SIRA funded programs

Overview

The SIRA equipment and workplace modifications program provides funding for workplace equipment or modifications that may help a worker to remain at work with their pre-injury employer or to commence work with a new employer.

Eligibility

A worker is eligible if:

• at the time of program commencement, they are receiving, or are entitled to receive, weekly payments under Part 3, Division 2 of the the Workers Compensation Act 1987 (1987 Act)
• a commutation or work injury damages settlement has not been accepted.

Principles

The application must include a detailed description of how the equipment and/or workplace modifications addresses the following principles:

1. It is not an item that should be provided by the employer as part of their obligations under the Work Health and Safety Act 2011.
2. The cost is reasonable and other alternatives have been explored and considered to be inappropriate.
3. It will be used for a reasonable period of time and is solely or mainly for the use of the worker.
4. The existing equipment or lack of the required item was not a contributing factor to the initial injury (where the worker is returning to the pre-injury employer).
5. It is essential to allow the worker to recover at, or return to work, or to commence a new work role (e.g. tools of the trade, such as a basic toolkit).
6. Workplace modifications are specific to the worker’s functional requirements in allowing them to return to work.
7. Application process.

A worker’s return to work coordinator, insurer, or approved workplace rehabilitation provider (provider) may prepare an application for equipment and workplace modifications.

The person developing the application must check whether the worker has an entitlement to new employment assistance (under section 64B of the 1987 Act). The insurer may be required to confirm this. Where the worker is entitled to claim such assistance, this entitlement must be exhausted before accessing funding under the SIRA equipment and workplace modifications program.

A worker who has an entitlement to new employment assistance may be eligible for funding under the SIRA equipment and workplace modifications program where:

• they have exhausted their entitlement to new employment assistance (this includes where an application exceeds $1,000 – note this does not apply to exempt workers), or
• the insurer disputes liability for new employment assistance (including where the insurer does not notify the worker of a decision within the required time period).

A combined new employment assistance and equipment and/or workplace modifications application may be developed where costs required exceed $1,000. In this instance, it will be necessary to demonstrate the application meets the requirements for both a new employment assistance claim and the SIRA equipment and workplace modifications program.

If any requirements cannot be met, justification must be provided outlining why the proposal is necessary to help the worker to recover at or return to work.

A SIRA equipment and/or workplace modifications application is submitted using the vocational program - details form together with:

• evidence addressing the relevant principles (this may be within a workplace assessment report completed by a suitably qualified professional or other appropriate documentation)
• confirmation that the intervention and associated costs are reasonable
• confirmation that the strategy is appropriate for the worker’s needs and functional capacity
• evidence that the employer has agreed to the installation of the proposed equipment/modification and ongoing maintenance.

SIRA does not prescribe an application form for new employment assistance.

Figure 1 below aims to guide application decision-making.

Assessing an application

Applications $500 or less

A provider can assess applications that are $500 or less. The provider must follow their service provision and internal quality assurance processes to confirm the application meets the SIRA equipment and workplace modifications requirements and relevant principles.

The provider can arrange supply of equipment and/or workplace modifications without seeking formal approval from the insurer. However, the provider must inform the insurer (in writing) of the specific costs relating to the application.

Applications above $500

Nominal Insurer scheme agent

When the worker’s claim is with a Nominal Insurer scheme agent, the agent will assess applications that are above $500.

The agent will write to the worker and the person submitting the application, advising their decision to approve or decline the request and the reason for their decision within 14 days.

If the application is not approved, the agent must advise the worker of the SIRA appeal process.

An agent for icare Insurance for NSW, self-insurer or specialised insurer

When the worker’s claim is with an agent for icare Insurance for NSW, the agent will assess applications for funding that cost more than $500 but less than $10,000.

When the worker’s claim is with a self or specialised insurer, the insurer will assess applications for funding that cost more than $500 but less than $2,000.

The agent/insurer will write to the worker and the person submitting the application, advising their decision to approve or decline the request and the reasons for their decision within 14 days.

If the application is not approved, the agent/insurer must advise the worker of the SIRA appeal process.

SIRA

If the application exceeds the cost an agent for icare Insurance for NSW, or self or specialised insurer may approve, the application must be sent via email to SIRA at [email protected] within 14 days.

The application must include the insurer’s opinion on whether they support the equipment and/or workplace modifications application with reference to the equipment and workplace modifications principles.

SIRA will then assess the application for funding in light of the insurer’s recommendation. The insurer will be advised of the outcome of the assessment in writing within 10 working days of receiving a complete application. The insurer will advise the worker of the outcome of the assessment, and the SIRA application appeal process if the application is not approved.

Payment

Payments should be made in line with the amount(s) approved.

Payment should only be made where there is evidence of cost/expenditure (eg purchase order, tax invoice, receipts or record of travel such as a travel log or fares).

The insurer/agent must have controls in place to prevent duplicate payments being made and claimed.

A completed vocational program – claim for payment form and relevant invoices or receipts must be submitted to facilitate payment.

Up to $300 may be paid in advance (where appropriate) for travel. To arrange an advance payment please send the request to [email protected].

Nominal Insurer scheme agent

When the claim is with a Nominal Insurer scheme agent, the agent is responsible for administering payment of vocational program expenses.

Agent for icare Insurance for NSW

When the claim is with an agent for icare Insurance for NSW, the agent is responsible for administering payment of vocational program expenses less than $10,000.

Self-insurer or specialised insurer

When the claim is with a self or specialised insurer, the insurer is responsible for administering payment of vocational program expenses less than $2,000.

SIRA

When the claim is with an agent for icare Insurance for NSW, self-insurer or specialised insurer and the costs exceed the amounts above, SIRA will make payments.

These payments will be processed when a vocational program – claim for payment form, copy of the vocational program – details form and relevant invoices or receipts are received at [email protected].

Insurer/agent reimbursement

Insurers and agents can request reimbursement from SIRA for program costs.

Insurers and agents are to ensure that all claims for reimbursement can be substantiated. Substantiated means programs are approved and supported by appropriate evidence of the expenses.

Self and specialised insurers

Reimbursements from SIRA can be claimed within six months of the costs being incurred by submitting a claim for payment, evidence of payment and relevant receipts.

Nominal insurer and agent for icare Insurance for NSW

Reimbursements from SIRA can be claimed by a tax invoice. The invoice should be accompanied by an itemised breakdown by claim and program type of the costs incurred.

For more information about making a claim for reimbursement contact [email protected].

Following approval

Installation

Following approval, the person who developed the application is responsible for confirming:

• the equipment or workplace modifications are installed correctly
• the worker (and employer where relevant) has been adequately trained to use the equipment or modifications
• the original need for equipment or workplace modifications has been addressed.

Ownership and maintenance

If the equipment is small, customised or movable, it will belong to the worker. Larger items, such as permanent fixtures or modifications to the workplace, will be owned by the employer, however they may be asked to contribute to the cost where appropriate.

If the worker is re-employed elsewhere within the first six months and still requires the equipment, SIRA may cover reasonable and necessary transport costs to relocate the equipment to a new workplace.

The employer will be responsible for normal maintenance, repairs and insurances in-line with obligations under the Work Health and Safety Act 2011 which requires an employer to provide and maintain a work environment that is without risks to health and safety.

When equipment is no longer required

If equipment is no longer required within six months of the date of issue and the provider is still in contact with the worker, re-issue of the equipment to another worker may be negotiated.

If the worker is no longer in contact with the provider, the worker should contact SIRA on 13 10 50.