WHS-PRO-007 Health Management: Workers Compensation Procedure

Intent

This Procedure has been established to outline the processes by which James Cook University (JCU; the University) supports their workforce to stay at work or return to work following a compensable injury, fulfilling the commitments of the Health Management Policy.

The Work-related injury management processes outlined in this procedure are based on the Queensland workers compensation system and have been developed in line with the Workers Compensation and Rehabilitation Act 2003 (the Act) and the Workers’ Compensation and Rehabilitation Regulation 2014 (the Regulation). This Procedure must be read in conjunction with the Health Management Policy.

Scope

This Procedure applies to JCU Staff Members, working in Australia, who work under a contract or undertaking, taken to be employment; and who are determined to be “Workers” under the Act.

This Procedure applies to JCU Staff Members who perform work in another Australian State or Territory, and at times other relevant State or Territory workers’ compensation legislation may apply.

This Procedure relates to compensable injuries. Refer to WHS-PRO-006 Health Management: Workplace Adjustments Procedure for processes relating to supporting provision of workplace adjustments for personal injuries and/or health conditions.

This Procedure does not apply to students, including Higher Degree by Research candidates, contractors, affiliates, volunteers or visitors. This Procedure does not apply to the Singapore or Brisbane campuses, or to JCU Controlled Entities.

Definitions

Except where otherwise indicated in this Procedure, the definitions used here are found in the Health Management Policy or the Policy Glossary.

External Rehabilitation Provider: An allied health practitioner trained in the provision of occupational/vocational services such as workplace assessments, developing suitable duties plans and conducting medical case conferences for example, to assist in workplace rehabilitation.

WorkCover Queensland (WorkCover): The University’s primary accident insurer. WorkCover makes decisions on a claim regarding the employer’s liability and coordinates the workers’ compensation claim. WorkCover works closely with the Injury Prevention and Management Advisor (IPaMA) to ensure the safest and best possible return to work outcome for the Worker.

Worker: As defined within 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 (Commonwealth), schedule 1, part 2-5.”

Workers’ Compensation Regulator: The Workers’ Compensation Regulator in Queensland Office of Industrial Relations, referred to as the Regulator, has functions including coordinating medical assessment tribunals and providing administrative reviews of WorkCover decisions.

Procedure

1. Roles and Responsibilities

1.1 The University, the injured Worker, their Supervisor, the Injury Prevention and Management Advisor (IPaMA) and WorkCover all have rights and responsibilities under The Act. Specific information relating to rights and responsibilities within workers’ compensation can be found by accessing The Act, the WorkSafe website or if applicable, other relevant State or Territory legislation. Key responsibilities are outlined in the following clauses.

1.2 The Worker will:

• Maintain ongoing open communication with their Supervisor, IPaMA and WorkCover;
• Comply with this Procedure when making a workers’ compensation claim;
• Comply with all reasonable requests from WorkCover in relation to their claim;
• Obtain up to date Work Capacity Certificates on or before each certificate expires and provide copies to WorkCover, their Supervisor and IPaMA;
• Participate in prescribed treatments;
• Participate in the identification of suitable duties and development of SDP’s, be open to alternative tasks, and communicate regularly with all parties;
• Adhere to medical restrictions and SDP’s;
• Update WorkCover and the IPaMA of any changes in your condition, treatment, or employment status;
• Update WorkCover, the Supervisor and IPaMA if workplace adjustments are no longer suitable, required or are not working effectively;
• Attend medical appointments associated with the injury outside of work hours wherever possible; and
• Avoid undertaking activities at work or outside of work which may aggravate the compensable injury or cause additional injury which may impact on their recovery.

1.3 The IPaMA will:

• Facilitate lodgement of the workers’ compensation claim;
• Provide advice and support to the injured Worker throughout their claim;
• Provide advice and support to the Supervisor regarding the workers’ compensation process;
• Assess the suitability of work tasks against the Worker’s capacity and provide guidance for SDP’s to ensure a safe working environment for recovery;
• Assess the need for, and coordinate the implementation of, workplace adjustments;
• Liaise with WorkCover, treating practitioners, the Worker and Supervisor to coordinate and manage the claim and workplace rehabilitation;
• Manage medical and personal information obtained throughout the workers’ compensation claim confidentially and in accordance with the Information Privacy Policy;
• Liaise with the Human Resources and Finance and Business Services directorates to ensure the appropriate leave category is entered, and reimbursements from WorkCover are correctly allocated for those receiving workers’ compensation wage benefits; and
• Engage an external rehabilitation provider where identified as beneficial, necessary or when requested by the Worker.

1.4 The Supervisor will:

• Report the workplace injury on RiskWare if the injured Worker is unable to do so themselves;
• Provide support and maintain contact with the Worker during periods of absence and throughout workplace rehabilitation;
• Assist with the identification of suitable work duties and implementation of workplace adjustments;
• Monitor the performance and adherence to SDP’s;
• Notify the IPaMA of any issues or concerns during the workplace rehabilitation program; and
• Maintain confidentiality regarding any personal medical information and, if necessary,  liaise with the injured Worker regarding how best to communicate relevant details regarding their workplace rehabilitation to team members e.g. reduced hours or altered tasks.

2. Incident Reporting

2.1 A Worker must report any workplace incident and/or injury to their Supervisor as soon as practicably possible. The information must be logged in JCU’s Risk Management System, RiskWare, within 48 hours or as soon as possible thereafter. Further information regarding reporting of incidents in RiskWare can be found in the WHS-PRO-005 Incident and Hazard Management Procedure.

2.2 Every workers’ compensation claim must have a corresponding RiskWare incident.

3. Workers’ Compensation Claim Lodgement

3.1 Workers who are injured at work, or whilst traveling to or from work, may lodge a workers’ compensation claim. An accepted workers’ compensation insurance claim will cover reasonable and necessary costs associated with the injury.

3.2 Information about WorkCover claims processes including timeframes for lodging, stakeholder rights and responsibilities and other information can be found on the WorkSafe Queensland website.

3.3 To be eligible to lodge a claim, the Worker must:

• Obtain a completed WorkCover Work Capacity Certificate from their treating medical practitioner outlining the:
  • Injury diagnosis;
  • Medical investigations/treatment;
  • Capacity to work and medical restrictions (where applicable);
  • Review date.
• Provide a copy of the Work Capacity Certificate to the IPaMA, their Supervisor and to WorkCover.

3.4 WHS will submit the claim to WorkCover. Alternatively, the Worker may choose to complete a claim form and lodge the claim to WorkCover through their medical centre or contact WorkCover directly for other claim lodgement options.

3.5 Exact processes associated with lodging, managing and determining a claim vary from state to state. Workers who permanently reside outside Queensland are to speak to the IPaMA for specific information regarding lodgement of workers’ compensation claims in other States and Territories.

4. Workers’ Compensation Claim Closure

4.1 WorkCover may close a claim when:

• the Worker has made sufficient recovery and progress to be deemed fit to complete the inherent requirements of their role and no longer requires treatment; or
• it determines that the Worker no longer suffers a work-related injury; or
• the Worker has reached maximum medical improvement; or
• The Worker fails to participate satisfactorily.

4.2 If, following the closure of their claim, a Worker continues to experience ongoing symptoms and impact in the workplace, this will be managed in accordance with the WHS-PRO-006 Health Management Workplace Adjustments Procedure.

5. Medical Information and Confidentiality

5.1 To fulfil the role of IPaMA in managing a workers’ compensation claim, providing workplace adjustments and creating a safe, effective workplace rehabilitation program, it is to be expected that an amount of personal medical information will need to be exchanged.

• Medical information related to the injury may be collected by the IPaMA and/or the Insurer through the Work Capacity Certificate, reports, questionnaires and other written communication methods, phone calls or face-to-face case conferences.
• Relevant medical information will be shared between JCU and WorkCover. WorkCover will withhold personal medical information that is not relevant to workplace adjustments or workplace rehabilitation.
• Instances involving direct communication between the IPaMA and a treating practitioner requires WHS-PRO-FORM-006c Medical Authorisation Form to have been completed.

5.2 Information obtained for the purpose of a workers’ compensation claim will be treated with sensitivity and confidentiality by all stakeholders and in accordance with JCU’s Information Privacy Policy and Right to Information Policy. If it is necessary to obtain or release information associated with a workers’ compensation claim to a third party, the Worker’s authority to obtain or release the information is to be completed.

5.3 Information regarding the impact of an injury on the Worker’s ability to undertake the inherent requirements of their role, and any workplace adjustments must be communicated between the Worker, IPaMA and relevant line management. Personal medical information is not provided to line management.

5.4 Injured Workers have the right to choose their own treating practitioners.

5.5 At times, the IPaMA and Insurer may require additional medical information to clarify, expand or specify certain information related to the workers’ compensation claim and workplace adjustments including workplace rehabilitation. The need for additional information will be discussed with the Worker and the Insurer. Supplementary information may be sought from treating allied health professionals, such as physiotherapists, exercise physiologists, psychologists and occupational therapists.

5.6 A Worker’s injury may indirectly impact upon work colleagues through absenteeism, reduced productivity, visible signs of injury, or through workplace adjustments. Workers are encouraged to speak with their Supervisor and/or the IPaMA about how best to communicate any necessary information to colleagues. This information might include SDP’s, altered work arrangements, limitations or absences affecting work output. Personal medical information is not required to be shared by the Worker.

6. Workplace Adjustments for Compensable Injuries

6.1 Requests for workplace adjustments relating to an accepted workers’ compensation claim are to be provided in writing to WorkCover and the IPaMA.

6.2 WorkCover will assess the medical evidence when considering approval of a workplace adjustment.

6.3 Approved workplace adjustments that require purchasing will be funded by WorkCover.

6.4 WorkCover will communicate with the Worker and IPaMA regarding the implementation of a workplace adjustment.

7. Workplace Rehabilitation for Compensable Injuries

7.1 The provision of workplace rehabilitation is a workplace adjustment provided by JCU in line with The Act and is available to injured Workers throughout their claim, subject to clause 9 and 10 of this procedure.

7.2 The aim of workplace rehabilitation is to assist with recovery and to maximise the individual’s physical, psychological and social potential throughout the recovery period. Returning, or continuing to work following a work-related injury, is considered beneficial and is an integral component of effective injury management.

7.3 A workplace rehabilitation program is initiated and/or managed by the IPaMA to assist Workers to safely continue to work, or return to work as soon as possible following a work-related injury. Workplace rehabilitation may include temporary adjustments to work hours or duties and the development of Suitable Duties Plans (SDP’s).

7.4 JCU adopts a risk-based approach with regard to workplace rehabilitation to ensure that an SDP does not place the health and safety of the Worker or others at risk.

7.5 Workplace rehabilitation will only proceed once clear medical guidance is received.

7.6 Workplace rehabilitation aims to return an injured Worker to their pre-injury occupation whenever possible.

7.7 JCU will:

• Where possible, accommodate the injured Worker with suitable duties in line with medical restrictions;
• When required, develop an SDP to document the temporary working arrangements;
• Coordinate workplace rehabilitation through the IPaMA, in consultation with the Worker, Supervisor, treating practitioner and other relevant stakeholders such as WorkCover;
• If required or requested, engage an external rehabilitation provider to assist with the workplace rehabilitation process and provision of support; and
• Take into account individual needs including recognition of cultural or linguistic background.

7.8 Whilst a Worker is undergoing workplace rehabilitation, the suitability of other flexible working arrangements may need to be reviewed e.g. working overtime and accrual of TOIL is not advised whilst recovering from an injury or illness, unless medical clearance has been received.

8. Workplace Rehabilitation: Suitable Duties Plans (SDP’s)

8.1 An SDP is required when an injured Worker has medical restrictions which prevent or limit their ability to undertake their usual work duties. The purpose of an SDP is to document the agreed temporary working arrangements.

8.2 SDP’s are developed by the IPaMA in line with medical advice, and in consultation with the Worker, Supervisor and other relevant stakeholders such as the Head of Work Unit.

8.3 At times, a Worker may be provided with medical advice to temporarily work from home as part of their workplace rehabilitation. If approved, the arrangements will be documented in the SDP. The IPaMA and Supervisor will consider the following when determining whether to support this reasonable adjustment request:

• Whether meaningful suitable duties can be completed at home;
• The home work environment, safety and workstation set up;
• The ability for JCU to monitor workplace rehabilitation progress and manage risk.

8.4 The Suitable Duties Plan Guideline provides further guidance in relation to SDP’s.

9. Workplace Rehabilitation: Review & Cessation

9.1 Workplace rehabilitation will be monitored on a regular basis by the IPaMA in conjunction with other parties involved, as applicable.

9.2 The progress of each case will be considered on medical grounds. If continued workplace rehabilitation is necessary, and the Worker’s progress is satisfactory to all concerned, and the University is able to continue to accommodate medical restrictions, then extensions to the workplace rehabilitation program may occur.

9.3 Workplace rehabilitation may cease if/when:

• The University is no longer able to accommodate the medical restrictions;
• The Worker fails to participate satisfactorily;
• No further assistance is required;
• There are changes to the Workers contract of employment, or;
• The injury is resolved.

10. Workplace rehabilitation participation

10.1 The Worker is required to participate in workplace rehabilitation and comply with the Suitable Duties Plan. The Worker is to maintain open communication with the IPaMA and their Supervisor and report any issues as soon as possible so that they can be addressed.

10.2 Failure to participate in workplace rehabilitation or voluntarily subjecting oneself to unsafe activities will be communicated to WorkCover. This may result in the inability of JCU to support workplace rehabilitation and WorkCover may suspend or terminate the Workers’ insurance benefits.

10.3 If JCU is not able to provide workplace rehabilitation, WorkCover may identify a host employer and require the Worker to attend an alternative workplace until they can participate in workplace rehabilitation at JCU.

11. Expenses

11.1 WorkCover will pay reasonable and necessary costs associated with an accepted workers’ compensation claim, pursuant to entitlements outlined in The Act.

11.2 If costs are incurred prior to liability being determined on the claim, it is the Worker’s responsibility to pay for, and retain proof of, expenses relating to their injury.

11.3 Workers must have a current Work Capacity Certificate outlining the necessary treatment in order to request reimbursement by WorkCover.

11.4 WorkCover will consider reimbursement of treatment, aid and/or equipment costs upon acceptance of the workers’ compensation claim. Should liability for the claim be declined, the expenses will not be reimbursed by WorkCover or JCU.

11.5 Throughout the duration of an accepted WorkCover claim, the Worker is to familiarise themselves with their expense entitlements and requirements for claiming, which can be found on the WorkSafe QLD website.

12. Time off due to work related injury

12.1 If a treating practitioner determines that a Worker requires time off work following a workplace injury, it must be recorded on the Work Capacity Certificate.

12.2 Prior to a workers’ compensation claim being accepted, fixed-term, continuing or part-time Workers are to follow the steps outlined below. Note that JCU will pay a Worker their wages on the day of injury as per The Act:

• The Worker is to lodge an application for leave through MyHR Online for time off work as per the Leave Procedure.  If the Worker is absent from the workplace because of their work-related injury and unable to lodge an application for personal/carers leave, their Supervisor or IPaMA is to contact Human Resources to lodge leave on the Worker’s behalf.
• JCU will reinstate the Worker’s leave entitlements only if the Insurer accepts liability for the claim and the leave taken is in line with the medical advice provided on the Work Capacity Certificate.

12.3 Once a claim has been accepted, the IPaMA will inform Human Resources of hours worked, to be paid as salary, and hours not worked, to be paid as workers’ compensation payments.

12.4 Casual Workers are to submit timesheets only for hours worked and will receive wage reimbursements determined by WorkCover for periods of incapacity documented on the Work Capacity Certificate.

13. Wages information

13.1 JCU will pay a Worker’s wages in accordance with The Act.

14. Overseas/Interstate Work Related Accident Insurance

14.1 Overseas Workers

14.1.1 Workers who are temporarily engaged in another country for periods of less than six months are covered under JCU’s workers’ compensation insurance. For temporary overseas engagement for periods greater than six months, workers’ compensation coverage will depend on individual employment circumstances including their principal place of employment which should be discussed with the IPaMA and JCU Insurance.

14.1.2 Workers who reside permanently overseas are not covered under JCU’s workers’ compensation insurance. In these instances, the approving manager should contact insurance@jcu.edu.au to discuss appropriate insurance coverage.

14.1.3 All Workers that travel overseas as part of JCU employment are to contact insurance@jcu.edu.au to discuss additional insurance requirements such as travel insurance.

14.2 Interstate Workers

14.2.1 If a Worker usually works in a State or Territory other than Queensland, and the Worker’s employment is connected with that State, then JCU will insure the Worker under an accident insurance policy according to that State or Territory’s legislated requirements. Workers’ compensation and workplace rehabilitation will take place in accordance with the relevant legislative requirements.

14.2.2 Workers who temporarily travel to States or Territories other than Queensland are insured by WorkCover.

15. Complaints

15.1 If a Worker is unhappy with a decision regarding workplace adjustments including workplace rehabilitation, the Worker may raise the matter with their Supervisor or the IPaMA. If unable to resolve the dispute informally, the Worker is to escalate the matter to their Head of Work Unit and/or the WHS Manager.

15.2 If unable to be resolved internally, the Worker can contact WorkCover to assist in dispute resolution.

15.3 If a Worker or JCU is dissatisfied with a liability decision made by WorkCover (i.e. to accept or decline a claim), the decision may be referred to the Workers’ Compensation Regulator. Strict time frames apply, and the Worker must contact WorkCover directly to obtain further information.

Related policy instruments

Health Management Policy

WHS-PRO-006 Health Management Workplace Adjustment Procedure

WHS-PRO-FORM-006a Work Capabilities Form 6A

WHS-PRO-FORM-006b Work Capabilities Form 6B

WHS-PRO-FORM-006c JCU Medical Authorisation Form

WHS-PRO-FORM-006d Suitable Duties Plan

WHS-PRO-GUI-006e Suitable Duties Plan Guideline

WHS-PRO-005 Incident & Hazard Management Procedure

Leave Procedure

Information Privacy Policy

Right to Information Policy

JCU Enterprise Agreement

Fair Work Act 2009 (Cth)

Workers’ Compensation and Rehabilitation Act 2003 (Qld)

Workers’ Compensation and Rehabilitation Regulation 2014 (Qld)

WorkSafe Queensland website

Schedules/Appendices

Nil

Administration

NOTE: Printed copies of this procedure are uncontrolled, and currency can only be assured at the time of printing.

Approval Details

Revision History