South Australian Consolidated Regulations South Australian Consolidated RegulationsSchedule 4—Self-insured employers terms and conditions of registration
1 The employer must ensure that forms for making a
claim under the Act, in a form approved by the Corporation, are reasonably
available to the employer's workers.
2 The employer must ensure that all claims under
the Act are promptly and efficiently investigated and determined.
3 The employer must ensure that any benefit to
which a worker is entitled under the Act is—
(a)
provided promptly; and
(b)
periodically reviewed in accordance with the Act.
4 (1) The employer
must ensure that a prompt assessment is made of whether a rehabilitation
program would be of assistance to a worker who has suffered a compensable
disability and, if required, ensure that an appropriate rehabilitation program
is provided for the worker.
(2) If the Corporation
considers that an appropriate rehabilitation program is not being provided to
a worker who has suffered a compensable disability, the employer must—
(a)
allow the Corporation to establish a rehabilitation program for the worker;
and
(b)
reasonably co-operate with any rehabilitation adviser in the implementation of
that program.
5 The employer must ensure, so far as is
reasonably practicable, that up to date programs that are designed to prevent
or reduce the incidence of compensable disabilities are established and
maintained at places where the employer's workers work.
6 The employer must, as soon as practicable after
the receipt of a claim under the Act, estimate the employer's expected
liability on the claim.
reporting period means a period of seven days or such longer period, not
exceeding 14 days, agreed between the Corporation and the relevant employer
from time to time.
(2) The employer must,
in respect of each reporting period, provide the following information to the
Corporation:
(a)
Employer details:
(i)
the name of the employer;
(ii)
the name used by the employer at the location to which
the report relates;
(iii)
the Employer Registration Number;
(iv)
the relevant Location Number;
(v)
the relevant Location Address;
(b)
Particulars relating to each new claim received by the employer during the
reporting period:
(i)
the claim number assigned by the employer;
(ii)
the full name of the worker;
(iii)
the sex of the worker;
(iv)
the date of birth of the worker;
(v)
the language usually spoken at home by the worker;
(vi)
the worker's country of birth;
(via)
the post code of the worker's residence;
(vib)
the worker's notional weekly earnings (if applicable);
(vic)
the post code of the location where the injury occurred;
(vid) if
the injury occurred at a particular workplace—the predominant class of
industry at that workplace;
(vii)
whether the worker is employed on a full time or part
time basis by the employer;
(viii)
whether the worker is employed on a permanent or casual
basis by the employer;
(ix)
the occupation of the worker at the time of the
disability (including, if the worker is an apprentice, making specific
reference to that fact);
(x)
the main tasks usually performed by the worker in the
stated occupation;
(xi)
the normal hours, and days per week, worked by the
worker;
(xii)
the date on which the worker commenced employment with
the employer;
(xiii)
the activity being undertaken by the worker at the time
of the occurrence of the disability;
(xiv)
the date of the occurrence of the disability;
(xv)
the time of day at which the disability occurred (so far
as is known to the employer);
(xvi)
the date on which the employer was first notified of the
disability;
(xvii)
the apparent cause of the disability;
(xviii)
a description of the disability;
(xix)
a statement as to the parts of the worker's body affected
by the disability;
(xx)
the date on which the worker ceased work (if
incapacitated for work);
(xxi)
if relevant, the date of death of the worker;
(xxii)
an estimate of the costs associated with the claim;
(xxiii)
the date on which the occurrence of the disability, or
the incident that caused the disability, was reported to the administrative
unit of the Public Service that is, under a Minister, responsible for the
administration of the Occupational Health, Safety and Welfare Act 1986
(if applicable);
(c)
Particulars relating to each claim that is open during any part of the
reporting period:
(i)
the WorkCover reference number;
(ii)
sufficient details to allow the worker and the claim to
be identified;
(iii)
the status of the claim (eg accepted, rejected,
undetermined, finalised, reopened);
(iv)
the total time lost from work by the worker during the
relevant period (if any);
(v)
the worker's last known work status;
(vi)
the date on which the worker resumed work (if known);
(vii)
the date on which the claim was determined and the date
and effect of any redetermination of the claim;
(d)
Particulars relating to each claim on which action has occurred during the
period, including details of any changes and, if relevant, the latest totals
of payments in the following categories:
(i)
income maintenance;
(ii)
medical services (eg medical practitioner or dentist);
(iii)
medical—allied health;
(iv)
medical—other goods and services;
(v)
hospital outpatient;
(vi)
hospital inpatient;
(vii)
rehabilitation;
(viii)
lump sum payments (section 43 or 44 of the Act);
(ix)
redemption of income maintenance payments
(section 42 or 42A of the Act);
(x)
redemption of medical expenses (section 42 of the
Act);
(xi)
common law;
(xii)
legal;
(xiii)
investigation;
(xiv)
travel;
(xv)
other goods and services;
(xvi)
other non-compensation;
(xvii)
property damage;
(xviii)
third party recovery;
(e)
Other information reasonably required by the Corporation (including
information required to meet national data collection requirements).
(3) For the purposes
of subregulation (2)—
(a) the
information must be provided in a manner and form (including by electronic
means), and at a time, determined by the Corporation;
(b) the
Corporation may, from time to time—
(i)
by notice in writing, waive or postpone the obligation to
comply with the requirements of that subregulation, either for an individual
self-insured employer or for self-insured employers of a specified class,
subject to conditions (if any) determined by the Corporation;
(ii)
on giving reasonable notice (by further notice in
writing), vary or revoke the operation of a notice under
subparagraph (i), or vary, revoke or substitute a condition that applies
under that subparagraph.
8 (1) The employer
must deliver to the Corporation—
(a)
within the prescribed period after the end of each financial year of the
employer—an audited copy of the employer's financial statements for that
financial year; and
(b)
within three months after the end of each financial year of the
employer—an actuarial report on the outstanding liabilities of the
employer under the Act, as at the end of that financial year.
(2) For the purposes
of this clause, the financial years of an employer are successive periods, not
exceeding 12 months, determined by the employer to be the employer's financial
years or, in the absence of such a determination, each period of 12 months
ending on the thirtieth day of June.
(3) In this
clause—
prescribed period means—
(a) in
relation to an employer that is a company incorporated under the Corporations
Law —the period within which the company must lodge an annual return
with the Australian Securities and Investments Commission under that law for
the relevant financial year; or
(b) if
paragraph (a) does not apply—three months.
9 (1) The employer
must at all reasonable times allow an authorised officer to examine—
(a) the
accounting and other records of the employer; and
(b) any
system or facility used by the employer in connection with acting as a
self-insured employer under the Act.
(2) The employer must
provide such assistance as may be reasonably required to facilitate an
examination referred to in subclause (1).
(3) The employer must,
at the request of a person carrying out an examination referred to in
subclause (1), provide any explanations, information or assistance that
the person may reasonably require for the purposes of the examination.
(4) The employer must
comply with any written notice served on the employer by an authorised officer
requiring the employer to exercise or perform a power or function of the
employer under the Act in accordance with the Act.
10 (1) The employer
must ensure that there is in force at all times a guarantee given by a
financial institution to or in favour of the Corporation which—
(a)
guarantees the payment of an amount to the Corporation in the event that the
employer becomes insolvent or ceases to be a self-insured employer; and
(b)
complies with subclause (3).
(2) The amount
guaranteed by a guarantee entered into for the purposes of
subclause (1)—
(a) must
be an amount, at least equal to the prescribed sum, determined by the
Corporation to be reasonable for the purposes of this provision after taking
into account the principle that the prescribed scaling factor should be
applied to—
• an actuarial
estimate of the value of the current and contingent liabilities of the
employer under the Act at the time of the determination (whether or not claims
have been made with respect to those disabilities); plus
• an actuarial
estimate of the value of the liabilities of the employer as a self-insured
employer under the Act in respect of compensable disabilities attributable to
traumas expected to arise from employment by the employer over the ensuing
period of 12 months; less
• an actuarial
estimate of the amounts expected to be paid out by the employer under the Act
over the ensuing period of 12 months; and
(b) must
be reviewed annually.
(3) A guarantee
complies with this subclause if—
(a) the
guarantee is given by a financial institution which has a credit rating at
least equal to a standard set by the Corporation for the purposes of this
provision and which is specifically approved by the Corporation as a financial
institution which can give guarantees under this clause; and
(b) the
guarantee is in a form, and for a term, approved by the Corporation.
(4) A financial
institution cannot give a guarantee under subclause (1) if the financial
institution and the employer are related corporations.
(5) The Corporation
and an employer may agree to enter into and maintain an arrangement that will
apply in substitution for a guarantee under this clause if the Corporation is
satisfied that the arrangement provides adequate and appropriate security to
the Corporation in case the employer becomes insolvent or ceases to be a
self-insured employer and, in the event of such an agreement, the employer is
not (while the agreement remains in force) required to comply with a preceding
subclause.
(6) In this
clause—
financial institution means—
(a) an
ADI; or
(b) a
person whose sole or principal business is the provision of financial
services;
prescribed scaling factor means—
(a) up
to and including 31 December 2008—1.75;
(b) from
1 January 2009—2;
prescribed sum means—
(a) in
respect of an amount that is to apply to a period that corresponds to, or ends
during, 1999—$520 000;
(b) in
respect of an amount that is to apply to a period that corresponds to, or ends
during, a subsequent year—a sum (calculated to the nearest multiple of
$10 000) that bears to $520 000 the same proportion as the Consumer
Price Index for the September quarter of the immediately preceding financial
year bears to the Consumer Price Index for the September quarter, 1998;
related corporations has the same meaning as in section 60(9) of the Act.
11 The employer must ensure that there is in force
at all times a contract of insurance, in a form approved by the Corporation,
for an amount approved by the Corporation, in excess of an amount approved by
the Corporation, against any liability of the employer that may arise under
the Act as a result of the occurrence of one event or series of events during
the period of the contract.
12 In relation to an employer that is a company
incorporated under the Corporations Law —
(a) the
employer must immediately give the Corporation written notice of the
commencement of any procedure to liquidate or wind up the employer; and
(b) the
employer must, within five business days, give the Corporation written notice
of—
(i)
the commencement of steps to merge or take over the
employer or the undertaking of the employer; or
(ii)
a change in the board of directors of the employer that
substantially changes the management of the employer; or
(iii)
a relocation of the undertaking of the employer; or
(iv)
the purchase or sale of any asset that materially changes
the financial position of the employer, the composition of its workforce or
the nature of the work undertaken by its workers; or
(v)
any other action that significantly affects the
employer's ability to meet its liabilities under the Act.
13 The employer must ensure that all documentation
that relates to a claim against the employer under the Act is retained for at
least six years after the claim is finalised.
14 (1) The employer
must, in carrying out its functions under the Act, take into account the
racial, ethnic and linguistic diversity of the employer's workforce, the
interests of both sexes, and the interests of those who may be physically,
mentally or intellectually impaired, and must ensure that those of the
employer's workers who are entitled to benefits under the Act are not
disadvantaged because of their origins or background, their sex, or some
physical, mental or intellectual impairment.
(2) The employer
should, as far as reasonably practicable, ensure that information provided for
use in the workplace is in a language and form appropriate for those expected
to make use of it.
(a)
self-insured employers who are registered under section 60 of the Act; and
(b)
self-insured employers who are deemed to be registered under the Act by virtue
of Schedule 1 to the Act.