For new start-up businesses, are you registered with Return to Work SA?
If not, it is critical to do so within 14 days of employing a person (including family members) who meet the definition of worker under section 4 of the RTW SA Act 2014. For online registration, go to Return to Work SA by clicking here and complete and send in an “Application for registration as an employer”.
What to do when a worker presents a Work Capacity (medical) Certificate for Compensation?
First, subject to critical early reporting by phone (which will save costs), a claim form must then be completed with the Work Capacity (medical) Certificate (if you have been given one) and submitted to your agent within five business days of receiving a claim from the worker. Penalties apply for failure to comply with the 5 day obligation. Click here for more.
- Complete this form and ideally the worker and the employer should complete it together (if after a quick investigation, you question whether work was really a significant contributing cause, call MTA to discuss and then note your concern on page 3 Section 9).
- Sign the Medical Authority and declarations (page 4) from the link above.
- Lodge this form with claims Agent ensuring you (the employer) and the worker complete and sign it. Send the form and Work Capacity Certificate to the claims agent 8127 1100.
If the worker is likely to be off work for more than 2 weeks, the agent should appoint a mobile case manager to meet with you and the worker.
Should you lodge the claim urgently/promptly?
To encourage the early reporting of a claim, an employer will be rewarded if they report, even by phone (to the agent) a claim within 5 business days, through a waiver of their responsibility to pay the first two weeks of an injured worker’s wages.
Call your claims agent as soon as possible to report a work injury including basic details. Your claims agent will advise you immediately whether a Case Manager will be assigned (to manage the claim).
If the employee is absent, phone such person. First, to see what happened (for example a personal injury such as non-work related or sporting injuries, or a work injury). Secondly, enquire how they are progressing. Third, expected time off and critically keep notes on file of what was said for the record or claims agent later!
Does a claim get investigated before it is accepted / rejected by the Claims agent and what interim payments are made?
Yes claims are investigated before acceptance and interim payments made before final determination. If the employer/other employees have genuine doubt that the injury was work related, liaise with the claims agent and speak with MTA – however – in most cases, it is far better to encourage an early return to work (and reduced income maintenance payments) than to contest the claim and potentially cost the business far more in workers compensation premiums going forward i.e. the risk is that the worker develops psychosomatic disorder about the fear of returning to work and what others think of him/her!
How long it takes before the claim is determined depends on various factors but clearly non contentious claims are accepted relatively quickly. For physical injuries the RTW SA Act 2014 requires work to be “a significant contributing cause” and for psychological injuries work has to be “the significant contributing cause”. However appeals to the SA Employment Tribunal about how to interpret these words has led to a different view than the plain and natural meaning! Some of these matters are now before the Supreme Court and we will update members if the Court makes a determination affecting this advice.
What payments increase the Employer Premium (annual levy) for the Return to Work Corporation?
Perhaps the most significant increase in levies/premiums paid annually are as a result of:
- Increases in payroll following wage rises or increased staff
- Weekly income maintenance payments paid out to injured workers
- Penalty premiums where the business fails to comply with return to work directions, particularly around the provision of suitable employment and returning injured workers to work.
For most employers the aim is to reduce time off to the “weekly income maintenance payments paid out to injured workers in order to minimise the impact via the experience rated premium scheme.” The effect of all other costs such as medical and hospital treatment also indirectly impact premiums via the process of setting industry base rates.
How can the MTA and an employer assist the doctor or claims agent to find suitable alternate duties in the workplace, to encourage the transition of an injured worker back to work?
First, the critical issue for any return to work is knowledge of the injured workers physical capacity to perform work safely and with support (where needed) whilst he/she recovers from the injury (or achieves “medical stabilisation”). This is where the treating doctor (GP or Specialist), issuing a fully completed work capacity certificate, is vital.
Secondly, to avoid arguments about what are suitable duties and to assist both the treating doctor and your claims agent, the MTA has developed 13 occupational groups of job tasks with physical pictures of tasks broken down for each job, time spent on each task, manual handling/physical exertion/twisting/bending involved in each task.
Third, contact MTA for the automotive job dictionary relevant to the injured worker’s occupation, each is quite detailed so check which tasks are relevant to your workplace. Some occupations such as Clerical work, Store duties may not be covered by these 13 occupational groups of job tasks, call your agent as these have been done by other employer organisations in conjunction with RTWSA, once you have them follow the procedure below or call MTA to assist.
Fourth, send the relevant job dictionary to your claims agent (EML or Gallagher Bassett) contacting them first (phone above) explaining which suitable duties you have so the Treating Doctor matches the physical capacity of the worker to your available duties – this avoids / minimises arguments about what are relevant and meaningful duties in your workplace. It also helps if the worker is at risk of further lost time off (which affects the employer levy/premium) and helps introduce the worker back to the workplace minimising lost time and contributing to some workplace productivity. Again call MTA if help on any issue (emerging or unforeseen) if required.
Does the legislation place strong emphasis on using the Work Capacity (Medical) Certificate to encourage early claims assessment and return to meaningful /suitable duties?
Yes, definitely. Ideally the Employer or Manager in a small business will take responsibility for encouraging/managing the return to work (if the certificate allows it) for numerous reasons- financial costs, reducing worker alienation / improved co-worker encouragement, lower risk of onset of mental fears of return to work, improved worker self-worth/feeling of contributing to the workplace.
In a larger business of more than 30 staff, where an in house manager/supervisor etc. is required to be appointed and trained as a Return to Work Coordinator. However any employees who have influence over an injured worker should be encouraged to communicate and assist giving them guidance on how to do so.
What claims costs affect the employer levy/premium?
As stated above (answer to question 5), weekly income maintenance payments, (once the claim is accepted) directly affect the employer’s levy/premium. Therefore it is vital, even if you think the claim is non work related, to encourage an early return to work with suitable duties and allow the agent to investigate whether the injury is compensable or sick leave.
Who pays for Medical and Hospital expenses?
Fortunately such expenses are not attributed to the individual employer but to the whole industry class /code. The rationale is to spread these medical expenses – which are often the result of an accumulated medical history with many employers.
Is the employer required to pay the 1st two weeks of any claim?
Yes the employer is expected to pay the 1st two weeks of any claim. However if the employer reports the claim e.g. by phone to the Agent (see contact number in question 2 above) within 5 days and / or forwards the medical certificate (ideally electronically), the employer will be reimbursed for any payment made in the first two weeks.
Should the employer blindly accept a medical certificate allowing continuous time off?
Definitely not! Contact your claims Agent quoting the claim number and employee name if this happens, it should not occur following the recent changes. If a mobile case manager has been appointed, you should discuss this with him/her. Any claim which has the potential to take more than 10 days should be managed by a mobile case manager, check with your claims agent if the medical certificate does not specify an early return to full duties. The mobile case manager or even the case manager should be a good liaison point for early return to work.
When should I challenge a certificate? Suitability of treatment? The Agent’s decision?
If the employer feels the injured worker’s return to work is not suitable or the worker complains treatment is not working contact the Claims Agent and liaise with the MTA as needed.If the employer is not happy with the Agent’s management of the claim, then contact the MTA’s Workplace Relations team for assistance by clicking here.