7304A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(d) if the settlement amount is more than $20,000 but less than $50,001 and the insurer wholly or partly denied liability for the claim— $2,000 plus 12% of the settlement amount over $20,000

 

WRK7305A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(e) if the settlement amount is $50,001 or more but less than $100,001 and the insurer wholly admitted liability for the claim— $4,100 plus 10% of the settlement amount over $50,000

 

WRK7306A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(f) if the settlement amount is $50,001 or more but less than $100,001 and the insurer wholly or partly denied liability for the claim—$5,600 plus 10% of the settlement amount over $50,000

 

WRK7307A

A

3

If:

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(g) if the settlement amount is $100,001 or more and the insurer wholly admitted liability for the claim—$9,100 plus 2% of the settlement amount over $100,000

 

WRK7308A

A

3

(a) the matter is referred to mediation and settlement occurs after the service of the pre-filing statement of claim without the issue of a certificate as to mediation under section 318B of the 1998 Act, or

(b) the matter is not referred to mediation (because the insurer denies liability) and settlement occurs without the commencement of court proceedings, or

(c) the insurer does not respond to the pre-filing statement of claim and settlement occurs without the commencement of court proceedings

(h) if the settlement amount is $100,001 or more and the insurer wholly or partly denied liability for the claim— $10,600 plus 2% of the settlement amount over $100,000

 

WRK7401A

A

4

If the matter is referred to mediation and settlement occurs after the issue of a certificate as to the mediation under section 318B of the 1998 Act but without the commencement of court proceedings— from service of the pre-filing statement to finalisation of the matter.

(a) an amount determined, in accordance with stage 3, by reference to the amount of the settlement,

 

WRK7402A

A

4

If the matter is referred to mediation and settlement occurs after the issue of a certificate as to the mediation under section 318B of the 1998 Act but without the commencement of court proceedings— from service of the pre-filing statement to finalisation of the matter.

(b) 2% of the amount of the settlement

 

No new

code as no

payment

applicable

A

4A

4A If the matter is referred to mediation and the claim is withdrawn by the claimant after the issue of a certificate as to the mediation under section 318B of the 1998 Act but before the commencement of court proceedings—from service of the pre-filing statement to finalization of the matter.

(a) in the case of a legal practitioner acting for a claimant—nil

 

WRK7403A

A

4A

4A If the matter is referred to mediation and the claim is withdrawn by the claimant after the issue of a certificate as to the mediation under section 318B of the 1998 Act but before the commencement of court proceedings—from service of the pre-filing statement to finalization of the matter.

(b) in the case of a legal practitioner acting for an insurer—$12,500

 

WRK7501A

A

5

If the matter is referred to mediation and is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

The total of the following:

(a) an amount determined in accordance with stage 4, by reference to the amount of the settlement or award as if that amount were the amount of the settlement referred to in stage 4

 

WRK7502A

A

5

If the matter is referred to mediation and is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

(b) 2% of the amount of the settlement or award

 

WRK7601A

A

6

If the matter is not referred to mediation and the matter is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

The total of the following:

(a) an amount determined in accordance with stage 3, by reference to the amount of the settlement or award as if that amount were the amount of the settlement referred to in stage 3,

 

WRK7602A

A

6

If the matter is not referred to mediation and the matter is finalised after the commencement of court proceedings (whether by way of settlement or an award of damages)—from service of the pre-filing statement to finalisation of the matter.

(b) 2% of the amount of the settlement or award

 

No new

code as no

payment

applicable

A

6A

If the matter is finalised after the commencement of court proceedings other than by settlement or an award of damages—from service of the pre-filing statement to finalisation of the matter.

(a) in the case of a legal practitioner acting for a claimant—nil

 

WRK7603A

A

6A

If the matter is finalised after the commencement of court proceedings other than by settlement or an award of damages—from service of the pre-filing statement to finalisation of the matter.

(b) in the case of a legal practitioner acting for an insurer—$20,600

 

WRK7101B

B

1

Advice on the certificate as to mediation (if the matter is referred to mediation).

$250

 

WRK7201B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(a) if the settlement amount or award is $20,000 or less—nil

 

WRK7202B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(b) if the settlement amount or award is more than $20,000 but less than $50,001— 10% of the settlement amount or award over $20,000

 

WRK7203B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(c) if the settlement amount or award is $50,001 or more but less than $100,001— $3,000 plus 8% of the settlement amount or award over $50,000

 

WRK7204B

B

2

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter by settlement or award of damages.

In addition to the $250 specified for stage 1 (if chargeable):

(d) if the settlement amount or award is $100,001 or more— $7,000 plus 2% of the settlement amount or award over $100,000

 

No new code as no payment applicable

B

3

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter other than by settlement or an award of damages.

(a) in the case of a legal practitioner acting for a claimant—nil

 

WRK7303B

B

3

From the giving of advice on the certificate of mediation (or, if the matter is not referred to mediation, from acceptance of the retainer) to finalisation of the matter other than by settlement or an award of damages.

(b) in the case of a legal practitioner acting for an insurer—in addition to the $250 specified for stage 1 (if chargeable)—$12,500

 

WRK7301B

Other

1

Costs associated with a dispute under Part 6 of Chapter 7 of the 1998 Act as to whether the degree of permanent impairment of a worker is sufficient for an award of damages (including costs associated with referring the dispute for assessment by an approved medical specialist under Part 7 of that Chapter)

 

$500

WRK7401B

Other

2

Costs associated with a dispute under section 317 of the 1998 Act as to whether a pre-filing statement is defective

 

$200

WRK7501B

Other

3

Cost of representation at a mediation under section 318A of the 1998 Act:

(a) flat fee

(a)

$400

WRK7502B

Other

3

Cost of representation at a mediation under section 318A of the 1998 Act:

(b) additional amount, at the mediator’s discretion, if the conference exceeds 2 hours

(b)

 

WRK7601B

Other

4

If the matter was referred to mediation and counsel advised before mediation about settlement:(a) counsel’s fee for advice about settlement

(a)

$500

WRK7602B

Other

4

If the matter was referred to mediation and counsel advised before mediation about settlement:

(b) cost of representation in court, per day, for advocate other than senior counsel

(b)

$1,500

WRK7603B

Other

4

If the matter was referred to mediation and counsel advised before mediation about settlement:

(c) cost of representation in court, per day, for senior counsel

(c)

$2,200

WRK7701B

Other

4

If the matter was not referred to mediation:

(a) cost of representation in court, per day, for advocate other than senior counsel

(a)

$1,500

WRK7702B

Other

4

If the matter was not referred to mediation:

(b) cost of representation in court, per day, for senior counsel

(b)

$2,2001

Interpreter services

WCIDRR06-99            Interpreter services

INT001                                   Interpreter services

The amounts paid to an approved interpreter service for services provided to the claimant for English language assistance or deaf sign interpreter services.

Medical investigation services

WCIDRR06-100                     If the services have been provided on behalf of the worker, payments for medical investigation services are to be reported from the worker medical investigation service codes that are prefixed with WIG/WIS.

WCIDRR06-101                     If the services have been provided for the insurer, payments for medical investigation services are to be reported from the insurer medical investigation service codes that are prefixed with IMG/IMS.

WCIDRR06-102                     For providing copies of clinical notes and medical records use WCO005.

WCIDRR06-103         Worker initiated medical investigations

WCIDRR06-104                      Where services requested by the worker or worker representative

WCIDRR06-105         Independent medical examiners  - general practitioners

WCIDRR06-106                     Payment for an examination by a general practitioner who is treating the worker when requested to provide an opinion in relation to a dispute or potential dispute in respect of a claim made by the worker..

WCIDRR06-107                     Refer to the Workers Compensation (Medical Examinations and Reports Fees) Order for service definitions.

WIG001                                  Examination and report- standard

WIG002                                  Examination and report- standard with interpreter

The interpreter is to invoice separately using code INT001.

WIG003                                  Examination and report– complex

WIG004                                  Examination and report– complex with interpreter

The interpreter is to invoice separately using code INT001

WIG005                                  Cancellation with 2 working days’ notice or less

WIG006                                  File review and report

WIG007                                  Supplementary report

WIG008                                  Update examination and report- update

WIG009                                  Travel

WCIDRR06-108         Independent medical examiners  - medical specialists

WCIDRR06-109                     Payment for an examination by a medical specialist who provides an impartial medical assessment of a worker to assist decisions such as the acceptance of a claim, ongoing liability and the worker's capacity for work, .

WCIDRR06-110                     Refer to the Workers Compensation (Medical Examinations and Reports Fees) Order for service definitions.

WIS001                                  Examination and report- standard

WIS002                                  Examination and report- standard with interpreter

The interpreter is to invoice separately using code INT001.

WIS003                                  Ear nose and throat – examination and report

WIS031                                  Ear nose and throat – examination and report with interpreter

The interpreter is to invoice separately using code INT001.

WIS004                                  Examination and report- moderately complex

WIS005                                  Examination and report- moderately complex interpreter

The interpreter is to invoice separately using code INT001.

WIS006                                  Examination and report- complex wis007 examination and report- complex with interpreter

The interpreter is to invoice separately using code INT001.

WIS008                                  Examination and report- psychiatric

WIS081                                  Examination and report– psychiatric with interpreter

The interpreter is to invoice separately using code INT001

WIS092                                  Cancellation with 2 working days’ notice or less

WIS010                                  File review and report

WIS011                                  Supplementary report

WIS012                                  Update examination and report

WIS013                                  Travel

WIS014                                  Consolidation of assessments – lead assessor

WCIDRR06-111         Insurer initiated medical investigations

WCIDRR06-112 Where services are requested by the insurer

WCIDRR06-113         Independent medical examiners  - general practitioners

WCIDRR06-114                     Payment for an examination by a general practitioner who is treating the worker when requested to provide an opinion in relation to a dispute or potential dispute in respect of a claim made by the worker,

WCIDRR06-115                     Refer to the Workers Compensation (Medical Examinations and Reports Fees) Order for service definitions.

IMG001                                  Examination and report - standard

IMG002                                  Examination and report- standard with interpreter

The interpreter is to invoice separately using code INT001.

IMG003                                  Examination and report– complex

IMG004                                  Examination and report– complex with interpreter

The interpreter is to invoice separately using code INT001.

IMG005                                  Cancellation with 2 working days’ notice or less

IMG006                                  File review and report

IMG007                                  Supplementary report

IMG008                                  Update examination and report-

IMG009                                  Travel

WCIDRR06-116         Independent medical examiners  - medical specialists

WCIDRR06-117                     Payment for an examination by a medical specialist who provides an impartial medical assessment of a worker to assist decisions such as the acceptance of a claim, ongoing liability and the worker's capacity for work,

WCIDRR06-118                     Refer to Workers Compensation (Medical Examinations and Reports Fees) Order for service definitions.

IMS001                                   Examination and report- standard

IMS002                                   Examination and report- standard with interpreter

The interpreter is to invoice separately using code INT001.

IMS003                                   Ear nose and throat – examination and report

IMS031                                   Ear nose and throat – examination and report with interpreter

The interpreter is to invoice separately using code INT001.

IMS004                                   Examination and report - moderately complex

IMS005                                   Examination and report- moderately complex with interpreter

The interpreter is to invoice separately using code INT001.

IMS006                                   Examination and report - complex

IMS007                                   Examination and report - complex with interpreter

IMS008                                   Examination and report- psychiatric

IMS081                                   Examination and report - psychiatric with interpreter

The interpreter is to invoice separately using code INT001.

IMS092                                   Cancellation with 2 working days’ notice or less

IMS010                                   File review and report

IMS011                                   Supplementary report

IMS012                                   Update examination and report

IMS013                                   Travel

IMS014                                   Consolidation of assessments – lead assessor

WCIDRR06-119         Other insurer investigation services

IIN103                                     Assessment of work capacity and ability to earn

This is the payment for services supplied to an insurer for the purpose of a work capacity assessment under Section 44A of the Workers Compensation Act 1987. This also includes payment for the assessment of a worker’s ability to earn in suitable employment for the purpose of Section 40 of the Workers Compensation Act 1987 for workers excluded from the legislative reforms (police officers, paramedics, fire fighters, volunteer bush fire fighters, emergency and rescue service volunteers and people with a dust disease claim).

Inclusions/exclusions:

  • Include assessments conducted by Workplace Rehabilitation Provider, medical practitioner or other health care professional (for example, neuropsychologist, occupational therapist, etc where an insurer has requested this service for the purposes mentioned above).
  • Excludes other assessments undertaken as part of workplace rehabilitation.

IIN104                                     Psychological assessment

Psychological assessment conducted to determine whether employment is the substantial contributing factor to the injury. This also includes the assessment to determine whether a psychological injury was caused by reasonable actions of the employer.

Inclusions/exclusions:

  • Include only psychological assessments pursuant to Sections 9A and 11A of the Workers Compensation Act 1987.

Non-medical investigation services

WCIDRR06-120         Worker investigation services

WIE001                                  Worker - non-medical investigation expenses

The amounts paid for technical assessment, site investigation, and gathering of facts relating to an incident.

WCIDRR06-121         Insurer investigation expenses

IIN102                                     Insurer - investigation

The investigation expenses incurred by the insurer

Inclusions/exclusions:

Include factual and surveillance reports, evidence gathering undertaken by the insurer, legal opinions on liability and recovery potential.

Shared claim and other insurer-to-insurer payments

WCIDRR06-122         Shared claim payments

SCP001                                  Shared claim payments - insurer not responsible for administering claim

The amounts paid to another workers compensation Insurer in respect of the agreed portion of liability for a shared claim. Only those insurers not responsible for the administration of the claim are to use this item.

SCP002                                  Shared claim payments - non-managed fund insurer

The amounts paid to another non-managed fund insurer in respect of the agreed portion of liability for a shared claim. Only those insurers not responsible for the administration of the claim are to use this item.

SCP003                                  Shared claim payments - compulsory third-party insurer only

The amounts paid to other compulsory third party insurers in respect of the agreed portion of liability for a shared claim.

SCP004                                  Shared claim payments - to other insurer excluding compulsory third party insurer

The amounts paid to other insurers excluding compulsory third party insurer in respect of the agreed portion of liability for a shared claim.

Recoveries

WCIDRR06-123         Recoveries of prescribed excess
from employer

RPE001                                  Recoveries of prescribed excess from employer

Recovery of prescribed excess amount from the employer, in respect of weekly compensation payments made to a worker for any period of total or partial incapacity at work.

Inclusions/exclusions:

  • Include only recoveries pursuant to Section 160, Workers Compensation Act 1987 No 70.

WCIDRR06-124         Recoveries - common law

RCL001                                  Recoveries - common law

The recovery of weekly payments, the amount awarded for any permanent impairment, pain and suffering or death payments when a person recovers damages in respect of an injury.

Inclusions/exclusions:

  • Include only recoveries pursuant to Section 151A, Workers Compensation Act 1987 No 70.

WCIDRR06-125         Recoveries - shared claim

RSC001                                  Recoveries - shared claim from insurer

The recovery of compensation paid by an insurer when another insurer has accepted liability to pay compensation to the worker in respect of the injury concerned.

Inclusions/exclusions:

  • Applicable legislation: Section 74, Insurance Contracts Act 1984
  • Include only recoveries of compensation paid pursuant to Section 272, Workplace Injury Management and Workers Compensation Act 1998, No 86.

RSC002                                  Recoveries - shared claim from insurer

The recovery of compensation paid by an insurer when, another non-managed fund insurer has accepted liability to pay compensation to the worker in respect of the injury concerned.

Inclusions/exclusions:

  • Applicable Legislation: Section 74, Insurance Contracts Act 1984. Include only recoveries of compensation paid pursuant to section 272, Workplace Injury Management and Workers Compensation Act 1988 No86.

WCIDRR06-126         Recoveries - against both employer  and stranger, section 151Z

RES001          Recoveries - against both employer and stranger, section 151Z - from compulsory third party insurer only

Recoveries received from compulsory third party insurer when an injury was caused under circumstances creating liability for some person other than the workers' employer to pay damages.

Inclusions/exclusions:

  • Include only recoveries for Compulsory Third Party insurers pursuant to Section 151Z, Workers Compensation Act 1987 No 70.
  • This Payment/Recovery type is for Recoveries received from Compulsory Third Party Insurers only. Compulsory Third Party Insurance covers personal injury costs for people injured in motor vehicle accidents, including drivers, passengers and pedestrians.

Notes: This recovery type is for recovery payments made by a Compulsory Third Party insurer. The worker must have been injured in a motor vehicle accident as a driver, passenger, pedestrian, cyclist or motorbike rider where another driver or owner of a motor vehicle who is not the claimant was partially or completely at fault.

RES002                                  Recoveries - against both employer and stranger, section 151Z - excluding compulsory third party insurer

Recoveries received when an injury was caused under circumstances creating liability for some person other than the workers' employer to pay damages excluding recoveries from Compulsory third Party.

Inclusions/exclusions:

  • Include only recoveries for that are not Compulsory Third Party pursuant to Section 151Z, Workers Compensation Act 1987 No 70.
  • This Payment/Recovery type is for recoveries received from S151Z excluding Compulsory Third Party Insurers and excluding recoveries from Common Law.
  • Some examples of recovery payments included in this code:
  • Labour Hire Firms
  • Injuries occurring at premises not owned/occupied by employer
  • Injuries occurring during lunch break
  • Injuries caused by slip or trip
  • Injuries involving train, boat or aeroplane
  • Injuries occurring in a public place
  • Injuries occurring during the use of machinery or equipment
  • Injuries caused by act or omission of a third party not being the employer or fellow employee
  • Injuries caused by a deliberate act of fellow employee.

WCIDRR06-127         Recoveries - over payments

ROP001                                 Recoveries - over payments due to fraud
or false claims

The recoveries of over-payments made to a person, purportedly made to an obligation arising under the Act and only after an Order has been made by SIRA.

Inclusions/exclusions:

  • Include only recoveries of over-payments pursuant to Section 235D, Workplace Injury Management and Workers Compensation Act 1998 No 86.
  • This recovery payment type does not refer to Section 235 of the Workers Compensation Act 1987 No 70.

Refund payments

WCIDRR06-128         Refund payment

RFD003                                  Medical refund to Medicare Australia or health fund

Payment to Medicare Australia when a settlement for a worker occurs and a valid Notice of Past Benefits has been received or a Notice of Charge has been issued.

Payment for medical expenses that are payable under the workers claim to a Health Fund.

Payment to a worker where Medicare Australia has deducted a portion or the whole amount of the 10% paid to them in advance of a Notice of Past Benefit or Notice of Charge being issued. The amount paid to the worker is the amount deducted by Medicare Australia.

Inclusions/exclusions:

  • Includes payments to health funds for medical expenses payable under a claim and payments to Medicare Australia where a Notice of Past Benefits has been received or a Notice of Charge has been issued
  • Includes a payment to a worker following deduction of money owed to Medicare Australia from an advanced payment.
  • Excludes payment to Medicare Australia where 10% of the workers settlement amount is paid in the absence of a valid Notice of Past Benefits or Notice of Charge.

Appendix

Retired or replaced payment codes

WCIDRR06-129 List of retired payment classification codes

Code

Payment Type

Description

Date retired

RMX001

Remedial Massage Therapy –

Non SIRA approved

Consultation and treatment of any time duration

1/1/2009

DEC002

Death Payment

Lump Sum Payment to Dependants of the Deceased worker

1/1/2010

IN7500

Legal Services – Insurer

Disbursement

1/1/2010

WK7500

Legal Services – Worker

Disbursement

1/1/2010

COU001

Counselling Services

Counselling Services

1/7/2011

OTT003

Other Therapies and Treatments

Work Related Activity /Work Conditioning Program

1/7/2011

VJC001

JobCover Placement Program

Wage Subsidy

1/7/2012

RFD001

Refunds to Other Agencies

Medicare Advanced payments

1/7/2012

RFD002

Refunds to Other Agencies

Centrelink

1/7/2012

WPT005

Section 36 weekly payments has no current work capacity first 13 weeks

The weekly payment of compensation to which, an injured worker who has no current work capacity is entitled during the first aggregate period (whether or not consecutive) of 13 weeks.

01/01/2015

WPT006

Section 37 weekly payments has no current work capacity first 14-130 weeks

The weekly payment of compensation to which, an injured worker who has no current work capacity is entitled during the second entitlement period (whether or not consecutive) of 117, after the expiry of the first entitlement period (13 weeks).

01/01/2015

WPT007

Section 38 weekly payments has no current work capacity greater than 130 weeks

The weekly payment of compensation to which, an injured worker who has no current work capacity is entitled after week 130. That is when the worker is likely to continue indefinitely to have no current work capacity.

01/01/2015

AID001

Hearing AID Assessments

This is the payment for the hearing needs assessment by an Audiologist or the hearing needs assessment by an Audiometrist.

9/9/2014

WIS091

Cancellation with 2 days notice

A medical specialist (examiner) may charge a cancellation fee equivalent to half of their gazetted hourly rate in the situation where a worker cancels with less than 2 days notice of cancellation.

31/12/2015

IIN101

Insurer – Allied Health Practitioner Investigation Expenses

Fees paid by an insurer for the provision of services provided by a SIRA Approved Allied Health Independent Consultant (IC) in respect of the provision of any assessment, interview, examination, file review, discussions and/or report, in accordance with the Workplace Injury Management and Workers Compensation (Independent Consultants) Fees Order.

31/12/2015

IIN106

Injury management consultants – cancellation with 2 working days notice

An Injury Management Consultant may charge a cancellation fee equivalent to half of their gazetted hourly rate in the situation where a worker provides 2 days notice of cancellation.

31/12/2015

IMS091

Cancellation  with 2 working  days notice

A medical specialist (examiner) may charge a cancellation fee equivalent to half of their gazetted hourly rate in the situation where a worker cancels with less than 2 days notice of cancellation.

31/12/2015

WPP015

Section 38 - Weekly payments, first 13 weeks – Return to work assist program for micro-employers

The weekly payments of compensation to a worker who is eligible for the program. As the program must take place within 13 weeks from the date of injury, a worker’s entitlement will be the lesser of 95 per cent of their pre-injury average weekly earnings or the maximum weekly compensation.

01/07/2019

WCIDRR06-130 List of replaced payment classification codes
(new definitions exist)

Code

Payment Type

Description

Date retired

OR01

Occupational Rehabilitation and Return to Work Services

Initial Rehabilitation Assessment

1/7/2008

OR02

Occupational Rehabilitation and Return to Work Services

Functional Assessment

1/7/2008

OR03

Occupational Rehabilitation and Return to Work Services

Workplace Assessment

1/7/2008

OR04

Occupational Rehabilitation and Return to Work Services

Job Analysis

1/7/2008

WCIDRR06-131 List of removed payment classification codes (no definition exists)

Code

Payment Type

Description

Date retired

OR05

Occupational Rehabilitation and Return to Work Services

Advice Concerning Job Modification

1/7/2008

OR06

Occupational Rehabilitation and Return to Work Services

Rehabilitation Counselling

1/7/2008

OR07

Occupational Rehabilitation and Return to Work Services

Vocational Assessment and Counselling

1/7/2008

OR08

Occupational Rehabilitation and Return to Work Services

Advice or Assistance Concerning Job Seeking

1/7/2008

OR09

Occupational Rehabilitation and Return to Work Services

Advice or Assistance in Arranging Vocational Retraining

1/7/2008

OR10

Occupational Rehabilitation and Return to Work Services

Preparation of Rehabilitation Reports

1/7/2008

OR13

Occupational Rehabilitation and Return to Work Services

Monitoring return to work

1/7/2008

OR14

Occupational Rehabilitation and Return to Work Services

Aids and Equipment

1/7/2008

OR15

Occupational Rehabilitation and Return to Work Services

Travel

1/7/2008

Part 7 : Payment classification and estimates reference

Download the Payment classification and estimates reference (xls file, 384 kb)

Part 8: Policy technical manual

A pdf version is also available.

General introduction

The Workers compensation insurer data reporting information requirements (Requirements) describes the rules and the process workers compensation insurers must follow to submit their workers compensation insurance data.

Purpose of the Requirements

The Requirements support delivery of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) and the Workers Compensation Regulation 2016 by establishing clear processes and procedures around the submission of policy data to SIRA.

The accurate and timely collection of policy data is essential to assist in the service delivery to people with a work-related injury, affordability, and the effective management and sustainability of the system.

The data collected is used by SIRA in achieving its function as the regulator, for example: ensure stakeholders comply with legislation and guidelines and to monitor their performance, identify areas of high risk and the publication of reports.

Publication notes

These Requirements are published by the State Insurance Regulatory Authority (SIRA) and replace the following documents:

  • Policy Technical Manual V 3.11 (published in 2015)

An independent agency located within the NSW Customer Service Cluster, the Authority is constituted under the State Insurance and Care Governance Act 2015 and is responsible for regulating workers compensation insurance, motor accidents compulsory third party (CTP) insurance and home building compensation insurance in NSW.

Replacement and transition

The following publication is repealed:

  • the Policy technical manual V 3.11

and is replaced by these Requirements.

These Requirements apply to all policy data submitted by Workers Compensation insurers.

Legislative framework

The data described in this requirement is collected under:

  • the conditions of the insurer’s licence and/or in accordance with s23(1)(m) and Section 40C of the 1998 Act and
  • Section 40B of the 1998 Act

Requirement making power

These Requirements are made under Section 40C of the 1998 Act.

Interpretation of the Requirements

These Requirements should be interpreted in a manner that supports the achievement of the objectives and general functions of SIRA under the workers compensation legislation as described in section 22 of the 1998 Act.

At this point in time, the data items detailed in this manual will only apply for the Nominal Insurer.

Commencement of the Requirements

The Workers compensation policy technical manual (WCIDRR08) is published by SIRA on 1 August 2019.

The Workers compensation policy data item guidance specification (WCIDRR09) is published by SIRA on 1 August 2019.

These Requirements are effective from the publication date until SIRA amends, revokes or replaces them in whole or in part. These Requirements supersede the previous requirements which were in place until 1 August 2019.

Parts of the Requirements

The policy reporting Requirements are divided into the following parts:

Part 8: Workers compensation policy technical manual: details the technical requirements for submitting workers compensation data.

Part 9: Workers compensation policy data item guidance specification: helps to explain how the data needs to be reported to SIRA.

Reference Data

Part 10: Workers compensation policy technical manual validations reference: provides a validation matrix which lists all validations, their severity and the data items impacted.

Part 11: Workers compensation policy technical manual code set reference: details all codes and code sets applicable to specific data items and provides a detailed description of each code and its use.

Compliance with the Requirements

SIRA will monitor and review compliance with the Requirements. Compliance and enforcement will be undertaken in accordance with the Authority’s Compliance and enforcement policy (July 2017).

Penalties for not meeting reporting requirements

It is the responsibility of the insurer to ensure the accuracy, quality and timeliness of the data provided.

Failure to comply with these Requirements may result in regulatory sanctions being imposed including imposition of penalties, civil penalties or loss of licence if applicable.

Requirement identifiers

Each requirement component has been allocated a unique identifier (e.g. WCIDRR08-01) to make it traceable.  This will assist when:

  • searching for a requirement
  • linking requirements
  • advising relevant stakeholders when a requirement has been revised, and
  • to assist insurers when they request advice or suggesting improvements.

Reporting requirements

WCIDR08-01              In preparing a policy reporting submission to SIRA, insurers must report on that submission all new policies written during the reporting period defined on the header record, and all changes to policy data that have not been previously reported to SIRA. SIRA requires that only changed data records be reported (i.e. a policy term detail record that has not changed since last reporting period will not be reported in this reporting period, regardless of other information that may need to be reported to SIRA e.g. Premium detail).

WCIDR08-02              SIRA requires claims data to be reported with a corresponding policy reported to SIRA. It may be necessary to ensure that relevant policy data has been reported to SIRA in advance of related claims data. As a minimum, the policy term detail record for the relevant policy renewal year (PRY) must be submitted and loaded into SIRA’s database to allow the claims data to load.

WCIDR08-03              It is the responsibility of the insurer to ensure the accuracy, quality and timeliness of the data provided.

Identifying policies

WCIDR08-04              SIRA requires and uses unique identifiers for policies, policy terms and policy term transactions. These identifiers are SIRA policyholder identifier, insurer number, period commencement date and transaction date.

Policy

WCIDR08-05              SIRA uses the policy and insurer numbers to uniquely identify a policy. The policy number that an insurer reports to SIRA for an employer, must remain the same for all policy terms.

Policy term

WCIDR08-06              The period commencement date (with policy and insurer numbers) uniquely identifies the policy term. SIRA’s system records data for each term of a policy (that is for each PRY that the policy is in force). Insurers cannot amend the commencement date except by “nulling” (refer to Part 8 Workers Compensation policy data item guidance specification).

WCIDR08-07              Insurers must submit data separately for each transaction on a policy or policy term. If activity occurs during the same submission period on two separate terms of the policy, two separate sets of data are required, one for each policy term.

WCIDR08-08              It is also possible for data on the one policy term to be reported more than once in a submission period. Hence there will be two or more sets of policy data on the submission for the policy term. Transaction date is used to uniquely identify each transaction (with policy term and policy) and to ensure they are processed in the correct sequence.

Policy term transaction

WCIDR08-09  If the insurer has processed two or more sets of data on one policy term on the same day (that is with the same transaction date), only the latest set of data for that day is required. If more than one set of data is sent for the same policy term, with the same transaction date, that policy submission will be rejected.

Supplying record types for special cases

New policies

WCIDR08-010            When a policy is first created, insurers must provide full details to SIRA. Insurers are required to submit details of all policy terms to SIRA. The requirements for each new policy and policy term are:

- a policy term detail record

- a premium detail record

- the associated activity detail records.

WCIDR08-011            Initially however, a policy term detail record can be sent in isolation to allow the reporting of claims data where the insurer does not have sufficient information to provide a premium detail and associated activity detail records.

Change in premium and activity details

WCIDR08-012            Where a policy term has previously been submitted to SIRA and details contained only in the premium detail record or the activity detail record have changed, insurers only need to submit the following record types:

- a premium detail record

- the associated activity detail records.

Change in policy term details

WCIDR08-013            Insurers only need supply a new policy term detail record if the change in a policy is to data contained within the policy term detail record, such as a change to the employer address.

Reporting of null policy terms

WCIDR08-014            Null policy terms can arise where the policy term has been created in error (duplicated or an incorrect policyholder number used) or the policy term is effectively null and void (i.e. the insurer is not providing insurance cover for that period covered by the policy term). For further information on how to report this, please refer to the Workers compensation policy data item guidance specification.

Reporting of minimum premium policies

WCIDR08-015            Where premium payable as calculated, is less than the regulated minimum premium then the minimum premium is applied.

Note: In this case the total premium payable should exactly equal the minimum premium amount. All other data items are to be specified as calculated.

Reporting of exempt employer administration fee

WCIDR08-016            Where an employer is deemed to hold a policy with the Nominal Insurer and the reporting of a claim has instigated the charging to the employer of an administration fee, the Insurer must report a policy record set for the period covering the date of injury and each day either side of the date of injury.

Reporting of retro paid loss policies

WCIDR08-017            Where an employer’s policy premium is calculated according to a retro paid loss premium method, premium information is to be reported as below:

Premium Detail and Activity Detail Records (except Total Premium Payable and GST)

WCIDR08-018            As calculated as per a non-retro paid loss policy.

WCIDR08-019            Claims costs (C0, C1, C2 & C3), Wages (W0, W1, W2 & W3), Experience Premium and Premium Payable are to be calculated and reported as per a non-retro paid loss policy.

Total Premium Payable

WCIDR08-020            As calculated according to the retro paid loss premium method.

GST

WCIDR08-021 Calculated based on the Total premium payable as per the Retro paid loss premium method.

Data submission

SIRA assistance

WCIDR08-022            For queries, suggested changes or enhancements about any aspect of this requirements, please contact the Data Quality and Exchange Team on ph: (02) 4321 5703 or email: data.information@sira.nsw.gov.au

Insurer types

WCIDR08-023            These are allocated by SIRA and advised to the insurers. Insurers are to provide data in accordance with their allocated insurer type.

Data submission

WCIDR08-024            In preparing a policy submission, insurers must report all new policies and all activity on a policy since its last successful report.

WCIDR08-025            SIRA may validate policy data submission prior to loading to ensure compliance with reporting requirements.

WCIDR08-026            A policy is considered to have been successfully reported when the data submitted does not trigger any abort or critical errors.

Record descriptions

WCIDR08-026.1         Header record:

Record Set 1. Must be the first record on the submission. There must only be one of these in the submission.

WCIDR08-026.2         Submission Trailer record:

Record Set 9. Must be the last record on the submission. There must only be one of these in the submission.

WCIDR08-026.3         Policy term detail record:

Record Set 2 – Record Identifier 1. Policy term detail record can be sent in isolation or, may have an associated premium detail record and an activity detail record.

WCIDR08-026.4         Premium detail record:

Record Set 2 – Record Identifier 2. Premium detail record must have associated activity detail record (either Tariff rating activity detail record or WIC rating activity detail record reported when reporting the premium detail record). May or may not have an associated policy term detail record.

WCIDR08-026.5         Tariff rating activity detail record:

Record Set 2 - Record Identifier 3. Tariff rating activity detail record where policy commencement date is less than 30 June 2001. Must have an associated premium detail record.

WCIDR08-026.6         WIC rating activity detail record:

Record Set 2 - Record Identifier 4. WIC rating activity detail records where policy commencement date is greater than or equal to 30 June 2001.  Must have an associated premium detail record.

Submission record sorting

WCIDR08-027            The submission records must be sorted in ascending sequence on the first 31 ASCII characters in each record.

WCIDR08-028            The records in the submission must be sorted in the following sequence:

  • record identifier within
  • transaction date within
  • period commencement date within
  • policy number within
  • record type

Submission frequency

WCIDR08-029            Insurers must provide a minimum of one submission of policy data per month. The header record will include the Submission start date (P: 1.5) and Submission end date (P: 1.6) that will define the reporting period. If there is no activity in a month a Null submission, i.e. a header and trailer record only, must be submitted.

WCIDR08-030            SIRA will negotiate lodgement schedules with individual insurers.

WCIDR08-031            Should an insurer be unable to lodge a submission according to the agreed schedule, it will be necessary to notify SIRA to make arrangements for rescheduling submission lodgement.

Submission characteristics

WCIDR08-032            The records in the submission must have the following characteristics:

  • ASCII format. Refer to table below.
  • All fields must be fixed length (zero or space filled as appropriate)
  • All records are fixed length of 900 characters
  • The submission file name must be formatted as POLnnn.WCA where nnn is the insurer number allocated by SIRA.
  • The submission must be zipped prior to upload.

WCIDR08-032.1        Acceptable ASCII characters

Decimal

Character

Hex

Decimal

Character

Hex

Decimal

Character

Hex

32

space

20

64

@

40

96

`

60

33

!

21

65

A

41

97

a

61

34

"

22

66

B

42

98

b

62

35

#

23

67

C

43

99

c

63

36

$

24

68

D

44

100

d

64

37

%

25

69

E

45

101

e

65

38

&

26

70

F

46

102

f

66

39

'

27

71

G

47

103

g

67

40

(

28

72

H

48

104

h

68

41

)

29

73

I

49

105

i

69

42

*

2a

74

J

4a

106

j

6a

43

+

2b

75

K

4b

107

k

6b

44

,

2c

76

L

4c

108

l

6c

45

-

2d

77

M

4d

109

m

6d

46

.

2e

78

N

4e

110

n

6e

47

/

2f

79

O

4f

111

o

6f

48

0

30

80

P

50

112

p

70

49

1

31

81

Q

51

113

q

71

50

2

32

82

R

52

114

r

72

51

3

33

83

S

53

115

s

73

52

4

34

84

T

54

116

t

74

53

5

35

85

U

55

117

u

75

54

6

36

86

V

56

118

v

76

55

7

37

87

W

57

119

w

77

56

8

38

88

X

58

120

x

78

57

9

39

89

Y

59

121

y

79

58

:

3a

90

Z

5a

122

z

7a

59

;

3b

91

[

5b

123

{

7b

60

<

3c

92

\

5c

124

|

7c

61

=

3d

93

]

5d

125

}

7d

62

>

3e

94

^

5e

126

~

7e

63

?

3f

95

_

5f

   

Submission structure

WCIDR08-033            This section gives the size and structure for the data items contained in each record of a submission.

WCIDR08-033.1 POLICY HEADER Record

Data Item

From

To

Size

Type

P: 1.1 Record Set

1

1

1

Number

P: 1.2 Insurer number

2

4

3

Number

P: 1.3 Submission type

5

10

6

Text

P: 1.4 Policy system release number

11

12

2

Number

P: 1.5 Submission start date

13

20

8

Date

P: 1.6 Submission end date

21

28

8

Date

Filler

43

900

858

Text

WCIDR08-033.2 POLICY TERM DETAIL Record

Data Item

From

To

Size

Type

Policy Details

    

P: 2.1.1 Record set

1

1

1

Number

P: 2.1.2 Policyholder identifier

2

20

19

Text

P: 2.1.3 Period commencement date

21

28

8

Date

P: 2.1.4 Transaction date

29

36

8

Date

P: 2.1.5 Record identifier

37

37

1

Number

P: 2.1.6 Policy status code

38

38

1

Code

P: 2.1.7 Insurer branch

39

58

20

Text

P: 2.1.8 Error report target

59

65

7

Text

P: 2.1.9 NO LONGER IN USE

66

84

19

Text

P: 2.1.10 Employer name

85

159

75

Text

P: 2.1.11 Trust name

160

234

75

Text

P: 2.1.12 Employer ACN or ARBN

235

243

9

Number

P: 2.1.13 Employer address - Street information

244

363

120

Text

P: 2.1.14 Employer address - Locality name

364

393

30

Text

P: 2.1.15 Employer address - Postcode

394

397

4

Code

P: 2.1.16 Employer ABN (Australian Business Number)

398

408

11

Number

P: 2.1.17 Employer registered for GST

409

409

1

Code

P: 2.1.18 Entitlement to input tax credits

410

412

3

Number

P: 2.1.19 Employer Group Number

413

418

6

Number

P: 2.1.20 Employer Group Exemption Flag

419

419

1

Code

P: 2.1.21 Period expiry date

420

427

8

Date

P: 2.1.22 Trust ABN

428

438

11

Number

P: 2.1.23 Entity Type

439

440

2

Code

Filler

441

900

460

 

WCIDR08-033.3 PREMIUM DETAIL Record

Data Item

From

To

Size

Type

P: 2.2.1 Record set

1

1

1

Number

P: 2.2.2 Policyholder identifier

2

20

19

Text

P: 2.2.3 Period commencement date

21

28

8

Date

P: 2.2.4 Transaction date

29

36

8

Date

P: 2.2.5 Record identifier

37

37

1

Number

P: 2.2.6 Period expiry date

38

45

8

Date

P: 2.2.7 Policy renewal year

46

49

4

Number

P: 2.2.8 NO LONGER IN USE

50

50

1

Filler

P: 2.2.9 Employer category code

51

51

1

Code

P: 2.2.10 Premium calculation code

52

52

1

Text

P: 2.2.11 Surcharge factor to insure for first $500 (X)

53

58

6

Value

P: 2.2.12 Basic tariff premium (BTP) - policy total

59

72

14

Value

P: 2.2.13 Experience adjustment factor (S)

73

82

10

Value

P: 2.2.14 Experience premium (E)

83

96

14

Value

P: 2.2.15 Cost of claims (C0) current period

97

110

14

Value

P: 2.2.16 Cost of claims (C1) last period

111

124

14

Value

P: 2.2.17 Cost of claims (C2) second last period

125

138

14

Value

P: 2.2.18 Premium adjustment levy (Q)

139

152

14

Value

P: 2.2.19 Policy dust diseases contribution (D)

153

166

14

Value

P: 2.2.20 Stamp duty

167

180

14

Value

P: 2.2.21 Premium payable (P)

181

194

14

Value

P: 2.2.22 GST Amount

195

208

14

Value

P: 2.2.23 Total premium payable

209

222

14

Value

P: 2.2.24 Input tax credit adjustment amount

223

236

14

Value

Premium Discount Scheme details

    

P: 2.2.25 NO LONGER IN USE

237

239

3

Text

P: 2.2.26 NO LONGER IN USE

240

240

1

Filler

P: 2.2.27 NO LONGER IN USE

241

241

1

Code

P: 2.2.28 NO LONGER IN USE

242

242

1

Code

P: 2.2.29 NO LONGER IN USE

243

250

8

Date

P: 2.2.30 NO LONGER IN USE

251

251

1

Number

P: 2.2.31 NO LONGER IN USE

252

256

5

Number

P: 2.2.32 NO LONGER IN USE

257

270

14

Value

Other details

    

P: 2.2.33 Labour hire flag

271

271

1

Code

P: 2.2.34 Cumulative premium received

272

285

14

Value

P: 2.2.35 Last premium payment transaction date

286

293

8

Date

P: 2.2.36 Late payment fee charged

294

307

14

Value

P: 2.2.37 Mine safety fund premium adjustment (M)

308

321

14

Value

Policy Details

    

P: 2.2.38 Apprentice incentive scheme amount (A)

322

335

14

Value

P: 2.2.39 Premium payment code

336

337

2

Code

Policy Details

    

P: 2.2.40 Premium paid in full in advance discount (Z)

338

351

14

Value

P: 2.2.41 Cost of claims (C3) third last period

352

365

14

Value

P: 2.2.42 Employer safety incentive

366

379

14

Value

P: 2.2.43 Small employer return to work incentive

380

393

14

Value

P: 2.2.44 Performance discount (PD)

394

407

14

Value

P: 2.2.45 Employer safety reward (ESR)

408

421

14

Value

P: 2.2.46 Basic tariff premium (BTP1) last period

422

435

14

Value

P: 2.2.47 Basic tariff premium (BTP2) second last period

436

449

14

Value

P: 2.2.48 Basic tariff premium (BTP3) third last period

450

463

14

Value

P: 2.2.49 Claims performance measure (CPM)

464

473

10

Value

P: 2.2.50 Claims performance rate (CPR)

474

483

10

Value

P: 2.2.51 Claim performance adjustment (CPA)

484

493

10

Value

P: 2.2.52 Claim performance adjustment amount (CPAA)

494

507

14

Value

Filler

508

900

393

 

WCIDR08-033.4 TARIFF RATING ACTIVITY DETAIL Record

Data Item

From

To

Size

Type

P: 2.3.1 Record set

1

1

1

Number

P: 2.3.2 Policyholder identifier

2

20

19

Text

P: 2.3.3 Period commencement date

21

28

8

Date

P: 2.3.4 Transaction date

29

36

8

Date

P: 2.3.5 Record identifier

37

37

1

Number

P: 2.3.6 Tariff rate number

38

40

3

Code

P: 2.3.7 Industry code - ASIC

41

44

4

Code

P: 2.3.8 Industry code - ANZSIC

45

48

4

Code

P: 2.3.9 Amount of wages paid

49

62

14

Value

P: 2.3.10 Number of per capita units / shifts

63

69

7

Number

P: 2.3.11 Number of employees

70

76

7

Number

P: 2.3.12 Tariff premium (at basic rate)

77

90

14

Value

P: 2.3.13 Tariff activity dust diseases contribution

91

104

14

Value

Filler

105

900

796

 

WCIDR08-033.5 WIC RATING ACTIVITY DETAIL Record

Data Item

From

To

Size

Type

P: 2.4.1 Record set

1

1

1

Number

P: 2.4.2 Policyholder identifier

2

20

19

Text

P: 2.4.3 Period commencement date

21

28

8

Date

P: 2.4.4 Transaction date

29

36

8

Date

P: 2.4.5 Record identifier

37

37

1

Number

P: 2.4.6 Workers Compensation Industry Classification (WIC) number

38

43

6

Code

P: 2.4.7 Filler

44

48

5

Filler

P: 2.4.8 Amount of wages paid

49

62

14

Value

P: 2.4.9 Number of per capita units

63

69

7

Number

P: 2.4.10 Number of employees

70

76

7

Number

P: 2.4.11 Tariff premium (at basic rate)

77

90

14

Value

P: 2.4.12 Activity dust diseases contribution

91

104

14

Value

P: 2.4.13 WIC premium adjustment flag

105

105

1

Code

P: 2.4.14 Wages for determined classes dust disease contribution

106

119

14

Value

P: 2.4.15 Determined classes dust diseases contribution

120

133

14

Value

P: 2.4.16 Amount of wages paid (W1) last period

134

147

14

Value

P: 2.4.17 Amount of wages paid (W2) second last period

148

161

14

Value

P: 2.4.18 Number of per capita units (U1) last period

162

168

7

Value

P: 2.4.19 Number of per capita units (U2) second last period

169

175

7

Value

P: 2.4.20 Activity mine safety fund premium adjustment

176

189

14

Value

Policy Details

    

P: 2.4.21 Amount of apprentice wages paid

190

203

14

Value

P: 2.4.22 Activity apprentice incentive scheme amount

204

217

14

Value

P: 2.4.23 Amount of wages paid (W3) third last period

218

231

14

Value

P: 2.4.24 Number of per capita units (U3) third last period

232

238

7

Value

P: 2.4.25 Workers Compensation primary activity classification number

239

247

6

Code

Filler

248

900

653

 

WCIDR08-033.6 POLICY SUBMISSION TRAILER Record

Data Item

From

To

Size

Type

P: 9.1 Record set

1

1

1

Number

P: 9.2 Number of policy detail records

2

10

9

Number

P: 9.3 Number of premium detail records

11

19

9

Number

P: 9.4 Number of tariff rating activity detail records

20

28

9

Number

P: 9.5 Number of WIC rating activity detail records

29

37

9

Number

P: 9.6 NO LONGER IN USE

38

46

9

Number

P: 9.7 Financial total - Basic tariff premium

47

61

15

Value

P: 9.8 Financial total - Experience premium

62

76

15

Value

P: 9.9 Financial total - Cost of claims (C0) current period

77

91

15

Value

P: 9.10 Financial total - Cost of claims (C1) last period

92

106

15

Value

P: 9.11 Financial total - Cost of claims (C2) second last period

107

121

15

Value

P: 9.12 Financial total - Premium adjustment levy

122

136

15

Value

P: 9.13 Financial total - Policy dust diseases contribution

137

151

15

Value

P: 9.14 Financial total - Premium payable

152

166

15

Value

P: 9.15 NO LONGER IN USE

167

181

15

Value

P: 9.16 Financial total - Amount of wages paid

182

196

15

Value

P: 9.17 Count - Number of per capita units

197

205

9

Number

P: 9.18 Count - Number of employees

206

214

9

Number

P: 9.19 Financial total - Tariff premium (at basic rate)

215

229

15

Value

P: 9.20 Financial total - Activity dust diseases contribution

230

244

15

Value

P: 9.21 NO LONGER IN USE

245

259

15

Value

P: 9.22 NO LONGER IN USE

260

274

15

Value

P: 9.23 Financial total – Premium GST amount

275

289

15

Value

P: 9.24 Financial total - Total premium payable

290

304

15

Value

P: 9.25 NO LONGER IN USE

305

319

15

Value

P: 9.26 NO LONGER IN USE

320

334

15

Value

P: 9.27 Financial total – Input tax credit adjustment amount

335

349

15

Value

P: 9.28 Financial total - Wages for determined classes dust diseases contribution

350

364

15

Value

P: 9.29 Financial total - Determined classes dust diseases contribution

365

379

15

Value

P: 9.30 Financial total - Amount of wages paid (W1)

380

394

15

Value

P: 9.31 Financial total - Amount of wages paid (W2)

395

409

15

Value

P: 9.32 Count - Number of per capita units (U1)

410

418

9

Number

P: 9.33 Count - Number of per capita units (U2)

419

427

9

Number

P: 9.34 Financial total – Activity mine safety fund premium adjustment

428

442

15

Value

P: 9.35 Financial Total - cost of claims (C3) third last period

443

457

15

Value

P: 9.36 Financial total - amount of wages paid (W3)

458

472

15

Value

P: 9.37 Count - number of per capita units (U3)

473

481

9

Number

Filler

482

900

419

 

Data quality

Data acceptance criteria

WCIDR08-034            There are 3 classes of validation rules applied across 4 data acceptance validation layers. The 3 classes of validations are:

  • Abort – if triggered the entire submission will be rejected
  • Critical – a policy triggering a critical error will not be loaded
  • Suspect – if triggered the policy will be loaded if it did not trigger any critical errors

WCIDR08-035            SIRA may add, remove or revise validations as required to ensure the quality of data provided.

WCIDR08-036            For a list of all current validations, refer to the SIRA Workers compensation policy technical manual validations reference.

Validation Layer 1 - Abort

WCIDR08-037            This validation layer will identify if the submission is formatted correctly and acceptable for further validation criteria. If an Abort error is identified, further validation layers will not be run on the submission. The submission will be rejected and the insurer will be required to correct and re-submit.

Validation Layer 2 – Critical - Technical Errors

WCIDR08-038            This validation layer will review the content in the individual data fields and ensure the format is correct.  Critical error number P6000 will identify all technical errors for a policy.  If technical errors are triggered, the policy will be rejected and further validation layers will not be run for that policy.  Technical errors are generated for not meeting the following format requirements:

Data field type

Format of Value Required

Text

Left justified, space filled

Date

YYYYMMDD

All dates supplied must be after 1 Jan 1987 and before submission end date plus fifty years.

Value

Right justified, defined decimal places, leading sign, zero filled

Number

Right justified, zero filled

Time

The HH component must be in range 00 to 23

The MM component must be in the range 00 to 59

Validation Layer 3 – Critical and Suspect - Business Rules

WCIDR08-039            This validation layer will review the data that passed validation layers 1, and 2 and report on all triggered critical and suspect errors.

Reporting

WCIDR08-040 SIRA produces a number of reports resulting from the validation or load of a data submission:

  • POL401: Policy Submission Validation Report – Layer 1 – Submission Abort (PDF)
  • POL403: Policy Submission Validation Report – Layer 2 – Technical Errors (CSV)
  • POL404: Policy Submission Validation Report – Layer 3 – Business Errors (CSV)
  • POL406: Policy Submission Validation Financial & Process Statistics (PDF)
  • POL407: Policy Submission Validation Error Analysis
  • POL408: Policy Submission Validation Aged Analysis

WCIDR08-041            The following file format is applied to all generated reports:

  • nnn_333333_POL4##_YYYYMMDD_val.pdf where
  • nnn – Insurer Number
  • 333333 – Submission number
  • 4## – Report number (EG: 401 or 406)
  • YYYYMMDD – Date that the submission file was run
  • Validation reports end with ‘val’
  • Load report submission names end with ‘ld’

Policy data definitions

WCIDR08-042            This section details each data item required. The data items are documented in record and reference number order. Each data item includes most of the following metadata where applicable but some data items have unique information specific to it:

  • Reference Number: The reference number allocated to the data item by SIRA.
  • Description: A textual description of the data item that expresses the essential nature of the data item.
  • Record Set: The record that the data item appears within the submission structure.
  • Start Position: The position of the first character of the data item in the record structure.
  • End Position: The position of the last character of the data item in the record structure.
  • Length: The number of characters allocated to the data item in the record structure
  • Size: The minimum number of characters to be completed for the data item.
  • Applies To: The insurer type/s that must provide this data in their submission. The value can be one of the following:
  • NI (Nominal Insurer)
  • Representational Layout: The layout of characters in a data item expressed by a character string representation
  • Number:
    • fill with leading zeros
  • Text:
    • fill with ending spaces
  • Date:
    • YYYYMMDD
  • Value:
    • must have a leading sign + if zero or positive or - for negative values.
    • fill with leading zeros after the sign where appropriate.
    • Dollar values have implied decimal before last two digits
  • Representational Format: The format of presentation for the data item: Number, Text, Date, Value.
  • Statutory Legislation: The specific piece of legislation, Act OR SIRA issued guideline that this data item relates to.
  • Notes: Notes applicable to the data item.

Record Set 1: WCIDR08-043 Policy Header Record

Must be the first record on the submission. There can be only one of these on the submission. The Submission start date (P: 1.5) in this record must be one day later than the Submission end date (P: 1.6) of the last successfully loaded submission.

This record contains:

  • P: 1.1 Record set
  • P: 1.2 Insurer number
  • P: 1.3 Submission type
  • P: 1.4 Policy system release number
  • P: 1.5 Submission start date
  • P: 1.6 Submission end date

P: 1.1                   Record Set

Description

Identifies the type of data in the record as either claims or policy.

Record Set

"Policy Header"

Start Position

1

End Position

1

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes

Must contain '1' for a Submission Header Record.

P: 1.2                   Insurer number

Description

A unique three digit number allocated by SIRA used to identify an insurer or the insurer’s data provider.

Record Set

"Policy Header"

Start Position

2

End Position

4

Length

3

Size

3

Applies To

NI

Representational Layout

NNN

Representational Format

Number

Notes

P: 1.3                   Submission type

Description

Identifies the type of the data in the submission as either claims or policy.

Record Set

"Policy Header"

Start Position

5

End Position

10

Length

6

Size

6

Applies To

NI

Representational Layout

Spaces

Notes

Must contain the word 'POLICY'.

P: 1.4                   Policy system release number

Description

Identifies the version of the policy system under which the data are being submitted to SIRA.

Record Set

"Policy Header"

Start Position

11

End Position

12

Length

2

Size

2

Applies To

NI

Representational Layout

NN

Representational Format

Number

Notes

Policy system release number must be 03

P: 1.5                   Submission start date

Description

The start date (or from date) of the submission period.

Record Set

"Policy Header"

Start Position

13

End Position

20

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Must be the day immediately following the submission end date of the previous accepted submission.

P: 1.6                   Submission end date

Description

The end date of the submission period.

Record Set

"Policy Header"

Start Position

21

End Position

28

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

The date should be the actual as at date (or close-off date) of the submission.

Record Set 2 -WCIDR08-044 Record Identifier 1: Policy Term Detail Record

Policy term detail record can be sent in isolation or, may have an associated premium detail record and an activity detail record.

This record contains:

  • P: 2.1.1 Record set
  • P: 2.1.2 Policyholder identifier
  • P: 2.1.3 Period commencement date
  • P: 2.1.4 Transaction date
  • P: 2.1.5 Record identifier
  • P: 2.1.6 Policy status code
  • P: 2.1.7 Insurer branch
  • P: 2.1.8 Error report target
  • P: 2.1.9 NO LONGER IN USE
  • P: 2.1.10 Employer name
  • P: 2.1.11 Trust name
  • P: 2.1.12 Employer ACN or ARBN
  • P: 2.1.13 Employer address - Street information
  • P: 2.1.14 Employer address - Locality name
  • P: 2.1.15 Employer address – Postcode
  • P: 2.1.16 Employer ABN (Australian Business Number)
  • P: 2.1.17 Employer registered for GST
  • P: 2.1.18 Entitlement to input tax credits
  • P: 2.1.19 Employer Group Number
  • P: 2.1.20 Employer Group Exemption Flag
  • P: 2.1.21 Period expiry date
  • P: 2.1.22 Trust ABN
  • P: 2.1.23 Entity Type

P: 2.1.1               Record Set

Description

Identifies the type of data in the record as either claims or policy.

Record Set

"Policy Term Detail"

Start Position

1

End Position

1

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a Policy Term Detail record.

P: 2.1.2               Policyholder identifier

Description

The identifier allocated to the policy by the insurer.

Record Set

"Policy Term Detail"

Start Position

2

End Position

20

Length

19

Size

19

Applies To

NI

Representational Format

Text

Notes

For exempt employers, report as a unique code for business (as per previous reporting or new if employer not previously reported).

P: 2.1.3               Period commencement date

Description

The period commencement date of the policy term.

Record Set

"Policy Term Detail"

Start Position

21

End Position

28

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes                                                          Notes

For exempt employers, report as the day before the date of the injury.

P: 2.1.4               Transaction date

Description

The date the insurer updated information on the policy term in the insurer’s system.

Record Set

"Policy Term Detail"

Start Position

29

End Position

36

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Notes      

P: 2.1.5               Record identifier

Description

The identifier code of the record within the data submission.

Record Set

"Policy Term Detail"

Start Position

37

End Position

37

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes

Must contain '1' for a policy term detail record. For exempt employers, report as 1.

P: 2.1.6               Policy status code

Description

Describes the status of the policy term for the employer.

Record Set

"Policy Term Detail"

Start Position

38

End Position

38

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Code

Notes

For exempt employers, report as ‘6’ – ‘Other’.

P: 2.1.7               Insurer branch

Description

Branch of the insurer responsible for handling the policy.

Record Set

"Policy Term Detail"

Start Position

39

End Position

58

Length

20

Size

20

Applies To

NI

Representational Format

Text

Notes    

P: 2.1.8               Error report target

Description

The insurer’s reference that allows error reports to be aggregated for a particular person or office.

Record Set

"Policy Term Detail"

Start Position

59

End Position

65

Length

7

Size

7

Applies To

NI

Representational Format

Text

Notes

If not applicable set to NA.

P: 2.1.10          Employer name

Description

The legal name of the employer.

Record Set

"Policy Term Detail"

Start Position

85

End Position

159

Length

75

Size

75

Applies To

NI

Representational Format

Text

Notes

Where it’s a Trust, only report the name of the Trustee.

P: 2.1.11             Trust name

Description

The trust name of the employer as it appears on the policy where it is different from the employer name.

Record Set

"Policy Term Detail"

Start Position

160

End Position

234

Length

75

Size

75

Applies To

NI

Representational Format

Text

Notes

Where it’s a Trust, only report the Trust name and not the name of the Trustee.

P: 2.1.12             Employer ACN or ARBN

Description

The Australian Company Number or Australian Registered Body Number of the employer.

Record Set

"Policy Term Detail"

Start Position

235

End Position

243

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes

For employers without an ACN or ARBN set this item to '000000000'. Note this includes foreign owned companies who do not hold an ACN/ARBN or are not entitled to an ACN/ARBN.

P: 2.1.13             Employer address – Street information

Description

The street address of the principal operating location of the employer for the policy term.

Record Set

"Policy Term Detail"

Start Position

244

End Position

363

Length

120

Size

120

Applies To

NI

Representational Format

Text

Notes                                                        

P: 2.1.14             Employer address – Locality name

Description

The locality name of the principal operating location of the employer for the policy term.

Record Set

"Policy Term Detail"

Start Position

364

End Position

393

Length

30

Size

30

Applies To

NI

Representational Format

Text

Notes                                                        

P: 2.1.15             Employer address – postcode

Description

The postcode of the principal operating location of the employer for the policy term.

Record Set

"Policy Term Detail"

Start Position

394

End Position

397

Length

4

Size

4

Applies To

NI

Representational Layout

NNNN

Representational Format

Code

Notes

P: 2.1.16             Employer ABN (Australian Business Number)

Description

The Australian Business Number (ABN) issued to the employer by the Australian Business Register.

Record Set

"Policy Term Detail"

Start Position

398

End Position

408

Length

11

Size

11

Applies To

NI

Representational Layout

NNNNNNNNNNN

Representational Format

Number

Notes

For employers without an ABN set this item to '00000000000'. Note this includes foreign owned companies who do not hold an ABN or are not entitled to an ABN.

P: 2.1.17             Employer registered for GST

Description

Indicates whether the employer has registered for GST with the Australian Taxation Office.

Record Set

"Policy Term Detail"

Start Position

409

End Position

409

Length

1

Size

1

Applies To

NI

Representational Format

Code

Notes

Must be specified for all policies reported after the 1st July 2000.

If no ABN is supplied, this flag must be set to 'N' or 'U'.

If the employer registered for GST is unknown, this flag must be set to 'U'.

P: 2.1.18             Entitlement to input tax credits

Description

The employer’s entitlement to GST input tax credits expressed as a percentage.

Record Set

"Policy Term Detail"

Start Position

410

End Position

412

Length

3

Size

3

Applies To

NI

Representational Layout

NNN

Representational Format

Number

Notes

Where an employer has registered for GST (Employer registered for GST (P: 2.1.17) is equal to 'Y') but has not notified an insurer of their entitlement at inception of policy, the insurer should default this field to 100%.

P: 2.1.19             Employer group number

Description

The unique number of the employer group

Record Set

"Policy Term Detail"

Start Position

413

End Position

418

Length

6

Size

6

Applies To

NI

Representational Layout

NNNNNN

Representational Format

Number

Notes

If not applicable set this data item to zero.

P: 2.1.20             Employer group exemption flag

Description

Indicates if a group employer’s Base Tariff Premium is excluded in calculating the group’s total experience factor.

Record Set

"Policy Term Detail"

Start Position

419

End Position

419

Length

1

Size

1

Applies To

NI

Representational Format

Code

Notes

P: 2.1.21             Period expiry date

Description

The expiry date of the policy term.

Record Set

"Policy Term Detail"

Start Position

420

End Position

427

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

For exempt employers, report as the day after the date of injury.

P: 2.1.22             Trust ABN

Description

The Australian Business Number (ABN) as issued by the Australian Business Register for a trust.

Record Set

"Policy Term Detail"

Start Position

428

End Position

438

Length

11

Size

11

Applies To

NI

Representational Layout

NNNNNNNNNNN

Representational Format

Number

Notes

Specify the ABN for all Trusts where the information has been notified to the insurer.

P: 2.1.23             Entity type

Description

A code that distinguishes the legal entity type of an employer.

Record Set

"Policy Term Detail"

Start Position

439

End Position

440

Length

2

Size

2

Applies To

NI

Representational Layout

NN

Representational Format

Code

Notes

Record Set 2 -WCIDR08-045 Record Identifier 2: Premium Detail Record

Premium detail record must have associated activity detail record (either Tariff rating activity detail record or WIC rating activity detail record reported when reporting the premium detail record). May or may not have an associated policy term detail record.

This record contains:

  • P: 2.2.1 Record Set
  • P: 2.2.2 Policyholder identifier
  • P 2.2.3 Period commencement date
  • P: 2.2.4 Transaction date
  • P: 2.2.5 Record identifier
  • P: 2.2.6 Period expiry date
  • P: 2.2.7 Policy renewal year
  • P: 2.2.8 NO LONGER IN USE
  • P: 2.2.9 Employer category code
  • P: 2.2.10 Premium calculation code
  • P: 2.2.11 Surcharge factor to insure for first $500 (X)
  • P: 2.2.12 Basic tariff premium (BTP) - policy total
  • P: 2.2.13 Experience adjustment factor (S)
  • P: 2.2.14 Experience premium (E)
  • P: 2.2.15 Cost of claims (C0) current period
  • P: 2.2.16 Cost of claims (C1) last period
  • P: 2.2.17 Cost of claims (C2) second last period
  • P: 2.2.18 Premium adjustment levy (Q)
  • P: 2.2.19 Policy dust diseases contribution (D)
  • P: 2.2.20 Stamp duty
  • P: 2.2.21 Premium payable (P)
  • P: 2.2.22 GST Amount
  • P: 2.2.23 Total premium payable
  • P: 2.2.24 Input tax credit adjustment amount
  • P: 2.2.25 NO LONGER IN USE
  • P: 2.2.26 NO LONGER IN USE
  • P: 2.2.27 NO LONGER IN USE
  • P: 2.2.28 NO LONGER IN USE
  • P: 2.2.29 NO LONGER IN USE
  • P: 2.2.30 NO LONGER IN USE
  • P: 2.2.31 NO LONGER IN USE
  • P: 2.2.32 NO LONGER IN USE
  • P: 2.2.33 Labour hire flag
  • P: 2.2.34 Cumulative premium received
  • P: 2.2.35 Last premium payment transaction date
  • P: 2.2.36 Late payment fee charged
  • P: 2.2.37 Mine safety fund premium adjustment (M)
  • P: 2.2.38 Apprentice incentive scheme amount (A)
  • P: 2.2.39 Premium payment code
  • P: 2.2.40 Premium paid in full in advance discount (Z)
  • P: 2.2.41 Cost of claims (C3) third last period
  • P: 2.2.42 Employer safety incentive
  • P: 2.2.43 Small employer return to work incentive
  • P: 2.2.44 Performance discount (PD)
  • P: 2.2.45 Employer safety reward (ESR)
  • P: 2.2.46 Basic tariff premium (BTP1) last period
  • P: 2.2.47 Basic tariff premium (BTP2) second last period
  • P: 2.2.48 Basic tariff premium (BTP3) third last period
  • P: 2.2.49 Claims performance measure (CPM)
  • P: 2.2.50 Claims performance rate (CPR)
  • P: 2.2.51 Claim performance adjustment (CPA)
  • P: 2.2.52 Claim performance adjustment amount (CPAA)

P: 2.2.1               Record Set

Description

Identifies the type of data in the record as either claims or policy.

Record Set

"Premium Detail"

Start Position

1

End Position

1

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a policy record.

P: 2.2.2               Policyholder identifier

Description

The identifier allocated to the policy by the insurer.

Record Set

"Premium Detail"

Start Position

2

End Position

20

Length

19

Size

19

Applies To

NI

Representational Format

Text

Notes

For exempt employers, report as a unique code for business (as per previous reporting or new if employer not previously reported).

P: 2.2.3               Period commencement date

Description

The period commencement date of the policy term.

Record Set

"Premium Detail"

Start Position

21

End Position

28

Length

8

Size

8

Applies To NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

For exempt employers, report as the day before the date of the injury.

P: 2.2.4               Transaction date

Description

The date the insurer updated information on the policy term in the insurer’s system.

Record Set

"Premium Detail"

Start Position

29

End Position

36

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

P: 2.2.5               Record identifier

Description

The identifier code of the record within the data submission.

Record Set

"Premium Detail"

Start Position

37

End Position

37

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a premium detail record.

P: 2.2.6               Period expiry date

Description

The expiry date of the policy term.

Record Set

"Premium Detail"

Start Position

38

End Position

45

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

For exempt employers, report as the day after the date of injury.

P: 2.2.7               Policy renewal year

Description

Identifies the policy renewal year to which the policy relates.

Record Set

"Premium Detail"

Start Position

46

End Position

49

Length

4

Size

4

Applies To

NI

Representational Layout

YYYY

Representational Format

Number

Notes

For exempt employers, report as the policy renewal year relative to the date of injury of the related claim.

P: 2.2.9               Employer category code

Description

A category to indicate the size or type of the employer for determining premium.

Record Set

"Premium Detail"

Start Position

51

End Position

51

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Code

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing

Notes

For exempt employers, report as ‘4’ ‘Small’.

P: 2.2.10             Premium calculation code

Description

Indicates the type of premium calculation.

Record Set

"Premium Detail"

Start Position

52

End Position

52

Length

1

Size

1

Applies To

NI

Representational Layout

Text

Representational Format

Code

Notes

For exempt employers, report as ‘2’ ‘Final premium’.

P: 2.2.11             Surcharge factor to insure for first $500 (X)

Description

Contains the excess surcharge factor for the employer determined in accordance with the appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Record Set

"Premium Detail"

Start Position

53

End Position

58

Length

6

Size

6

Applies To

NI

Representational Layout

+/- NNNNN

Representational Format

Value

Notes                                                      

Applicable to Insurers only.  Other Approved Insurer Types must set this item to zero.

Applies only to Category B employers.

If the employer has elected not to pay surcharge set this item to zero.

For exempt employers, report as zero.

P: 2.2.12             Basic tariff premium (BTP) – policy total

Description

The sum of the basic tariff premiums for the policy term.

Record Set

"Premium Detail"

Start Position

59

End Position

72

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing

Notes                                                      

For exempt employers, report as zero.

P: 2.2.13             Experience adjustment factor (S)

Description

The value as calculated in accordance with the method applicable to the policy term for adjusting the premium based on experience.

Record Set

"Premium Detail"

Start Position

73

End Position

82

Length

10

Size

10

Applies To

NI

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing

Notes                                                      

For exempt employers, report as zero.

P: 2.2.14             Experience premium (E)

Description

The adjustment to the premium relating to the cost of claims and calculated in accordance with the method applicable to the policy term.

Record Set

"Premium Detail"

Start Position

83

End Position

96

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing
Workers Compensation Regulation 2010

Notes                                                      

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.15             Cost of claims (C0) current period

Description

The total of the cost of claims for the employer for this policy term.

Record Set

"Premium Detail"

Start Position

97

End Position

110

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Code

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing
Workers Compensation Regulation 2010

Notes                                                      

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.16             Cost of claims (C1) last period

Description

The total of the cost of claims for the employer in respect of the last period of 12 consecutive months which occurred before this policy term.

Record Set

"Premium Detail"

Start Position

111

End Position

124

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing
Workers Compensation Regulation 2010

Notes                                                      

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.17         Cost of claims (C2) second last period

Description

The total of the cost of claims for the employer in respect of the second last period of 12 consecutive months which occurred before this policy term.

Record Set

"Premium Detail"

Start Position

125

End Position

138

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing
Workers Compensation Regulation 2010

Notes                                                      

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.18             Premium adjustment levy (Q)

Description

An amount levied or rebated to a policy holder for a particular policy renewal year.

Record Set

"Premium Detail"

Start Position

139

End Position

152

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing
Workers Compensation Regulation 2010

Notes                                                      

Must be calculated as per appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Reserved for possible future use.  Set this item to zero

For exempt employers, report as zero.

P: 2.2.19             Policy dust diseases contribution (D)

Description

The total amount payable by the employer for the Dust Diseases contribution in accordance with the method applicable to the policy term.

Record Set

"Premium Detail"

Start Position

153

End Position

166

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing

Notes                                                        

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.20             Stamp duty

Description

The amount of stamp duty payable on the policy

Record Set

"Premium Detail"

Start Position

167

End Position

180

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing Stamp Duties Act 1920

Notes                                                      

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.21             Premium payable (P)

Description

The premium payable by the employer for this policy term.

Record Set

"Premium Detail"

Start Position

181

End Position

194

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing

Notes                                                      

For exempt employers, report as zero.

P: 2.2.22             GST amount

Description

The GST amount applicable to the Total Premium Payable.

Record Set

"Premium Detail"

Start Position

195

End Position

208

Length

14

Size

14

Applies To

NI

Representational Layout

+/- NNNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

A New Tax System (Goods and Services Tax) Act 1999 NO.55

Notes                                                        

Must be specified for policy terms with a commencement date later than or equal to the commencement date of the GST.

For exempt employers, report $15.91 for one claim in the policy renewal year, $31.82 for two claims on the same day in the policy renewal year, $47.73 for three claims on the same day in the policy renewal year etc

P: 2.2.23             Total premium payable

Description

The total premium payable by the employer for this policy term.

Record Set

"Premium Detail"

Start Position

209

End Position

222

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Insurance Premiums Order or Market Practice and Premiums Guidelines

Notes                                                      

For exempt employers, report the administration fee applicable $175.00 for one claim, $350.00 for two claims etc.

P: 2.2.24             Input tax credit adjustment amount

Description

The amount of the adjustment to the premium payable by the employer to compensate employers who cannot claim all GST paid on premium as input tax credits.

Record Set

"Premium Detail"

Start Position

223

End Position

236

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

For policy periods commencing on or after 30/06/2015 this item must be set to zero.

For exempt employers, report as zero

P: 2.2.33             Labour hire flag

Description

Indicates if the employer is a provider of   labour hire workers.

Record Set

"Premium Detail"

Start Position

271

End Position

271

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Code

Notes                  

For exempt employers, report as “2” Not a Labour Hire Firm OR in the case of a genuine labour hire employer must be reported as “1” Labour hire firm.

P: 2.2.34             Cumulative premium received

Description

Cumulative total of premium received from the employer for this policy period.

Record Set

"Premium Detail"

Start Position

272

End Position

285

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                      

Must be specified where premium has been received.

If not applicable set to zero

For exempt employers, report the value of administrative fee collected

P: 2.2.35             Last premium payment transaction date

Description

Date the last premium payment was made for the policy term.

Record Set

"Premium Detail"

Start Position

286

End Position

293

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes                                              

Must be specified where premium has been received. If not applicable set to zeros.

P: 2.2.36             Last payment fee charged

Description

The late payment fee amount for the policy term.

Record Set

"Premium Detail"

Start Position

294

End Position

307

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                      

Only report if a late payment has occurred. If not applicable set to zero.

P: 2.2.37             Mine safety fund premium adjustment (M)

Description

The amount payable by the employer to the Mine Safety fund.

Record Set

"Premium Detail"

Start Position

308

End Position

321

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes            

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.38             Apprentice Mine safety fund premium adjustment (M)

Description

The amount of discount applicable to the premium payable based on the total amount of Apprentice Wages payable for the policy term.

Record Set

"Premium Detail"

Start Position

322

End Position

335

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Apprenticeship and Traineeship Act 2001

Notes                                                        

If not applicable then set this item to zero. For exempt employers, report as zero.

P: 2.2.39             Premium payment code

Description

Indicates the schedule of payment for the premium.

Record Set

"Premium Detail"

Start Position

336

End Position

337

Length

2

Size

2

Applies To

NI

Representational Layout

NN

Representational Format

Code

Notes                                          

If not applicable then set this item to zero. For exempt employers, report as zero or one.

P: 2.2.40             Premium paid in full in advance discount (Z)

Description

The discount amount when the premium is paid in full in advance.

Record Set

"Premium Detail"

Start Position

338

End Position

351

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                       

For exempt employers, report as zero.

P: 2.2.41             Cost of claims (C3) third last period

Description

The total of the cost of claims for the employer in respect of the third last period of 12 consecutive months which occurred before this policy term.

Record Set

"Premium Detail"

Start Position

352

End Position

365

Length

14`

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation                              

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Workers Compensation Regulation 2010

Notes                                                        

If not applicable then set this item to zero.

P: 2.2.42             Employer safety incentive

Description                                              

The discount amount applicable to the premium payable based upon the employer safety incentive.

Record Set

"Premium Detail"

Start Position

366

End Position

379

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation                            

Appropriate Insurance Premiums Order or Insurer’s Premium Filing.

Notes                                                        

If not applicable then set to zero.

P: 2.2.43             Small employer return to work incentive

Description                                              

The discount amount applicable to the premium payable based upon the employer safety incentive.

Record Set

"Premium Detail"

Start Position

380

End Position

393

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                

If not applicable then set to zero.

P: 2.2.44             Performance discount (PD)

Description                                              

The discount applied to the premium based on the performance of the scheme.

Record Set

"Premium Detail"

Start Position

394

End Position

407

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Insurer’s Premium Filing

Notes                                                      

If not applicable then set this item to zero.

P: 2.2.45             Employer safety reward (ESR)

Description                                              

The discount amount applicable to the premium payable based on the employer safety reward percentage.

Record Set

"Premium Detail"

Start Position

408

End Position

421

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Insurer’s Premium Filing

Notes                                                      

If not applicable set this item to zero.

P: 2.2.46             Basic tariff premium (BTP1) last period

Description                                              

The amount of the basic tariff premium in respect of the last period of 12 consecutive months which occurred before this policy term.

Record Set

"Premium Detail"

Start Position

422

End Position

435

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 2.2.47             Basic tariff premium (BTP2) second last period

Description                                          

The amount of the basic tariff premium in respect of the second last period of 12 consecutive months which occurred before this policy term.

Record Set

"Premium Detail"

Start Position

436

End Position

449

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 2.2.48             Basic tariff premium (BTP3) third last period

Description                                              

The amount of the basic tariff premium in respect of the third last period of 12 consecutive months which occurred before this policy term.

Record Set

"Premium Detail"

Start Position

450

End Position

463

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes

P: 2.2.49             Claim performance measure (CPM)

Description                                              

The employer’s Claims Performance Measure calculated in accordance with the relevant Insurer’s Premium Filing for the relevant policy year.

Record Set

"Premium Detail"

Start Position

464

End Position

473

Length

10

Size

10

Applies To

NI

Representational Layout

+/-NNNNNNNNN

Representational Format

Value

Statutory Legislation

Insurer’s Premium Filing

Notes                                                      

If the policy term is not experience adjusted then set this item to zero.

P: 2.2.50             Claim performance rate (CPR)

Description                                              

The employer’s Claims Performance Rate calculated in accordance with the relevant Insurer’s Premium Filing for the relevant policy year.

Record Set

"Premium Detail"

Start Position

474

End Position

483

Length

10

Size

10

Applies To

NI

Representational Layout

+/-NNNNNNNNN

Representational Format

Value

Statutory Legislation

Insurer’s Premium Filing

Notes                                                      

If the policy term is not experience adjusted then set this item to zero.

P: 2.2.51             Claim performance measure (CPA)

Description                                              

The employer’s Claim Performance Adjustment figure specified in accordance with the appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing. for the relevant policy year.

Record Set

"Premium Detail"

Start Position

484

End Position

493

Length

10

Size

10

Applies To

NI

Representational Layout

+/-NNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes                                                        

P: 2.2.52             Claim performance adjustment amount (CPAA)

Description                                              

The actual amount the premium is adjusted by once the Claims Performance Adjustment is applied to the Basic Tariff Premium.

Record Set

"Premium Detail"

Start Position

494

End Position

507

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes

Record Set 2: WCIDR08-046 Record Identifier 3: Tariff Rating Activity Detail Record

Tariff rating activity detail record where policy commencement date is less than 30 June 2001. Must have an associated premium detail record.

This record contains:

  • P: 2.3.1 Record Set
  • P: 2.3.2 Policyholder identifier
  • P: 2.3.3 Period commencement date
  • P: 2.3.4 Transaction date
  • P: 2.3.5 Record identifier
  • P: 2.3.6 Tariff rate number
  • P: 2.3.7 Industry code – ASIC
  • P: 2.3.8 Industry code – ANZSIC
  • P: 2.3.9 Amount of wages paid
  • P: 2.3.10 Number of per capita units / shifts
  • P: 2.3.11 Number of employees
  • P: 2.3.12 Tariff premium (as basic rate)
  • P: 2.3.13 Tariff activity dust diseases contribution

P: 2.3.1               Record set

Description                                              

Identifies the type of the data in the record as either claims or policy.

Record Set

"Tariff Rating Activity Detail"

Start Position

1

End Position

1

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes                                                        

Must contain '2' for a policy record.

P: 2.3.2               Policyholder identifier

Description                                              

The identifier allocated to the policy by the insurer.

Record Set

"Tariff Rating Activity Detail"

Start Position

2

End Position

20

Length

19

Size

19

Applies To

NI

Representational Format

Text

Notes                                                        

P: 2.3.3               Period commencement date

Description                                              

The date upon which the period of insurance cover referred to in this policy commences.

Record Set

"Tariff Rating Activity Detail"

Start Position

21

End Position

28

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes                                                        

P: 2.3.4               Transaction date

Description                                              

The date the insurer updated information on the policy term in the insurer’s system.

Record Set

"Tariff Rating Activity Detail"

Start Position

29

End Position

36

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

P: 2.3.5               Record identifier

Description                                            

A code that distinguishes the record as an activity detail record.

Record Set

"Tariff Rating Activity Detail"

Start Position

37

End Position

37

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes                                                        

Must contain '3' for a tariff activity detail record.

P: 2.3.6               Tariff rate number

Description                                            

Identifies the relevant tariff rate number as per the Insurance Premiums Order or Market Practice and Premiums Guidelines.

Record Set

"Tariff Rating Activity Detail"

Start Position

38

End Position

40

Length

3

Size

3

Applies To

NI

Representational Layout

NNN

Representational Format

Code

Statutory Legislation

Insurance Premiums Order or Market Practice and Premiums Guidelines

Notes

P: 2.3.7               Industry code - ASIC

Description                                            

Identifies the industry being conducted by the employer. Coded according to ASIC.

Record Set

"Tariff Rating Activity Detail"

Start Position

41

End Position

44

Length

4

Size

4

Applies To

NI

Representational Layout

NNNN

Representational Format

Code

Statutory Legislation

Insurance Premiums Order or Market Practice and Premiums Guidelines

Notes                                                        

P: 2.3.8               Industry code - ANZSIC

Description                                            

Identifies the industry being conducted by the employer. Coded according to ANZSIC (Australian and New Zealand Standard Industrial Classification).

Record Set

"Tariff Rating Activity Detail"

Start Position

45

End Position

48

Length

4

Size

4

Applies To

NI

Representational Layout

NNNN

Representational Format

Code

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes

P: 2.3.9               Amount of wages paid

Description                                              

The amount of wages paid in respect of the non-per capita activity in this activity detail record.

Record Set

"Tariff Rating Activity Detail"

Start Position

49

End Position

62

Length

14

Size

14

Applies To

NI

Representational Layout

NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                      

If not applicable set this data item to zero.

P: 2.3.10             Number of per capita units/ shifts

Description                                              

The number of per capita units / shifts, logged against the tariff in this tariff rating activity detail record for the period covered by the policy term for the tariff.

Record Set

"Tariff Rating Activity Detail"

Start Position

63

End Position

69

Length

7

Size

7

Applies To

NI

Representational Layout

NNNNNN

Representational Format

Number

Statutory Legislation                              

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes                                                        

P: 2.3.11             Number of employees

Description                                              

The number of persons employed within the activity for this activity detail record.

Record Set

"Tariff Rating Activity Detail"

Start Position

70

End Position

76

Length

7

Size

7

Applies To

NI

Representational Layout

NNNNNNN

Representational Format

Number

Notes

P: 2.3.12             Tariff premium (at basic rate)

Description                                              

The amount of the premium as calculated against the relevant rate classification as per the appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Record Set

"Tariff Rating Activity Detail"

Start Position

77

End Position

90

Length

14

Size

14

Applies To

NI

Representational Layout

NNNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation     

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

P: 2.3.13             Tariff activity dust diseases contribution

Description                                              

The amount payable by the employer in respect of the amount due to the Dust Diseases Fund and the Dust Diseases Outstanding Liability Reserve Fund.  Include any amounts arising from determined classes of employees.

Record Set

"Tariff Rating Activity Detail"

Start Position

91

End Position

104

Length

14

Size

14

Applies To

NI

Representational Layout

NNNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation                        

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Record Set 2: WCIDR08-047 Record Identifier 4: WIC Rating Activity Detail Record

WIC rating activity detail records where policy commencement date is greater than or equal to 30/06/2001. Must have an associated premium detail record.

This record contains:

  • P: 2.4.1 Record Set
  • P: 2.4.2 Policyholder identifier
  • P: 2.4.3 Period commencement date
  • P: 2.4.4 Transaction date
  • P: 2.4.5 Record identifier
  • P: 2.4.6 Workers Compensation Industry Classification (WIC) number
  • P: 2.4.7 No Longer In Use
  • P: 2.4.8 Amount of wages paid
  • P: 2.4.9 Number of per capita units
  • P: 2.4.10 Number of employees
  • P: 2.4.11 Tariff premium (at basic rate)
  • P: 2.4.12 Activity dust diseases contribution
  • P: 2.4.13 WIC premium adjustment flag
  • P: 2.4.14 Wages for determined classes dust disease contribution
  • P: 2.4.15 Determined classes dust diseases contribution
  • P: 2.4.16 Amount of wages paid (W1) last period
  • P: 2.4.17 Amount of wages paid (W2) second last period
  • P: 2.4.18 Number of per capita units (U1) last period
  • P: 2.4.19 Number of per capita units (U2) second last period
  • P: 2.4.20 Activity mine safety fund premium adjustment
  • P: 2.4.21 Amount of apprentice wages paid
  • P: 2.4.22 Activity apprentice incentive scheme amount
  • P: 2.4.23 Amount of wages paid (W3) third last period
  • P: 2.4.24 Number of per capita units (U3) third last period
  • P: 2.4.25 Workers compensation primary activity classification number

P: 2.4.1               Record set

Description                                            

Identifies the type of the data in the record as either claims or policy.

Record Set

"WIC Rating Activity Detail"

Start Position

1

End Position

1

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes                           

Must contain '2' for a claim record.

P: 2.4.2               Policyholder identifier

Description                                              

The identifier allocated to the policy by the insurer.

Record Set

"WIC Rating Activity Detail"

Start Position

2

End Position

20

Length

19

Size

19

Applies To

NI

Representational Format

Text

Notes      

For exempt employers, report as a unique code for business (as per previous reporting or new if employer not previously reported).

P: 2.4.3               Period commencement date

Description                                              

The period commencement date of the policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

21

End Position

28

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes                                                    

For exempt employers, report as the day before the date of the injury.

P: 2.4.4               Transaction date

Description                                              

The date the insurer updated information on the policy term in the insurer’s system.

Record Set

"WIC Rating Activity Detail"

Start Position

29

End Position

36

Length

8

Size

8

Applies To

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

P: 2.4.5               Record identifier

Description                                              

The identifier code of the record within the data submission.

Record Set

"WIC Rating Activity Detail"

Start Position

37

End Position

37

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes        

Must contain ‘4’ for a WIC rating activity detail record.

P: 2.4.6  Workers Compensation Industry Classification (WIC) number

Description                                              

Identifies the relevant Workers Compensation Industry Classification (WIC) number as per the appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing for the appropriate policy renewal year.

Record Set

"WIC Rating Activity Detail"

Start Position

38

End Position

43

Length

6

Size

6

Applies To

NI

Representational Layout

NNNNNN

Representational Format

Code

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes

P: 2.4.8               Amount of wages paid

Description                                              

The amount of wages paid in relation to the WIC.

Record Set

"WIC Rating Activity Detail"

Start Position

49

End Position

62

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                

If not applicable set this data item to zero. For exempt employers, report as zero.

P: 2.4.9               Number of per capita units

Description                                              

The number of per capita units applicable to the WIC.

Record Set

"WIC Rating Activity Detail"

Start Position

63

End Position

69

Length

7

Size

7

Applies To

NI

Representational Layout

NNNNNNN

Representational Format

Number

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes                                                        

If not applicable set this data item to zero. For exempt employers, report as zero.

P: 2.4.10             Number of employees

Description                                              

The number of employees applicable to the WIC.

Record Set

"WIC Rating Activity Detail"

Start Position

70

End Position

76

Length

7

Size

7

Applies To

NI

Representational Layout

NNNNNNN

Representational Format

Number

Notes                                                        

For exempt employers, report the number of injured workers.

P: 2.4.11             Tariff premium (at basic rate)

Description                                              

The amount of the basic premium as calculated against the relevant WIC for the policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

77

End Position

90

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes                                                        

For exempt employers, report as zero.

P: 2.4.12             Activity dust diseases contribution

Description                                              

The amount payable by the employer for the Dust Diseases contribution.

Record Set

"WIC Rating Activity Detail"

Start Position

91

End Position

104

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Workers Compensation (Dust Diseases) Act 1942

Notes                                                        

For exempt employers, report as zero.

P: 2.4.13             WIC premium adjustment flag

Description                                              

A flag to indicate if the Basic Tariff Premium has been adjusted.

Record Set

"WIC Rating Activity Detail"

Start Position

105

End Position

105

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Code

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes                                                        

For exempt employers, report as zero.

P: 2.4.14             Wages for determined classes dust disease contribution

Description                                              

This amount of wages used to calculate the Determined classes dust diseases contribution.

Record Set

"WIC Rating Activity Detail"

Start Position

106

End Position

119

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                      

If not applicable set to zero. For exempt employers, report as zero.

P: 2.4.15             Determined classes dust disease contribution

Description                                              

The amount payable by an employer for the Determined classes dust diseases contribution.

Record Set

"WIC Rating Activity Detail"

Start Position

120

End Position

133

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                       

If not applicable set to zero. For exempt employers, report as zero.

P: 2.4.16             Amount of wages paid (W1) last period

Description                                              

The amount of wages paid for this WIC in respect to the last period of 12 consecutive months which occurred before this policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

134

End Position

147

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                      

If not applicable set to zero. For exempt employers, report as zero.

P: 2.4.17             Amount of wages paid (W2) second last period

Description                                              

The amount of wages paid for this WIC in respect to the second last period of 12 consecutive months which occurred before this policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

148

End Position

161

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

If not applicable set to zero. For exempt employers, report as zero.

P: 2.4.18             Number of per capita units (U1) last period

Description                                              

The number of per capita units paid for this WIC in respect to the last period of 12 consecutive months which occurred before this policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

162

End Position

168

Length

7

Size

7

Applies To

NI

Representational Layout

NNNNNNN

Representational Format

Number

Notes                           If not applicable set to zero. For exempt employers, report as zero.

P: 2.4.19   Number of per capita units (U2) second last period

Description                                              

The number of per capita units paid for this WIC in respect to the second last period of 12 consecutive months which occurred before this policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

169

End Position

175

Length

7

Size

7

Applies To

NI

Representational Layout

NNNNNNN

Representational Format

Number

Notes                                                        

If not applicable set to zero. For exempt employers, report as zero.

Notes

P: 2.4.20             Activity mine safety fund premium adjustment

Description                                              

The amount payable by the employer for this WIC to the Mine safety fund.

Record Set

"WIC Rating Activity Detail"

Start Position

176

End Position

189

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Statutory Legislation

Insurer’s Premium Filing

Notes                                                        

If not applicable set to zero. For exempt employers, report as zero.

P: 2.4.21             Amount of apprentice wages paid

Description                                              

The amount of wages paid by the employer to apprentices for this WIC

Record Set

"WIC Rating Activity Detail"

Start Position

190

End Position

203

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                  

For exempt employers, report as zero.

P: 2.4.22             Activity apprentice incentive scheme amount

Description                                              

The incentive amount calculated for apprentice wages for this WIC as per the appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Record Set

"WIC Rating Activity Detail"

Start Position

204

End Position

217

Length

14

Size

14

Applies To

NI

Representational Layout

NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

For exempt employers, report as zero.

P: 2.4.23             Amount of wages paid (W3) third last period

Description                                              

The amount of wages paid for this WIC in respect to the third last period of 12 consecutive months which occurred before this policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

218

End Position

231

Length

14

Size

14

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNN

Representational Format

Value

Notes                                                      

If not applicable set this data item to zero.

P: 2.4.24             Number of per capita units (U3) third last period

Description                                              

The number of per capita units paid for this WIC in respect to the third last period of 12 consecutive months which occurred before this policy term.

Record Set

"WIC Rating Activity Detail"

Start Position

232

End Position

238

Length

7

Size

7

Applies To

NI

Representational Layout

NNNNNNN

Representational Format

Number

Notes                                                        

If not applicable or policy period commences on or after 30/6/2015, set this data item to zero.

P: 2.4.25             Workers compensation primary activity classification number

Description                                              

The Workers Compensation Primary Activity Classification number as per the appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing for the appropriate policy renewal year.

Record Set

"WIC Rating Activity Detail"

Start Position

239

End Position

247

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Code

Statutory Legislation

Appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

Notes

Record Set 2: WCIDR08-048 Policy Submission Trailer

Submission Trailer record. Must be the last record on the submission.

This record contains:

  • P: 9.1 Record Set
  • P: 9.2 Number of policy detail records
  • P: 9.3 Number of premium detail records
  • P: 9.4 Number of tariff rating activity detail records
  • P: 9.5 Number of WIC rating activity detail records
  • P: 9.6 NO LONGER IN USE
  • P: 9.7 Financial total - Basic tariff premium
  • P: 9.8 Financial total - Experience premium
  • P: 9.9 Financial total - Cost of claims C0
  • P: 9.10 Financial total - Cost of claims C1
  • P: 9.11 Financial total - Cost of claims C2
  • P: 9.12 Financial total - Premium adjustment levy
  • P: 9.13 Financial total - Policy dust diseases contribution
  • P: 9.14 Financial total - Premium payable
  • P: 9.15 NO LONGER IN USE
  • P: 9.16 Financial total - Amount of wages paid
  • P: 9.17 Count - Number of per capita units
  • P: 9.18 Count - Number of employees
  • P: 9.19 Financial total - Tariff premium (at basic rate)
  • P: 9.20 Financial total - Activity dust diseases contribution
  • P: 9.21 NO LONGER IN USE
  • P: 9.22 NO LONGER IN USE
  • P: 9.23 Financial total – Premium GST amount
  • P: 9.24 Financial total - Total premium payable
  • P: 9.27 Financial total – Input tax credit adjustment amount
  • P: 9.28 Financial total - Wages for determined classes dust diseases contribution
  • P: 9.29 Financial total - Determined classes dust diseases contribution
  • P: 9.30 Financial total - Amount of wages paid (W1)
  • P: 9.31 Financial total - Amount of wages paid (W2)
  • P: 9.32 Count - Number of per capita units (U1)
  • P: 9.33 Count - Number of per capita units (U2)
  • P: 9.34 Financial total – Activity mine safety fund premium adjustment
  • P: 9.35 Financial Total - cost of claims C3
  • P: 9.36 Financial total - amount of wages paid (W3)
  • P: 9.37 Count - number of per capita units (U3)

P: 9.1                   Record set

Description                                              

Identifies the type of the data in the record as either claims or policy.

Record Set

"Policy Submission Trailer"

Start Position

1

End Position

1

Length

1

Size

1

Applies To

NI

Representational Layout

N

Representational Format

Number

Notes                                                        

Must contain '9' for a Submission Trailer Record.

P: 9.2                   Number of policy detail records

Description                                            

A count of the number of Policy Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

2

End Position

10

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes                                                        

P: 9.3                   Number of premium detail records

Description                                              

A count of the number of Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

11

End Position

19

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes

P: 9.4                   Number of tariff activity detail records

Description                                              

A count of the number of Tariff Rating Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

20

End Position

28

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes                                                        

P: 9.5                   Number of WIC rating activity detail records

Description                                              

A count of the number of WIC Rating Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

29

End Position

37

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes                                                        

P: 9.7                   Financial total -  basic tariff premium

Description                                              

The sum of all of the basic tariff premiums on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

47

End Position

61

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes

P: 9.8                   Financial total -  experience premium

Description                                              

The sum of all of the experience premiums on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

62

End Position

76

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.9                   Financial total -  cost of claims (C0) current period

Description                                              

The sum of all of the cost of claims C0 on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

77

End Position

91

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.10                Financial total -  cost of claims (C1) last period

Description                                              

The sum of all of the cost of claims C1 on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

92

End Position

106

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes

P: 9.11                Financial total -  cost of claims (C2) second last period

Description                                              

The sum of all of the cost of claims C2 on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

107

End Position

121

Length

15,

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.12                Financial total -  premium adjustment levy

Description                                              

The sum of all of the premium adjustment levies on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

122

End Position

136

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.13                Financial total -  policy dust diseases contribution

Description                                              

The sum of all of the policy dust diseases contributions on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

137

End Position

151

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes

P: 9.14             Financial total -  premium payable

Description                                              

The sum of all of the premiums payable on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

152

End Position

166

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.16                Financial total -  amount of wages paid

Description                                              

The sum of all of the amounts of wages paid on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

182

End Position

196

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.17                Count – number of per capita units

Description                                              

The sum of all of the numbers of per capita units on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

197

End Position

205

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes

P: 9.18                Count – number of employees

Description                                              

The sum of all of the numbers of employees on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

206

End Position

214

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes                                                        

P: 9.19       Financial total – tariff premium (at basic rate)

Description                                              

The sum of all of the tariff premiums at basic rate on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

215

End Position

229

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.20                Financial total –activity dust diseases contribution

Description                                              

The sum of all of the activity dust diseases contribution on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

230

End Position

244

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes

P: 9.23                Financial total – premium GST amount

Description                                              

The sum of all of the GST amounts on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

275

End Position

289

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

value

Notes                                                        

P: 9.24                Financial total – total premium payable

Description                                              

The sum of all of the total premium payables on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

290

End Position

304

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.27                Financial total – input tax credit adjustment amount

Description                                              

The sum of all of the Input Tax Credits Adjustment amounts on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

335

End Position

349

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes

P: 9.28                Financial total – wages for determined classes dust diseases contribution

Description                                              

The sum of all the wages amounts used to calculate the determined classes dust diseases contribution amounts on all of the WIC Activity Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

350

End Position

364

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.29                Financial total –determined dust diseases contribution

Description                                              

The sum of all the determined classes dust diseases contribution amounts on all of the WIC Activity Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

365

End Position

379

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes

P: 9.30                Financial total –amount of wages paid (W1)

Description                                              

The sum of all of the amounts of wages paid W1 on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

380

End Position

394

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.31                Financial total –amount of wages paid (W2)

Description                                              

The sum of all of the amounts of wages paid W2 on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

395

End Position

409

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.32                Count – Number of per capita units (U1)

Description                                              

The sum of all of the numbers of per capita units U1 on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

410

End Position

418

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNNNNNNNN

Representational Format

Number

Notes

P: 9.33               Count – number of per capita units (U2)

Description                                              

The sum of all of the numbers of per capita units U2 on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

419

End Position

427

Length

9

Size

9

Applies To

NI

Representational Layout

NNNNNNNNNNNNNNN

Representational Format

Number

Notes                                                        

P: 9.34                Financial total – Activity mine safety fund premium adjustment

Description                                              

The sum of all of the amounts of activity mine safety fund premium adjustment on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

428

End Position

442

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.35                Financial total – cost of claims (C3) third last period

Description                                              

The sum of all of the cost of claims C3 on all of the Premium Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

443

End Position

457

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes

P: 9.36                Financial total – amount of wages paid (W3)

Description                                            

The sum of all of the amounts of wages paid W3 on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

458

End Position

472

Length

15

Size

15

Applies To

NI

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

Notes                                                        

P: 9.37                Count – number of per capita units (U3)

Description                                            

The sum of all of the numbers of per capita units U3 on all of the Activity Detail Records in the submission.

Record Set

"Policy Submission Trailer"

Start Position

473

End Position

481

Length

15

Size

15

Applies To

NI

Representational Layout

NNNNNNNNNNNNNNN

Representational Format

Number

Notes

Reference Data

WCIDR08-049            SIRA relies on externally and internally sourced reference data to verify the information submitted by insurers and stored in the SIRA Corporate Data Repository. Insurers and SIRA will be required to collaboratively utilise the same reference data to ensure consistent data quality and content in related systems.

WCIDR08-050            Reference data can be regarded as tables that provide a valid source of information that can be used to validate information gathered and maintained within the system. Some form of reference data will be available to Insurers for population into their own claims and policy system. SIRA will verify data reported by Insurers with these reference tables.

WCIDR08-051            The application of reference data can be found within the reporting requirements section of this document.

WCIDR08-052            The following table is an example of the reference data; the rationale and responsibilities involved for successful implementation and ongoing management.

Agency/ Data source

Type of data

Data Elements and descriptions

Rationale for use

Expected Frequency

Responsibility

Australia Post

The formal Australian register of addresses.

Street address, suburbs and postcodes

Address details provided by insurers are consistent with those held on the Australian Post Code register.

To be used to verify the postcode against locality for Employer Address, Injured worker’s Address, Workplace Address and Accident Location.

As required

SIRA will be responsible for coordinating the timeliness of loading new versions however insurers will be required to source the information directly from Australia Post and load into their database.

Part 9 - Policy data item guidance specification

A PDF version is also available.

General Introduction

The Insurer data reporting information requirements (Requirements) describes the rules and the process workers compensation insurers must follow to submit their workers compensation insurance data.

Purpose of the Requirements

The Requirements support delivery of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) and the Workers Compensation Regulation 2016 by establishing clear processes and procedures around the submission of policy data to SIRA.

The accurate and timely collection of policy data is essential to assist in the service delivery to injured people, affordability, and the effective management and sustainability of the system.

The data collected is used by SIRA in achieving its function as the regulator for example: stakeholders comply with legislation and guidelines and to monitor their performance, identify areas of high risk and the publication of reports.

Publication notes

These Requirements are published by the State Insurance Regulatory Authority (SIRA) and replace the following documents:

  • Policy Technical Manual V 3.11 (published in 2015)

An independent agency located within the NSW Customer Service Cluster, the Authority is constituted under the State Insurance and Care Governance Act 2015 and is responsible for regulating workers compensation insurance, motor accidents compulsory third party (CTP) insurance and home building compensation insurance in NSW.

Replacement and transition

To avoid doubt,

  • the Policy Technical Manual V 3.11

and is replaced by these Requirements.

These Requirements apply to all policy data submitted by Workers Compensation insurers.

Legislative framework

The data described in this requirement is collected under:

  • the conditions of the insurer’s licence and/or in accordance with s23(1)(m) and Section 40C of the 1998 Act and
  • Section 40B of the 1998 Act

Requirement making power

These Requirements are made under Section 40C of the 1998 Act.

Interpretation of the Requirements

These requirements should be interpreted in a manner that supports the achievement of the objectives and general functions of SIRA under the workers compensation legislation as described in section 22 of the 1998 Act.

At this point in time, the data items detailed in this manual will only apply for the Nominal Insurer.

Commencement of the Requirements

The Workers compensation policy technical manual (WCIDR08) is published by SIRA on 1 August 2019.

The Workers compensation policy data item guidance specification (WCIDR09) is published by SIRA on 1 August 2019.

These Requirements are effective from the publication date until SIRA amends, revokes or replaces them in whole or in part. These Requirements supersede the previous requirements which were in place until 1 August 2019.

Parts of the Requirements

The policy reporting requirements are divided into the following parts:

Part 8: Workers compensation policy technical manual: details the technical requirements for submitting workers compensation data.

Part 9: Workers compensation policy data item guidance specification: helps to explain how the data needs to be reported to SIRA.

Reference Data

Part 10: Workers compensation policy technical manual validations reference: provides a validation matrix which lists all validation, their severity and the data items impacted.

Part 11: Workers compensation policy technical manual code set reference: details all codes and code sets applicable to specific data items and provides a detailed description of each code and its use.

Compliance with the Requirements

SIRA will monitor and review compliance with the Requirements. Compliance and enforcement will be undertaken in accordance with the Authority’s Compliance and Enforcement Policy (July 2017)

Penalties for not meeting reporting requirements

It is the responsibility of the insurer to ensure the accuracy, quality and timeliness of the data provided.

Failure to comply with these Requirements may result in regulatory sanctions being imposed including imposition of penalties, civil penalties or loss of licence if applicable.

Requirement identifiers

Each requirement component has been allocated a unique identifier (e.g. WCIDRR09- 01) to make it traceable. This will assist when:

  • searching for a requirement
  • linking requirements
  • advising relevant stakeholders when a requirement has been revised and
  • to assist insurers when requesting advice or suggesting improvements.

Data item guidance

SIRA assistance

WCIDR09-01                For queries, suggested changes or enhancements about any aspect of these requirements, please contact the Data Quality and Exchange Team on ph: (02) 4321 5703 or email: data.information@sira.nsw.gov.au

WCIDR09-02                SIRA will be reconciling this data and if any discrepancy occurs, insurers will be asked to resolve, correct and, if appropriate, resubmit data.

WCIDR09-03                SIRA will use the data for monitoring insurer performance and for ensuring compliance with their licensing conditions.

WCIDR09-04                SIRA may use the data for any other purpose in accordance with its legislative powers.

Data Item

WCIDR09-05                This section details what additional information is relevant for each data item to assist in its reporting. Where nothing appears in the ‘Notes/ Comments’ column, no additional information has been provided by SIRA for entering this data item.

WCIDR09-05.1             POLICY HEADER Record

Data Item

Description

Notes/ Comments

P: 1.1 Record type

Identifies the type of data in the record as either claims or policy.

 

P: 1.2 Insurer number

A unique three-digit number allocated by SIRA used to identify an insurer or the insurer's data provider

The number is allocated to the insurer by SIRA.

P: 1.3 Submission type

Identifies the type of data in the submission as either claims or policy.

 

P: 1.4 Policy system release number

Identifies the version of the policy system under which the data are being submitted to SIRA

 

P: 1.5 Submission start date

The start date (or from date) of the submission period

 

P: 1.6 Submission end date

The end date of the submission period.

The date should be the actual as at date (or close-off date) of the submission.

Filler

  

WCIDR09-05.2             POLICY TERM DETAIL Record

Data Item

Description

Notes/ Comments

P: 2.1.1 Record set

Identifies the type of data in the record as either claims or policy.

 

P: 2.1.2 Policyholder identifier

The identifier allocated to the policy by the insurer.

The ID does not change when an employer changes insurer.

For new policyholders, the number will be an insurer allocated policy number that includes the insurer number.

The last 3 digits of the Policyholder number must be the unique insurer number:

Examples

Example 1: A123546033

033 being the unique number for an insurer.

Example 2: 123456016

016 being the insurer number

Example 3: 1ABC0123456122

122 being the insurer number.

P: 2.1.3 Period commencement date

The period commencement date of the policy term.

Policies issued for 12 months commence and expire on the same date plus one year, the relevant time being 4:00pm on the date policies commence and expire.

Examples

Employer completed a proposal for the period 30 June 2016 to 30 June 2017. Commencement date = 30 June 2016 at 4pm.

From 30 June 2018, policies issued or renewed by the Nominal Insurer commence from 12 midnight.

Example

Employer completed a proposal for the period 30 June 2018 to 30 June 2019. Commencement date = 30 June 2018 at 12 midnight

P: 2.1.4 Transaction date

The date the insurer updated information on the policy term in the insurer’s system.

Specify the actual date when the activity occurred in the insurer's office.  Do not specify the submission start or end date or a similar arbitrary date.

If more than one transaction is processed for a policy term on the same day only the latest set of data for that day should be reported to SIRA.

Example

Insurer changes policy detail record.

P: 2.1.5 Record identifier

The identifier code of the record within the data submission.

 

P: 2.1.6 Policy status code

Describes the status of the policy term for the employer

The policy status code must be updated if for any reason the employer will not be renewing the next term with the nominal insurer.

Required for policy terms with a period commencement date on or after 1 October 1995.

Examples

This example highlights when and how the policy status code is to be reported.

Example 1: A new employer takes out a policy with the Nominal Insurer with a Policy Term Commencement Date (PCD) of 31 March 2018.

March 2018 – Nominal Insurer reports Policy Status Code as ‘1’

In March 2019 the employer renews with a Specialised Insurer on 31 March 2019.

March 2019 – Nominal Insurer reports Policy Status Code for PCD of 31 March 2018 as ‘3’

Example 2: Existing employer renews policy on 30 April 2018

April 2018 – Nominal Insurer reports Policy Status Code as ‘2’

26 January 2019 – Employer goes into Voluntary administration January 2019 - Nominal Insurer reports Policy Status Code as ‘8’

P: 2.1.7 Insurer branch

Branch of the insurer responsible for handling the policy.

Insurers must notify SIRA when new Branches are created. Required for policy terms with a period commencement date on or after 1 October 1995. If not applicable then set this item to spaces.

Examples

SYDNEY01, PARRAMATTA, NEWCASTLE

P: 2.1.8 Error report target

The insurer’s reference that allows error reports to be aggregated for a particular person or office.

This item is the responsibility of the agent/insurer. It is used by SIRA to provide control breaks on error reports. If not applicable then set this item to spaces.

Examples

Error Report Target           Reason
Rural                                  As they look after all rural                                            policies.
J Smith                              Dedicated Policy Case                                            Manager for the employer.

P: 2.1.10 Employer name

The legal name of the employer.

Must be the correct legal name of the employer.

Acronyms should not be used unless they form part of the full legal name of the employer.

Example: BT (for Bankers Trust) is not acceptable

Comments must not be recorded in the Employer legal name field.

Example: Expired on 30 June 1992 is not acceptable

Title words such as 'The' and 'and' which form part of an employer name should be included in their logical order in the name string.

Example: The Rocking Horse Shop but not Rocking Horse Shop, The

Commas, brackets, numerals and any other special characters, which form part of an employer legal name, should be included in their logical position in the name.

Example: 7-Eleven Stores Pty Ltd

The Boots Company (Australia) Pty Ltd

In those cases where the ACN forms part of the employer’s trading name, it is acceptable to supply it in the Employer Legal name field in the following format:

Example: ACN 001950380 Pty Ltd

‘Care of’ (c/o) or ‘Attention’ names are not to be recorded in the Employer Legal Name.

Example: Westmorley Company, C/o Penn and Jones Solicitors

Employer Legal Name: Westmorley Company

Asterisks must not be used in the Employer Legal Name field.

Example: **Null Policy** is not acceptable.

If the employer is an individual use the combination of Entity Name Given Name, Entity Name Other Given Names, Entity Name Family Name AND Entity Name Suffix with a space between each field.

Example: James Ferdinand Poulson

The name must be entered in the order that the people would use to introduce themselves.

Example: Alison Gray, but not Gray, Alison

For partnerships, the Given name and other names are to be reported in full with a space between the Given name and Surname. Each partners name is to be separated by an ampersand

Example: Mary Jones and Brian Smith would be reported as Mary Jones & Brian Smith.

If the employer is an ‘Other partnership’, then each of the partners must be listed in alphabetical order rather than the name of the partnership. (generally applies to accountancy and legal firms)

Example: A Apple & B Baker & C Charlie rather than AppleBakerCharlie

Where two companies are in partnership, the name of both companies is to be provided. If more than 2 companies are involved in the partnership provide as much information as possible.

If the employer is a superannuation fund then the employer legal name can contain ‘Proprietary Limited’, ‘Pty Ltd’ or ‘Proprietary Ltd’

If the employer is an Australian private company, limited partnership or other incorporated entity then the employer legal name can contain ‘Proprietary Limited’, ‘Pty Ltd’ or ‘Proprietary Ltd’

For all Australian public and private companies, the name registered with ASIC is what should be reported.

Strata Title - only requires the words Strata Plan and the number. All other information (e.g. managing agent names, proprietor names, property names) must be omitted.

Example: Strata Plan No. 1234356 to be reported as Strata Plan 1234356

and The Proprietors of Strata Plan 9835343 to be reported as Strata Plan 9835343

Where the employer is a trustee, enter the trustee name in this field. The ABN for this trustee will need to be entered in the Employer ABN (Australian Business Number) field (P: 2.1.16)

Examples

R Citizen as Trustee for the Citizen Family Trust.

R Citizen is the Trustee - reported to Employer Legal Name (P: 2.1.10)

R Citizen has a Trustee ABN of 53 004 082 345 - reported to Employer ABN (P: 2.1.16)

The ABN for the Citizen Family Trust is 53 004 084 567 - reported to Trust ABN (P: 2.1.22)

The trust name is Citizen Family Trust - reported to Trust Name (P: 2.1.11)

Where the employer is a Trust, the Employer Legal Name (P: 2.1.10), Trust Name (P: 2.1.11), Employer ABN (Australian Business Number) P: 2.1.16 and Trust ABN (P: 2.1.22) all combined constitute the full legal entity that is against the policy.

P: 2.1.11 Trust name

 

If the employer is registered on the ABR (Australian Business Register) with a Trust name, then enter the Trust name using section 12 for Employer Name Format rules.

The Trust name provided could be greater than 75 characters so in these cases truncate the name at 75 characters.

The ABN for this trust name will need to be entered in the Trust ABN field (P 2:1.22).

Examples

R Citizen as Trustee for the Citizen Family Trust

R Citizen is the Trustee - reported to the Employer Legal Name (P: 2.1.10)

R Citizen has a Trustee ABN of 53 004 082 345 - reported to Employer ABN (P: 2.1.16)

The ABN for the Citizen Family Trust is 53 004 084 567 - reported to Trust ABN (P: 2.1.22)

The trust name is Citizen Family Trust - reported to Trust Name (P: 2.1.11)

Where the employer is a Trust, the Employer Legal Name (P: 2.1.10), Trust Name (P: 2.1.11), Employer ABN (Australian Business Number) (P: 2.1.16) and Trust ABN (P: 2.1.22) all combined constitute the full legal entity that is against the policy.

If the employer is registered on the ABR (Australian Business Register) with a Trust name, then enter the trust name using section 12 for Employer Name Format Rules.

If not applicable set this item to spaces.

P: 2.1.12 Employer ACN or ARBN

The Australian Company Number or Australian Registered Body Number of the employer.

Ensure the ACN or ARBN specified is that of the employer identified in the Employer legal name (P: 2.1.10) field.

Required for policies written for employers who have an ACN or ARBN.

P: 2.1.13 Employer address – Street information

The street address of the principal operating location of the employer for the policy term.

The address information must be supplied for the principal operating location of the employer during the applicable policy period. It must be a physical address, not a mailing address or post office number.

Must be the address applicable for the policy period.

Must remain as reported for previous policy periods.

Examples

See section Address format rules

P: 2.1.14 Employer address – Locality name

The locality name of the principal operating location of the employer for the policy term.

Must be the address applicable for the policy period.

Must remain as reported for previous policy periods.

Examples

See section Address format rules

P: 2.1.15 Employer address – Postcode

The postcode of the principal operating location of the employer for the policy term.

Must be the postcode of the address applicable for the policy period.

Must remain as reported for previous policy periods.

P: 2.1.16 Employer ABN (Australian Business Number)

The Australian Business Number (ABN) as issued by the Australian Business Register for the legal entity.

Specify the ABN for all legal entities where the information has been notified to the insurer.

Ensure the ABN specified is that of the employer identified in the Employer legal name field (P: 2.1.10).

Where the entity type (P: 2.1.23) = 03 'Trust', then specify the Trustee ABN in the Employer ABN (Australian Business Number) (P: 2.1.16) field and the Trust ABN in the trust ABN Field (P: 2.1.22)

P: 2.1.17 Employer registered for GST

Indicates whether the employer has registered for GST with the Australian Taxation office.

Note an employer may have an ABN but not be registered for GST.

P: 2.1.18 Entitlement to input tax credits

The employer's entitlement to GST input tax credits expressed as a percentage.

Must equal previously reported value for policy term, where the previous record was not an auto-renewal.

Where the discount is 90% or less, a value should appear in item P: 2.2.24 as the employer is entitled to a discount premium.

Examples

N = 000 (No ITC entitlement)

Y = 100 (default value if employer registered but ITC not advised)

Y = 100 (notified by employer)

Y = 50 (notified by employer)

U = 100 (default value as ITC unknown)

P: 2.1.19 Employer Group Number

 

A unique number allocated by the Nominal Insurer to identify the Employer Group to which the employer belongs.

Each policyholder who is part of the group will have the same unique Employer Group Number

P: 2.1.20 Employer Group Exemption Flag

Indicates if a group employer's Base Tariff Premium is excluded in calculating the group’s total experience factor.

Must only be used where Employer Group Number (P: 2.1.19) is not zero.

P: 2.1.21 Period expiry date

The expiry date of the policy term.

 

P: 2.1.22 Trust ABN

The Australian Business Number (ABN) as issued by the Australian Business Register for a Trust.

Ensure the ABN specified is that of the Trust as identified in the Trust Name field (P: 2.1.11).

The two prefix check digits must be valid. The algorithm is located in examples.

P: 2.1.23 Entity Type

A code that distinguishes the legal entity type of an employer.

 

Filler

  

WCIDR09-05.3             PREMIUM DETAIL Record

Data Item

Description

Notes/ Comments

P: 2.2.1 Record set

Identifies the type of data in the record as either claims or policy.

 

P: 2.2.2 Policyholder identifier

The identifier allocated to the policy by the insurer.

The ID (also known as policy number) does not change when an employer changes insurer.

For new policyholder’s the number will be insurer allocated policy number including the insurer number.

Examples

The last 3 digits of the Policyholder number must be the unique insurer number.

Example 1: A123546701

701 being the unique number for an insurer.

P: 2.2.3 Period commencement date

The period commencement date of the policy term.

Policies issued for 12 months commence and expire on the same date plus one year, the relevant time being 4:00pm on the date policies commence and expire.

Examples

Employer completed a proposal for the period 30 June 2016 to 30 June 2017. Commencement date = 30 June 2016 at 4pm.

From 30 June 2018, policies issued or renewed by the Nominal Insurer commence from 12 midnight.

Example

Employer completed a proposal for the period 30 June 2018 to 30 June 2019. Commencement date = 30 June 2018 at 12 midnight

P: 2.2.4 Transaction date

The date the insurer updated information on the policy term in the insurer’s system.

Specify the actual date when the activity occurred in the insurer's office.  Do not specify the submission start or end date or a similar arbitrary date.

If more than one transaction is processed for a policy term on the same day only the latest set of data for that day should be reported to SIRA.

P: 2.2.5 Record identifier

The identifier code of the record within the data submission.

 

P: 2.2.6 Period expiry date

The expiry date of the policy term.

 

P: 2.2.7 Policy renewal year

Identifies the policy renewal year to which the policy relates.

The year to be specified is the start year of the period.

The policy renewal year is the period 30 June to 30 June commencing and expiring at 4pm

e.g. PRY 2019 = 30 June 2019 to 30 June 2020.

P: 2.2.9 Employer category code

A category to indicate the size or type of the employer for determining premium.

 

P: 2.2.10 Premium calculation code

Indicates the type of premium calculation

 

P: 2.2.11 Surcharge factor to insure for first $500 (X)

Contains the excess surcharge factor for the employer determined in accordance with the appropriate Insurance Premiums Order, Market Practice and Premiums Guidelines or Insurer’s Premium Filing.

The surcharge factor is not applicable for policies with a Policy Period commencement date on or after 31 December 2005.

P: 2.2.12 Basic tariff premium (BTP) policy total

The sum of the basic tariff premiums for the policy term.

Must equal the sum of the basic tariff premium amounts from the activity detail records, which are included in this set of policy data.

P: 2.2.13 Experience adjustment factor (S)

The value as calculated in accordance with the method applicable to the policy term for adjusting the premium based on experience.

For policies commencing on or after 30 June 2015

This item must be set to zero except where it is a retro-paid loss employer.

For policies commencing before 30 June 2015

This item must be supplied where the policy term is experience adjusted.

Must be calculated to four decimal places and rounded up.

If the policy term is not experience adjusted then set this item to zero.

An adjustment of an employer’s premium based on the losses that employer has experienced.

P: 2.2.14 Experience premium (E)

The adjustment to the premium relating to the cost of claims and calculated in accordance with the method applicable to the policy term.

For policies commencing on or after 30 June 2015.

This item must be set to zero except where it is a retro-paid loss employer.

P: 2.2.15 Cost of claims (C0) current period

The total of the cost of claims for the employer for this policy term.

For policies commencing on or after 30 June 2015.

This item must be set to zero except where it is a retro-paid loss employer.

For retro-paid loss employers

This item must be zero for an estimated premium or automatic renewal transaction.

Must be the figure used for C0 in the calculation of the experience premium.

For final premiums it must reflect the cost of claims as at the period expiry date of this policy term.

P: 2.2.16 Cost of claims (C1) last period

The total of the cost of claims for the employer in respect of the last period of 12 consecutive months which occurred before this policy term.

For policy terms commencing prior to 30 June 2015

Must be the figure used for C1 in the calculation of the experience premium. For estimated premiums it must reflect the cost of claims as at the period commencement date of this policy term as detailed in the Legislation.

For final premiums it must reflect the cost of claims as at the period expiry date of this policy term.

For policy terms commencing on or after 30 June 2015.

The figure used for C1 must be used in the calculation of the Claim performance measure (P: 2.2.49).

For all premium calculations it must reflect the cost of claims as at the period commencement date of this policy term as detailed in the Legislation.

P: 2.2.17 Cost of claims (C2) second last period

The total of the cost of claims for the employer in respect of the second last period of 12 consecutive months which occurred before this policy term.

For policy terms commencing prior to 30 June 2015.

Must be the figure used for C2 in the calculation of the experience premium. For estimated premiums it must reflect the cost of claims as at the period commencement date of this policy term as detailed in the Legislation.

For final premiums it must reflect the cost of claims as at the period expiry date of this policy term.

For policy terms commencing on or after 30 June 2015

The figure used for C2 must be used in the calculation of the Claims performance measure (P: 2.2.49). For all premium calculations it must reflect the cost of claims as at the period commencement date of this policy term as detailed in the Legislation.

P: 2.2.18 Premium adjustment levy (Q)

An amount levied or rebated to a policy holder for a particular policy renewal year.

This data item is reported as zero.

P: 2.2.19 Policy dust diseases contribution (D)

The total amount payable by the employer for the Dust Diseases contribution in accordance with the method applicable to the policy term.

Must equate to the sum of the dust diseases contributions as reported on the activity records for this policy, for policy terms commencing on or after 1 October 1995.

Include any amounts arising from determined classes of employees.

P: 2.2.20 Stamp duty

The amount of stamp duty payable on the policy.

 

P: 2.2.21 Premium payable (P)

The premium payable by the employer for this policy term.

Refer to Insurance Premiums Order or Market Practice Premiums Guidelines for a detailed explanation of Formula.

For policies prior to the introduction of GST (Period Commencement Date before 30 June 2000)

If the set of policy data is for a Category B employer and the basic tariff premium is less than the minimum specified for the policy renewal year, the premium payable must equal the minimum premium, as specified in the Insurance Premiums Order or Market Practice Premiums Guidelines.

If the set of policy data is for a domestic policy and the basic tariff premium is less than the minimum specified for the policy renewal year, the premium payable must equal the minimum domestic premium, as specified in the Insurance Premiums Order or Market Practice Premiums Guidelines.

For policies after the introduction of GST (Period Commencement Date on or after 30 June 2000 until 29 June 2001)

After the commencement of GST, the Premium Payable, as specified in the Insurance Premiums Order or Market Practice Premiums Guidelines, includes a component for GST in the calculation of the Premium Payable. This Premium Payable includes the Dust Disease Contribution, is before the adjustment for the employer’s ITC entitlement and before applying the minimum premium.

For policies after the introduction of Premium Discount Scheme (Period Commencement Date on or after 30 June 2001 until 30 December 2005)

Premium payable is to be calculated as per the following formula:

Category A employer PP = ((T x (1 - S)) + (E x S)) + Q - Y + D

Category B employer PP = (T + (X x T)) + Q - Y + D

For policies after the introduction of Premium Reform (i.e. Period Commence Date on or after 31 December 2005)

Premium payable is to be calculated as per the following formula:

For Small Employers PP = T + Q

For medium and large employers PP = ((T x (1 - S)) + (E x S )) + Q

For policies from 30 June 2013 premium payable is to be calculated as per the following formula.

For Small Employers PP = T + Q

For medium and large employers PP = ((T x (1 - S)) + (E x S )) + Q

For policies commencing on or after 30 June 2015 premium payable is to be calculated as per the following formula:

For Small Employers PP = BTP + Q

For medium and large employers PP = BTP x CPA + Q

P: 2.2.22 GST Amount

The GST amount applicable to the Total Premium Payable.

GST amount must be less than the Total Premium Payable (P:  2.2.23).

P: 2.2.23 Total premium payable

The total premium payable by the employer for this policy term.

For policies prior to the introduction of GST (Period Commencement Date before 30 June 2000)

Where policies have a commencement date before the commencement date of GST, then the Total Premium Payable will be equal to the Premium Payable (P: 2.2.21).

For policies after the introduction of GST (Period Commencement Date on or after 30 June 2000 until 29 June 2001)

Where policies have a commencement date on or after the commencement date of GST, then the Total Premium Payable will be equal to the Premium Payable (P: 2.2.21) less the Input Tax Credit Adjustment Amount (P: 2.2.24).

If applicable the minimum premium payable by the employer as per Insurance Premiums Order or Market Practice Premiums Guidelines, must be recorded here.

For policies after the introduction of PDS (Period Commencement Date on or after 30 June 2001 until 30 December 2005)

Total premium payable is to be calculated as per the following formula:

Category A employers

TPP = ((T x (1 - S )) + (E x S )) + Q - Y + D - I

Category B employers

TPP = (T + ( X x T)) + Q - Y  + D - I

For policies after the introduction of Premium Reform (i.e. Period Commencement Date on or after 31 December 2005)

Total premium payable is to be calculated as per the following formula:

For small employers

TPP = T + Q - Y + D - I

For medium & large employers

TPP = ((T x (1 - S)) + (E x S)) + Q - Y + D - I

From 30 June 2006 the Mine safety premium adjustment (P: 2.2.37) was introduced and where applicable should apply as follows:

For small employers

TPP = T + Q - Y + D - I + M

For medium & larger employers

TPP = ((T x (1 - S)) + (E x S)) + Q - Y + D - I + M

For policies after the introduction of Apprentice Incentive Scheme (Commencement date on or after 31 December 2006)

Total premium payable is to be calculated as per the following formula:

For small employers

TPP = T + Q - Y + D - I + M - A

For medium and large employers

TPP = ((T x (1 - S )) + (E x S )) + Q - Y + D - I + M - A

For policies after the introduction of Premium Paid in Full in Advance (Commencement date on or after 30 June 2007)

Total premium payable is to be calculated as per the following formula:

For small employers

TPP = T + Q - Y + D - I + M - A - Z

For medium and large employers

TPP = (( T x (1 - S )) + (E x S )) + Q - Y + D - I + M - A - Z

Must be equal to zero if Premium Calculation Code equals 6 (null policy)

For policies from 30 June 2013 following the introduction of small employer reforms.

From 30 June 2013, the following formula will apply to Total Premium Payable for small employers;

The following formula applies:

For small employers TPP = T – ESI - RTWI + Q - Y + D - I + M - A – Z

For policies commencing on or after 30 June 2015

Total premium payable is to be calculated as per the following formula:

For small employers

TPP = BTP – ESI - RTWI + Q + D + M - A – Z - PD

For medium and large employers

TPP = BTP x CPA –ESI –ESR + Q + D + M – A – Z - PD

P: 2.2.24 Input tax credit adjustment amount

The amount of the adjustment to the premium payable by the employer to compensate employers who cannot claim all GST paid on premium as input tax credits.

Refer to the Insurance Premiums Order (IPO) or Market Practice Premiums Guidelines for the relevant Policy Renewal Year (PRY) for a detailed explanation of the formula.

Other details

  

P: 2.2.33 Labour hire flag

Indicates if the employer is a provider of labour hire workers.

 

P: 2.2.34 Cumulative premium received

Cumulative total of premium received from the employer for this policy period.

Cumulative premium includes the total premium received (this includes extra premium from wage audits) plus late payment fees received (including late payment fees from wage audits).

It does not include wage audit fees, dishonour fees or claims excesses.

Not applicable for policies with a policy renewal year prior to 2005.

Examples

Total premium payable = $10,251.50

Payment made on 15/01/2008 of $2000

Payment made on 15/02/2008 of $5251.50

Cumulative total to be reported is $ 7251.50

P: 2.2.35 Last premium payment transaction date