GN 7.1 SIRA funded programs general

Published: 12 August 2019
Last edited: 30 April 2020

Application: This guidance applies to exempt workers

Overview

Section 53 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) allows SIRA to develop, administer or coordinate vocational rehabilitation schemes for workers. These schemes include:

  • financial assistance for the rehabilitation and retraining of workers with a workplace injury or illness, including formal training and on the job experience with a host employer such as a work trial
  • financial incentives for employers who retain workers (such as recover at work assistance for small businesses) or employers who offer new employment to workers i.e. the JobCover placement program
  • assistance to workers to address any immediate, short term barrier or need preventing them from accepting employment in a new work role i.e. the transition to work program.

This guidance note provides information on general insurer requirements (including reporting) for the following SIRA funded programs:

  • Recover at work assist for small business
  • Work trials
  • JobCover placement program
  • JobCover 6 placement program
  • Training program
  • Transition to work
  • Equipment and workplace modifications
  • Connect2work program.

Specific information for each SIRA-funded program can be found in Insurer guidance GN 7.2 to GN 7.8.

Note: During the COVID-19 (Coronavirus) pandemic, workers and employers may need additional support to manage recovery at work. SIRA funded programs have been modified in response to this event. Insurers should refer to the following guidance notes for further information:

Two new SIRA funded programs have been created in response to the COVID-19 pandemic:

All the SIRA funded programs can be used during the COVID-19 period and should be proactively considered in the recovery planning process to optimise outcomes for workers.

Insurers should contact vocprograms@sira.nsw.gov.au if unsure.

General insurer requirements

This information outlines the administration, management and reporting of SIRA funded programs to support recovery at work.

Costs

Costs associated with these programs are funded from the Workers Compensation Operational Fund.

The payments are to be recorded against a claim but are excluded from an employer’s experience-adjusted premium.

Quality assurance process

The insurer is required to use an internal quality assurance process for the review of all program proposals, before notifying the parties of a decision.

All decisions (including high-cost proposals) should be made in accordance with the quality assurance process and the relevant vocational program guidance material.

Review of applications

If the insurer determines that a worker and/or employer meet SIRA’s eligibility criteria and requirements, the worker and/or employer will be accepted and the insurer will administer the program.

While most applications are assessed by insurers, SIRA assesses applications in certain circumstances.

If the insurer or SIRA decides an application does not meet eligibility criteria and program requirements, the insurer is required to provide a decision in writing to the worker and advise the worker of how to request a review. The worker, employer or someone acting on behalf of the worker can ask the insurer or SIRA to review the decision.

Administration and payment

The insurer will administer and make payment for the costs as outlined in each program's guidance material, except where it is indicated that SIRA will administer the payment.

Insurers should have controls in place to prevent duplicate payments being made and claimed.

Premium calculation

In the same way as interpreter fees are excluded from premium setting, the cost of section 53 programs are not to be included in the cost of claim for premium setting purposes.

Reporting

All costs paid by the insurer that are associated with vocational re-education programs are to be reported in the insurance agent's monthly claim submission and monthly financial reporting returns.

These costs are for SIRA vocational programs including:

  • work trials
  • training
  • equipment and workplace modifications
  • financial incentives (JobCover placement program, JobCover6 and Connect2work)
  • transition to work
  • recover at work assist for small business.

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

To ensure transaction-level data is reported against each claim in the insurer's monthly claim submission for all vocational programs, the claims technical manual reporting requirements are to be used.

Reimbursements

Insurers can request reimbursement from SIRA for program costs. All claims for reimbursement must be substantiated. Substantiated means programs are approved and claims are supported by appropriate evidence of the expenses.

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.

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