The processes for monitoring, determining and applying all legislative entitlements relating to economic loss, and non-economic loss lump sum payments. 1.1.2 Medical Expenses s33 s34 s35 s62 s63 Reg 21 Reg 22 Reg 23 Reg 24 Reg 25 Injury management documents explain: The process for assessing, approving, claiming and rejecting a medical expense. The timeframe a worker can ordinarily expect reimbursement of medical expenses. How a provider will be notified and informed of their rights when charges have been disallowed or reduced. The notification and approval process for services that are approved in advance of the costs being incurred How and when an injured worker will be informed of the entitlement period relating to medical expenses will end. The process for: Claiming and assessing entitlements to compensation for property damage. Making payment of funeral benefits. Making payment for counselling services. Policy Procedure Standard letters Information kits Information Sheets Pro-forma Notice displays Intranet Training material 1.1.2 Weekly payments s39 s41 s42 s44 s59 Reg 27 Injury management documents explain: How entitlement periods will be monitored and changes to entitlements communicated to a worker (serious and non-serious injury claims). The Provision of written notification of a decision to the worker at least 14 days prior the end of the first designed period informing them of the 80% adjustment to designated weekly payments. The Provision of written notification to the worker at least 28 days prior the end of the second designed period informing them of the date weekly payments will cease. How weekly payments are calculated, reviewed and terminated with consideration of retiring age. In relation to death claims process steps involved in assessing the entitlements of dependent spouse or domestic partners including the review of weekly payments. Process for determining any supplementary allowances Notification process that informs the dependent spouse and/or child of the application process seeking commutation of weekly payments. Policy Procedures Calendars Standard letters Information kits Information Sheets Pro-forma Notice Board displays Intranet Training material
1.1.2 Income support for incapacity resulting from surgery s40 Reg 26 Injury management documents explain: The process steps for determining and documenting a worker’s entitlement to supplementary income support, How a worker will be informed of their rights to seek supplementary income support. How and when a worker can claim for supplementary income support. Whether the worker has “an incapacity for work” as a result of the approved surgery. The written notification to the worker informing them of the date supplementary payments commence and cease as well as the rate of those payments, including CPI adjustments. Policy Procedure Standard letters Information kits Information Sheets Pro-forma Notice Board displays Intranet Training material Topic RTW Act Specific Requirements to be Addressed Reference Document 1.1.2 Adjustments due to change from original arrangements s45 Injury management documents explain: The process steps involved when undertaking an adjustment to weekly payments. How a worker can make a request for a review of the calculation of the average weekly earnings rate. How a worker is advised of their rights to seek a review of the calculation of the average weekly earnings, including the manner the request must be made. The provision of notification to the worker. How the worker can make written representations regarding this review and when this information is required How provision of written notification to the worker setting out the decision, the grounds and evidence for the decision, when the decision effect, and the worker’s right to seek a review of the decision will occur. Policy Procedure Standard letters Information kits Information Sheets Pro-forma Notice Board displays Intranet Training material
Process for discontinuance of weekly payments on retiring age Process involving in making a determination regarding suspension of weekly payment where a worker is imprisoned. 1.1.2 Redemption of liabilities associated with weekly payments s49 s53 s54 Reg 31 Reg 32 Injury management documents explain process involved in reaching an agreement and entering into an arrangement to redeem the liability to make weekly payments or enter into a deed of release, including: Approval processes for entry into redemption offers and negotiations. Notification to a worker of requirements to seek professional, legal and financial advice. The setting of the amount of ongoing weekly payments that the redemption payment will discharge under s.49(2)Notification of payments to ReturnToWorkSA, Medicare and any other agency with a statutory power to recover from the workers redemption payment. Process steps involving in reaching an agreement and entering into an arrangement to redeem the liability to make payment of medical expenses. Policy Procedure Standard letters Information kits Information Sheets Pro-forma Notice Board displays Intranet Training materials 1.1.2 Permanent impairment – economic loss determination s55 s56 Reg 33 Injury management documents explain process steps involving in making a determination for permanent impairment – economic loss, including: The method used to determine the workers entitlement taking into account the workers age, WPI and “hours worked factor”. Notifying the worker of their right to seek a review of the decision. Notification of payments to ReturnToWorkSA, Medicare and any other agency with a statutory power to recover from the workers entitlement. Policy Procedure Standard letters Information kits Information Sheets Pro-forma Notice Board displays Intranet Training materials
1.1.3 Service Standards (NED) Sch 5 Injury management documents explain: Processes for making a claim Processes for lodging, recording, responding and resolving complaints, including: Communication arrangement to inform employees how to lodge a complaint Written notification process to the person who lodged the complaint notifying them of the outcome of the complaint, and any rights of review that may exist. The role of managers and supervisors in the development and review of recovery and return to work plan A self-insured employer’s commitment to: Provision of relevant information in a manner that aims to ensure ease of understanding. Communication of information that appropriately considers an injured worker’s cultural and linguistic diversity. The right of an injured employee to request a support person to be present at recovery and return to work meetings. Policy Procedure Standard letters Information kits Information Sheets Pro-forma Notice Board displays Intranet Training materials Standard 1 Condition of Registration as a self-insured employer Element 2 Resources A self-insured employer must have arrangements in place to ensure it has in place adequate resources to administer claims and provide effective return to work services to injured employees. These arrangements shall include: 1.2.1. Documented job descriptions for all injury management personnel and relevant, management, supervisors and employees.
Where further investigation is required the self-insured employer seeks any information necessary to determine if an expense is reasonable. Reasonable associated with immediate transportation to a hospital or health practitioner for initial treatment are paid. Reasonable costs associated with property damage are paid. 2.3.2 a self-insured employer receives an application made by a worker seeking advanced approval for the provision of services, a written determination must be issued to the worker and where approval is not given, state the ground for the decision and inform the worker of their right to apply to have the decision reviewed. s33 Documents on file demonstrate the self-insured employer has applied its procedures to ensure: Workers are informed of the right to apply for future services. Applications for pre-approval of services are determined within 1 of receipt in accordance with legislation. Claim files Standard 2 Claims Management Element 4 Income Support 2.4.1. AWE entitlements are determined in accordance with Part 4, Division 4 of the Act, including income support for incapacity resulting from surgery. 2.4.2. AWE calculations are made in accordance with section 5 of the Act and copies of information used to calculate AWE are held on file. 2.4.3. AWE is appropriately adjusted in all where a worker has previously redeemed entitlement to weekly payments. 2.4.4. AWE adjustments are made in accordance with section 45 of the Act. 2.4.5. AWE Reviews are made in accordance with section 46 of the Act. 2.4.6. Reduction/discontinuance of weekly payments is made in accordance with section 48 of the Act. 2.4.7. there has been a delay in the making of weekly payments and the delay was not the fault of the worker, then the self-insured employer shall calculate and apply interest at the prescribed rate to the amount in arrears within one month, and issue a written notice to the worker setting out details of the interest applied to the amount in arrears.
2.8.5 Where a worker has not returned to employment within 6 months from date of first incapacity and is not working to their full capacity, new or other employment options are considered for the worker when reviewing the plan. Section 25 Regulation 15,16,17 Documents on file demonstrate the self-insured employer has applied its procedures to ensure: Status of the worker’s return to work is documented on each occasion the recovery and return to work plan is reviewed. New or other employment options for the worker need to be taken into account in order to assist the worker to return to work in suitable employment. The objectives and goals of Plans reflect the obligation on the self-insurer to provide suitable employment. (Unless new or other employment options have not been agreed with the worker in accordance with s25(10) of the Act). Claim files 2.8.6 Where a self-insurer does not provide suitable employment, the self-insurer notifies ReturnToWorkSA. Code of conduct Documents on file demonstrate the self-insured employer has applied its procedures to ensure: Written notification to ReturnToWorkSA, and a self-insurer does not provide suitable employment to an employee who has some work capacity (Unless new or other employment options have not been taken into account in accordance with s25(10) of the Act). Within 7 days of assessing an inability to provide suitable employment or of suitable employment ReturnToWorkSA is notified in writing of the inability to provide suitable employment (Unless new or other employment options have not been agreed with the worker in accordance with s25(10) of the Act). files
and the Registrar must be notified as per the regulations of the details of the nominated officer. The Registrar at the SAET has been notified of the appointment of the Reconsideration Officer in the prescribed manner. 3.1.2 The reconsideration process must comply with Part 6, Division 4 of the Act. S102 Reg 43 Documents on file demonstrate the self-insured employer has applied its procedures to ensure: Reconsiderations processes are conducted by a suitable person within the stipulated timeframes. The person conducting the reconsideration reviews the decision and the evidence used as a basis for the decision. A person assigned to reconsider a decision is nominated to the registrar of the SAET. files Standard 3 Dispute Resolution Element 2 SAET Orders 3.2.1. Where a determination has been made by the South Australian Employer Tribunal (SAET) and an Order or direction issued, the self-insured employer must comply with the Order within the timeframe specific by the SAET. RTW Act Specific Requirements to be Addressed Reference Document 3.2.1 Where a determination has been made by the South Australian s99 s100 s101 s102 Documents on file demonstrate the self-insured employer has applied its procedures to ensure: Orders of the SAET are actioned within stipulated timeframes. Any other requirement of the SAET (including Tribunal rules) is met. files
Employer Tribunal (SAET) and an Order or direction issued, the self-insured employer must comply with the Order within the timeframe specific by the SAET. s103 Reg 43 Standard 4 Measurement, Monitoring and Review Element 1 Delegated powers and discretions 4.1.1. Processes are in that monitor, measure and review the effective implementation of delegated powers and discretions granted to a self-insured employer under the Act and where relevant, strategies to improve performance of the injury management system are identified. 4.1.1.1. The implementation and performance of the injury management system is reviewed against the, fundamental principles, rights and obligations within section 13 of the Act. 4.1.1.2. Delegated powers and discretion set out in section 134 of the Act. 4.1.1.3. Service Standards set out in Schedule 5, Part 2 of the Act. Topic RTW Act Specific Requirements to be Addressed Reference Document 4.1.1 Processes are in place that monitor, measure and review the effective implementation of the implementation and S13 The self-insured employer has undertaken defined and documented activities to confirm the effective implementation of its planned arrangements for: Ensuring early and timely intervention occurs to improve recovery and return to work outcomes including after retraining (if required); and Achieving timely, evidence decision-making that is consistent with the requirements of this Act; and System reviews. Internal Audits. Performance reports. Management Reports.