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 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 takes 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
1.2.2. Ensuring injury management personnel are competent to administer the self-insured employers delegated powers and discretions in a reasonable manner. 1.2.3. Ensuring the allocation of resources is appropriate for the organisations type, volume and complexity of the case load. 1.2.4. Suitability of facilities and accommodation to ensure restricted access to information, including maintaining confidentiality during interaction with injured workers and service providers. 1.2.5. A self-insured employer must appoint a return to work coordinator and ensure the person appointed to this role has successfully completed relevant training. Where this role becomes vacant, the self-insured employer must re-appoint an employee within 3 months and ensure the employee(s) appointed have received relevant training within 3 months of the appointment being made. Topic RTW Act Specific Requirements to be Addressed Reference Document 1.2.1 Documented Job Descriptions 129(11) s26 Reg 18 Documented job description(s) define responsibilities and delegation for: Claims decision makers covering financial and liability decisions. Return to work coordinator(s). Managers and supervisors(s). Any other relevant person. Injury management documents explain: Arrangements to identify and manage any conflict of interest issues that may arise. Arrangements to identify and manage disagreement between the delegated decision maker and other officers of the self-insured employer. Policy Procedure Standard letters Information kits Information Sheets Notice Board displays Intranet Training materials
A self-insured employer shall provide all relevant data set out in Schedule 3, Part 5 of the RTW Regulations 2015: 1.4.1. Fortnightly, unless an alternative arrangement has been agreed to by ReturnToWorkSA. 1.4.2. All errors at batch and line level shall be resolved within one month of receiving the data transmission return file. 1.4.3. A self-insured employer must notify ReturnToWorkSA at least one month prior to the implementation of any change to the workers compensation data system. RTW Act Specific Requirements to be Addressed Reference Document 1.4.1 Fortnightly provision of data Reg 2015 – Sch 3 Injury management documents explain and ensure: The process for providing Third Schedule data to ReturnToWorkSA; include roles and responsibilities of key personnel. Where the timeframe for the provision of data cannot be complied with, the procedures must explain how ReturnToWorkSA will be notified and the arrangements to conform to an alternative arrangement agreed to by ReturnToWorkSA. Policy Procedure Technical Manuals 1.4.2 All batch and line errors to be resolved within one month Reg 2015 – Sch 3 Injury management documents explain and ensure: Errors with data reporting are rectified within one month, and where the correction cannot be made with one month, the process for informing and seeking an alternative arrangement agreed to by ReturnToWorkSA. Policy Procedure Technical Manuals 1.4.3 Notification of change to the workers compensation data system Reg 2015 – Sch 3 Injury management documents explain and ensure: Where a change or upgrade to the system is planned, ReturnToWorkSA is notified of this proposed change. Policy Procedure Technical Manuals Standard 1 Condition of Registration as a self-insured employer Element 5 Financials A self-insured employer shall provide to ReturnToWorkSA:
Topic RTW Act Specific Requirements to be Addressed Reference Document 2.1.1 All decisions and determinations are identifiable and relevant supporting notes and documents maintained. Various Documents on file demonstrate the self-insured employer has applied its procedures to ensure retention of all relevant records. Claim Forms Investigations Authorisation by delegated person(s) General correspondence (including emails) Determinations Legal Correspondence (not subject to legal privilege) Medical Reports AWE Calculations File Notes Payroll records RRTW Plans, progress reports Agreements (i.e. redemptions) Statutory notices (i.e. lump sum returns; Medicare) Any other documentation relevant to the claim/RTW process files 2.1.2 Notices and information are provided in accordance with RTW Act requirements. Various Documents on file demonstrate notices and information required under the Act are provided, examples: Acceptance and rejections Notice of interim payments Discontinuance Entitlement periods Reviews Reconsiderations Claim files
Interest on back pay entitlements provided where applicable. Interim decisions are based on evidence from a medical practitioner. Interim decisions are made following consultation with the worker. Standard 2 Claims Management Element 6 Permanent Impairment – Economic Loss & Non-Economic Loss 2.6.1. Determinations of entitlement to economic and non-economic loss are issued in writing and detail the calculation applied to determine the economic and non-economic loss lump sum entitlements and the workers’ rights to a review of the decision. 2.6.2. Within one month from the date the determination notice was issued to the worker, the self-insured employer must provide ReturnToWorkSA with a completed Notice of Lump Sum Determination Return, including all relevant supporting documentation. Topic RTW Act Specific Requirements to be Addressed Reference Document 2.6.1 Determinations issued in writing, include calculation applied and the worker’s review rights. s22 Documents on file demonstrate the self-insured employer has applied its procedures to ensure: WPI Assessments are undertaken where injury is stabilised. Consultation occurs with worker with respect to assessment. Claim files 2.6.2 Provision of the Notice of Lump Sum Determination Return, including all s22 Code of conduct Documents on file demonstrate the self-insured employer has applied its procedures to ensure: ReturnToWorkSA is notified (including provision of required documentation) of any assessment of WPI and lump sum payment for non-economic loss or economic loss. Claim 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. Claim 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. Topic 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. Claim files
Standard: Condition of Registration as a Self-insured Employer 1 Element: Financials 1.5 Sub Element: A self-insured employer provide to ReturnToWorkSA: A copy of financial statements within 5 months of the self-insured audited employer’s financial year end date, or within an alternative timeframe approved by ReturnToWorkSA. 1.5.1 An actuarial report on the outstanding workers compensation liabilities of the employer within 3 months of the self-insured employer‘s financial year end date or within an alternative timeframe approved by ReturnToWorkSA. 1.5.2 The self-insured employer shall provide a financial guarantee that meets all the terms and conditions set out in written correspondence issued by ReturnToWorkSA. 1.5.3 A self-insured employer shall provide to ReturnToWorkSA a contract of insurance that meets all requirements set out in Schedule 3, Part 9 of the Return to Work Regulations 2015. 1.5.4 Outcome: Evidence