Guide to Workers Compensation for Small Employers

Transcription

1 Guide to Workers Compensation for Small Employers

2 Your Guide to Workers Compensation CONTENTS PAGE Employer Obligations 1 Claims Lodgement Checklist 3 Pre Injury Average Weekly Earnings 4 Return to Work Your Return to Work Plan Obligations 5-7 Offer of Suitable Employment 8 Medical and Like Expenses 9 Weekly Compensation Rates 10 Workers Compensation Forms 11 CGU Workers Compensation (Vic) Limited

3 Your obligations as the Employer of an injured worker This guide explains the basic processes of the Victorian workers compensation scheme, and what you need to do should one of your employees sustain a workrelated injury or disease. The aim throughout the workers compensation process is to ensure the injured employee makes a timely, safe and durable return to work. As a first step, once a claim is received you should forward all documents, whether it be minor or standard claim, to CGU Workers Compensation (Vic) Limited ( CGU ) within 10 days of receiving them from the worker. When you receive the claim for weekly payments, you must acknowledge this in writing to the worker. Your initial employer liability is: The first 10 days an injured worker is absent from the workplace The first $582* of medical and like expenses. (* This figure is correct as at 1/7/2009. This amount is indexed annually on 1st July of each year. Please contact your Case Manager to determine the current rate). Please note that CGU cannot pay any accounts until we have received copies of the accounts that you have paid with an enclosed Advice of Payment Form. You must ensure that weekly payments of compensation are paid to the worker before the expiry of 7 days after the end of the week you would normally pay those wages. If a worker has 20 Calendar days off work, a Return to Work Plan is required to be prepared as soon as practicable. CGU requires a copy of the Return to work plan no later than 30 days after the cease work date to avoid possible liability for penalties. When you receive a medical certificate or a worker returns to work on partial hours, you must complete the Partial Reimbursement Form send it together with the medical certificates to CGU. All medical certificates must be forwarded to CGU on receipt from the worker. Please note that the Patient Declaration on the reverse side of the certificate must be signed and dated to ensure validity. As an employer, you have three (3) months after making weekly compensation payments to a worker to seek reimbursement from CGU. If weekly compensation is sought after the 3-month period, an employer s request for reimbursement is at risk of being rejected, depending on the reasons for the delay in seeking reimbursement. CGU Workers Compensation (Vic) Limited 1

4 It is an employer s responsibility to liaise with the worker, treating medical practitioner and rehabilitation provider to determine any return to work possibilities and to provide the worker with any other assistance. At any stage when you determine that an independent rehabilitation provider is required, you must forward a list of at least 3 providers that you nominate to provide this service. This list should include the name of the provider, the contact details, and website where possible. You can find this information (available here) on the Victorian WorkCover Authority Website. As an employer you must display the If you are injured poster in a prominent position in each workplace. A register of injuries book must be accessible at each workplace. WorkSafe Victoria provide comprehensive guidelines as to your obligations in the Return to Work Guide for Victorian Employers Reminder Any time loss claims regardless whether they are minor or standard, must be forwarded to CGU within 10 days of receiving the claim from the worker You must acknowledge receipt of the claim to the worker in writing A return to work plan must be developed following 20 days time lost Any correspondence you receive relating to a claim should be forwarded to CGU marked with the relevant claim number Please contact your Case Manager for any assistance. CGU Workers Compensation (Vic) Limited 2

5 CLAIMS LODGEMENT CHECKLIST EMPLOYER NUMBER: WORKPLACE NUMBER: WORKERS NAME: WORKER TO COMPLETE IN FULL A WORKERS COMPENSATION CLAIM FORM TAKING SPECIFIC NOTE OF THE ITEMS LISTED BELOW: 1. Authority to release medical information signed and dated 2. Declaration signed, dated and witnessed 3. Actual date of injury specified (e.g. 1/1/2008 or 1/1/08) (Please note that any claim without a specific date of injury in the above format is invalid). COMPLETE IN FULL THE EMPLOYER CLAIM REPORT TAKING SPECIFIC NOTEOF THE ITEMS LISTED BELOW: WorkCover Employer Number WorkCover Workplace Number Ceased work date (if applicable) Pre-Injury Average Weekly Earnings Return to work date (if applicable) Employer contact details Employer declaration, signed, dated and witnessed PROVIDE 12 MONTHS PAYROLL SUMMARY PRIOR TO THE DATE OF INJURY, DETAILING AMOUNTS OF OVERTIME AND SHIFT ALLOWANCES BROKEN DOWN ON A WEEKLY BASIS COMPLETE IN FULL OVERTIME/SHIFT ALLOWANCE PROOF SHEET PROVIDE COMPLETED WORKER CONFIRMATION OF OVERTIME/SHIFT ALLOWANCE CERTIFICATES OF CAPACITY Ensure Patient Declaration (reverse side Of medical certificate) is completed in full CGU Workers Compensation (Vic) Limited 3

6 PRE INJURY AVERAGE WEEKLY EARNINGS (PIAWE) PIAWE is the average weekly earnings of the worker for the previous 12 months or less if employed continuously by the same employer for that period together with any shift allowance and/or overtime. If the worker has been employed by the same employer for less than 12 months, the weekly earnings are averaged over the period worked. The PIAWE includes: The worker s ordinary time rate of pay for the normal number of hours, and Overtime and/or shift allowance. Generally overtime and/or shift allowance will be included in the injured workers PIAWE calculation if: The injured worker worked paid overtime during the relevant period/worked a shift that incurred a shift allowance during the relevant period and; It is likely that the worker would have worked paid overtime/received shift allowance at any time in the 26 weeks after the incapacity, but for the injury What CGU requires from you: When lodging a claim for compensation you will need to supply CGU with the following: months payroll summary prior to the date of injury, detailing amounts of Overtime and Shift Allowances broken down to a weekly level 2. Complete in full Overtime/Shift Allowance proof sheet 3. Completed Worker Confirmation of Overtime/Shift Allowance (injured worker to complete) CGU Workers Compensation (Vic) Limited 4

7 Your Return to Work Obligations Aside from prevention, early return to work has the greatest positive impact on your WorkCover premium. Not only do you have a legislative obligation to return injured workers to work, doing so as soon as possible after an injury will significantly reduce your claims costs and minimise premium impact. At CGU, we can provide advice and assistance with return to work, however you as the employer are in the best position to facilitate a prompt return to work. Return to Work Plans (Section 156 of Accident Compensation Act) Section 156 requires that: you must prepare a Return to Work Plan for any worker who has a work related injury and is likely to be incapacitated for greater than 20 days. you must prepare the Return to Work Plan as soon as practicable but not later than 10 days following acceptance of the claim. Although a plan is only required by law in the above circumstances, your chances of successfully returning an injured worker to work are increased if their plan is developed earlier than this. Your chances of maintaining an injured worker at work, or returning an injured worker to work who has a partial work capacity, will also increase if you have a plan in place for them and you actively manage their return to work. Click here for a copy of the WorkSafe proforma Return to Work Plan, including detailed instruction for completion. Your Plans should be in the same or a similar format and contain all the required information detailed in the example. Return to Work Plans must be: signed by you be on your letterhead, or attached to a covering letter, or ed to CGU Please ensure that your Return to Work Plans are prepared and forwarded to us as soon as possible following injury but not later than 10 days following claim acceptance. CGU Workers Compensation (Vic) Limited 5

8 Employer duty to Re-Employ Worker (Section 155A of Accident Compensation Act) Section 155A requires you to re-employ (return to work) workers that no longer have an incapacity or who have a capacity for suitable employment. You must: provide employment in a position which is the same, or equivalent to the position the worker held before the injury, if the worker no longer has an incapacity, or provide suitable employment if a worker cannot undertake pre-injury employment but has a capacity for suitable employment These obligations apply for a period of 12 months (or the sum of periods not more than 12 months) during which the worker has an incapacity for work. Click here for a copy of the WorkSafe proforma Offer of Suitable Employment, including detailed instruction for completion. Your Offers should be in the same or a similar format and contain all the required information detailed in the example. Summary You must prepare a Return to Work Plan for any worker who has a work related injury and is likely to be incapacitated for greater than 20 days. You must prepare the Return to Work Plan as soon as practicable but not later than 10 days following acceptance of the claim and forward this to CGU. (Section 156) You must re-employ (return to work) workers that no longer have an incapacity or who have a capacity for suitable employment. (Section 155A) If you require any assistance or additional information with regard to your obligations please contact your Injury Claims Consultant or alternatively you can refer to the Return to Work Guide for Victorian Employers. CGU Workers Compensation (Vic) Limited 6

9 Return to Work Plans Your return to work plan obligations 1. Ensure the required actions to prepare the return to work plan are carried out. Record details of your return to work co-ordinator on the plan 2. Contact your injured worker (if practicable) and their treating practitioner to obtain information about their capacity to work, and prepare the plan in accordance with the medical advice 3. Aim to arrive at a consensus in relation to the plan. Sign it and invite your worker to endorse the plan 4. Specify any occupational rehabilitation services that are reasonably necessary for the return to work and the maintenance at work of your injured worker 5. Prepare the plan within 10 days of your injured worker's 20th day of no current work capacity 6. Incorporate any offer of suitable employment 7. Estimate the date your injured worker should be able to return to work 8. Revise the plan as soon as you are aware of any changes to the worker's circumstances (e.g. medical condition, work capacity). The plan should also be revised when requested by the worker, their treating practitioner, the occupational rehabilitation provider, your worker's supervisor or CGU 9. Contact CGU to inform us of the relevant circumstances and respond to any enquiries regarding the need for any occupational rehabilitation services or the engagement of an approved occupational rehabilitation provider CGU Workers Compensation (Vic) Limited 7

10 Offer of Suitable Employment What is an offer of suitable employment? It's the written outline of the suitable duties you have identified to return your injured worker to work. What is suitable employment? It is defined in the law and means work that suits the nature of your worker's injury and their current work capacity. It is work your injured worker can do without the risk of further injury. The aim is to support your injured worker so they can stay at work while they recover and return to their regular job when possible. When must I offer suitable employment? You should offer any injured worker the opportunity to undertake suitable work while they recover from their injury. If your injured worker has a current work capacity, you are required by law to provide them with suitable employment to assist them to return to work. When they no longer have an incapacity for work, you are required by law to provide them with employment that is the same as, or equivalent to, their pre-injury employment. You should speak to your CGU if you are unsure of your obligations under the law. CGU Workers Compensation (Vic) Limited 8

11 MEDICAL and LIKE EXPENSES What are the reasonable costs of medical and like services? Reasonable costs of medical and like services/expenses include bills for medical treatment, hospital services, nursing, ambulance, medicines, physiotherapy, chiropractic, osteopathy and other services. There isn t a specific list of what constitutes reasonable costs of medical and like expenses. This is because the needs of each particular injured worker will be different, the Workers Compensation system is flexible to allow each individual case to be assessed on own merit. To determine whether the treatment is reasonable or not will depend on the amount charged for the service and on how appropriate the treatment is for the worker s injury and circumstances. Employer liability Employer liability is the amount that you are required to pay on the acceptance of a claim, similar to an insurance excess, unless you have purchased a Buy Out option with your WorkCover Policy. Essentially, as the employer you will be required to pay the first $582* (this amount is indexed annually on 1st July). What CGU requires from you 1. Pay invoices to the amount of $582* (amount is indexed annually)* 2. To mark on invoices PAID, as part of your employer liability 3. Complete the Advice of Payment form, attach it to the accounts that you have paid and send to CGU (*) Note: Employer liability is the first $582 in total. If payment of an invoice results in an overpayment of this amount, you may seek reimbursement from CGU or you may part pay the invoice and have CGU pay the difference. CGU Workers Compensation (Vic) Limited 9

12 WEEKLY COMPENSATION RATES Weekly compensation payments are payable on an accepted claim when an injured worker loses anytime away from work. Effective rates of Weekly Compensation Payments: NO CURRENT WORK CAPACITY 1. 95% of the PIAWE for the first 13 weeks of compensation 2. 80% of the PIAWE post 13 weeks of compensation CURRENT WORK CAPACITY 1. 95% of the PIAWE for the first 13 weeks of compensation 2. 80% of the PIAWE for post 13 weeks of compensation if the worker has Current Work Capacity and the employer cannot provide suitable Employment 3. 80% of the PIAWE post 13 weeks of compensation and the worker has returned to work Please see further information on Partial Reimbursement Forms for calculation on weekly compensation payments with a current work capacity. CGU Workers Compensation (Vic) Limited 10

13 FORMS You can obtain a copy of the Worker's Injury Claim Form from: Your local Post Office CGU Workers Compensation WorkSafe Advisory Service By printing the PDF copy available on the WorkSafe website (or by clicking here) and making a photocopy for your own records Employer Claim Report: You can obtain a copy of this form or by clicking here. Return to Work Plan and Offer of Suitable Employment: You can obtain a copy of this form by clicking here. CGU Workers Compensation (Vic) Limited 11