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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)

Part of the NSW Department of Finance, Services and Innovation, 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The following publications are repealed: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)

Part of the NSW Department of Finance, Services and Innovation, 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.

RR06-06       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/ surgical 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. Refer to code PDO001.

WCIDRR06-45       Optometry & visual aid services

Inclusions/exclusions:

  • Excludes ophthalmologists (these are medical services refer to AMA Codes).
  • Exclude repair or replacement of spectacles damaged in a workplace injury
  • Refer to code PDO001.

OPT001                          Optometry services

Payments for services provided by optometrists registered with the NSW Optometrists Registration Board.

OPT002                         Spectacles

This is for the purchase, repair or replacement of spectacles or contact lenses, required as a result of the workplace injury.

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.
  • Exclude weekly compensation made in respect of a worker who receives an injury on a journey claim made before the 19 June 2012.

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)