Workers' Compensation and Rehabilitation Regulation 2003


Queensland Crest
Workers’ Compensation and Rehabilitation Regulation 2003
Queensland Workers’ Compensation and Rehabilitation Act 2003 Workers’ Compensation and Rehabilitation Regulation 2003 Current as at 8 November 2013
Information about this reprint This reprint shows the legislation current as at the date on the cover and is authorised by the Parliamentary Counsel. A new reprint of the legislation will be prepared by the Office of the Queensland Parliamentary Counsel when any change to the legislation takes effect. This change may be because a provision of the original legislation, or an amendment to it, commences or because a particular provision of the legislation expires or is repealed. When a new reprint is prepared, this reprint will become a historical reprint. Also, if it is necessary to replace this reprint before a new reprint is prepared, for example, to include amendments with a retrospective commencement, an appropriate note would be included on the cover of the replacement reprint and on the copy of this reprint at www.legislation.qld.gov.au. The endnotes to this reprint contain detailed information about the legislation and reprint. For example— The table of reprints endnote lists any previous reprints and, for this reprint, gives details of any discretionary editorial powers under the Reprints Act 1992 used by the Office of the Queensland Parliamentary Counsel in preparing it. The list of legislation endnote gives historical information about the original legislation and the legislation which amended it. It also gives details of uncommenced amendments to this legislation. For information about possible amendments to the legislation by Bills introduced in Parliament, see the Queensland Legislation Current Annotations at www.legislation.qld.gov.au/Leg_Info/ information.htm. The list of annotations endnote gives historical information at section level. All Queensland reprints are dated and authorised by the Parliamentary Counsel. The previous numbering system and distinctions between printed and electronic reprints are not continued.
Queensland Workers’ Compensation and Rehabilitation Regulation 2003 Contents Part 1 1 2 3 5 Part 2 Division 1 6 7 8 9 10 11 12 14 15 15A Division 2 16 Division 3 19 20 20A 21 22 Page Preliminary Short title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Commencement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 WorkCover’s capital adequacy—Act, s 453 . . . . . . . . . . . . . . . . . 17 Employer insurance Policies and premium assessments Application for policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Policies and renewals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Assessment of premium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Declaration of wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Value of board and lodging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Payment of premium by instalments. . . . . . . . . . . . . . . . . . . . . . . 20 Additional premium for late payment of premium—Act, ss 61 and 62 ....................................... 21 Premium for appeals—Act, s 569(2)(a) . . . . . . . . . . . . . . . . . . . . 22 Former employer may apply to cancel policy . . . . . . . . . . . . . . . . 22 Cancellation of policy if workers no longer employed. . . . . . . . . . 23 Employer excess Excess period—Act, s 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Self-insurance Application fees—Act, s 70. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Annual levy—Act, s 81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Provisional annual levy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Additional amount for late payment of levy—Act, s 82 . . . . . . . . . 26 Conditions of licence—Act, s 83. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Workers’ Compensation and Rehabilitation Regulation 2003 Contents 23 23A 24 Part 3 Division 1 25 26 Division 2 27 28 Division 3 29 Division 4 30 31 32 Part 4 Division 1 Subdivision 1 33 Subdivision 2 34 35 36 37 38 39 40 41 42 43 Subdivision 3 44 45 Premium payable after cancellation of self-insurer’s licence—Act, s 98 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deemed levy for appeals—Act, s 569(2)(a) . . . . . . . . . . . . . . . . . Actuarial procedure—self-insurers . . . . . . . . . . . . . . . . . . . . . . . . Other insurances Students Insurance of work experience students . . . . . . . . . . . . . . . . . . . . Insurance of vocational placement students . . . . . . . . . . . . . . . . Eligible persons Proposal for contract of insurance—Act, s 24 . . . . . . . . . . . . . . . Documents to be kept by eligible person . . . . . . . . . . . . . . . . . . . Other persons Contracts of insurance for other persons . . . . . . . . . . . . . . . . . . . Contracts of insurance generally Entitlements of persons mentioned in ch 1, pt 4, div 3, sdivs 1, 2 and 4 ........................................ WorkCover not liable if premium not paid. . . . . . . . . . . . . . . . . . . Duty to report injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amount of calculation of liability for self-insurers Outstanding liability Purpose of div 1 Purpose of div 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculation Appointment of actuary for calculation . . . . . . . . . . . . . . . . . . . . . Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Regulator to give actuaries information . . . . . . . . . . . . . . . . . . . . Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement on calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reference to arbiter if no agreement . . . . . . . . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment of amount for outstanding liability . . . . . . . . . . . . . . . . . Transfer of claims information. . . . . . . . . . . . . . . . . . . . . . . . . . . . Recalculation Purpose of sdiv 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Application of sdiv 3 for group employers. . . . . . . . . . . . . . . . . . . 27 28 28 28 30 31 31 32 32 33 33 34 34 34 35 35 36 36 36 37 37 37 38 38 Page 2
46 47 48 49 50 51 52 53 54 Division 2 55 56 57 58 59 60 61 62 63 64 65 Division 3 66 67 68 69 70 71 72 73 74 75 Division 3A 75A 75B 75C Workers’ Compensation and Rehabilitation Regulation 2003 Contents Appointment of actuary for recalculation . . . . . . . . . . . . . . . . . . . Recalculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Regulator to give actuaries information . . . . . . . . . . . . . . . . . . . . Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement on recalculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reference to arbiter if no agreement . . . . . . . . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment of amount for recalculation . . . . . . . . . . . . . . . . . . . . . . Total liability Purpose of div 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appointment of actuary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parties to give actuaries information . . . . . . . . . . . . . . . . . . . . . . Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement on calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reference to arbiter if no agreement . . . . . . . . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment of amount for total liability . . . . . . . . . . . . . . . . . . . . . . . Transfer of claims information. . . . . . . . . . . . . . . . . . . . . . . . . . . . Liability after cancellation of self-insurer’s licence Purpose of div 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appointment of actuary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Former self-insurer to give actuaries information . . . . . . . . . . . . . Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reference to actuarial arbiter if no agreement . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment of amount for liability . . . . . . . . . . . . . . . . . . . . . . . . . . . Estimated claims liability Purpose of div 3A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Definition for div 3A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Approved actuary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 38 39 39 41 41 41 41 41 43 43 43 44 44 45 45 45 46 46 46 47 47 47 47 48 49 49 49 49 49 50 50 50 Page 3
Workers’ Compensation and Rehabilitation Regulation 2003 Contents 75D 75E 75F 75G 75H 75I 75J 75K 75L Division 3B Subdivision 1 75M 75N Subdivision 2 75O 75P 75Q 75R 75S 75T 75U 75V 75W Subdivision 3 75X 75Y 75Z 75ZA 75ZB 75ZC 75ZD 75ZE 75ZF 75ZG Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Self-insurer to give Regulator and approved actuary information Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Copy of actuarial report to Regulator and self-insurer . . . . . . . . . Regulator to advise self-insurer whether agreement . . . . . . . . . . Reference to Regulator’s actuary if no agreement . . . . . . . . . . . . Agreement on estimated claims liability . . . . . . . . . . . . . . . . . . . . Reference to arbiter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Self-insurers who become non-scheme employers Preliminary Purpose of div 3B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Definition for div 3B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculation Appointment of actuary for calculation . . . . . . . . . . . . . . . . . . . . . Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-scheme employer to give actuaries information . . . . . . . . . . Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reference to actuarial arbiter if no agreement . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment of amount for liability . . . . . . . . . . . . . . . . . . . . . . . . . . . Recalculation Purpose of sdiv 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appointment of actuary for recalculation . . . . . . . . . . . . . . . . . . . Recalculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WorkCover to give actuaries information . . . . . . . . . . . . . . . . . . . Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement on recalculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reference to arbiter if no agreement . . . . . . . . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment of amount for recalculation . . . . . . . . . . . . . . . . . . . . . . 50 51 51 52 53 53 53 53 54 54 54 54 54 55 55 56 57 57 57 57 58 58 58 59 59 60 60 61 61 61 Page 4
Division 3C 75ZH 75ZI 75ZJ 75ZK 75ZL 75ZM 75ZN 75ZO 75ZP 75ZQ 75ZR Division 4 76 77 78 79 Part 5 Division 1 80 81 82 83 84 Division 2 85 85A 86 87 88 89 91 Division 3 92 Workers’ Compensation and Rehabilitation Regulation 2003 Contents Total liability—member of a group who becomes non-scheme employer Purpose of div 3C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appointment of actuary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parties to give actuaries information . . . . . . . . . . . . . . . . . . . . . . Actuarial report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement on calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reference to arbiter if no agreement . . . . . . . . . . . . . . . . . . . . . . Arbiter’s costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment of amount for total liability . . . . . . . . . . . . . . . . . . . . . . . Transfer of claims information. . . . . . . . . . . . . . . . . . . . . . . . . . . . Actuarial arbiter Function of actuarial arbiter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appointment of actuarial arbiter . . . . . . . . . . . . . . . . . . . . . . . . . . Decision of arbiter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arbiter’s decision is final . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Compensation Calculation of NWE Calculation of NWE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . What amounts may or may not be taken into account . . . . . . . . . NWE if impracticable to calculate rate of worker’s remuneration . NWE if worker worked for 2 or more employers . . . . . . . . . . . . . . NWE if insurer considers calculation unfair . . . . . . . . . . . . . . . . . Compensation application and other procedures Application for compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . Application for compensation for assessment of DPI—Act, s 132A Certificate given by dentist, doctor or nurse practitioner . . . . . . . If dentist, doctor or nurse practitioner not available . . . . . . . . . . . Examination of claimant or worker—Act, ss 135 and 510 . . . . . . Payment for treatment arranged by employer other than self-insurer ..................................... Special medical treatment, hospitalisation or medical aid . . . . . . Entitlement to compensation for permanent impairment Calculating lump sum compensation—Act, s 180 . . . . . . . . . . . . 62 62 63 63 63 65 65 65 65 65 66 66 66 67 67 68 68 68 69 69 69 70 71 71 72 72 73 74 Page 5
Workers’ Compensation and Rehabilitation Regulation 2003 Contents 95A 96 97 Part 6 Division 1 98 99 Division 2 99B 99C Division 3 101 103 104 105 106 106A 107 108 109 110 Part 7 111 112 112A 112B Part 7A 112C 112D 112E 112F Page 6 Additional lump sum compensation—workers with latent onset injuries that are terminal conditions—Act, s 128B . . . . . . . . . . . . Additional lump sum compensation for certain workers—Act, s 192 ......................................... Additional lump sum compensation for gratuitous care—Act, s 193 ......................................... Rehabilitation Caring allowance Further information required in occupational therapist’s report—Act, s 224 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Extent of liability for caring allowance—Act, s 225 . . . . . . . . . . . . Rehabilitation and return to work coordinators Functions of rehabilitation and return to work coordinator—Act, s 41(b) ......................................... Employer’s obligation to appoint rehabilitation and return to work coordinator—Act, s 226 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Standard for rehabilitation Who this division applies to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Standard for rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Doctor’s approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Worker’s file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rehabilitation and return to work plan . . . . . . . . . . . . . . . . . . . . . Suitable duties program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Early worker contact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Confidentiality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Damages Notice of claim for damages—Act, s 275 . . . . . . . . . . . . . . . . . . . Notice of claim and urgent proceedings—Act, s 276 . . . . . . . . . . Insurer may add another person as contributor—Act, s 278A . . . Contributor’s response—Act, s 278B . . . . . . . . . . . . . . . . . . . . . . Assessment of damages Prescribed amount of damages for loss of consortium or loss of servitium—Act, s 306M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rules for assessing injury scale value—Act, s 306O(1)(c)(i) . . . . General damages calculation provisions—Act, s 306P . . . . . . . . Prescribed amount of award for future loss—Act, s 306R . . . . . . 74 74 74 75 75 76 77 77 78 78 78 78 79 79 80 80 80 81 85 86 86 87 87 88 88
Part 8 Division 1 113 Division 2 114 115 116 117 118 Part 8A 118A 118B 118C 118D 118E 118F 118G Part 9 119 120 120A 120B Part 10 Division 1 121 122 Division 2 123 124 Workers’ Compensation and Rehabilitation Regulation 2003 Contents Costs Proceeding before industrial magistrate or industrial commission Costs—proceeding before industrial magistrate or industrial commission ..................................... Claim for damages Who this division applies to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Definition for div 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Costs before proceeding started . . . . . . . . . . . . . . . . . . . . . . . . . Costs after proceeding started . . . . . . . . . . . . . . . . . . . . . . . . . . . Outlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical assessment tribunals Medical assessment tribunals . . . . . . . . . . . . . . . . . . . . . . . . . . . Constitution of General Medical Assessment Tribunal . . . . . . . . . Chairperson and deputy chairperson of General Medical Assessment Tribunal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Constitution of specialty medical assessment tribunal . . . . . . . . . Chairperson and deputy chairperson of specialty medical assessment tribunal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Constitution of composite tribunals . . . . . . . . . . . . . . . . . . . . . . . Chairperson and deputy chairperson of composite tribunal . . . . . Miscellaneous Documents to be kept—Act, s 520 . . . . . . . . . . . . . . . . . . . . . . . . Reasons for decisions must address certain matters—Act, ss 540(4) and 546(3AA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Declaration of designated courts—Act, s 114 . . . . . . . . . . . . . . . Declaration of provisions that are a State’s legislation about damages for work related injury—Act, s 322 . . . . . . . . . . . . . . . . Transitional provisions Provisions for Workers’ Compensation and Rehabilitation Amendment Regulation (No. 1) 2004 Estimated claims liability for ss 20 and 23A . . . . . . . . . . . . . . . . . Adjustment of annual levy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Provisions for Workers’ Compensation and Rehabilitation and Other Legislation Amendment Regulation (No. 1) 2004 Costs in proceedings before industrial magistrate . . . . . . . . . . . . Excess period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 90 90 90 91 92 93 93 94 95 95 95 97 97 98 99 99 100 100 101 101 Page 7
Workers’ Compensation and Rehabilitation Regulation 2003 Contents Division 3 125 126 127 Division 4 128 Division 5 129 Schedule 1 Schedule 2A 1 2 Schedule 3 1 2 Schedule 4 1 2 Schedule 5 1 2 Schedule 5A 1 Schedule 6 Schedule 7 Schedule 8 Part 1 1 Provisions for Workers’ Compensation and Rehabilitation Amendment Regulation (No. 1) 2008 Excess period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rehabilitation and return to work coordinators. . . . . . . . . . . . . . . Adding person as contributor . . . . . . . . . . . . . . . . . . . . . . . . . . . . Provision for Workers’ Compensation and Rehabilitation and Other Legislation Amendment Act 2010 Excess period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Transitional provision for Workers’ Compensation and Rehabilitation Amendment Regulation (No. 1) 2013 General Medical Assessment Tribunal constituted before commencement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Graduated scale for additional compensation for workers with terminal latent onset injuries . . . . . . . . . . . . . . . . . . . . . . Graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to use this graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . Graduated scale of additional compensation for certain workers ..................................... Graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to use the graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . . Graduated scale for additional compensation for gratuitous care ......................................... Graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to use this graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . Graduated scale of care required for payment of caring allowance ...................................... Graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to use this graduated scale . . . . . . . . . . . . . . . . . . . . . . . . . High risk industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Categorisation of industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Legal professional costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Designated courts and provisions that are a State’s legislation about damages for work related injury . . . . . . . . . Matters to which court is to have regard in the application of schedule 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Objectives of schedule 9 (Ranges of injury scale values) Objectives of sch 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 102 102 103 103 105 106 106 106 108 108 108 111 111 111 113 113 113 115 115 118 119 120 120 Page 8
Part 2 Division 1 2 3 4 5 6 7 Division 2 8 9 10 11 12 13 14 Schedule 9 Part 1 1 2 3 4 5 6 7 8 9 Part 2 10 11 12 13 Part 3 Division 1 14 15 Workers’ Compensation and Rehabilitation Regulation 2003 Contents How to use schedule 9 Injury Injury mentioned in sch 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multiple injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multiple injuries and maximum dominant ISV inadequate . . . . . . Adverse psychological reaction . . . . . . . . . . . . . . . . . . . . . . . . . . Mental disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Aggravation of pre-existing condition . . . . . . . . . . . . . . . . . . . . . . Other matters Court must have regard to particular provisions of sch 9 . . . . . . . Court may have regard to other matters. . . . . . . . . . . . . . . . . . . . DPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical report stating DPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Greater weight to assessments based on AMA 5 . . . . . . . . . . . . Greater weight to assessments of PIRS rating. . . . . . . . . . . . . . . ISV must be a whole number . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ranges of injury scale values . . . . . . . . . . . . . . . . . . . . . . . . . Central nervous system and head injuries Quadriplegia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paraplegia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hemiplegia or severe paralysis of more than 1 limb. . . . . . . . . . . Monoplegia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Extreme brain injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious brain injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate brain injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor brain injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor head injury, other than an injury mentioned in part 3 . . . . . Mental disorders Extreme mental disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious mental disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate mental disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor mental disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Facial injuries Skeletal injuries of the facial area Extreme facial injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious facial injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 121 122 122 123 123 123 124 124 124 125 125 125 126 126 127 128 128 128 131 132 134 136 138 138 138 139 139 140 Page 9
Workers’ Compensation and Rehabilitation Regulation 2003 Contents 16 17 18 Division 2 19 20 21 22 Part 4 Division 1 Division 2 23 24 25 26 27 28 29 Division 3 30 31 32 33 Division 4 34 35 Part 5 Division 1 36 37 38 39 Division 2 40 41 Moderate facial injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor facial injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Injury to teeth or gums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scarring to the face Extreme facial scarring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious facial scarring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate facial scarring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor facial scarring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Injuries affecting the senses General comment Injuries affecting the eyes Total sight and hearing impairment . . . . . . . . . . . . . . . . . . . . . . . Total sight impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Complete sight impairment in 1 eye with reduced vision in the other eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Complete sight impairment in 1 eye or total loss of 1 eye . . . . . . Serious eye injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate eye injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor eye injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Injuries affecting the ears Extreme ear injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious ear injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate ear injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor ear injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Impairment of taste or smell Total loss of taste or smell, or both . . . . . . . . . . . . . . . . . . . . . . . . Partial loss of smell or taste, or both . . . . . . . . . . . . . . . . . . . . . . Injuries to internal organs Chest injuries Extreme chest injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious chest injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate chest injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor chest injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lung injury other than asthma Extreme lung injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious lung injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 143 144 145 145 146 146 147 147 148 148 149 149 149 150 151 152 152 153 154 154 155 156 157 160 161 Page 10
Workers’ Compensation and Rehabilitation Regulation 2003 Contents 42 43 Division 3 44 45 46 47 Division 4 48 49 50 51 Division 5 52 53 Division 6 Subdivision 1 54 55 56 57 Subdivision 2 58 59 60 61 Division 7 62 63 64 65 Division 8 66 67 68 69 Moderate lung injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor lung injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Asthma Extreme asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Severe asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Injuries to male reproductive system Impotence and sterility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Loss of part or all of penis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Loss of both testicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Loss of 1 testicle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Injuries to female reproductive system Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Any other injury to the female reproductive system . . . . . . . . . . . Injuries to digestive system Injury caused by trauma Extreme injury to the digestive system caused by trauma . . . . . . Serious injury to the digestive system caused by trauma . . . . . . Moderate injury to the digestive system caused by trauma . . . . . Minor injury to the digestive system caused by trauma . . . . . . . . Injury not caused by trauma Extreme injury to the digestive system not caused by trauma . . . Serious injury to the digestive system not caused by trauma . . . Moderate injury to the digestive system not caused by trauma . . Minor injury to the digestive system not caused by trauma . . . . . Kidney or ureter injuries Extreme injury to kidneys or ureters. . . . . . . . . . . . . . . . . . . . . . . Serious injury to kidneys or ureters . . . . . . . . . . . . . . . . . . . . . . . Moderate injury to kidneys or ureters . . . . . . . . . . . . . . . . . . . . . . Minor injury to kidneys or ureters . . . . . . . . . . . . . . . . . . . . . . . . . Liver, gall bladder or biliary tract injuries Extreme injury to liver, gall bladder or biliary tract . . . . . . . . . . . . Serious injury to liver, gall bladder or biliary tract . . . . . . . . . . . . . Moderate injury to liver, gall bladder or biliary tract . . . . . . . . . . . Minor injury to liver, gall bladder or biliary duct . . . . . . . . . . . . . . 162 162 163 164 164 164 165 166 167 167 168 169 171 172 173 173 174 175 177 178 179 180 181 181 182 182 183 184 Page 11
Workers’ Compensation and Rehabilitation Regulation 2003 Contents Division 9 70 71 72 73 Division 10 74 75 76 77 Division 11 78 79 80 Division 12 81 82 83 Part 6 Division 1 84 85 86 87 88 Division 2 89 90 91 92 93 Division 3 94 95 Bowel injuries Extreme bowel injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious bowel injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate bowel injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor bowel injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bladder, prostate or urethra injuries Extreme bladder, prostate or urethra injury . . . . . . . . . . . . . . . . . Serious bladder, prostate or urethra injury . . . . . . . . . . . . . . . . . . Moderate bladder, prostate or urethra injury . . . . . . . . . . . . . . . . Minor bladder, prostate or urethra injury . . . . . . . . . . . . . . . . . . . Spleen and pancreas injuries Injuries to the pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Loss of spleen (complicated) . . . . . . . . . . . . . . . . . . . . . . . . . . . . Injury to the spleen or uncomplicated loss of spleen . . . . . . . . . . Hernia injuries Severe hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Orthopaedic injuries Cervical spine injuries Extreme cervical spine injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious cervical spine injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate cervical spine injury— fracture, disc prolapse or nerve root compression or damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate cervical spine injury—soft tissue injury . . . . . . . . . . . . Minor cervical spine injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thoracic spine or lumbar spine injuries Extreme thoracic or lumbar spine injury . . . . . . . . . . . . . . . . . . . . Serious thoracic or lumbar spine injury . . . . . . . . . . . . . . . . . . . . Moderate thoracic or lumbar spine injury— fracture, disc prolapse or nerve root compression or damage. . . . . . . . . . . . . . Moderate thoracic or lumbar spine injury—soft tissue injury . . . . Minor thoracic or lumbar spine injury . . . . . . . . . . . . . . . . . . . . . . Shoulder injuries Extreme shoulder injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious shoulder injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 185 185 186 187 187 187 188 189 190 191 191 192 192 193 194 196 197 198 200 201 202 203 204 205 206 Page 12
96 97 Division 4 98 99 Division 5 100 101 102 103 Division 6 104 105 106 107 Division 7 108 109 110 111 112 113 114 115 116 117 118 119 Division 8 120 121 122 Workers’ Compensation and Rehabilitation Regulation 2003 Contents Moderate shoulder injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor shoulder injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amputation of upper limbs Loss of both upper limbs, or loss of 1 arm and extreme injury to the other arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Loss of 1 upper limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Elbow injuries Extreme elbow injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious elbow injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate elbow injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor elbow injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Wrist injuries Extreme wrist injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious wrist injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate wrist injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor wrist injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hand injuries Total or effective loss of both hands . . . . . . . . . . . . . . . . . . . . . . . Serious injury to both hands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total or effective loss of 1 hand . . . . . . . . . . . . . . . . . . . . . . . . . . Amputation of the thumb or part of the thumb . . . . . . . . . . . . . . . Amputation of index, middle and ring fingers, or any 2 of them . . Amputation of individual fingers . . . . . . . . . . . . . . . . . . . . . . . . . . Amputation of thumb and all fingers. . . . . . . . . . . . . . . . . . . . . . . Any other injury to 1 or more of the fingers or the thumb . . . . . . . Extreme hand injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious hand injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate hand injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor hand injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Upper limb injuries, other than injuries mentioned in divisions 3 to 7 Extreme upper limb injury, other than an injury mentioned in divisions 3 to 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious upper limb injury, other than an injury mentioned in divisions 3 to 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate upper limb injury, other than an injury mentioned in divisions 3 to 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 208 209 210 212 213 213 214 215 216 216 217 218 218 219 220 221 222 223 224 227 228 228 229 229 231 232 Page 13
Workers’ Compensation and Rehabilitation Regulation 2003 Contents 123 Division 9 124 125 126 127 Division 10 Subdivision 1 128 129 Subdivision 2 130 131 Division 11 132 133 134 135 Division 12 136 137 138 139 Division 13 140 141 142 143 Division 14 Subdivision 1 144 145 Page 14 Minor upper limb injury, other than an injury mentioned in divisions 3 to 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pelvis or hip injuries Extreme pelvis or hip injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious pelvis or hip injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate pelvis or hip injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor pelvis or hip injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amputation of lower limbs Amputation of both lower limbs Loss of both lower limbs above or through the knee . . . . . . . . . . Below the knee amputation of both lower limbs . . . . . . . . . . . . . . Amputation of 1 lower limb Above or through the knee amputation of 1 lower limb . . . . . . . . Below the knee amputation of 1 lower limb . . . . . . . . . . . . . . . . . Lower limb injuries, other than injuries mentioned in division 9 or 10 or divisions 12 to 15 Extreme lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15 . . . . . . . . . . . . . . . . . . . . . . Serious lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15 . . . . . . . . . . . . . . . . . . . . . . Moderate lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15 . . . . . . . . . . . . . . . . . . . . . . Minor lower limb injury, other than an injury mentioned in division 9 or 10 or divisions 12 to 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Knee injuries Extreme knee injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious knee injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate knee injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor knee injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ankle injuries Extreme ankle injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious ankle injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate ankle injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor ankle injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Foot injuries Amputations Amputation of both feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amputation of 1 foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 234 235 236 237 238 239 240 240 241 242 243 244 246 246 247 248 248 249 250 250 251 252
Workers’ Compensation and Rehabilitation Regulation 2003 Contents Subdivision 2 146 147 148 149 Division 15 150 151 152 153 Division 16 Part 7 154 Part 8 Part 9 155 156 157 Part 10 158 159 160 161 Schedule 10 Part 1 1 2 Part 2 3 4 5 6 7 8 Part 3 9 Other foot injuries Extreme foot injury that is not an amputation . . . . . . . . . . . . . . . . Serious foot injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate foot injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor foot injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Toe injuries Extreme toe injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious toe injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate toe injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor toe injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Limb disorders Scarring to parts of the body other than the face Scarring to a part of the body other than the face . . . . . . . . . . . . Burn injuries Injuries affecting hair Extreme injury affecting head hair . . . . . . . . . . . . . . . . . . . . . . . . Serious injury affecting head hair . . . . . . . . . . . . . . . . . . . . . . . . . Moderate injury affecting head hair or loss of body hair. . . . . . . . Dermatitis Extreme dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serious dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Minor dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Matters relevant to PIRS assessment by medical expert . . . Explanation of the PIRS PIRS rates permanent impairment caused by mental disorder . . Areas of functional impairment. . . . . . . . . . . . . . . . . . . . . . . . . . . Assessment of PIRS rating Medical expert must comply with requirements . . . . . . . . . . . . . . How to assess a PIRS rating . . . . . . . . . . . . . . . . . . . . . . . . . . . . Assessment if pre-existing mental disorder . . . . . . . . . . . . . . . . . How to work out a median class score . . . . . . . . . . . . . . . . . . . . . Conversion table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Example worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Particular cases Refusal of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 253 254 254 254 256 257 257 260 264 264 265 265 265 266 266 267 267 267 268 268 269 270 270 272 272 Page 15
Workers’ Compensation and Rehabilitation Regulation 2003 Contents 10 11 Part 4 12 Schedule 11 Schedule 12 1 2 3 4 Schedule 13 Cognitive impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pre-existing mental disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Report of PIRS rating Court to be given PIRS report . . . . . . . . . . . . . . . . . . . . . . . . . . . Psychiatric impairment rating scale . . . . . . . . . . . . . . . . . . . . General damages calculation provisions . . . . . . . . . . . . . . . . General damages calculation provision—1 July 2010 to 30 June 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General damages calculation provision—1 July 2011 to 30 June 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General damages calculation provision—1 July 2012 to 30 June 2013 ......................................... General damages calculation provision—1 July 2013 . . . . . . . . . Dictionary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 273 274 276 288 288 289 291 293 295 Endnotes 1 2 3 4 5 6 7 Index to endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date to which amendments incorporated. . . . . . . . . . . . . . . . . . . . . . Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Table of reprints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . List of legislation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . List of annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Information about retrospectivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 300 301 301 302 305 321 Page 16
Workers’ Compensation and Rehabilitation Regulation 2003 Part 1 Preliminary [s 1] Workers’ Compensation and Rehabilitation Regulation 2003 [as amended by all amendments that commenced on or before 8 November 2013] Part 1 Preliminary 1 Short title This regulation may be cited as the Workers’ Compensation and Rehabilitation Regulation 2003 . 2 Commencement This regulation commences on 1 July 2003. 3 Definitions Schedule 13 defines particular words used in this regulation. 5 WorkCover’s capital adequacy—Act, s 453 In order to maintain capital adequacy for section 453(b) of the Act, WorkCover’s total assets must at least be equal to its total liabilities. Current as at 8 November 2013 Page 17
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 6] Part 2 Employer insurance Division 1 Policies and premium assessments 6 Application for policy An application for a policy must be made to WorkCover in the approved form. 7 Policies and renewals (1) On payment of the premium shown as payable in a premium notice issued by WorkCover to an employer, WorkCover must issue to the employer a policy, in the approved form, for the period of insurance stated in the notice. (2) A policy has no force or effect until— (a) WorkCover receives the premium payable to WorkCover for the policy or its renewal; or (b) WorkCover enters into an instalment plan for the policy under section 11. 8 Assessment of premium (1) This section does not apply to a policy for household workers. (2) WorkCover must assess premium payable under a policy for each period of insurance shown in a premium notice. (3) For a period of insurance before 1 July 2003, an assessment of premium must be made in accordance with the provisions of a former Act in force at the time of the relevant period of insurance. (4) If, after the premium is assessed, WorkCover is satisfied that premium for the period has been overpaid, WorkCover must refund or credit the amount of overpayment to the employer to whom the premium notice is given. Page 18 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 9] (5) If, after the premium is assessed, WorkCover is satisfied that premium for the period has been underpaid, the employer to whom the premium notice is given must pay the premium as assessed. 9 Declaration of wages (1) This section does not apply to an employer who employs only household workers. (2) Each employer, other than a self-insurer, must, on or before 31 August in each year, lodge with WorkCover a declaration of wages so WorkCover can assess the employer’s premium. (3) The declaration must be in— (a) the approved form; or (b) with WorkCover’s approval—another form acceptable to WorkCover. (4) If an employer does not comply with subsection (2), the employer must pay an additional premium under schedule 1. (5) The additional premium payable under schedule 1 is the amount specified opposite the time after 31 August in a year when the employer complies with subsection (2). 10 Value of board and lodging (1) This section applies if an employer provides, or is to provide, board to a worker during a period of insurance. (2) The value of board provided is taken to be wages paid, or to be paid, by the employer to the worker. (3) For each week the employer provides, or is to provide, board, the value of board is not less than— (a) the weekly allowance for board provided for under the industrial instrument governing the calling in which the worker is engaged; or (b) if paragraph (a) does not apply—6% of QOTE. Current as at 8 November 2013 Page 19
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 11] (4) In this section— board means accommodation, meals, laundry services or any other entitlement having a monetary value provided when lodging. 11 Payment of premium by instalments (1) WorkCover may accept payment of premium by instalments under an instalment plan approved by WorkCover if WorkCover is satisfied that payment of premium by the due date would impose financial hardship on the employer. (2) The instalment plan is subject to the following conditions— (a) interest at a rate specified by WorkCover’s board by gazette notice must be added to the amount of each instalment; (b) interest must be calculated from the due date; (c) the interest rate that applies at the start of the instalment plan remains constant until the plan ends; (d) on acceptance of the instalment plan, the employer must, if required by WorkCover, enter into a payment arrangement acceptable to WorkCover; (e) if an instalment of premium is not paid on or before the due date for payment of the instalment— (i) the total amount of unpaid instalments and interest on outstanding instalments to that day immediately becomes payable to WorkCover; and (ii) additional premium under section 12 applies to the unpaid instalments and interest; and (iii) the policy for which the premium is payable ceases to have effect; and (iv) the employer contravenes section 48 of the Act. Page 20 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 12] 12 Additional premium for late payment of premium—Act, ss 61 and 62 (1) This section applies if, on or before the due date, an employer does not pay— (a) the amount of premium payable under a premium notice; or (b) the amount by which a final assessment of premium by an industrial magistrate or the Industrial Court is more than the amount of assessment of premium paid under section 551(4) of the Act. (2) To remove any doubt, this section does not apply if WorkCover has accepted payment of the amount under an instalment plan and instalments are paid under the plan. (3) This section does not apply to an employer who employs only household workers. (4) The additional premium payable under section 61 or 62 of the Act is— (a) if payment of the amount is made to WorkCover within 30 days after the due date—5% of the amount; or (b) if payment of the amount is made to WorkCover after 30 days but within 60 days of the due date—10% of the amount; or (c) if payment of the amount is made to WorkCover after 60 days of the due date or if no payment is made—10% of the amount plus interest at the annual rate mentioned in section 11(2)(a) for the period from the due date, or a later date decided by WorkCover, until the amount and all additional premium is paid to WorkCover. Current as at 8 November 2013 Page 21
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 14] 14 Premium for appeals—Act, s 569(2)(a) (1) For section 569(2)(a) of the Act, premium, for an employer for a period of insurance, is an amount calculated under the formula— P = W ---- 1 --- 0 - × -- 0 --- R --- (2) In subsection (1)— P means premium. R means the rate for the employer’s industry or business specified in the notice under section 54 of the Act that applies to the period of insurance. W means— (a) the wages of the employer for the preceding period of insurance; or (b) if the employer has only been insured for part of a period of insurance—a reasonable estimate of the wages of the employer for the period of insurance. 15 Former employer may apply to cancel policy (1) This section applies if a person wishes to cancel a policy because the person has stopped employing workers (a former employer ). (2) This section does not apply to a former employer of only household workers. (3) The former employer must give WorkCover— (a) written notice that the former employer— (i) stopped employing workers on and from a date stated in the notice; and (ii) wishes to cancel the policy; and (b) written details of— (i) the address to which any document addressed to the former employer may be sent; and Page 22 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 15A] (ii) the former employer’s wages in relation to the period starting on 1 July last preceding the day on which employment of workers stopped and ending on that day ( last employment period ). 15A Cancellation of policy if workers no longer employed (1) This section applies if— (a) a person (a former employer ) has notified WorkCover under section 15 that the former employer has stopped employing workers; or (b) WorkCover is satisfied, after making reasonable enquiries, that a person has stopped employing workers (also a former employer ). (2) WorkCover may cancel the former employer’s policy. Editor’s note For WorkCover’s liability to pay compensation for an injury sustained by a worker, see section 109(2) (Who must pay compensation) of the Act. (3) WorkCover must assess the premium payable by the former employer for the period during which the former employer was required by the Act to maintain a policy. (4) If the premium paid by the former employer for the last employment period is— (a) greater than the amount of premium assessed under subsection (3)—WorkCover must refund to the former employer the amount overpaid; or (b) less than the amount of premium assessed under subsection (3)—the former employer must pay WorkCover the amount of the deficit on or before the due date under a final premium notice issued for the amount of the deficit. (5) This section does not limit anything in chapter 2, part 3, division 2 of the Act. Current as at 8 November 2013 Page 23
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 16] Division 2 Employer excess 16 Excess period—Act, s 65 For section 65(2) of the Act, the amount prescribed is the lesser of the following— (a) QOTE; (b) the amount of weekly compensation payable to a worker under chapter 3, part 9 of the Act. Division 3 Self-insurance 19 Application fees—Act, s 70 For section 70 of the Act, the amount of the application fee is— (a) for a single employer—$15000; or (b) for a group employer—$20000. 20 Annual levy—Act, s 81 (1) For section 81 of the Act, the amount of the levy payable by a self-insurer for each financial year or part of a financial year of a licence is an amount calculated under the formula— L = ( ECL × R) + $ 10000 (2) In subsection (1)— ECL means estimated claims liability calculated under part 4, division 3A stated in the most recent actuarial report agreed by the Regulator, or decided by the arbiter, under that division, before a date fixed by the Regulator by gazette notice. L means annual levy. R means the rate published in the gazette notice under section 81 of the Act for the particular financial year. Page 24 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 20A] 20A Provisional annual levy (1) If— (a) the Regulator and the self-insurer have not agreed on the calculation of estimated claims liability under part 4, division 3A; and (b) the arbiter has not decided the estimated claims liability; the Regulator may use the amount of the estimated claims liability assessed by the approved actuary to calculate a provisional annual levy for a financial year under section 20 to ensure the self-insurer’s compliance with section 81 of the Act. (2) If the Regulator and the self-insurer agree to the amount of the estimated claims liability ( agreed amount ), the Regulator must give the self-insurer an adjusted levy notice based on the agreed amount within 14 days after the Regulator and the self-insurer agree to the amount of the estimated claims liability. (3) If the Regulator and the self-insurer do not agree to the amount of the estimated claims liability and the amount decided by the arbiter (the decided amount ) is not the same as the amount of the estimated claims liability used to calculate the provisional annual levy, the Regulator must give the self-insurer an adjusted levy notice based on the decided amount within 14 days after the Regulator or the self-insurer receives the statement of the arbiter’s decision about the estimated claims liability. (4) If the amount of the adjusted levy is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the amount of the provisional annual levy and the amount of the annual levy actually payable by the self-insurer . (5) If the amount of the adjusted levy is less than the provisional annual levy paid by the self-insurer, the Regulator must pay the self-insurer the difference between the actual annual levy payable and the amount paid as the provisional annual levy . Current as at 8 November 2013 Page 25
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 21] 21 Additional amount for late payment of levy—Act, s 82 (1) This section applies if, on or before the due date, a self-insurer does not pay the amount of levy payable under a notice given by the Regulator under section 81 of the Act. (2) The additional amount payable under section 82 of the Act is— (a) if payment of the amount is made to the Regulator within 30 days after the due date—5% of the amount; or (b) if payment of the amount is made to the Regulator after 30 days but within 60 days of the due date—10% of the amount; or (c) if payment of the amount is made to the Regulator after 60 days of the due date or if no payment is made—10% of the amount plus interest at a rate specified by the Regulator by gazette notice for the period from the due date, or a later date decided by the Regulator, until the amount and all additional amounts are paid to the Regulator. 22 Conditions of licence—Act, s 83 A self-insurer’s licence is subject to the following conditions— (a) the self-insurer must lodge with the Regulator, for each year or part of a year of a licence, a declaration in the approved form of the self-insurer’s wages; (b) the unconditional bank guarantee lodged under section 84 of the Act— (i) must be issued by a bank or Queensland Treasury Corporation; and (ii) must not be issued by a bank that is a related body corporate to the self-insurer; and (iii) must be satisfactory to the Regulator. Page 26 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 2 Employer insurance [s 23] 23 Premium payable after cancellation of self-insurer’s licence—Act, s 98 (1) This section applies if a former self-insurer continues to be an employer after the self-insurer’s licence is cancelled. (2) The premium payable by the former self-insurer for the first 2 periods of insurance after cancellation is to be calculated according to the method and at the rate specified by WorkCover by gazette notice under section 54 of the Act as if the employer were a new employer. (3) However, the rate under subsection (2) can not be less than the rate calculated under the following formula— R = ( --- P ----- + ----- L ----- + - W ---- A ---- ) ---- x ---- 1 --- 0 --- 0 -- (4) In subsection (3)— A means the administrative costs associated with claims incurred during the final period of licence, calculated by multiplying P + L by 0.095. final period of licence means— (a) for an employer licensed as a self-insurer for 3 or more years immediately before cancellation of the licence—3 years; or (b) for an employer licensed as a self-insurer for less than 3 years immediately before cancellation of the licence—the period of the licence. L means an actuarial estimate of the outstanding liability at the end of the self-insurer’s licence for claims incurred during the final period of licence, excluding liability for the excess period. P means the actual payments made by the former self-insurer, less recoveries received and payments made that are the equivalent of amounts payable for the excess period, for claims incurred during the final period of licence. R means the premium rate. Current as at 8 November 2013 Page 27
Workers’ Compensation and Rehabilitation Regulation 2003 Part 3 Other insurances [s 23A] W means the wages of the self-insurer during the final period of licence. 23A Deemed levy for appeals—Act, s 569(2)(a) (1) For section 569(2)(a) of the Act, deemed levy, for a self-insurer for a financial year of the self-insurer’s licence, is an amount calculated under the formula— DL = ECL × R (2) In subsection (1)— DL means deemed levy. ECL means estimated claims liability calculated under part 4, division 3A that was used to calculate the annual levy under section 20. R means the rate published in the gazette under section 81 of the Act for the particular financial year. 24 Actuarial procedure—self-insurers (1) Actuarial estimates required under this division must be carried out by an actuary. (2) The actuary must calculate the estimate under guidelines issued by the Regulator by gazette notice. Part 3 Other insurances Division 1 Students 25 Insurance of work experience students (1) In this section— Page 28 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 3 Other insurances [s 25] chief executive (education) means the chief executive of the department in which the Education (General Provisions) Act 2006 is administered. educational establishment see the Education (Work Experience) Act 1996 , section 5. student see the Education (Work Experience) Act 1996 , schedule. work experience has the meaning given by the Education (Work Experience) Act 1996 , section 4. work experience place means a place where work experience is, or is to be, provided for a student. (2) WorkCover may enter into a contract of insurance with an educational establishment or the chief executive (education) to insure the educational establishment or the chief executive (education) against liability for compensation for injury to a student arising out of work experience. (3) For this section, when deciding whether an injury arises out of, or in the course of, work experience, chapter 1, part 4, division 6, subdivisions 2 and 3 of the Act apply as if— (a) the student were a worker; and (b) work experience were the employment; and (c) the work experience place were the place of employment; and (d) the chief executive (education) or the educational establishment were the employer. (4) A student has the same entitlements to compensation as a worker. (5) For the entitlements of a student to compensation, all the provisions of the Act under which entitlements are decided apply to the student in the same way as they would apply to a worker including, for example— the provisions of chapter 3 (Compensation) the provisions of chapter 11 (Medical assessment Current as at 8 November 2013 Page 29
Workers’ Compensation and Rehabilitation Regulation 2003 Part 3 Other insurances [s 26] tribunals) the provisions of chapter 13 (Reviews and appeals). (6) However, insurance cover provided under a contract of insurance under this section is limited to compensation under chapter 3, parts 10 and 11 of the Act. (7) Also, the contract does not cover payment of damages for injury sustained by the student. (8) WorkCover has a liability under a contract of insurance entered into under this section only if the premium assessed for the contract has been paid in full. 26 Insurance of vocational placement students (1) In this section— vocational placement has the meaning given by the Vocational Education, Training and Employment Act 2000 , section 17, but does not include a paid placement. vocational placement place means a place where vocational placement is, or is to be, provided for a vocational placement student. vocational placement student means a student undertaking a course at a registered training organisation. (2) WorkCover may enter into a contract of insurance with a registered training organisation to insure the organisation against liability for compensation for injury to a vocational placement student arising out of a vocational placement. (3) For this section, when deciding whether an injury arises out of, or in the course of, vocational placement, chapter 1, part 4, division 6, subdivisions 2 and 3 of the Act apply as if— (a) the vocational placement student were a worker; and (b) vocational placement were the employment; and (c) the vocational placement place were the place of employment; and (d) the registered training organisation were the employer. Page 30 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 3 Other insurances [s 27] (4) A vocational placement student has the same entitlements to compensation as a worker. (5) For the entitlements of a vocational placement student to compensation, all the provisions of the Act under which entitlements are decided apply to the student in the same way as they would apply to a worker including, for example— the provisions of chapter 3 (Compensation) the provisions of chapter 11 (Medical assessment tribunals) the provisions of chapter 13 (Reviews and appeals). (6) However, insurance cover provided under a contract of insurance under this section is limited to compensation under chapter 3, parts 10 and 11 of the Act. (7) Also, the contract does not cover payment of damages for injury sustained by the student. (8) WorkCover has a liability under a contract of insurance entered into under this section only if the premium assessed for the contract has been paid in full. Division 2 Eligible persons 27 Proposal for contract of insurance—Act, s 24 For section 24 of the Act, an eligible person is taken to express a wish to enter into a contract of insurance with WorkCover by lodging a fully completed and signed proposal in the approved form with WorkCover. 28 Documents to be kept by eligible person (1) This section applies if WorkCover has entered into a contract of insurance for chapter 1, part 4, division 3, subdivision 4 of the Act with an eligible person. (2) The eligible person must keep documents showing the remuneration or other benefit for performing work, or Current as at 8 November 2013 Page 31
Workers’ Compensation and Rehabilitation Regulation 2003 Part 3 Other insurances [s 29] providing services, that the eligible person has received as an eligible person. (3) If the eligible person applies for weekly payments of compensation under chapter 3, part 9, division 4, subdivision 4 or division 5, subdivision 2 of the Act but can not substantiate remuneration or other benefit received, WorkCover may pay an amount WorkCover considers is reasonable. Division 3 Other persons 29 Contracts of insurance for other persons (1) This section applies if a contract of insurance for chapter 1, part 4, division 3, subdivision 5 of the Act provides for a matter to be decided by a medical assessment tribunal in accordance with chapter 11 of the Act or for an appeal to a court in accordance with chapter 13 of the Act. (2) The provisions of the Act apply and jurisdiction is conferred on the tribunal or court to hear and decide the matter. Division 4 Contracts of insurance generally 30 Entitlements of persons mentioned in ch 1, pt 4, div 3, sdivs 1, 2 and 4 For the entitlements of a person mentioned in chapter 1, part 4, division 3, subdivision 1, 2 or 4 of the Act to compensation, all the provisions of the Act apply to the person in the same way as they would apply to a worker including, for example— the provisions of chapter 11 (Medical assessment tribunals) the provisions of chapter 13 (Reviews and appeals). Page 32 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 3 Other insurances [s 31] 31 WorkCover not liable if premium not paid WorkCover is not liable under a contract of insurance under chapter 1, part 4, division 3 of the Act if the premium for the contract has not been paid in full to WorkCover on or before the due date. 32 Duty to report injury (1) This section applies if a person who is entitled to compensation under chapter 1, part 4, division 3 of the Act and is covered by a contract of insurance sustains an injury for which compensation may be payable. (2) However, this section does not apply to an eligible person. (3) The person with whom WorkCover has entered into the contract must complete a report in the approved form and send it to the nearest office of WorkCover. (4) The report must be sent immediately after the first of the following happens— (a) the person with whom WorkCover has entered into the contract knows the injury has been sustained; (b) the person covered by the contract reports the injury to the person with whom WorkCover has entered into the contract; (c) the person with whom WorkCover has entered into the contract receives WorkCover’s written request for a report. (5) If the person with whom WorkCover has entered into the contract fails to comply with subsection (3) within 10 days after any of the circumstances mentioned in subsection (4), the person commits an offence, unless the person has a reasonable excuse. Maximum penalty—20 penalty units. Current as at 8 November 2013 Page 33
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 33] Part 4 Amount of calculation of liability for self-insurers Division 1 Outstanding liability Subdivision 1 Purpose of div 1 33 Purpose of div 1 This division sets out the process for the calculation of an amount for a self-insurer’s outstanding liability for section 87 of the Act. Subdivision 2 Calculation 34 Appointment of actuary for calculation WorkCover and the employer must each appoint an actuary to calculate an amount for the outstanding liability. 35 Calculation (1) The calculation must— (a) be prepared under the actuarial standard; and (b) apply a central estimate of the outstanding liability; and (c) as far as practicable, be based on the employer’s claims experience from claims incurred before the employer becomes or became a self-insurer; and (d) apply the risk free rate of return; and (e) include claims administration expenses of 7% of the outstanding liability; and (f) not include a prudential margin. Page 34 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 36] (2) The calculation must be based on data as at the last day (the assessment day ) of the financial quarter immediately before the day the application for self-insurance is lodged. 36 Regulator to give actuaries information The Regulator must give the actuaries the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 37(3). 37 Actuarial report (1) After completing the calculation, each actuary must prepare an actuarial report on the calculation the actuary made. (2) The report must— (a) be prepared under the actuarial standard; and (b) clearly state the key assumptions made for the calculation and how the assumptions have been derived, including— (i) the average amount of claims for compensation against the employer; and (ii) the average amount of claims for damages against the employer; and (iii) claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and (iv) the frequency of claims for compensation against the employer; and (v) the frequency of claims for damages against the employer; and (vi) the net amount of the claims after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the outstanding liability; and Current as at 8 November 2013 Page 35
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 38] (viii) the rate of inflation used; and (c) state the following about the data used in the calculation— (i) the nature of the data; (ii) the actuary’s assessment of its accuracy; (iii) how the actuary interpreted the data; and (d) state the actuarial model used in the calculation; and (e) state the results of the calculation; and (f) state the actuary’s confidence in the results of the calculation. (3) The actuaries must complete the calculations and the reports within 35 days after the day the application for self-insurance is lodged. 38 Summary report (1) The actuaries must jointly prepare a summary report that— (a) includes the individual actuarial reports; and (b) states how the individual reports agree or differ. (2) The actuaries must give a copy of the completed summary report to the Regulator, WorkCover and the employer within 2 months after the day the application for self-insurance is lodged. 39 Agreement on calculation WorkCover and the employer may agree on the calculation having regard to the summary report. 40 Reference to arbiter if no agreement If WorkCover and the employer can not agree on the calculation, the Regulator must refer the summary report to the arbiter for decision within 14 days after the Regulator is Page 36 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 41] given a copy of the summary report. 41 Arbiter’s costs The arbiter’s costs in deciding on the calculation are to be paid by WorkCover and the employer in equal amounts. 42 Payment of amount for outstanding liability (1) The amount WorkCover must pay for the employer’s outstanding liability is the amount agreed to by WorkCover and the employer (the agreed amount ) or, if there is no agreement, the amount decided by the arbiter (the decided amount ). (2) WorkCover must pay the employer— (a) 75% of the agreed or decided amount on the day the licence commences; and (b) the balance within 1 month after the day the licence commences. (3) The agreed or decided amount paid to the employer must be adjusted by WorkCover’s actuary to take into account— (a) compensation and damages payments made between the assessment day and the day the employer becomes liable for the employer’s outstanding liability; and (b) claims lodged against the employer between the assessment day and the day the employer becomes liable for the employer’s outstanding liability. 43 Transfer of claims information WorkCover must give the employer claims information in relation to the employer’s outstanding liability before the day the licence commences. Current as at 8 November 2013 Page 37
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 44] Subdivision 3 Recalculation 44 Purpose of sdiv 3 This subdivision sets out the process for the recalculation of an amount for a self-insurer’s outstanding liability if the self-insurer has made an election under the repealed WorkCover Queensland Regulation 1997 , part 9, division 1, subdivision 2, as in force immediately before its repeal, to accept an interim payment on account of the outstanding liability. 45 Application of sdiv 3 for group employers If the self-insurer is a group employer, this subdivision applies only in relation to— (a) the members of the group as at the day the self-insurer became liable for compensation and damages for the self-insurer’s outstanding liability; or (b) if the self-insurer applied, on or before the day the self-insurer became liable for compensation and damages for the self-insurer’s outstanding liability, for WorkCover’s consent to change the group membership on the licence—the proposed members of the group as at that day. 46 Appointment of actuary for recalculation At the end of 5 years after the self-insurer became liable for compensation and damages for the self-insurer’s outstanding liability, WorkCover and the self-insurer must each appoint an actuary to recalculate an amount for the outstanding liability. 47 Recalculation (1) The recalculation must— (a) be prepared under the actuarial standard; and Page 38 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 48] (b) apply a central estimate of the outstanding liability; and (c) as far as practicable, be based on the self-insurer’s claims experience from claims incurred before the self-insurer became a self-insurer; and (d) apply the same risk free rate of return that was used in the calculation of an amount for the liability under subdivision 2; and (e) include claims administration expenses of 7% of the outstanding liability; and (f) not include a prudential margin; and (g) have regard to compensation and damages payments made in relation to the liability between the day the self-insurer became liable for compensation and damages for the self-insurer’s outstanding liability and the end of 5 years after that day; and (h) exclude an amount for liability in relation to a change in the self-insurer’s membership after the day the self-insurer became liable for compensation and damages for the self-insurer’s outstanding liability. (2) The recalculation must be based on data as at the last day (the assessment day ) of the last financial quarter for which data is available at the end of 5 years after the self-insurer became liable for compensation and damages for the self-insurer’s outstanding liability. 48 Regulator to give actuaries information The Regulator must give the actuaries the information necessary to enable the actuaries to complete the recalculation within the time mentioned in section 49(3). 49 Actuarial report (1) After completing the recalculation, each actuary must prepare an actuarial report on the calculation the actuary made. (2) The report must— Current as at 8 November 2013 Page 39
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 49] (a) be prepared under the actuarial standard; and (b) clearly state the key assumptions made for the recalculation and how the assumptions have been derived, including— (i) the average amount of claims for compensation against the self-insurer; and (ii) the average amount of claims for damages against the self-insurer; and (iii) claims anticipated to have been incurred by the self-insurer for which no formal claim has been lodged; and (iv) the frequency of claims for compensation against the self-insurer; and (v) the frequency of claims for damages against the self-insurer; and (vi) the net amount of the claims after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value as calculated at the same risk free rate of return that was used in the calculation of an amount for the liability under subdivision 2; and (viii) the rate of inflation used; and (c) state the following about the data used in the recalculation— (i) the nature of the data; (ii) the actuary’s assessment of its accuracy; (iii) how the actuary interpreted the data; and (d) state the actuarial model used in the recalculation; and (e) state the results of the recalculation; and (f) state the actuary’s confidence in the results of the recalculation. Page 40 Current as at 8 November 2013
Workers’ Compensation and Rehabilitation Regulation 2003 Part 4 Amount of calculation of liability for self-insurers [s 50] (3) The actuaries must complete the recalculations and the reports within 35 days after the end of 5 years after the self-insurer became liable for compensation and damages fo