Procedure for Workers Compensation Insurance and Employee Entitlements State-wide Distribution

Transcription

1 Workplace Rehabilitation and Return to Work Policy Document Number # QH-PCD :2012 Procedure for Compensation Insurance and Employee State-wide Distribution Custodian/Review Officer: Senior Director, Organisational Health Version no: 1.1 Applicable To: All Queensland Health employees (permanent, temporary and casual). Approval Date: 01/12/2012 Effective Date: 01/12/2012 Next Review Date: 01/09/2012 Authority: Lyn Rowland, Chief Human Resources Officer, System Support Services Division Approving Officer 1. Purpose This Procedure describes the processes for: arrangements to ensure appropriate workers compensation insurance and prompt premium payment the remuneration of Queensland Health employees who have sustained an injury or illness, whether work related or not, who are eligible to receive Worker s Compensation payments or other paid leave staff accessing income, by other means i.e. income protection entitlements, whilst absent from work due to injury/illness This document also defines categories of medical staff who are identified as workers in accordance with the Compensation and Rehabilitation Act and are entitled to remuneration under this Procedure Name Lyn Rowland, Chief Human Resources Officer, System Support Services Division Supersedes: 3-4#38, 3-9#38 and 3-8#38 Key Words: WorkCover, Rehabilitation, Early Treatment, Ill Health, Income Protection, Harassment Accreditation References: EQuIP and other criteria and standards 2. Scope This Procedure applies to all Queensland Health employees (permanent, temporary and casual). 3. Supporting documents Authorising Policy and Standard/s: Workplace Rehabilitation and Return to Work Policy Implementation Standard for Workplace Rehabilitation and Return to Work Version No: 1.1 Effective From: 01 Dec 2012 Page 1 of 9

2 Procedures, Guidelines, Protocols Workplace Rehabilitation and Return to Work Procedure Forms and templates Declaration of Wages (WorkCover Qld) 4. Related documents Compensation and Rehabilitation Act 2003 Compensation and Rehabilitation Regulation 2003 WorkCover Queensland Declaration of Wages Explanatory Guide QSuper Income Protection Benefit Claim Public Service Directive No. 7/08 (July 2008): Leave without Salary Credited as Service Your Return to Work brochure 5. Procedure for Compensation Insurance Arrangements 5.1 In accordance with the Compensation and Rehabilitation Regulation, Part 2, section 9(2), on or before the 31 August each year policy holding entities shall: declare to the insurer their actual gross wages for the preceding financial year provide an estimate of the gross wages they expect to pay in the next financial year (refer to the WorkCover Declaration of Wages Explanatory Guide). 5.2 The insurer uses the figure of gross wages obtained from the Declaration of Wages form to calculate an annual premium for the employer (policyholder). A Premium Notice shall then be forwarded to the policyholder for payment. 5.3 Prompt workers compensation premium payment shall required by 16 September annually to incur a discount, providing the Declaration of Wages Form was lodged with WorkCover on or before 31 August. 5.4 Preparing Declaration of Wages Policy holding entities with policy numbers are listed in Attachment B Hospital and Health Services (HHS) may also enter into a contract of insurance to cover volunteers and others, which should be negotiated between the workers compensation insurer and the HHS The Queensland Health Corporate Office Policy covers all State-wide and Shared Services functions including Shared Services Provider, Clinical and State-wide Services, Information Division, Linen Services and Corporate Office functions, irrespective of their geographical location. Version No: 1.1 Effective From: 01 Dec 2012 Page 2 of 9

3 5.4.4 Finance Branch of Corporate Office shall prepare a report at the conclusion of each financial year that outlines the gross wages arising from their allocated cost centres for confirmation. The report shall contain, but is not limited to: a Declaration Summary wages Declaration Workings accruals extract Summary outlining costs centres included in the Declaration Summary The report shall be provided to local Finance units for each of the policy holding entities and shall ask for confirmation or clarification within a four week timeframe prior to central lodgement of the Declaration of Wages Form with the insurer The insurer does not require Declaration of Wages Forms to be signed. It can be lodged directly once policy holding entities have confirmed the figures reported Once confirmation is received by Corporate Office Finance, the Director of Safety and Wellbeing shall lodge all Declarations of Wages Forms centrally with the workers compensation insurer prior to 31 August to ensure that all policies have met their renewal obligations. 5.5 Categories of Medical Staff Covered by Compensation Insurance Arrangements The HHS workers compensation liability, in the event of accident or injury to medical staff, depends on the category of medical staff and whether they are classified as a worker under the Act The following categories of medical staff are "workers" under the Act and are therefore covered by the HHS Compensation insurance policy: Medical Superintendents with right of private practice Medical Officers with right of private practice visiting Medical Officers paid on an hourly or sessional rate private Medical Practitioners paid an hourly fee for services including: o administering anaesthetics o conducting outpatients clinics at various outpatients centres and hospitals o performing surgery or manipulative procedures o providing prolonged clinical assistance in respect to an in-patient o attendance at the hospital for clinical duties during periods when the hospital Version No: 1.1 Effective From: 01 Dec 2012 Page 3 of 9

4 o medical Officer is absent on medical escort duties o acting as the medical escort for a public patient requiring interhospital transfer o when called in for consultation by a Medical Superintendent of a country hospital o providing lectures to Nurses o providing lectures to Medical Trainees in rural health o providing pre-operative consultations o providing weekend relief. 5.6 Categories of Medical Staff not Covered by Compensation The following category of medical staff are/s not workers for the purposes of the Act: Private medical practitioners paid as a company/incorporated body Any Compensation claim applied for by a medical practitioner in this category either at a facility within a HHS or on their journey to or from such a facility would have no entitlement to compensation as they do not meet the definition of worker under the legislation In the event of a claim being made by a medical practitioner who does not meet the definition of worker, a detailed statement of all relevant facts, circumstances and contractual arrangements shall be provided to the insurer The insurer shall consider all relevant information at the time of application for compensation with respect to definitions of worker, event and injury. It will then determine whether the claim has special features that may require a special ruling. 6. Procedure for Workplace Rehabilitation Employee 6.1 Remuneration Queensland Health shall continue to pay employees directly whilst they are receiving Compensation benefits. The employee will therefore not be required to cease or suspend any salary sacrificing arrangements during this period The Compensation insurer (insurer) shall reimburse Queensland Health the equivalent of the employee s benefit This option is not available to Income Protection Claims Communication between the rehabilitation and return to work coordinator (RRTWC), human resources practitioner (HR)/payroll, line manager/supervisor, Compensation insurer (insurer), and Income Version No: 1.1 Effective From: 01 Dec 2012 Page 4 of 9

5 Protection insurer (IP Insurer), is essential to ensure accurate payment of wages Remuneration of employees on either Worker s Compensation or Income Protection benefits remains a payroll function and shall be managed in close consultation with the line manager/supervisor Employees who suffer from a work related injury/illness can submit a claim for Compensation benefits. If accepted by WorkCover Queensland the following compensation is paid, as per legislative entitlements: First 26 weeks - 85% of the employee s normal weekly earnings or the amount payable under an industrial instrument (whichever is the greatest). After 26 weeks up to 2 Years - 75% of the employee s normal weekly earnings or 70% of Queensland Full Time Adult s Ordinary Time Earnings (QOTE) (whichever is the greatest). After 2 years up to end of 5 Years - If an employee demonstrates to the insurer that the injury could result in a work related impairment of more than 15%: o 75% of the worker s normal weekly earnings; or o 70% of QOTE (whichever is the greater); or o an amount equal to the single pension rate. 6.2 Calculation of Employees Weekly Payment Entitlement under Compensation Two weekly pay rates are required by the insurer when completing the Employers Report component i.e. gross weekly rate of salary/wages (under the Award or Industrial Agreement) and gross normal weekly earnings (NWE) The insurer shall make the decision on the weekly benefit payable. Calculation of wages is a reviewable decision by the Queensland Compensation Regulator (regulator), and either the employee or employer may apply for a review if either party are aggrieved by the insurer s decision The gross weekly rates of salary/wages (under the Award or Industrial Agreement) are the standard hours of employment, times the hourly rate at the time of injury. It should be noted that if the employee is acting in a higher position the insurer shall be informed of the date the higher duties cease and the correct rate of pay after that date. This is only required if the higher duties cease during the term of the claim Gross NWE are the weekly earnings of an employee from continuous or intermittent employment during the 12 months prior to the injury. If the employee has not been employed (by Queensland Health) for 12 months then the earnings for the period they have been employed shall be used. Version No: 1.1 Effective From: 01 Dec 2012 Page 5 of 9

6 6.2.5 NWE are not necessarily the same as average weekly earnings. Average weekly earnings are the average of all amounts paid to the worker. NWE takes into account only regular payments made to the employee, which would have continued if not for the injury. NWE shall be calculated in accordance with legislative requirements outlined in the Compensation and Rehabilitation Regulation The Payment Process All Hospital and Health Services have access to a payroll team whose role it is to process cases involving Compensation and Income Protection claims. 6.4 Rostered Day Off/Accrued Day Off An employee with this entitlement will be granted leave for the number of hours which would have been worked and paid for a standard day. The appropriate credit will accrue towards the accumulated day off. The accruing of hours towards an accrued day off shall not continue in excess of three months. 6.5 Payment of Approved Annual Leave An injured/ill employee who has pre-booked annual leave but sustained an injury prior to that leave may elect to delay taking leave until fully or sufficiently recovered. The decision to take leave during a Compensation claim should be discussed with the line manager/supervisor and the insurer in the first instance Should the employee wish to continue with annual leave, the WorkCover Case Manager shall consider each case individually and on its own merit. Factors considered include interference with treatment plan, costs and benefits of annual leave and medical advice. Should this be the preferred option the Compensation claim may become medical expenses only for the duration of the annual leave. 6.6 Leave While on Compensation or extended sick leave without pay, leave entitlements shall be managed in accordance with Leave without Salary Credited as Service - C For Compensation claims of total incapacity all leave accruals shall continue for the first three months with only long service leave continuing past this point For extended sick leave without pay, all leave accruals shall continue for the first three months only. Version No: 1.1 Effective From: 01 Dec 2012 Page 6 of 9

7 6.7 Remuneration for employees with a Non-Work Related Injury/Illness During Voluntary Participation in Rehabilitation and Return to Work Queensland Health shall pay employees with non-work related injuries/illnesses for all hours worked during the voluntary participation phase of their rehabilitation and return to work process Where reduced hours are advised by the employee s treating medical practitioner, the employee shall be entitled to access leave entitlements to make up wages for hours lost due to non-work related injury/illness Employees who are temporarily incapacitated, and/or participating in a graduated return to work program for a non-work related injury/illness, may have the option of lodging a claim for loss of income through an Income Protection insurer The line manager/supervisor shall provide payroll with accurate information concerning the employee s hours of work and the type of leave being accessed to ensure correct payment of wages during the rehabilitation and return to work process Payment options shall be discussed directly with the injured/ill employee prior to commencement of the rehabilitation and return to work process. 6.8 Income Protection Payments Employees may wish to change from Compensation insurance to an income protection claim at some time. They can elect to do this provided they notify the Compensation insurer in writing to terminate their payments. Employees can only receive income protection benefits from one insurer at a time The Superannuation (State Public Sector) Deed provides for the member to receive an income protection benefit when they become temporarily disabled and have been absent from duty on sick leave without salary for a continuous period of fourteen calendar days In order for a Queensland Health employee to qualify and/or change from workers compensation insurance to income protection benefit the following shall apply: workers compensation entitlements shall cease paid sick leave entitlements shall be exhausted an application to change from special leave without pay to sick leave without pay, should be made and supported by a current medical certificate an application for Income Protection Benefit shall be lodged when complete, Queensland Health shall complete the Employer Certification Section of Income Protection Benefit Claim. Version No: 1.1 Effective From: 01 Dec 2012 Page 7 of 9

8 6.8.4 The Income Protection benefit payable under the QSuper Scheme is 75% of current salary Salary in this context is defined as the base rate of pay outlined in an industrial award, industrial agreement or contract of employment, including any approved allowances. The Income Protection insurer can advise what approved allowances are included. 7. Definition of Terms Term Definition / Explanation / Details Source Normal Weekly Earnings Declaration of Wages Form Regulator Insurer Income Protection Insurer Employer Employee / Worker Event (Workplace Rehabilitation) Injury Includes overtime, higher duties, penalties and certain allowances. A Compensation Insurance form used to collect information needed to assess an employer s Accident Insurance Policy premium. This form must be completed and returned to WorkCover by 31 August each year. Q-Comp, the Queensland workers compensation industry regulatory authority. (Q-COMP is an independent statutory authority, established on 1 July 2003 under the Workers' Compensation and Rehabilitation Act 2003 to oversee Queensland's workers' compensation scheme). WorkCover Queensland, Queensland Health s Compensation insurer. QSuper, Queensland Health staff s income protection insurer, or other insurer according to individual arrangement. An employer means Queensland Health. The employing HHS at the time of the injury/illness, remains responsible for the compensation and rehabilitation of the injured/ill employee An employee of Queensland Health (permanent, temporary or casual), who has sustained a personal injury or illness, either work-related or non-work-related. An event is anything that results in injury, including latent onset injury, to a worker. An Injury is a personal injury arising out of, or in the course of employment if the employment is a significant contributing factor to the injury Compensation and Rehabilitation Act 2003 (s 106) Compensation and Rehabilitation Regulation 2003 (Part 2, Division 1) Compensation and Rehabilitation Act 2003 (s 326) Compensation and Rehabilitation Act 2003 (s 380) Queensland Health Queensland Health Compensation and Rehabilitation Act 2003 (s 11) Compensation Rehabilitation 2003 (s 31) Compensation Rehabilitation 2003 (s 32) and Act and Act Version No: 1.1 Effective From: 01 Dec 2012 Page 8 of 9

9 8. Consultation (optional) Key stakeholders (position and business area) who reviewed this version are: Injury Disease Management Team, Safety and Wellbeing Principal Officer, Policy and Performance 9. Procedure Revision and Approval History Version No. Modified by Amendments authorised by Approved by 1.0 L Griffiths, OHS Principal Consultant, Injury Disease Management Team L O Neill, Principal OHS Officer, Safety and Wellbeing 1.1 Kyle Fogarty - Policy Planning and Communications Adviser, Organisational Health Graham Easterby, a/director, Safety and Wellbeing, System Support Services Division Adam Williams - Senior Director, Organisational Health Lyn Rowland, Chief Human Resources Officer, System Support Services Division Lyn Rowland, Chief Human Resources Officer, System Support Services Division Version No: 1.1 Effective From: 01 Dec 2012 Page 9 of 9

10 Attachment A Payment Process 1. Time Lost WorkCover Claim Submitted Payment for time lost on day of injury will be paid as Earning Code 290 (W/C Day 1) for hours lost All other payments are made against already accrued leave entitlements. Payment will continue until determination of claim or leave entitlements are exhausted (whichever comes first). If paid against recreation leave, loading is not paid. Where leave entitlements are exhausted or there was a nil leave balance, sick leave without pay will be paid. Any deductions normally paid become the workers responsibility. 2. WorkCover Determination 2A.Claim Allowed Excess period paid in accordance with excess notification from WorkCover. Paid as Earning Code 291 (W/C days 2-5) and any top-up to the 85% rate required would be as Earning Code 292 (W/C 2-5 top-up) Queensland Health will continue to pay at base award rate for the duration of entitlement to weekly benefits WorkCover will reimburse weekly benefits to Queensland Health and any adjustments between the award rate and the 85% of the normal weekly earnings will be paid in full. 2B. Claim Rejected Any entitlements not paid (such as leave loading) to be paid Options discussed with employee. 3. Return to Work Programs Where the employee is working above establishment the hours worked are paid as Earning Code 294 (W/C Rehab). Balance of hours not worked paid by Queensland Health. Where the employee is working within establishment the hours worked are paid as Earning Code 001 (Ordinary Hours) After each pay fortnight a Reduced Earnings for Suitable Duties Program Form is Completed and submitted to WorkCover. Reimbursement of wages paid for hours not worked will be by WorkCover to Queensland Health.

11 Attachment B WorkCover Employer/Trading Name WorkCover Policy Number Cairns and Hinterland Hospital and Health Service Cape York Hospital and Health Service Central Queensland Hospital and Health Service Central West Hospital and Health Service Children's Health Queensland Hospital and Health Service Darling Downs Hospital and Health Service Gold Coast Hospital and Health Service Mackay Hospital and Health Service Metro North Hospital and Health Service (Northside) Metro North Hospital and Health Service (RBWH) Metro South Hospital and Health Service (PAH) Metro South Hospital and Health Service (Southside) North West Hospital and Health Service Queensland Health Corporate Office South West Hospital and Health Service Sunshine Coast Hospital and Health Service Torres Strait and Northern Peninsula Hospital and Health Service Townsville Hospital and Health Service West Moreton Hospital and Health Service Wide Bay Hospital and Health Service (Wide Bay) Wide Bay Hospital and Health Service (Fraser Coast) GAA WPA GAA WGA WAA GAA WNA GAA GAA WAA WAA GAA WHA GAA GAA GAA WPA GAA GAA GAA WFA