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Working with you for successful claims outcomes Lynn Milne Customer Advisor WorkCover Queensland.

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Presentation on theme: "Working with you for successful claims outcomes Lynn Milne Customer Advisor WorkCover Queensland."— Presentation transcript:

1 Working with you for successful claims outcomes Lynn Milne Customer Advisor WorkCover Queensland

2 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)

3 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

4 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

5 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

6 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.

7 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/legislativeamendmentsworkcoverqld.com.au/legislativeamendments

8 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 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.ATO online decision tool 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.

9 Industry statistics – total claims costs (stat & common law)*

10 Industry statistics – Stay at work percentage

11 Industry statistics – average days to first return to work (RTW)

12 Industry statistics – Injury location (2013/14)

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14 Industry statistics – Final RTW percentage

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

16 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.

17 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).

18 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) Current premium rate Current industry rate 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. Scenario – Crush injury to right foot sustained when hydraulic gate in seed spreader closed

19 Statutory claims costs and impact on premium EntitlementCost Rehabilitation$200Includes physiotherapy, return to work assessment Travel$1,700For treatment Weekly benefit$10,000 (13 weeks totally incapacitated) Medical$14,000Specialist consults, radiography, surgical procedure, medical reports Permanent impairment $39,000Not accepted Total$25,900A maximum of $175,000 per statutory claims impacts premium

20 Statutory claims costs and impact on premium SituationsCrush type injury to foot (under the max. Statutory cost $175,000) $19,500 claim with $6,900 wages (employer has offered suitable duties at the 6 week mark saving $3,100 (4 weeks x $770) $182,600 PremiumIncreased premium to $189,700 ($7,100) Increased premium to $187,600 ($5000). This will have an accumulative saving over 3 years Premium rate (no capping applies to premium as under 1.5xR) 2.62 Industry rate * Wages $6,200,000Same

21 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.

22 Online services 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. 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.

23 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.

24 Contact us If you would like more information, please call or me: workcoverqld.com.au


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