Workcover Procedures and Important Regulations.
The key to both manager’s and the wage clerk’s role in handling potential and actual Workcover claims is to at all times make sure the claims are handled with great urgency and to make sure all forms are meticulously completed. Government regulations stipulate very short notification periods and severe penalties for lateness. Processing these claims quickly can reduce the considerable risk of upsetting staff and help to protect us against fraudulent claims. A claim that is not handled quickly and professionally will create resentment from staff when management has spent years endeavouring to develop good team spirit through fair treatment of staff.
Always refer to the appropriate section in the manuals when handling Workcover and do not hesitate to ask our claims agent for advice. Know the name of the manager at our claims agent and involve them in any problems.
The following steps must be followed without fail.
When an accident occurs, enter it with all relevant detail into the injury register. This includes gradual injuries, eg. Back strain. It is the responsibility of the duty manager to record all details in the register and the responsibility of the Safety Officer to make sure that it is done. Fill in each column accurately. Refer to Workcover books and FAI if you are unsure about any sections of the entry. Only serious injuries need to be reported to the Department of Labour, ring them to establish if formal notification is necessary.
Submitting & Monitoring a Claim
When a claim should be submitted
A claim should be submitted to the claims agent for all standard claims, when there is any doubt as to whether a minor claim might extend to a standard claim and if any doubt exists as to the legitimacy of a minor claim. If we are unsure as to the authenticity of the claim, refer it to our claims agent. Ring first and then send forms in. A minor claim is one where the claim does not exceed the employer’s liability, ie does not exceed 5 days of work or current medical limit. If we dispute a claim, provide good evidence to support our view. Refer to FAI and the booklets for details.
Submitting a claim
It is very important that all relevant forms are filled out, and that they are filled out correctly. Check all of this information thoroughly as mistakes will create problems and delays. Refer to the Workcover brochures to establish what forms are necessary and to check what information should be on the Workcover medical certificate. If a certificate is backdated the doctor must state the reasons for backdating. Unless the injury is very serious the certificates are only valid for 28 days. New certificates must be obtained to extend it beyond this period. When claims have been submitted monitor them closely. Make sure the certificates are up to date and approved, files of current claims should be checked weekly while doing the wages.
Other important notes
‘Making a claim’ & ‘Avoiding injury’ posters must always be displayed for staff in an obvious spot – ie the lunchroom.
Keep up to date with changes, notify management of any significant changes.
Substantial fines are imposed if we:
– fail to forward claims within 5 working days
– fail to make weekly payments
– fail to provide an alternative job
– fail to notify return to work
– fail to return the Annual Adjustment Return Form
– fail to notify the Commission of dates workers commence & cease work
– fail to pay our levy on time
Workcover claims statement
In April of each year we will receive a claims statement which lists all Workcover claims which will be included in our next bonus & penalty scheme calculations. It is essential that you go through this thoroughly to check the accuracy of all the recorded payments and claims, the levy we are charged will depend on it. (Make sure claims more than 2 years old are not used to penalise our levy).
Certify our remuneration
This must be done annually and consequently an adjustment will be made when the amount we should have paid is compared with what we actually have paid. Make sure the refund is received if we are entitled to it. This total remuneration does not include holiday and long service paid on termination of employment. Other details of what constitutes remuneration are listed in the Workcover handbooks.
You need to be systematic with your filing and check current claims frequently. You should keep a supply of all relevant forms. Ring Workcover for additional forms.
At this stage, new employees do not require a medical, however this may be reviewed in the future.
These accidents do not effect our penalty levy so make sure they are not included. Refer to the booklet if such an accident does occur to make sure you fully understand the procedure for processing a claim of this type.
Consult management before making any payments, whether we are accepting liability or rejecting it.