WS016 REHABLITATION AND RETURN TO WORK POLICY

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1 WS016 REHABLITATION AND RETURN TO WORK POLICY NEW SOUTH WALES Purpose EI is committed to the rehabilitation of workers who are injured at work. This policy outlines how EI will aim to ensure such workers are able to remain working, or return to work as quickly as possible. This policy will also set out employees rights and responsibilities in regard to rehabilitation and return to work, while also outlining the process to lodge a claim for workers compensation. Scope This policy applies to all workers of EI who are engaged to work on a client worksite and is to be used when a worker believes they have genuinely sustained a workplace injury. For the purpose of this policy, a worker is a person who is covered under an existing workers compensation policy of EI. A workplace injury is a medical condition or injury which has resulted from an incident related to work. Work related incidents can be a one off event, or a series of events which occur over a period of time and are directly related to the workers employment. This policy may also apply to workers who believe they have aggravated a pre-existing condition or injury as a result of a work related incident. This policy is not to be used in circumstances where a worker has sustained an injury or aggravated a pre-existing condition in an incident unrelated to the workplace. Any such condition, injury or aggravation will be managed directly between the worker, the relevant Human Resource Business Partner and worksite manager/supervisor in line with the workers legislative entitlement to personal/carers leave. If a worker is unsure as to whether a condition/injury or an aggravation of a pre -existing condition / injury is attributable to a workplace incident, they are able to seek a medical opinion for clarification and/or commence to lodge a workers compensation claim in line with this policy. Should it be determined that the condition, injury or aggravation is not attributable to work, management of the workers return to work will refer back to the relevant Human Resource Business Partner and be managed under the employee s legislative entitlement to personal/carers leave. References EI will comply with the relevant jurisdictional work safe legislation and regulations, the Fair Work Act and other relevant legislation and industry standards. EI acknowledges this policy was prepared with reference to Codes of Practice and guides prepared by relevant state safe work authorities. To the extent this policy describes benefits and entitlements; these are discretionary in nature and are not intended to be contractual or binding on EI. If the policy specifies an entitlement granted under federal or state legislation, then this entitlement arises from this legislation and not EI and as such may change from time to time following relevant legislative amendments. This procedure does not form part of a workers contract of employment, however failure to comply with the procedure may lead to disciplinary action up to and including the termination of employment and/or other legal action. Issue Date: 01/12/2014 Reference: WS016 Rehabilitation and Return to Work Policy NSW Page 1 of 5

2 This policy may be amended from time to time at the discretion of EI. Return to Work Coordinators EI s Return to Work Coordinators (RTWCs) hold the day to day responsibility in the implementation of EI s injury management system and play a pivotal role in the successful return to work of injured workers. EI has appointed the following people to this role who can all be reached on the NSW office mainline: 1. NSW HR Business Partner; 2. NSW HR Coordinator. EI NSW MAIN OFFICE NUMBER RTWC s will work with the injured worker, worksite supervisors and/or managers, treating medical practitioners, medical experts, vocational rehabilitation providers and insurers to coordinate and monitor rehabilitation in the workplace. Incident/Injury Reporting An incident is any event at work which did, or had the potential to, cause injury. Workers are required to report incidents to their worksite supervisor/manager within 24 hours of the incident occurring. Your worksite supervisor/, manager is responsible for then notifying EI of an incident taking place. You are also able to inform EI directly of an incident occurring through the use of EI s Accident/Incident report form. Completed report forms can be faxed or ed to one of EI s RTWC s. Completed forms can be faxed or ed to: Fax: (02) What will EI do upon receipt of an Injury Report? Upon receipt of an incident report, one of EI s RTWCs will make contact with the injured employee. The RTWC will consult with the employee to determine the underlying causes of the incident. This information will then be used in order to allow EI to consult with the client worksite supervisors /managers in order to implement control measures which aim to prevent a similar incident causing injury again. The RTWC will also assist an employee lodge a claim for workers compensation should the employee incur an y medical costs and/or lost time due to the incident. Should a worker sustain injury but at the time of reporting the incident to EI are yet to incur lost time or medical expenses, EI will notify its Workers Compensation Insurer in anticipation of a claim. How to lodge a claim for Workers Compensation If a worker believes they have sustained an injury due to a work related incident they are entitled to lodge a claim for workers compensation. As soon as possible after sustaining an injury a worker should se e a doctor of their choice and request they complete a Work Cover Certificate of Capacity. The Work Cover Certificate of Capacity and any associated medical invoices should then be sent to one of EI s workplace rehabilitation coordinators. EI then has a legal requirement to notify the insurer and lodge all necessary Issue Date: 01/12/2014 Reference: WS016 Rehabilitation and Return to Work Policy NSW Page 2 of 5

3 paperwork within 48 hours of receiving the documents. EI or EI s Workers Compensation Insurer may then request an injured worker complete a workers claim form. Injured workers are required to comply with such requests. EI s Workers Compensation Insurer must begin making weekly payments within 7 days of being notified of an injury, unless there exists a reasonable excuse not to do so. Within this 7 day period, EI s workers compensation ins urer will advise an injured worker if their claim for compensation has been; A. Accepted Upon acceptance of a claim weekly payments for compensation will commence if the injured worker is incapacitated for work. Further information on payments can be found later in this policy. B. Provisionally Accepted In some instances a claim for compensation may not be immediately accepted by EIs workers compensation insurers. In such instances the claim may be provisionally accepted which allows EI s workers compensation insurer to commence making weekly payments for compensation without admitted liability, allowing EI s insurer additional time to make a final decision on liability. Final liability decisions must be made within 12 weeks of a claim being provisionally accepted. C. Declined In some instances, a workers claim for compensation may be declined. In such instances neither EI nor EI s Workers Compensation insurer are liable for the payment of lost time and/or medical expenses. If you are unhappy with the decision, you have a right to appeal. Further information on appeals can be found in the disputes section of this policy. Disputes If an injured worker is unhappy with a decision made by EI s Workers Compensation Insurer, in the first instance they are able to contact WorkCover s Customer Service Centre on or the WorkCover Independent Review Office (WIRO) on to obtain further information and advice. If the injured worker decides they wish to have a decision formally reviewed they should firstly complete a disput e notice application form which is attached to the notice letter sent to them by the insurer to inform them of their initial liability decision. The completed form should then be forwarded to EI s Workers Compensation Insurer who will respond within 14 days. Should the worker still not be satisfied with the decision they are able to then lodge a dispute with the Workers Compensation Commission. The Workers Compensation Commission can be contacted and further information on disputes obtained by calling or online via At any stage, a worker is able to contact the WIRO who has the power to investigate and make recommendations regarding a workers complaint/dispute. Rehabilitation 1. Medical Certificate of Capacity An injured workers treating doctor must provide a Work Cover Certificate of Capacity in order to allow a claim for Workers Compensation to be made. Once a claim is accepted an injured workers nominated treating doctor will direct medical treatment and review progress through regular certificates of capacity, until the injured worker is Issue Date: 01/12/2014 Reference: WS016 Rehabilitation and Return to Work Policy NSW Page 3 of 5

4 capable of completing their pre-injury duties or other meaningful employment. Workcover Certificates of Capacity are an important part of managing an injured employees return to work as they set the workers capacity for work and required medical treatment. Furthermore, in order to be eligible to receive payments for lost time and medical expenses, an injured worker must present with a valid and c urrent certificate of capacity. 2. Payments For employees who have had a claim for workers compensation accepted, they will be entitled to payment for lost time and reasonable medical expenses. Weekly entitlements (known as Pre Injury Average Weekly Earnings or PIAWE) for compensation are paid in accordance with applicable industrial instruments and are calculated as the average weekly wage for the employee over the 52 week period prior to them having sustained the injury. An employee s entire service will be used to calculate average weekly wages if they have been employed for a period less than 12 months. An injured worker who is in some way incapacitated for work is entitled to the following weekly benefits; 0 to13 weeks 95 % of PIAWE less any current earnings. 14 to 130 weeks 80% of PIAWE less any current earnings. Where the worker has capacity for work and is working 15 hours or more per week the weekly payment is made up of 95 % of PIAWE less any current earnings. A worker will not be entitled to weekly payments after receiving weekly payments for 130 weeks unless; The worker has completed an application for continued weekly payments and; Is working 15 hours or more per week and earning at least $168 per week and has been assessed by the insurer as indefinitely incapable of undertaking further employment to increase their earnings or; The worker is seriously injured with greater than 30 per cent permanent impairment. If the injured worker is entitled to payments beyond 130 weeks, weekly entitlements are calculated based on the lesser of: 80 per cent of PIAWE minus current weekly earnings or the amount that has been assessed as being able to be earned in suitable employment and the value of any deductible amount, or The maximum weekly compensation amount minus any current weekly earnings and the value of any deductable amount. Seriously injured workers are exempt but will be subject to a work capacity assessment at least every two years. Payments for compensation will cease after 260 weeks (five years) of weekly payments except for: seriously injured workers (workers with greater than 30% permanent impairment) workers with greater than 20% permanent impairment who have no work capacity (and likely to continue indefinitely) or who are working 15 hours or more and earning at least $168 or more per week and who are indefinitely incapable of undertaking further employment to increase their earnings. An employee s weekly entitlement for compensation will be paid to an employee in line with their usual pay cycle. EI will only process payment for weekly entitlements if: Issue Date: 01/12/2014 Reference: WS016 Rehabilitation and Return to Work Policy NSW Page 4 of 5

5 The claim has been accepted in full by our Workers Compensation Insurer, and; A valid and current certificate of capacity has been presented. Reasonable medical expenses are also able to be claimed if a claim for workers compensation has been accepted. Such expenses can include expenses incurred through GP, physio, medicine and other treatment providers. EI s Workers compensation insurer will only approve the payment of such expenses after determining that they were reasonably necessary, and in many instances will require expenditure to be pre-approved. Medical expenses are only payable to an injured worker for 12 months after having sustained the injury, unless weekly payments for compensation are still being made. 3. Return to work programs A return to work program (RTWP) will be developed by one of EI RTWCs when: a) A treating doctor indicates to EI in writing, that an RTWP is required, or; b) When EI receives a certificate of capacity stating an injured employee has regained some capacity for work. RTWP s will be developed based on the advice of the injured worker and their nominated treating doctor. In some situations, EIs RTWCs may outsource this function to an accredited workplace rehabilitation provider. An example of a situation where an accredited Rehabilitation provider may be used is where an onsite assessment is required to identify available suitable duties on site. RTWP s will be reviewed in line with progress certificates of capacity and/or on the advice of the employees treating doctor. Workers should also be aware that if they choose not to cooperate with a RTWP, and refuse the reasonable suitable duties offered, their benefits may be stopped or reduce. Confidentiality Participants of a RTW process should be aware of, and respect the confidentiality of information on individual RTW programs. Confidentiality will normally cover doctors certificates and other medical advice, rehabilitation assessments and RTW plans. Issue Date: 01/12/2014 Reference: WS016 Rehabilitation and Return to Work Policy NSW Page 5 of 5

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