Working with you for successful
claims outcomes
Lynn Milne
Customer Advisor
WorkCover Queensland
About WorkCover Queensland
• Statutory authority operating as an
independent commercial enterprise
• Expert provider of tailored workers’
compensation insurance solutions
• We deliver Australia’s lowest
average premium rate
$1.20 (per $100 in wages)
About WorkCover Queensland
• One of Australia’s best return to work rates
• Balance the needs of employers and injured
workers
• Customer satisfaction drives continuous service
improvement and online innovation
• Expert management of the entire claims
management life cycle keeps claims costs down
Benefits to employers
•
Strong industry alignment
•
Simplified premium model for
employers with ≤ $1.5 million
in wages
•
Prudent financial management
delivers premium certainty
•
Online customer service
innovations deliver real value
for money and cut red tape
Benefits to injured workers
•
Australian first Worker Assist app
delivers real-time data on
claim expenses, upcoming
medical appointments and
payment timeframes
•
In 2013–2014, 96% of injured
workers returned to work
within 12 months. This means
improved workplace productivity
and reduced family and
community impacts
Employer obligations:
As an employer you have obligations for workers’ compensation and return
to work. You must:
• have a current workers’ compensation insurance policy that covers all
your workers
• submit your wages information and pay your premium by the due dates
• notify WorkCover Queensland of any workplace injuries within eight
business days
• make suitable duties available to your injured workers where possible
• work with WorkCover Queensland, the injured worker, their doctor and
other health-care providers to develop an effective return to work program
• not dismiss an injured worker solely or mainly because of their injury
within 12 months of the injury or illness occurring.
Legislative amendments
• The Workers’ Compensation and Rehabilitation and Other Legislation
Amendment Bill 2013 was passed in parliament in October 2013
• The main changes applying from 15 October 2013
• New method in determining permanent impairment
• A > 5% common law threshold has been introduced
• Requirement & training for a RRTWC has changed
• The main changes applying from 29 October 2013
• The way psychological/psychiatric claims are determined
• The insurer is responsible for rehabilitation (including common law)
• Employers can now ask workers for disclosure of pre-existing injuries
• We have a video of a webinar, and detailed presentations
• Detailed information at workcoverqld.com.au/legislativeamendments
Who is a worker
- Changes to legislation from 1 July 2013 may affect who is a worker
according to the Workers’ Compensation and Rehabilitation Act 2003
- To reduce red tape, WorkCover has aligned the definition of who is a
worker to the Australian Taxation office (ATO) definition.
- You can utilise the ATO online decision tool for determining ‘who is a
worker’ and keep a copy of the determination for your records.
Section 11 of the Act:
A worker is ‘a person who works under a contract and, in relation to the
work, is an employee for the purpose of assessment for PAYG withholding
under the Taxation Administration Act 1953 (Cwlth), schedule 1, part 2-5’.
Only an individual can be a worker (even if they have an Australian
Business Number (ABN) or are responsible for their own tax)
Companies, partnerships and trusts are excluded.
Industry statistics – total claims costs (stat &
common law)*
$14,000,000
$12,000,000
$10,000,000
$8,000,000
$6,000,000
$4,000,000
$2,000,000
$0
Horticulture statutory
claims cost
Horticulture common
law cost
Industry statistics – Stay at work percentage
Industry statistics – average days to first
return to work (RTW)
Industry statistics – Injury location (2013/14)
Industry statistics – Injury location (2013/14)
Industry statistics – Final RTW percentage
105.00%
100.00%
95.00%
90.00%
Mushroom & vege
growing
Fruit & Tree Nut Growing
85.00%
Other Crop Growing
80.00%
75.00%
2010/11 2011/12 2012/13 2013/14 2014/15
Health benefits of work
• Early return to work reduces the risk of long-term
disability
• Injured workers who are offered suitable duties are
twice as likely to return to work
• Strong evidence suggests that work absence tends to
perpetuate itself: that is, the longer someone is off work,
the less likely they become ever to return
• We encourage a stay at, or prompt return to work
strategy. This is possible through a suitable duties
program or host employment.
The longer someone remains off work the less likely it
is they will ever return. If someone is off work for:
• 20 days, the chance of ever getting back to work is
70%
• 45 days, the chance of ever getting back to work is
reduced to 50% and
• 70 days, the chance is then again reduced to 35%.
Realising the Health Benefits of Work
Best practice injury management
When a workplace injury occurs:
• notify WorkCover Queensland within eight business days
• encourage early medical attention and treatment
• make suitable duties available to your injured workers where possible
• work with WorkCover Queensland, the injured worker, their doctor and
other health-care providers to develop an effective return to work program
• do not dismiss an injured worker solely or mainly because of their injury
within 12 months of the injury or illness occurring.
Suitable Duties
• Where possible, a ‘stay at work’ approach is best for
rehabilitation
• Duties and hours at work are just as important as other
treatments
• Suitable duties allow people to develop confidence by:
-gradually increasing tasks back to their usual job
demands
-maintaining social contact and support
-feeling valued for what they contribute
-creating a positive workplace culture
-contributing to productivity
Think about :
• What tasks are required
• Are there tasks within the persons role or not
• Consider tasks with different positions
(seated/standing).
Scenario – Crush injury to right foot sustained
when hydraulic gate in seed spreader closed
General assumptions:
No actual claim details have been
used for privacy and confidentiality
• A fictitious employer policy has
been used
• Minimal current claims (statutory
•
•
•
•
•
or common law)
Premium prior to injury $182,600
WIC is Vegetable Growing (outdoors)
012317
Current premium rate 2.551
Current industry rate 2.636
Wages remain the same at
$6,200,000.
The worker was travelling in a
seed spreader when the
hydraulic gate closed on his
foot. He sustained a crush
injury to his right foot. The
worker works a 38 hour
week.
Diagnosis: Crush injury
including multiple fractures to
foot
Conservative and surgical
treatment was undertaken.
No return to work.
Statutory claims costs and impact on premium
Entitlement
Cost
Rehabilitation
$200
Includes physiotherapy,
return to work assessment
Travel
$1,700
For treatment
Weekly benefit
$10,000 (13 weeks totally
incapacitated)
Medical
$14,000
Specialist consults,
radiography, surgical
procedure, medical reports
Permanent
impairment
$39,000
Not accepted
Total
$25,900
A maximum of $175,000
per statutory claims
impacts premium
Statutory claims costs and impact on premium
Situations
Crush type injury to foot $19,500 claim with $6,900
(under the max. Statutory wages (employer has
cost $175,000)
offered suitable duties at the
6 week mark saving $3,100
(4 weeks x $770)
$182,600 Premium
Increased premium to
$189,700 ($7,100)
Increased premium to
$187,600 ($5000). This will
have an accumulative saving
over 3 years
Premium rate 2.551 2.65 (no capping applies to
premium as under 1.5xR)
2.62
Industry rate 2.636
2.636*
2.636*
Wages $6,200,000
Same
Same
What you can do
• prevention is better than cure—keep your
workplace safe and prevent injuries
• be return to work focused and provide
suitable duties—focus on what your worker
can do, not what they can’t
• work with us to help your worker stay at, or
return to work as soon as possible
• consider Recover At Work (RAW)
opportunities
• communicate regularly and openly with all
parties—stay in contact with your worker
and check their progress
• utilise consultancy services.
Online services
Our online services are free, quick and easy to
use. You can access your policy information at
a time that suits you. You can also lodge
information online and opt to receive your
policy information and updates electronically –
convenient and good for the environment.
Employer online
•
•
•
•
•
•
declare wages and pay your premium
view premium notices
produce a Certificate of Currency
find key dates for workers’ compensation
performance scorecards
useful links.
Free services
Some ways we can help you:
• forecast your premium
• develop return to work strategies including suitable duties plans
• provide individual and industry performance analysis
• access online services
• access industry pages, films and case studies
• network opportunities with peers via industry forums
• work with Workplace Health and Safety Queensland to develop
workplace health and safety initiatives
• download the worker assist app.
Contact us
workcoverqld.com.au
If you would like more information, please
call or email me:
• 3006 6770
• lynn.milne @workcoverqld.com.au