COMPARISON – CURRENT SCHEME AND NEW – 04 AUGUST 2014 AS PROVIDED BY WORKCOVER SA CURRENT SCHEME NEW SCHEME Rehabilitation and Compensation Return to Work Scheme Scheme/Agents/Self Insured manage Legislated requirements for provision of early implementation intervention, recovery, return to work, and retraining (where required) Eligibility Eligibility Arising out of or in the course of Employment a significant contributing cause of the employment (physical injury) injury (physical injury, secondary and disease) Employment contributed to the injury (secondary and disease) Employment the significant contributing cause Employment a substantial cause (psychiatric injury) (psychiatric injury) Income maintenance Income maintenance • 0 – 13 weeks – 100% • 14 – 26 weeks – 90% • 0 – 52 weeks – 100% • From 27 weeks – 80% • 53 – 104 weeks – 80% • Work Capacity Review at 130 weeks • Payments cease at 104 weeks unless seriously injured i.e. a whole person impairment (WPI) of 30% or more in which case payments remain at 80% until retirement Periods based on aggregated Periods based on elapsed weeks entitlement weeks Only serious injured workers receive annual Annual economic adjustment for income economic adjustments for income support maintenance The Federal minimum wage is used as a safety net Step–downs can reduce workers below for average weekly earnings and step the minimum wage No Provisional liability, instead interim benefits must Gallagher Bassett South Australia, John Cvetko 0417 100 274, Jarrad Wegener 0439 944 116 Provisional liability in place be offered if a determination is not made within 10 business days Working directors treated the same as others workers Income support level is capped for working directors to their declared remuneration Retirement age is 65 years Retirement age linked to federal aged pension age A Ministerial direction prevents WorkCover from deeming that a worker Income support may be ceased if there is capacity has capacity and ceasing payments prior to work in suitable employment, regardless of to 2 ½ years employment availability, providing no less than 6 months’ notice is given to the worker Employer requests for reimbursements of income maintenance payments can Employer reimbursement requests for weekly be submitted at any time and this payments must be within 3 months practice is not covered by the Act Permanent Impairment lump sum Permanent Impairment lump sum payments payments Eligibility threshold of WPI 5% and above Eligibility threshold of WPI 5% and Only one permanent impairment assessment per above claim Multiple permanent impairment $472,000 and be indexed from 01 Jan 2015 assessments and multiple permanent No dependency test when calculating lump sums for lump sum payments occur on one claim death claims and income from invested lump sums The maximum lump sum for permanent cannot be included in future reviews of income impairment is $471,747 (01 Jan 2014) Statutory economic loss payments available to Dependency of surviving spouse affects workers with a whole person impairment loss of the entitlement to a lump sum for death between 5% and 29% (e.g. max $350k at 25 years old and 29% WPI / $70k at 65 years old and 29% WPI). Permanent Impairment assessors Permanent Impairment assessors Accreditation scheme established and Appointed by the Minister on the recommendation of managed by WorkCover the Advisory Committee Redemptions Redemptions Available under only under certain Redemptions only by agreement of both parties. circumstances (weekly payments do not Current limitations removed exceed $30, the worker is at least 55 years and has no work capacity, or as approved by the Tribunal) Rehabilitation services Recovery and return to work services Rehabilitation programmes can be put in Rehabilitation programmes have been combined place for workers, workers of a particular with return to work plans to create recovery /return class, or injuries of a particular class to work plans Rehabilitation and return to work plans Recovery/return to work plans must be put in place must be put in place at 13 weeks (with at 4 weeks (with certain exceptions) certain exceptions) Return to work obligations Return to work obligations Employers have an obligation to return WorkCover has strengthened obligations to return workers to suitable employment (subject workers to suitable employment or provide suitable to certain exceptions) training • If the employer has less than 10 Employers have an obligation to support injured employees that obligation ceases 1 year workers including participating in recovery/return to after the work injury work plans Workers can request that WorkCover investigate an employer if the worker has reason to believe the employer has suitable employment available for the worker. The worker can also apply to the Tribunal for the employer to provide suitable employment Workers have an obligation to return to suitable employment if they have capacity to perform work Seriously injured workers (30% or more WPI) do not have return to work obligations, unless they wish to do so Dispute resolution Dispute resolution Workers Comp Tribunal manages Move to South Australian Employment Tribunal workers compensation matters Income maintenance can continue (on request) in Income maintenance reduces or ceases relevant disputes during dispute resolution on expiry of notice period Employment Tribunal to access Independent Medical panels consider a range of Medical Advisers within the Medical Advisors Board medical questions when required Only questions of law proceed beyond Only questions of law proceed beyond the the Workers Comp Tribunal to the Employment Tribunal to the Supreme Court, with Supreme Court, with costs following the costs following the event event WorkCover Ombudsman WorkCover Ombudsman Reviews certain issues about the The office and position of the WorkCover operation or administration of the Act Ombudsman will cease to exist Code of claimants rights Service Standards S.123B provides for a Code of Claimants WorkCover, self-insured employers, claims agents Rights to be prescribed regulation. To and service providers must adopt and apply the date no regulation has been made. service standards set out in Schedule 5. A Worker or an employer who has a concern about a breach of the standards may i. If it relates to WorkCover, make a complaint with the State Ombudsman; or ii. If it relates to a self-insurer, make a complaint to WorkCover To be registered as a self-insurer, employers must adopt and apply the service standards Recovery from third parties Recovery from third parties The worker must either pursue the third When recovering from third parties, WorkCover can party for recovery or WorkCover can enter into a deed of release to pay the worker the pursue the third party in its own right. If damages received in excess of the compensation WorkCover receives damages that already paid exceeds the amount of compensation The specific contributory negligence provision has already paid to the worker, the only way been removed for this excess to be paid to the worker is through a cost neutral redemption Contributory negligence provision was introduced in 2012 to ensure contributory negligence was taken into account Worker Rehab and Compensation Ministers Advisory Committee Advisory Committee Advises on a policy and investigates Advises on matters requested by the Minister or on work related injury and disease- must own initiative – no prescribed number of meetings meet 6 times a year Recommends permanent impairment assessors Reports to advise the Minister on own Participates in selection of Independent Medical initiative or at the request of the Minister Advisers Carries out other functions as Carries out other functions as determined by the determined by the Minister Minister Premiums Premiums Premium provisions and orders make Premium provisions and orders no longer make the the distinction between claim costs distinction between claim cost associated with associated with primary and secondary primary and secondary injuries injuries The Remissions and Supplementary Payments The Remissions and Supplementary scheme must be approved by the Minister Payments scheme is regulated with the details appearing in the Gazzette Includes a supplementary payment if employer is paying worker below the federal minimum wage Industry Rates are capped at 7.5% No statutory industry rate cap Average Premium rate 2.75% (3.34% real cost) Average Premium rate between 1.5% and 2.0% (saving employers $180 million) WHOLE ADJUSTED EXAMPLE OF CALCULATION TO SHOW ADJUSTMENT FOR AGE PERSON STATUTORY (NOTE: IF WORKER IS WORKING PART TIME, THEN THERE IS IMPAIRMENT WPI LUMP SUM ALSO AN ADJUSTMENT FOR PART TIME) ADJUSTED PAYMENT IF WORKER IS 25 YEARS OR ADJUSTED PAYMENT IS WORKER IS 65 YEARS AT YOUNGER AT DATE OF INJURY DATE OF INJURY 0 to 4% $0.00 Not applicable Not applicable 5% $11,800.00 $5,000.00 $1,000.00 10% $20,768.00 $41,342.00 $8,268.00 15% $31,624.00 $86,453.00 $17,291.00 20% $45,920.00 $153,296.00 $30,659.00 29% $107,449.00 $350,000.00 $70,000.00 $0.00 Not applicable Not applicable 30% to 100%
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