Aim
Roles and responsibilities
Process for reporting an incident and making a claim
Disputes
Referring workers’ compensation matters to the Office of the Director of Public Prosecutions

Aim    

• rehabilitate the sick or injured worker back into the workforce as soon as possible; and

• ensure that the sick or injured worker (or his or her dependants) is compensated for lost wages, and medical and other rehabilitation costs.

Roles and responsibilities    

Government agencies

• ensuring that all employees have ready access to:

• a summary of the provisions under the Workers Rehabilitation and Compensation Act 1988 (these must be prominently displayed in every workplace);
• the employer’s rehabilitation policy – required by all employers with 20 or more workers (see the Rehabilitation Policy section on Workcover Tasmania’s website for information on the criteria that must be incorporated into the policy);
• rehabilitation coordinator contact details (employers with 50 or more employees are required to appoint a rehabilitation coordinator who has responsibility for coordinating the timely and safe return to work of an injured worker in accordance with the employer's rehabilitation policy).

• keeping records of all injuries notified by their workers (regardless of whether there is a formal claim for compensation);

• reporting serious and dangerous incidents to Workplace Standards Tasmania, in accordance with section 47 of the Workplace Health and Safety Act 1995;

• completing the employer’s report section of a Worker’s Claim for Compensation form, ensuring that the worker has completed the worker’s report section and provided a fully completed Workers Compensation Medical Certificate, and sending the duly authorised claim form (and medical certificate) to Marsh within five working days of its receipt;

• deciding whether to dispute liability for an injury or a medical or other expense, and if a decision is made to dispute the claim, serving (or requesting in writing that Marsh serve) a formal notice of dispute to the worker (or his or her dependants) and, where applicable, the Workers Rehabilitation and Compensation Tribunal or service provider, in the form and within the timeframe specified in the Workers Rehabilitation and Compensation Act 1988;

• appointing, or requesting Marsh to appoint, a rehabilitation provider, if this is considered necessary;

• if the injured worker is incapacitated for longer than 14 days, preparing a return-to-work plan, in consultation with the injured worker, his or her medical practitioner, the rehabilitation provider, the injured worker’s supervisor and, if the employee desires, a union representative. This must be done as soon as practicable but no later than 5 days after that 14 day period;

• paying weekly income replacement payments and seeking reimbursement from Marsh. Duly authorised requests for reimbursement must be lodged using the standard reimbursement form developed by Marsh. It is the agency’s responsibility to ensure that the weekly income replacement payment amounts for which the agency is seeking reimbursement are calculated in accordance with the payment amounts prescribed by the Workers Rehabilitation and Compensation Act 1988 (eg are appropriately adjusted for Award changes, ‘step down’ requirements, paid holidays etc). Any additional amounts paid by an agency are the direct responsibility of the agency - not the Tasmanian Risk Management Fund. Marsh has the authority to refuse incorrect or incomplete claims for reimbursement. It is also important that Marsh is advised of weekly income replacement payments made during the excess period (and which are therefore not reimbursable by Marsh), to ensure that its records are complete;

• authorising medical and other benefits, and forwarding them to Marsh for payment. Note that these are not subject to an excess period and are immediately payable by Marsh;

• providing Marsh with written directions on the administration of workers’ compensation claims; and

• ensuring that the Office of the Director of Public Prosecutions is furnished with all necessary instructions and assistance when seeking legal advice.

• keep the injured worker’s pre-injury position open for 12 months, unless it can be shown that this is not reasonably practical, or there is no longer any reason for that position to exist; and

• if practical, provide suitable alternative duties for a worker for up to 12 months following an injury.

Fund Administration Agent (see Marsh Pty Ltd)

• administer workers’ compensation claims. This includes reimbursing agencies the cost of wages; paying medical and other expenses approved by the agency; meeting regularly with agencies to review claims; and, at the written direction of agencies: investigating liability; managing disputes; and seeking legal advice from the Office of the Director of Public Prosecutions;

• review all claim and payment documentation to make sure that it is complete, accurate and appropriate (ie that it has been prepared in accordance with the requirements/prescriptions of the Workers Rehabilitation and Compensation Act 1988). Marsh has the authority to refuse incomplete or incorrect claims for payment;

• provide rehabilitation and claims management (but not legal) advice to agencies, either proactively or in response to a request by agencies (but it is the responsibility of agencies to decide whether to accept or reject the advice);

• provide regular reports to agencies on the progress, and actual and outstanding costs associated with each claim; and

• broker the purchase of separate workers’ compensation cover, if required, for agency employees residing interstate or overseas.

• assess the needs of the injured worker and the workplace requirements;

• identify and coordinate any health and vocational services, and workplace modifications, needed to return the injured worker to work; and

• monitor the return-to-work process and ensure that goals remain appropriate and achievable.

• reporting any work-related injury or disease to their supervisor as soon as practicable, regardless of whether or not the worker intends to claim workers’ compensation;

• obtaining a Workers’ Compensation Medical Certificate from an accredited medical practitioner;

• completing a Worker’s Claim for Compensation form and providing it (and the Workers’ Compensation Medical Certificate) to their employer. All claims should be lodged within six months of the date of injury;

• in the event of an extended absence from work, ensuring that a new Workers’ Compensation Medical Certificate is provided to their employer before (or just after) their previous Certificate expires. Payment of benefits depends on this requirement being met;

• participating in a rehabilitation program or undertaking suitable alternative duties. Weekly benefits are dependant on the worker’s cooperation in this regard;

• making themselves available for a medical examination by a doctor provided and paid for by the employer, at any reasonable time and place, and undertake any recommended treatment. Failure to do so will result in the suspension of weekly payments until the matter is determined by the Workers Rehabilitation and Compensation Tribunal. An exception is if the worker refuses surgery. In this case, weekly payments continue until the Workers Rehabilitation and Compensation Tribunal determines the matter; and

• obtaining a clearance certificate from their medical practitioner before returning to work.

• select their own treating doctor and have a say in the selection of their rehabilitation provider;

• be involved in the management of their injury, including being consulted on when and how they return to work;

• access the Workers Rehabilitation and Compensation Tribunal for the early resolution of any disputes that may arise; and

• under certain conditions, access damages in addition to the benefits provided under the Workers Rehabilitation and Compensation Act 1988, by undertaking a common law action.

Process for reporting an incident and making a claim    

Step	Action	When	Further information
1.	Notification of injury	As soon as practicable after incurring the injury (and preferably on the same day)	Employees should report all injuries to their supervisor, or someone else in authority, either verbally or in writing (using the agency’s incident/accident report form, if provided). The information provided in the report should include: the name and address of the person injured the nature and cause of the injury; and the date and time it was incurred. A formal notice of injury should be lodged regardless of whether the employee intends to make a claim for worker’s compensation (note that a person may not be entitled to compensation later if a notice of injury was not lodged at the time of the incident). Agencies should keep a record of all injuries incurred in the workplace. NOTE: Agencies should report all lost-time injuries immediately to Marsh. In addition, in accordance with section 47 of the Workplace Health and Safety Act 1995, Workplace Standards Tasmania must be immediately advised of all serious and dangerous incidents (including potentially serious and dangerous), followed by a written report within 48 hours.
2.	Lodgement of a workers’ compensation claim by injured worker	As soon as practicable but no later than 6 months after the injury was incurred	Worker’s Claim for Compensation forms are available from nominated areas within agencies (usually Human Resources) or Marsh. A sample form is provided on this website for information only. A Workers Compensation Medical Certificate must be lodged with the claim form. A claim for compensation is only deemed to have been made, and benefits be payable, when both documents have been provided to the employer. The injured employee should complete the worker’s report section only. The employee should retain the brown copy of the form.
3.	Receipt of a workers’ compensation claim form by the employer	Upon receipt of the claim (or before if the employer is aware that one is to be lodged)	Upon receipt of a workers’ compensation claim, agencies should: 1. first consider whether the injury or disease is work-related. It is advisable to consult Marsh if there are any doubts about this. It may be necessary to: investigate the claim (Marsh would normally be responsible for engaging loss assessors to undertake this); and/or seek independent medical advice (normally arranged by Marsh). If the agency decides that it is going to dispute liability, it should begin to implement formal dispute procedures (see Step 8). 2. regardless of the decision made above, the agency should also immediately start to consider (and implement) the steps required to return the worker quickly, safely and durably to work and finalise the claim. Early intervention and proactive management are critical in achieving return-to-work goals. In consultation with the treating general practitioner, this may include: preparing a return-to-work plan (see Step 9); engaging a rehabilitation provider; and considering alternative duties.
4.	Employer to forward claim to Marsh	Within 5 days of receipt of claim by employer	The government agency should complete the employer’s report section of the claim form and forward it, and the Workers Compensation Medical Certificate, to Marsh within 5 working days of its receipt. The agency should retain the black copy of the form.
5.	Marsh to allocate a claim number and acknowledge receipt of the claim	On the day that a claim is received	Marsh will acknowledge receipt of a claim within 3 working days. The acknowledgement will include advice of the claim number allocated to the claim. This claim number must be quoted in all future correspondence concerning the claim, including when submitting certificates and accounts to Marsh.
6.	Marsh to forward a copy of the claim to Workcover Tasmania Board	Within 5 days of receipt of claim by Marsh	Marsh will forward a copy of the claim to the Workcover Tasmania Board. Marsh retains the blue copy of the form.
7.	Payment of weekly income replacement payments	On the next normal payday or within 14 days following receipt of a claim	Income replacement payments are payable: on the next normal payday; or no later than 14 days after, receipt of a claim (together with a Workers Compensation Medical Certificate) by the agency, regardless of whether the agency intends to dispute liability for the injury or disease (although if an agency does intend to dispute a claim, it is not obliged to meet medical or other costs associated with the claim). Weekly payments are payable from the date of incapacity or 14 days before the claim was provided to the employer, whichever is later. It is advisable for agencies to check with Marsh regarding the calculation of weekly income replacement payments. The Workers Rehabilitation and Compensation Act 1988 requirements regarding paid holidays etc, are quite complex. Ongoing payments are subject to the receipt of periodic medical certificates. These should be forwarded to Marsh upon receipt by the agency. After a period of 13 weeks, weekly payments reduce to: 85% of the normal weekly payment for weeks 14 to 78, inclusive; and 80% of the normal weekly payment, thereafter, for up to a maximum of 9 years. Weekly payments cease if the Workers Rehabilitation and Compensation Tribunal finds that the employer has made a "reasonably arguable case" concerning liability. The cost of the weekly income replacement payments is reimbursed to the agency by Marsh. Agencies should lodge a standard reimbursement form to Marsh each fortnight. Marsh will reimburse agencies within 10 working days of receipt of the form. Note that the TRMF will only cover agencies for payments made in accordance with the requirements of the Workers Rehabilitation and Compensation Act 1988. Agencies are directly responsible for any additional amounts paid.
8.	Disputing liability for an injury or disease	Within 84 days of receipt of a claim (NB: Medical expenses and payments to dependants must be disputed within 28 days. See Other Benefits and Payments to Dependants for further information)	If an agency disputes liability for an injury or disease, the agency (or Marsh acting on the agency’s written instructions) must, within 84 days of receiving the claim: serve the injured worker with written notice that the agency disputes liability, providing details of the reasons for doing so; and refer the matter to the Workers Rehabilitation and Compensation Tribunal. It is important to note that the referral to the Tribunal must be accompanied by all evidentiary material upon which the employer intends to rely at the hearing. The Tribunal may disallow the introduction of evidentiary material after the referral has been lodged. The Chief Workers Rehabilitation and Compensation Commissioner or another Commissioner will determine whether the employer has made a "reasonably arguable case" and make an order regarding the continued payment of weekly income replacement and other benefits. If an agency does not dispute a claim within 84 days, it is deemed to have accepted liability for the claim. See Other Benefits for information on the processes and timeframes for disputing medical and other expenses. See Payments to Dependants for information on the processes and timeframes for disputing liability in relation to a claim made by the dependants of a deceased worker.
9.	Return-to-work plan	If a worker is incapacitated for more than 14 days, as soon as practicable, but no later than 5 days, after the end of this period (but preferably consideration should be given to the steps required to return an injured worker to work as soon as the injury is notified)	Consideration should be given to the steps required to return an injured worker to work as soon as notification of the injury is received. The Workers Rehabilitation and Compensation Act 1988 requires that a formal return-to-work plan be prepared within 5 days of a 14 day period of incapacitation, but initial steps should already have been considered and implemented by this stage. The return-to-work plan should be prepared by the employer in consultation with the injured worker, his or her treating medical practitioner and the rehabilitation provider. The plan should be realistic and achievable. The objective of the plan is to ensure that the injured worker returns to work in a safe and timely manner. The return-to-work plan should include: the name of the injured worker; an estimate of the date that the injured worker should be fit to return to work; an offer of suitable duties; the steps to be taken to facilitate the worker’s return to work. This may include re-training, workplace enhancements, a graduated return to work etc; and a statement of the long-term goal or aim of the plan. Ideally, the plan should be signed by both the employer and the worker. A sample plan is provided in A Guide to Workers Compensation in Tasmania. Copies of the plan should be provided to the worker, the treating doctor, and Marsh. A clearance certificate should be obtained from the treating general practitioner before a worker returns to work.
10.	Ongoing claim management	Ongoing	Agencies should meet regularly with Marsh and rehabilitation providers to review all open workers’ compensation claims. The focus of the reviews should always be on finalising the claims as soon as possible. Issues that may be considered at the reviews include: the impact and effectiveness of treatment and whether the return-to-work plan needs to be modified; investigations (results or need for); independent medical reviews (results or need for); and payment of weekly benefits, ie ensuring that payments are stepped-down in accordance with the entitlements prescribed in the Workers Rehabilitation and Compensation Act 1988. Responsibility for carrying out agreed actions should be clearly assigned at the meeting. Marsh provides agencies with regular reports to enable them to keep track of the progress, and actual and outstanding costs associated with each claim. Agencies should also keep in regular contact with the injured worker to ensure that he or she is kept informed of all future processes, understands their purpose, and is provided with the opportunity to ask questions.
11.	Finalising a claim		Medical requirements A clearance certificate must be obtained from the treating general practitioner before a worker returns to work. Administrative requirements When a claim is finalised, especially if there is no settlement, it is important to note all the circumstances that led to the finalisation of the claim, on the claimant’s file. Agencies must advise Marsh, in writing, that the claim is to be, or has been, finalised. Note that if an employee leaves the State Service, this does not stop his or her entitlement to compensation. Legal requirements The Office of the DPP must be consulted if a claim is to be settled or if a common law action is brought against the agency. Agencies should note that the TRMF will only reimburse agencies if the Office of the DPP considers that a settlement amount is reasonable. Agencies are directly responsible for any additional amounts paid. Settling a claim: Claims may be settled by agreement between the parties, after 12 months, if the injury is stable. Common law actions: An injured worker may sue an agency for damages under common law only when the injury or disease results in a 30% or greater whole-person impairment. The claim may be settled if the agency is liable and an amount is agreed upon. A Deed of Release must be obtained, if an action is settled, to prevent future actions arising from the same incident. When providing instructions to the Office of the DPP, the following documentation should be provided: the current file(s); and details of other claims made by the employee, including the date of the injury leading to the claim, the nature of the injury, and how the claim was settled.

Disputes    

• disputes as to the reasonableness or necessity of any medical or rehabilitation service;

• reviewing settlements (within three months from the date of settlement). The Tribunal may set aside an agreement it deems to be inequitable, made under duress, or made by a party lacking the legal capacity to make it.

Referring workers’ compensation matters to the Office of the Director of Public Prosecutions    

• disputes regarding liability (section 81A);

• termination or reduction of benefits (section 86 and section 88);

• contributions or indemnity from third parties (section 134);

• notice to bring action on (section 136);

• election to claim damages (section 138AB);

• common law proceedings;

• hearings in the Workers Rehabilitation and Compensation Tribunal or Supreme Court;

• claims involving factual disputes as to the cause of an injury;

• claims involving disputes as to quantum;

• claims involving disputes as to the status of the injured party – eg whether the injured party is an employee or a contractor;

• claims involving possible fraud;

• calculation of settlement figures;

• drawing a Deed of Release;

• requesting written reports from experts; and

• interpreting and/or evaluating reports from experts.