FREQUENTLY ASKED QUESTIONS

• Who is eligible to claim for workers compensation?
• How do I lodge a claim for workers compensation?
• How soon can I receive workers compensation benefits for treatment and time off?
• How is my pay affected under a workers compensation claim?
• How can I get my treatment paid for by the insurer?
• I/ my staff member has been medically certified fit for suitable duties. How can I get assistance with returning to work?
• What if my workers compensation claim is declined by the insurer?
• What if I am left with a permanent injury or disability?
• What is the role of the insurer in my workers compensation claim?

All employees of the University of Sydney, including casual staff, can claim compensation for wages and medical costs under the NSW Workplace Injury Management and Workers Compensation Act 1998 as amended, if they suffer an injury or illness arising out of, or in the course of their employment.

Injuries arising out of journeys to and from work may also be covered if they meet the prescribed legislative requirements.

Workers compensation may also be claimed if a previous injury or condition is aggravated in the course of employment.

Late reporting of injury and illness can delay the insurer acceptance of your claim and payment of benefits.

If you sustain an injury or illness in the course of your employment;

• Seek appropriate medical attention and obtain a NSW WorkCover medical certificate from your doctor.
• Report your injury or illness as soon as possible to your supervisor and complete a University of Sydney Occupational Injury, Illness or Injury Form.
• Report your injury/illness to the Workers Compensation Claims Officer at OHS & Injury Management on x 14052.
• Complete relevant insurer forms as instructed by the Workers Compensation claims officer and return these to OHS & Injury Management as soon as possible with your medical certificate.
• Remember to keep your supervisor informed and submit copies of your medical certificates to them.

Early reporting of work related injury and illness facilitates prompt access to workers compensation benefits. The insurer must notify staff within 7 days of being notified of a new injury or illness regarding their decision to pay for reasonable medical treatment and wages for time off work.

If an injury or illness is reported more than 2 months after it occurred, the insurer has the right to withhold approval of benefits for treatment and wages until they fully assess the claim within 21 days of their receipt of completed claim forms.

There are various legislated limits that can affect the level of a staff members pay under a workers compensation claim. Two of the common limits are briefly described below;

• Whilst a staff member remains unfit for work there is a maximum level of wages that can be claimed. If your wage exceeds this level then OHS & Injury Management will advise you of this and discuss any possible options to maintain your salary.
• Once a staff member has claimed 26 weeks of wage benefits for complete or partial incapacity under a claim, they are only entitled to claim a statutory wage rate from that point for any ongoing periods of time they remain unfit for work. Staff are notified by OHS & Injury Management if they are nearing this point in their claim.

The insurer must notify staff within 7 days of being notified of a new injury or illness regarding their decision to pay for reasonable medical treatment.

Please note: if an injury/illness is reported more than 2 months after it occurred then the insurer has the right to withhold treatment approval until they fully assess the claim within 21 days of their receipt of completed claim forms.

Some treatment providers choose not to bill the insurer direct for their costs and may ask staff to pay up front for treatment. Staff can seek reimbursement from the insurer for the costs of any insurer approved treatment, through submission of receipts to OHS & Injury Management.

Throughout the duration of a workers compensation claim, the insurer routinely re-assesses their approval of reasonable treatment costs and may decide to cease funding of previously approved treatment, for example if they determine further benefit is not being gained.

As is required by NSW Workers Compensation legislation, it is the University’s policy to offer suitable duties wherever possible to staff on workers compensation claims to facilitate a safe and durable return to work. Staff are required to actively participate in rehabilitation and return to work programs to remain eligible for workers compensation benefits.

Return to work programs for staff on suitable duties are coordinated by the Rehabilitation Coordinator at OHS & Injury Management, contactable on x14714.

OHS & Injury Management, with the approval of the insurer, may utilise the services of an Accredited Rehabilitation Provider to assist in the coordinating and monitoring of a staff members return to work program.

Details of the University’s policy and procedures in relation to return to work programs for staff with workers compensation claims can be found in the Injury Management Policy and Procedures at the following link http://www.usyd.edu.au/ohs/policies/injury/policy.shtml or by calling the Rehabilitation Coordinator on x14714.

The insurer must formally notify staff if their claim has been declined, indicating the reason for this decision and noting the available avenues of appeal for staff.

After a decline of a claim any ongoing medical costs are the responsibility of the staff member.

Staff should continue to submit any relevant medical certificates and leave forms to their supervisor after the decline of a claim.

Staff and departments are referred to the Case Management Group for assistance in coordinating and monitoring return to work programs where there are ongoing medical or work restrictions after a claim has been declined.

The workers compensation legislation allows for staff to receive a financial benefit if they have sustained a permanent injury or loss of function based on strict eligibility criteria. Such assessment of permanent injury can usually only be accurately made some time after a serious injury has occurred, to allow time for maximal recovery.

If you feel you have sustained a permanent injury you should consider seeking legal advice on submitting relevant documents to the insurer to commence negotiation regarding any entitlements in this area.

If an insurer independent medical examiner indicates to the insurer you have sustained a permanent injury that meets the legislated eligibility criteria, then the insurer must notify you of this finding and will recommend you seek independent legal advice on this matter.

The insurer makes decisions in regard to approval or decline of a workers compensation claim

The insurer is required to contact all staff with new claims where they have medical recommendations for restrictions to their duties at work.

The insurer makes decisions regarding what treatment is approved for each claim based on the medical advice available and what they consider to be reasonable.

The insurer may choose to send staff to independent medical examinations to assist in clarifying the progress in injury recovery and to review treatment needs. Attendance at these insurer medical examinations is compulsory.

The insurer may also choose to appoint an independent investigator to a claim to conduct factual interviews with various key parties. This is commonly the case with claims for psychological injury or illness. This type of factual investigation is aimed at assisting the insurer in determining their acceptance or decline of the claim.