WORKERS COMPENSATION AND REHABILITATION QUESTIONS AND ANSWERS

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1 WORKERS COMPENSATION AND REHABILITATION QUESTIONS AND ANSWERS The Work Health & Safety Unit has responsibility for the management of workers compensation claims and the rehabilitation of injured employees. A number of commonly asked questions are outlined below with general answers which can be used as a guide for employees in relation to workers rehabilitation and compensation matters. Further information can be obtained from: Cheryl Hughes Workers Compensation Administrator Ph: Fax: or Workers.Compensation@utas.edu.au

2 Information about Workers Compensation Entitlement to Workers Compensation: If you suffer an injury at work which arises out of or in the course of your employment with us you may be entitled to workers compensation. In some cases you may be entitled to workers compensation if you suffer a recurrence or an aggravation of some pre-existing injury or disease where your employment with us is the major or most significant factor contributing to that recurrence or aggravation. Some injuries are referred to as diseases. If you suffer a disease you may be entitled to workers compensation if work has been the major or most significant factor in relation to that condition. Insurer Details: The University is currently insured with Allianz Australia Insurance Ltd. Who can Claim? All casual, fixed-term and permanent employees of the University are eligible to claim for Workers Compensation, whilst contractors and students are not. If a student has an injury on campus they should contact their Student Association/Union for assistance. Making a Claim: Q. How do I make a claim for workers compensation? A. 1. Report an injury to your supervisor as soon as practicable. 2. Obtain a worker s compensation certificate from your doctor. You need to have a worker s compensation certificate before your claim is complete. 3. Obtain a worker s compensation claim form by phoning Cheryl Hughes on ext Complete and lodge the claim form and the workers compensation medical certificate with the Work Health & Safety Unit. You should also have completed an online Incident Report or complete an Incident Report Form and attach it to your claim. Once these documents have been received by the Work Health & Safety Unit you have lodged your Workers Compensation claim. At this stage the University will forward your claim to the Insurer and write to your Head of School/Section to advise that you have lodged a Workers Compensation claim. Acceptance of Claims: Q. When will I know if my claim has been accepted? A. The University must commence payments of compensation regardless of whether it accepts your claim. Once the claim has been accepted we will write to you informing you that your claim has been accepted. In any event you must be told within 28 days if no decision has been made to accept your claim and in those circumstances what steps the University needs to take before it can make a decision about that. The University has a maximum 84 days from the time you lodge your claim to dispute liability for the claim. Disputed Claims: Q. Why would the University dispute my claim? A. For the University to successfully dispute your claim it must show that there was a reasonably arguable case in relation to some issue associated with your claim. If your claim is disputed you will receive a letter from us setting down why your claim is disputed together with a copy of a referral that has been made to the Workers Rehabilitation & Compensation Tribunal. That referral will have attached to it any documentary material that we rely on in disputing your claim. 2

3 Q. What happens if liability for my claim is disputed? A. You will receive notification in writing that liability for your claim is disputed. The reasons for this decision will also be given. Due to the requirements of the Workers Rehabilitation and Compensation Act this notification will normally be hand delivered or posted by certified mail. The matter must then be referred to the Workers Rehabilitation and Compensation Tribunal for determination. Q. What happens next? A. The Tribunal will convene a hearing before a Commissioner to determine whether the University has a reasonably arguable case to dispute the claim. Both you and a representative from the University and its Insurer are required to attend this hearing. Q. Can I be represented at the hearing? A. The Commissioner has discretion to allow you to be represented at the hearing by a person of your choice. It would only be in rare circumstances that you would not be allowed to be represented. Q. Will I have to speak at the hearing? A. The University will speak first and put forward its case as to why there is a reasonably arguable case. If you are represented the Commissioner will then ask your representative if they have any submissions to make in relation to what the University has said. In some circumstances you may be able to call evidence in relation to issues. If you are not represented the Commissioner will ask you whether you have any submissions to make or wish to call any evidence. However it is normally the case that the University and its insurer do most of the talking as it is they who must justify their action in disputing your claim. When you receive the referral you may accept that the University has grounds to dispute your claim. If that is the case you should tell the University because a document can be prepared to send to the Tribunal which makes it unnecessary for either you or us to attend the hearing. Q. How long does the hearing last? A. The hearing is only of short duration. Usually it is over within thirty minutes. Q. How long does the Commissioner take to make a decision? A. Normally the Commissioner makes a decision at the end of the hearing. However in some cases it may take up to 3 weeks. Q. What happens then? A. The Commissioner has to decide whether the University has a reasonably arguable case to dispute your claim. If the Tribunal decides that it has then the University is no longer required to make payments to you, either weekly payments, medical expenses or any other expenses under the Act. If the Tribunal decides that the University does not have a reasonably arguable case then you are entitled to continue to receive weekly payments of compensation if you produce appropriate medical certificates and in addition are entitled to have your medical and reasonable other expenses paid. 3

4 If the Tribunal decides in favour of the University then that is a preliminary finding. You are at liberty to then lodge your own referral with the Tribunal where you ask that there be a full hearing of the matters in dispute. At that hearing doctors and witnesses can be called by both parties to give evidence. Prior to that process occurring there will be a compulsory conciliation conference where the parties meet to see if the issues can be resolved. It is likely that any conciliation will not take place for some months after a referral and if the matter cannot be resolved at conciliation it may be 2 or 3 months after that time before a hearing occurs. Your Entitlements: 1. Wage payments calculated at the rate of your normal weekly earnings. 2. Payment of reasonable expenses for medical services provided to you. These services include hospital, nursing and rehabilitation services. 3. A lump sum payment if you have suffered a permanent disability of not less than 5% of your whole person. Q. How do you calculate my normal weekly earnings? A. Normal weekly earnings are equal to your average weekly earnings for the period of time that you have been continuously employed by us if that is greater than 14 days. For example, if prior to your injury you had been employed by us for 38 weeks your total wages would be divided by 38. If you had been employed by us for greater than 52 weeks we simply look at the average of your 52 weeks earnings. If you have been employed by us for less than 14 days your rate is set by looking at comparable employees. Alternatively your wages may be set by looking at your ordinary time rate of pay for the hours during which you worked before the period of your incapacity. We must pay you the greater amount of normal weekly earnings or your ordinary time rate of pay. In most cases overtime will not be included in the calculation of your normal weekly earnings (it is irrelevant for an ordinary time rate of pay calculation) unless it is: (a) a requirement of your employment contract; (b) was worked in accordance with a regular and established pattern and in accordance with a roster; (c) that pattern was substantially uniform; and (d) that you would have continued to work overtime if you had not been injured. Q. Can my normal weekly earnings be reduced? A. Under the Act, normal weekly earnings are stepped down after periods of incapacity according to the following scale: (a) 100% of normal weekly earnings is paid for the first 26 weeks following the date of the initial incapacity; (b) 90% of normal weekly earnings for 26 weeks but not exceeding 78 weeks following the date of the initial incapacity; (c) 80% of normal weekly earnings for 78 weeks but not exceeding 9 years except in some circumstances set down below. You will be advised in writing of step downs to your workers compensation payments prior to their commencement. 4

5 In some circumstances weekly payments can be made beyond 9 years if your Whole Person Impairment is: (a) Between 15-20% for 12 years; (b) Between 20-30% for 20 years; and (c) Above 30% until the age of 65. Q. What happens to the level of my workers compensation payment if there is an Academic or General Staff Agreement increase in my normal classification? A. Your workers compensation rate is increased by the same amount as the increase in your normal award classification. Q. For how long can I continue to receive payment of workers compensation? A. As set down above the normal maximum is 9 years for weekly payments of compensation although in some circumstances benefits can extend beyond that period of time. Medical expenses are paid for a maximum period of 10 years but once again depending on your Whole Person Impairment that can be extended by 1 extra year beyond what has been set down above for weekly payments. Q. What do I do with my medical accounts? A. Any medical accounts should be forwarded to Work Health & Safety who will arrange payment with the University s Insurer. If you have already paid your medical account you must not claim it on Medicare. Simply send your receipt to Work Health & Safety who will arrange for you to be reimbursed. Please note that you must lodge a Worker s Compensation claim if you want your medical accounts to be paid. If you do not lodge a claim all medical accounts are your responsibility. Choice of Doctor: You are free to choose your own doctor provided they are accredited with the Work Cover Board of Tasmania. The University does not have its own doctor for workers compensation purposes. Medical Reviews: If your absence is an extended one or there are grounds for doing so, the University may arrange for you to be medically examined by a specialist/s of its choice. This is a standard procedure and gives us a second opinion on the appropriateness of your treatment and rehabilitation. This will only be done after we have contacted your own treating medical practitioner. If you are asked to attend such a review it in no way implies that we doubt the genuineness of your injury. Submission of Medical Certificates: If you have not submitted a certificate for more than 14 days, your entitlement to compensation may cease if we dispute liability but we need to challenge that in the Tribunal. We are not obliged to pay weekly payments of compensation unless you submit a worker s compensation medical certificate. Rehabilitation: The University has a strong commitment to rehabilitation of injured workers. Our Work Health & Safety staff are well trained in rehabilitation procedures and will be in contact with you and your doctor to discuss the possibility of a return to work on restricted duties. It is a legal requirement that we produce a return to work plan if it appears likely that you will be incapacitated for more than 14 days. Our Insurer also has experienced case managers who are involved in this process. 5

6 We also make use of external rehabilitation specialists in complicated or long term cases. Further information on rehabilitation is available from Work Health & Safety. Return to Normal Duties: Before returning to normal duties you should obtain a certificate from your doctor clearing you for normal duties. Journey Accidents: Journey accidents involving an employee travelling to and from their normal workplace are not compensable under Workers Compensation. However if you are injured while travelling in behalf of the University, e.g. between campuses, then your injury will be compensable. Meal/Rest Breaks and Sporting Activities: Injuries occurring during a temporary absence from work (e.g. lunch break) or during a social or sporting activity are not compensable under Workers Compensation except where the employee s involvement in the activity is at the direction of the employer and forms part of the employee s employment. Additional Information: If you have any further questions regarding Workers Compensation you should contact: Cheryl Hughes Workers Compensation Administrator Ph: Fax: or Workers.Compensation@utas.edu.au Page Updated April