Recent changes to Queensland s Workers Compensation Scheme

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Miles Green
8 years ago
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1 Recent changes to Queensland s Workers Compensation Scheme EVERYTHING OLD IS NEW AGAIN almost Presentation on 1 October 2015 Jacqi Marshall, Senior Associate Section 193A Additional lump sum compensation for particular workers (1) This section applies to a worker who sustained an injury on or after 15 October 2013 and before 31 January 2015, if (a) the worker s injury (i) results in a DPI of 5% or less; and (ii) is not a terminal condition; and (b) the worker has not accepted or rejected an offer of lump sum compensation from an insurer under section 189. (2) The worker is entitled to additional lump sum compensation for the injury (a) up to an amount prescribed by regulation; and (b) subject to the conditions prescribed by regulation. (3) A regulation may provide for the establishment of a panel of appropriately qualified persons to review a decision of an insurer about whether a worker is entitled to addition lump sum compensation under this section. 1

2 Specified Workers Applies only: To injuries between 15 October 2013 and 30 January 2015 If the worker s injury is assessed with a DPI of 5% or less (and is not a terminal condition) The worker has not already accepted or rejected their offer of lump sum compensation Section 193A For those workers whose DPI was decided prior to the commencement of the section and who are also specified workers on commencement, the insurer must as soon as practicable decide the matters in s112f of the Regulations. For those workers who have not yet had their DPI decided, the insurer must notify the worker of their entitlement to section 193A compensation in the notice of assessment. 2

3 Graduated Scale DPI - % DPI amount - $ 1 6, , , , ,490 Regulations Section 112D qualifying condition A specified worker is entitled to s193a compensation only if (a) (b) The insurer is satisfied, on the balance of probabilities, the worker s employer is, or would have been, liable to pay damages to the worker; but The worker can not seek damages because of the application of former section 237(1)(a)(i). 3

4 Process for deciding qualifying condition Does the insurer have enough information to decide whether the qualifying condition is satisfied for the worker? Yes No next slide Is the qualifying condition satisfied Yes No s193a notice - amount of the compensation payable s193a notice a. Insurer s decision b. Worker may ask for written reasons c. The worker may apply to the panel for a review only if they have asked for reasons for decision See panel review process Process for deciding qualifying condition Does the insurer have enough information to decide whether the qualifying condition is satisfied for the worker? No s193a notice a. Insurer s decision b. That the worker may within 60 business days give information to enable a decision c. If information not provided within 60 business days: (i) The qualifying condition will be taken not to be satisfied for the worker; and (ii) Worker not entitled to s193a compensation; and (iii) Worker has no right to apply to the panel for a review of (i) and (ii). The worker a. May give information relevant to the decision within 60 business days after receiving the notice; and b. If they give information they must advise whether they have engaged a lawyer and incurred legal costs in giving the information. c. May ask for an extension of the 60 business days The insurer may decide to allow an extension of the time above if reasonable excuse given The worker does not provide information The worker does provide information Qualifying condition is taken not to be satisfied and no review possible. The insurer must consider the information and decide whether the qualifying condition is satisfied. 4

5 Process for deciding qualifying condition The insurer must consider the information and decide whether the qualifying condition is satisfied. The insurer must make a decision within the later of: a. 60 business days after receiving the information b. If the insurer meets with the worker under section 112K 10 business days after the meeting Is the qualifying condition satisfied No Yes Before making the decision the insurer must: a. Give the worker an opportunity to meet the insurer to discuss the proposed decision b. If the worker agrees to meet, give them any relevant information held by the insurer at least 10 business days before the meeting s193a notice - amount of the compensation payable The insurer must give the worker written reasons for the decision No Is the qualifying condition satisfied Yes If no decision within timeframe insurer taken to have decided not satisfied Panel review process Entitlement to seek review of the insurer s decision The worker has received written reasons that the insurer s decision is that the qualifying condition is not satisfied The worker has provided information to the insurer and no decision was made during the prescribed period The worker may apply to the panel for review within 20 business days after the worker receives the written reasons for decision The worker may apply to the panel for review within 20 business days after the worker becomes aware that the insurer has failed to decide whether the qualifying condition is satisfied within the prescribed period The worker s application must include: a. The worker s reasons for asking for a review of the decision; b. The written reasons for decision if received; c. If the worker has not already had a opportunity to provide information to the insurer, any information they want the panel to consider; d. If the worker has engaged a lawyer and incurred legal costs in relation to the application, a statutory declaration to this effect. The insurer must, as soon as practicable after receiving the workers application, give the panel and worker any information the insurer considered in their decision. 5

6 Panel review process Review by the panel The panel must consider the application and the insurer s decision and decide to: a. Confirm the decision; or b. Cancel the decision and substitute a new decision. The panel must give the worker and insurer written notice of and reasons for their decision The panel confirms the decision that the qualifying condition is not met. The panel cancels the decision and substitutes a decision that the qualifying condition is met. No s193a compensation is payable but the worker can still accept their original lump sum offer. The insurer issues a s193a notice stating the amount of compensation payable Important points The new regulations provide their own review process and the decision of the panel is final it is not a reviewable decision to the regulator. There is no right of review for the employer if they are aggrieved by the insurer s decision and there is no requirement for the employer to be consulted. If the worker has multiple injuries, they only have entitlement to one payment for the higher of the DPI percentages in the NOA. 6

7 Legal costs payable under the Regulations Circumstance Giving information to an insurer under section 112I within the period mentioned in the section The worker and the worker s lawyer attending a meeting mentioned in section 112K Legal cost amount $ 1,700 2,000 The worker, under section 112N, applying to the 1,000 panel to review an insurer s decision The worker giving information to the panel under section 112N(2)(c) 1,700 Total potential exposure Total potential Total exposure s193a compensation including DPI - % compensation $ maximum costs $ $ ,298 9,447 14, ,596 18,894 23,594, 3 18,894 28,341 33, ,192 37,788 42, ,490 47,235 51,935 7

8 Thank you JACQI MARSHALL, SENIOR ASSOCIATE Phone j.marshall@hopgoodganim.com.au 8

Recent changes to Queensland s Workers Compensation Scheme

Recent changes to Queensland s Workers Compensation Scheme EVERYTHING OLD IS NEW AGAIN almost Presentation on 1 October 2015 Robert Tidbury, Partner The previous position for workers entitlement to seek