Standard of practice principles

Commencement date: 21 October 2019

Standard of practice principles articulate the core outcomes that should drive insurer claims administration and conduct at various points in the life of a claim. It is expected that insurers will adhere to these standard of practice principles from 1 January 2019.

Standard Principle
Standard 1:
Worker consent
The confidentiality of workers’ personal and health information will be respected at all times and workers’ personal and health information will be dealt with only in accordance with their consent.
Standard 2:
Worker access to personal information
Workers will be provided with convenient and timely access to their personal and health information in accordance with relevant privacy and workers compensation laws.
Standard 3:
Initial liability decisions – general, provisional, reasonable excuse or full liability
Liability decisions will be informed by careful consideration of all available information and proactive consultation with the worker and employer.
Standard 4:
Liability for medical or related treatment
Liability decisions will be informed by careful consideration of all available information and proactive consultation with relevant stakeholders.
Standard 5:
Recurrence or aggravation of a previous workplace injury
All available evidence will be considered to determine whether an injury is the recurrence of a previous injury or a new injury, and all reasonable support will be provided to the worker in either case.
Standard 6:
Claims will be screened early to determine whether any third-party recoveries are to be pursued.
Standard 7:
Interim pre-injury average weekly earnings calculation
Weekly payments to workers will commence as soon as possible. Workers will not be disadvantaged if the insurer has not been able to obtain all information required to calculate PIAWE, or if an insurer has not yet approved a PIAWE agreement.
Standard 8:
Insurer making weekly payments
The rights and responsibilities of all parties will be respected in circumstances where weekly payments will be made by the insurer.
Standard 9:
Reduction in payments of compensation
Workers will be provided with notice in advance before a statutory step-down in their weekly payments.
Standard 10:
Payment of invoices and reimbursements
Workers and providers will receive prompt payment of invoices and reimbursements for medical, hospital and rehabilitation services.
Standard 11:
Changes in capacity
A worker’s work capacity will be re-assessed promptly upon receipt of new information indicating a change in work capacity.
Standard 12:
Injury management plans
Injury management planning will be undertaken in a timely and proactive manner to support workers’ treatment, rehabilitation and return to work.
Standard 13:
Additional or consequential medical conditions
Prompt action will be taken to assess and address any additional or consequential medical condition identified on a certificate of capacity.
Standard 14:
Referral to an injury management consultant
Injury management consultants will be engaged to assist workers identified as at risk of delayed recovery and in circumstances where a specific issue has been identified.
Standard 15:
Approval and payment of medical, hospital and rehabilitation services
Prompt consideration will be given to approving medical, hospital and rehabilitation services and payment will be made as soon as practicable after services are invoiced.
Standard 16:
Case conferencing
Case conferences will be conducted in a manner that promotes return to work and respects the worker’s right to confidential medical consultations.
Standard 17:
Section 39 Notification
Workers affected by the 260-week limit to weekly payments will be provided with appropriate notice before the cessation of weekly payments.
Standard 18:
Retiring age notification
Workers affected by the 12-month limit to weekly payments after a worker reaches retirement age will be provided with appropriate notice prior to the cessation of weekly payments.
Standard 19:
Section 59A notification
Workers whose medical benefits are due to cease will be provided with appropriate notice before the cessation of those benefits.
Standard 20:
Permanent impairment assessment reports
Permanent impairment assessment reports will be objectively evaluated to ensure correct and consistent assessment for the determination of entitlements.
Standard 21:
Negotiation on degree of permanent impairment
Where appropriate, parties will be encouraged to consider negotiating and agreeing the degree of permanent impairment.
Standard 22:
Insurer participation in disputes and mediations
All parties will participate in Commission teleconferences, conciliations/arbitrations and mediations in good faith and with a view to achieving the timely and effective resolution of disputes.
Standard 23:
Recovery of overpayments due to insurer error
Risks relating to overpayment or duplication of payments to workers will be mitigated where practicable while ensuring efficient management of claims, and overpayments will be managed in a fair and transparent manner.
Standard 24:
Factual investigations
Factual investigations will only be used when necessary and will always be undertaken in a fair and ethical manner.
Standard 25:
Decisions to engage surveillance services will be based on firm evidence; surveillance will be conducted in an ethical manner; and information obtained through surveillance will be used and stored appropriately.
Standard 26:
Arrangement for payments to Medicare Australia
Due care will be given in the management of claims to mitigate risks arising from the interaction between Medicare and the workers compensation scheme.
Standard 27:
Notification and recovery of Centrelink benefits from lump sum payments
The implications of lump sum payments for Centrelink benefits, including possible repayments to Centrelink or temporary preclusion from Centrelink benefits, will be proactively managed to minimise impacts on workers.
Standard 28:
Interpreter services
Workers will have access to qualified and culturally-appropriate interpreter services in the worker’s nominated language.
Standard 29:
Cross-border provisions
Workers who work in more than one State or Territory will be provided with assistance to understand their entitlement to compensation.
Standard 30:
Closing a claim
All relevant stakeholders will be notified prior to the closure of a claim.
Standard 31:
Death claims
Death claims will be managed with empathy and respect, and liability decisions and payment of entitlements in relation to death claims will be prioritised and not unnecessarily delayed.
Standard 32:
Managing claims during the COVID-19 pandemic
Insurers will be flexible and adaptable during the COVID-19 pandemic and ensure that claims are managed with empathy and transparency, making liability decisions and paying entitlements without delay.