Workers Rehabilitation and Compensation Guide

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Workers Rehabilitation and
Compensation Guide
All guides are intended to give further details to information contained in a particular piece of legislation, policy,
code, agreement or procedure and must therefore be read in conjunction with them.
INTRODUCTION
In the Northern Territory, you are entitled to compensation, under the Workers Rehabilitation and
Compensation Act, for any personal injury or disease, or an aggravation of an injury or disease that
occurs:
During the course of your employment;
By any incident arising out of employment;
On a journey to or from work, except if the accident involved a motor vehicle (see below).
This legislation aims to:
Provide fair compensation; and
Ensure that injured workers are rehabilitated.
The following information is contained in this Guide:
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Injury occurring on a journey to or from work;
Reporting of accidents incidents and injuries;
Making a Workers Compensation claim;
Completing the Workers Compensation claim form;
Workers Compensation medical certificates;
Vocational rehabilitation;
Absence from work due to illness/injury;
Entitlements under Workers Compensation;
Responsibilities;
The role of NT WorkSafe;
Finalisation of claim.
Workers Rehabilitation and Compensation Guide
Contact Officer: Injury Management Consultant
Version 1
Page 1 of 6
1.
Injuries occurring on a journey to or from work ............................................................................... 2
2.
Reporting of accidents, incidents and injuries ................................................................................. 2
3.
Making a Workers Compensation claim ......................................................................................... 2
4.
Completing the Workers Compensation Claim Form...................................................................... 3
5.
Workers Compensation medical certificates ................................................................................... 3
6.
Vocational Rehabilitation ................................................................................................................. 4
7.
Absence from work due to illness/injury .......................................................................................... 4
8.
Entitlements under Workers Compensation ................................................................................... 4
9.
Responsibilities ............................................................................................................................... 5
10.
The role of NT WorkSafe ............................................................................................................ 5
11.
Finalisation of claim ..................................................................................................................... 5
12.
Essential Supporting Information ................................................................................................ 5
1. Injuries occurring on a journey to or from work
If you are injured in a motor vehicle accident whilst travelling to or from work, you are generally not
entitled to claim workers compensation, but may claim under the Motor Accidents Compensation
scheme (MAC) which is administered by the Territory Insurance Office (TIO). If you are injured whilst
travelling to or from work, and you believe you are entitled to claim workers compensation, you may
submit a completed workers compensation claim form to Work Health and Safety (WHS) who will then
forward your claim form to the University’s Insurer. If the claim is rejected by the University’s Insurer
on the basis only that it is a journey claim, and TIO (MAC) disputes that it is a journey claim only on
the basis that it is a workers compensation claim, then both parties enter into the dispute process.
For further information refer to NT WorkSafe bulletin: Guidelines for Journey Claims
2. Reporting of accidents, incidents and injuries
When an accident, incident or injury occurs, you must report it as soon as possible after the event, to
WHS (email: whs@cdu.edu.au or phone 8946 6473). An Accident, Incident and Injury Report form
should also be completed and forwarded to whs@cdu.edu.au. For further information regarding the
reporting of accidents, incidents and injuries, please refer to the First Aid Procedures
3. Making a Workers Compensation claim
If you wish to make a Workers Compensation claim, please contact WHS (email:
whs.wc@cdu.edu.au or phone 8946 6493) and they will forward a Workers Compensation Pack to
you. The Workers Compensation Pack comprises the following documents:
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CDU Letter to claimant
CDU Workers Compensation Information for Employees
Claim Form for Workers Compensation
NT WorkSafe bulletin: Workers Guide to Workers Compensation
On receipt of the Workers Compensation Pack, please read through the documents carefully to
ensure you have an understanding of what the process will involve before you decide to complete and
submit the Workers Compensation Claim Form.
Workers Rehabilitation and Compensation Guide
Contact Officer: Injury Management Consultant
Version 1
Page 2 of 6
4. Completing the Workers Compensation Claim Form
The Workers Compensation Claim Form comprises:
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Information for Workers – Guidance to Part 1 of the Claim Form
NT Workers Compensation Claim Form: Part 1 – Workers Report on Injury/Disease
Please complete Part 1 (questions 1 to 8) on the claim form and make sure it is signed
twice (in the Authorisation section and in the Declaration section). The more information
you provide on the form, the quicker the claim can be progressed. If there is not enough
space on the form to include the relevant information, you should attach full details on
separate page(s).
NT Workers Compensation Claim Form: Part 2 – Employers Report on Injury/Disease
Employer (CDU) will complete questions 9 to 13 on page 2
Claims should be made within six (6) months, but in certain circumstances a claim can be made after
six months.
Once the Workers Compensation Claim Form is completed, signed and dated, and a copy of the
Workers Compensation First Medical Certificate (if you are claiming for lost time) and any other
related documentation, eg: medical invoices, have been attached to the Claim Form, all documents
should be delivered to HRS Reception in building Orange 12 Level 2. Please ask to see the Injury
Management Consultant from the WHS team who will go through the paperwork with you and answer
any questions you may have.
If it is not possible to attend in person, the documents can be scanned and emailed to
whs.wc@cdu.edu.au. Original paperwork should be forwarded to:
Internal mail
Confidential
Box 26 – Office of HRS/WHS
Orange 12, Level 2
or
External mail
Confidential
Work Health and Safety
Orange 12
Charles Darwin University
Ellengowan Drive, Darwin, NT 0909
WHS has three (3) workings days from receipt of your paperwork to submit it to the Insurer. The
Insurer then has ten (10) workings days from receipt of the paperwork to make a decision on your
claim.
The Insurer’s decision must be one of the following:
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Accept liability for the claim – this means you will be paid for any time off work,
reasonable medical and rehabilitation expenses;
Defer liability for the claim (the Insurer then has 56 days to further investigate your claim
and reach a decision as to whether they will accept or dispute the claim);
Dispute liability for the claim – the Insurer will advise you in writing the reasons for their
rejection of your claim and your right of appeal.
5. Workers Compensation medical certificates
When you seek medical treatment from your GP or medical practitioner, a Workers Compensation
First Medical Certificate will be issued to you. The medical certificate should state whether you are:
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Fit to return to pre-injury duties;
Fit to return to modified duties (e.g.: with restricted duties and/or restricted hours); or
Totally unfit for work.
If ongoing treatment is required from your treating practitioner, you will be issued with Workers
Compensation Progress Medical Certificates. Once your treating practitioner deems that you are fit to
return to pre injury duties, a Workers Compensation Final Medical Certificate will be issued.
Workers Rehabilitation and Compensation Guide
Contact Officer: Injury Management Consultant
Version 1
Page 3 of 6
Please forward all Workers Compensation Medical Certificates to whs.wc@cdu.edu.au. WHS will
then forward the medical certificates on to the Insurer and advise your Supervisor of any restrictions
that have been determined by the medical practitioner.
Please note: Until such time as the Insurer has reached a decision on the claim, (eg: accept, defer
or decline) you will be liable for the costs of all medical treatment.
6. Vocational Rehabilitation
If specialist services are required to assist your return to work, the Insurer will appoint an approved
vocational rehabilitation provider to assess your situation and provide assistance with a gradual return
to work, if appropriate. The vocational rehabilitation provider will meet regularly with you and your
Supervisor to ensure compliance with the Graduated Return to Work Program and address any
queries that you or your Supervisor might have in respect of your return to work.
7. Absence from work due to illness/injury
If you are required to take time off work (as determined in the Workers Compensation First Medical
Certificate), you will need to apply for personal leave (e.g.: sick leave, recreation leave). If the
Insurer then accepts or defers your claim, any personal leave that you have taken in respect of your
illness/injury will be re-credited to you. If the Insurer decides to dispute your claim, you will not be recredited the leave. You do have the right to appeal the Insurer’s decision and the process for
appealing will be outlined in the advice from NT WorkSafe.
8. Entitlements under Workers Compensation
Weekly compensation
For the first 26 weeks of incapacity, you will be entitled to receive normal weekly earnings (NWE) as
determined by our Insurer. NWE is made up of your normal number of hours per week at your normal
hourly rate and also includes the following:
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Overtime, where the overtime was worked in a regular and established pattern;
Shift allowance where worked in a regular and established pattern;
Over-award payments;
Climate allowance;
District allowance;
Leading hand allowance;
Qualification allowance; and
Service grant.
After 26 weeks of incapacity, you will normally receive 75% of your NWE.
Medical treatment and expenses
If your claim is accepted or deferred, you will be entitled to reasonable hospital, medical and ancillary
expenses which may include:
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Medical, surgical and rehabilitation treatment;
Hospitalisation in a public or private hospital;
Pharmaceutical expenses;
Travelling to attend for treatment or examinations;
Accommodation costs incurred while away from the normal place of residence to attend
for treatment or examinations.
Workers Rehabilitation and Compensation Guide
Contact Officer: Injury Management Consultant
Version 1
Page 4 of 6
Please note: You are not entitled to take or accrue leave while you are absent from work due to your
workers compensation injury, nor will you be entitled to receive employer superannuation
contributions whilst you are absent from work.
9. Responsibilities
Claimant’s responsibilities
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Inform the University of any work-related illness/injury as soon as practicable. This can
be done verbally and/or by completing an Accident Incident and Injury Report;
Comply with your obligation to participate in a rehabilitation program or undertake suitable
alternative duties provided by the University;
Participate in any examination by a medical practitioner provided and paid for by the
Insurer at reasonable intervals;
Provide the University with a Workers Compensation Medical Certificate for the period(s)
that you are incapacitated for work; and
Participate in establishing and co-operating in a return to work program, including
attending appointments as required.
Supervisor’s responsibilities
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Submit a response to WHS in respect of a claim;
Take all reasonable steps to participate in the rehabilitation and return to work process.
Insurer’s responsibilities
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Make an initial decision on the claim within 10 working days of CDU receiving the claim
form;
Manage and make decisions about the claim; and
Supply the claimant with general information about their claim.
The role of NT WorkSafe
The role of NT WorkSafe is to administer and enforce the Workers Rehabilitation and Compensation
Act. It does not have the role or the legislative power to review claims decisions made by insurers. If a
claimant does not agree with the decision reached by our Insurer, they may apply to NT WorkSafe for
mediation and an independent mediator will be appointed. For more information go to the NT WorkSafe
website.
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Finalisation of claim
Your workers compensation claim will be finalised by the Insurer on receipt of a Workers
Compensation Final Medical Certificate stating that you are fit to return to pre-injury duties with no
restrictions and no further medical treatment required. On receipt of the Workers Compensation Final
Medical Certificate, the Insurer will then settle all outstanding expenses and advise you and WHS that
they have finalised the claim. WHS will then advise your Supervisor that your claim has been
finalised.
If, after your claim has been finalised, you feel you would like to have a chat with someone regarding
the finalised claim, please contact WHS at whs.wc@cdu.edu.au or phone extension 6493.
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Essential Supporting Information
CDU Policies, Guides or Procedures
Workers Rehabilitation and Compensation Guide
Contact Officer: Injury Management Consultant
Version 1
Page 5 of 6
Work Health and Safety Policy
First Aid Procedures
Privacy Policy
Acts & Regulations
Work Health and Safety (National Uniform Legislation) Act 2011
Work Health and Safety (National Uniform Legislation) Regulations
Workers Rehabilitation and Compensation Act
Workers Rehabilitation and Compensation Regulations
Guides and Fact Sheets
NT WorkSafe Guides
Document History and Version Control
Version
Date Approved
Approved by
Brief Description
1
07/08/2014
WHS Manager
Created document
Workers Rehabilitation and Compensation Guide
Contact Officer: Injury Management Consultant
Version 1
Page 6 of 6
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