STATUTORY RULES.
1949. No. 90.
REGULATIONS UNDER THE COMMONWEALTH
EMPLOYEES' COMPENSATION ACT 1930-1948.*
I, THE GOVERNOR-GENERAL in and
over the Commonwealth of Australia, acting with the advice of the Federal Executive
Council, hereby make the following Regulations under the Commonwealth
Employees' Compensation Act 1930-1948.
Dated this seventeenth day of November, 1949.
W. J. McKELL
Governor-General.
By His
Excellency's Command,
Treasurer.
AMENDMENTS OF THE EMPLOYEES' COMPENSATION REGULATIONS.
Commonwealth authorities.
1. Regulation 14 of the Employees'
Compensation Regulations is repealed and the following regulation inserted in
its stead :—
" 14. The authorities under the Commonwealth to employees of
which the application of the Act shall extend shall be as follows :—
Australian Aluminium Production Commission;
Australian Broadcasting Commission;
Australian Commonwealth Shipping Board;
Australian Shipping Board;
Board of Management appointed under the Australian War Memorial Act 1925;
Bush Fire Council appointed under the Careless Use of Fire Ordinance 1936-1946 of the Australian Capital
Territory ;
Canberra Community Hospital Board;
Commonwealth Bank of Australia;
Commonwealth Scientific and Industrial Research Organization;
Commonwealth Railways Commissioner;
Commonwealth Savings Bank of Australia;
Director of Shipping;
Overseas Telecommunications Commission (Australia);
R.A.A.F. Canteens Service Board;
Trustees of the Services Canteens Trust Fund.".
Special liability of Commonwealth.
2. Regulation 15 of the Employees' Compensation Regulations is amended by
omitting the word " and " and inserting in its stead the word "
or ".
*
Notified in the Commonwealth Gazette on
, 1949.
Statutory Rules 1945, No. 23, as amended by
Statutory Rules 1946, No. 37 ; 1947, Nos. 27 and 132 ; and 1948, No. 13.
3944.—Price 5d.
10/11.10.1949.
Declarations.
3. Regulation 19 of the Employees' Compensation Regulations is amended
by inserting after the words “ post office," the words “ an adult
permanent officer of the Public Service of the Commonwealth,".
The Schedule
4. The Schedule to the Employees' Compensation repealed and the
following Schedule inserted in its stead :—
“ THE
SCHEDULE.
Form A.
Regulation 3.
Commonwealth
Employees' Compensation Act 1930-1948.
Claim For Compensation.
CLAIM
BY INCAPACITATED EMPLOYEE.
To—
I, [here write full name]of
[here write full postal address]hereby claim compensation under the above-mentioned Act in respect
of personal injury sustained by me and arising out of or in the course of my
employment by the Commonwealth and declare that, to the best of my knowledge
and belief, the following replies to the questions and requests for Information
are true and correct in every particular :—
Questions and Requests for Information. | Replies. |
On date of injury you
were employed :— |
(a) In what precise capacity? ...................................................................... |
(b) By what Department or Authority? ........................................................ |
If you were a member
of the Naval, Military or Air Force of the Commonwealth at date of injury—
|
(c) What was your rank? ............................................................................ |
(d) What was your unit? ............................................................................. |
If you are claiming in
respect of incapacity arising from injury by accident :— |
(a) What is the nature of your injury? ......................................................... |
(b) At what hour did injury occur? .............................................................. |
(c) On what date did injury occur? .............................................................. |
(d) Where did injury occur? ....................................................................... |
(e) Describe briefly how injury was caused ................................................. |
(f) Were you incapacitated for work? .......................................................... |
(g) On what date were you incapacitated for work? ...................................... |
(h) Give names of any
persons who were present at time of accident or immediately afterwards ....................................................................................
|
(i) If accident
occurred whilst travelling to or from place of employment, training school or
any place to obtain a medical certificate or to receive medical, surgical or
hospital treatment or compensation in respect of a previous injury, give
particulars of journey .............................................................
|
If you are claiming in
respect of incapacity arising from a disease :— |
(a) What is nature of disease? ..................................................................... |
(b) How was disease caused? ..................................................................... |
(c) When was disease caused? .................................................................... |
(d)When were you first incapacitated by such disease? ................................ |
(e) For what period were you engaged in your employment? ........................ |
(f) If you have previously suffered from such disease, state :— ..................... |
(i) Approximate date
on which such disease first manifested itself ....... |
(ii) Extent to which
such disease interfered with your employment ...... |
Questions and Requests for Information. | Replies. |
Was notice of accident or incapacity served? ........................................... |
On whom was notice served? ................................................................. |
On what date was notice served? ............................................................ |
|
If so, give full
particulars |
State wages received .............................................................................. |
If this claim is made
more than six months after occurrence of accident or commencement of incapacity,
give reasons for failure to make claim within that period
|
Are you receiving or
entitled to receive from the Commonwealth any payment, allowance or benefit
in respect of your incapacity under—
|
(a) Australian Soldiers'
Repatriation Act 1920-1949, e.g., pension;
|
(b) Social Services
Consolidation Act 1947-1949, e.g., unemployment, sickness, or rehabilitation benefits or
invalid pension ;
|
(c) any other law (other than Commonwealth Employees'
Compensation Act 1930-1948)?
|
If so, give particulars ............................................................................. |
Have you any other
claim against the Commonwealth or any person for compensation or damages or
for any payment (other than payment under an insurance policy privately
effected by you or from a friendly society) in respect of the incapacity? ...................................................................
|
Give particulars of
one of following :— |
(a) wife of employee; or
|
(b) female over age of 16 years caring for a child wholly or
mainly dependent upon employee's earnings and under age of 16 years ; or
|
(c) female member of employee's family over 16 years of age ..........
|
Was she wholly or
mainly dependent, upon employee's earnings at date of injury? ..............................................................................................
|
Has she continuously remained so dependent? ......................................... |
Is she now so dependent? ....................................................................... |
If not, state extent of dependence ............................................................ |
Full
name of each child under 16 years of age dependent upon employee's earnings. | Age. | Date
of birth. | Relationship
to employee. | State whether wholly, mainly or partially dependent upon
employee's earnings at date of injury. |
Declared at on the day of , 19 .
Signature
ofDeclarant.
Before
me—
Form B.
Regulation
4.
Commonwealth
Employees' Compensation Act 1930-1948.
Claim For Compensation.
CLAIM
BY DEPENDANT OF EMPLOYEE.
To—
I, [here write full name]of
[here write full postal address]hereby claim compensation under the abovementioned Act for myself
and children named below in respect of the death of [here write full name of deceased employee]and
declare that, to the best of my knowledge and belief, the following replies to
the questions and requests for information are true and correct in every
particular :—
Questions and Requests for Information. | Replies. |
On date of injury,
above-named employee was employed :— |
(a) In what precise capacity?
.......................................................... |
(b) By what Department or Authority? ............................................. |
If he was a member of
the Naval, Military or Air Forces of the Commonwealth at date of injury—
|
(c) What was his rank?.................................................................... |
(d) What was his unit? .................................................................... .............................................................................................................. |
If death of employee was caused by injury by accident :— ....................... |
(a) What was nature of injury? ........................................................ |
(b)At what hour did injury occur? .................................................... |
(c) On what date did injury occur? ................................................... |
(d) Where did injury occur? ............................................................ |
(e) Describe briefly how injury was caused ...................................... |
(f) Give names of any
persons who were present at time of accident or immediately afterwards. .........................................................
|
(g) If accident
occurred whilst employee was travelling to or from place of employment,
training school or any place to obtain a medical certificate or to receive
medical, surgical or hospital treatment or compensation in respect of a
previous injury, give particulars of journey
...........
|
If death of employee was caused by a disease .......................................... |
(a) What was nature of
disease?.......................................................
|
(b) How was disease caused?
..........................................................
|
(c) When was disease caused?
.........................................................
|
(d) When was employee
first incapacitated by such disease? .............
|
(e)For what period was
employee engaged in his employment?..........
|
(f) If employee ever
previously suffered from such disease, state :— ..
|
(i) Approximate date
on which such disease first manifested itself .............................................................................................................. |
(ii) Extent to which
such disease interfered with his employment. .............................................................................................................. |
Was notice of accident or incapacity served? ........................................... |
On whom was notice served?.................................................................. |
On what date was notice served? ............................................................ |
What is your relationship to deceased employee? .................................... |
Were you wholly dependent upon employee's earnings at date of
his death? .............................................................................................................. |
Were you in part dependent upon employee's earnings at data of
his death? .............................................................................................................. |
If so, give full particulars ....................................................................... |
Questions and Requests for Information. | Replies. |
Was any other person contributing towards your maintenance at
date of employee's death? .................................................................................
|
If so, give full
particulars ............................................................... |
Were you in receipt of a pension or other payment (other than
Child Endowment) from the Commonwealth at the date of employee's death? ........................
|
If so, give
particulars...................................................................... |
Did you at date of
employee's death have any other means of support ? |
If so, give full
particulars................................................................ |
Are you receiving or entitled to receive from the Commonwealth
in respect of the death of the employee, or was the employee receiving or
entitled to receive, any payment under—
|
(a) Australian Soldiers'
Repatriation Oct 1920-1949, e.g., pension; |
(b) any other law
(other than Commonwealth Employees' Compensation Act 1930-1948) ?
|
If so, give particulars ................................................................... |
|
Give names, addresses and relationships to deceased employee of
all other persons (except children) known to you, who were dependent upon his
earnings at date of his death ...........................................................................................
|
|
Full name of each child dependent upon deceased employee's
earnings. | Age. | Date of birth. | Relationship to deceased employee. | State whether wholly, mainly or partially (giving full
particulars) dependent upon employee's
earnings at date of his death. |
Declared at on the day of , 19 .
Signature
ofDeclarant.
Before
me—
Form C.
Regulation
6.
Commonwealth of Australia.
Commonwealth
Employees' Compensation Act 1930-1948.
REPORT
OF MEDICAL REFEREE, MEDICAL BOARD OR MEDICAL
PRACTITIONER.
*Medical Referee | under |
*I, | a Medical Board |
We, | Medical Practitioner |
the Commonwealth
Employees' Compensation Act 1930-1948, have this day examined of , whose signature appears in the
margin of this Form, a claimant for compensation under the above-named Act. On
examination—
*I, | find that claimant is about | years of age and is
suffering from (a) |
We, |
The
above condition is the result of (b)
and is
such that the claimant is thereby incapacitated at present to the extent of per
cent. of total incapacity at his employment at the date of the injury, and per
cent. of total incapacity in the general labour market.
Claimant is fit to undertake
employment in such occupations as
(c)The
above condition is the result of (d)
a disease which | *was | due to the nature of
his employment by the Commonwealth. |
was not |
In | *my | opinion claimant | *has | previously suffered
from the above-mentioned disease. |
our | has not |
General
Remarks—
* Medical Referee.
Medical Board.
Medical Practitioner.
Date ,
19 .
* Strike out what is inapplicable.
(a) Fully describe claimant's general condition.
(b) State whether
accident or disease.
(c) This part to be
filled in only in case of claimant suffering from a disease.
(d) State nature of
disease.
Note.—Attention is invited to the provisions of
the Third Schedule to the Act, copy of which is shown on the back of this form.
Form D.
Regulation
10.
Commonwealth
Employees' Compensation Act 1930-1948.
ELECTION
UNDER SECTION 15.
Note.—Before making an election the employee
should make himself fully acquainted with the compensation or other benefits
provided for under the relative determination by the Public Service Arbitrator
and under the Commonwealth Employees' Compensation Act 1930-1948.
I, of
,
being a person entitled
to elect to take compensation or benefits under the Commonwealth Employees'
Compensation Act 1930-1948 or under the provisions of a determination made
by the Public Service Arbitrator appointed under the Arbitration (Public Service) Act 1920-1947
in respect of personal injury by accident arising out of or in the course of my
employment by the Commonwealth, hereby elect to :take compensation or benefits
under the Commonwealth Employees' Compensation Act 1930-1948.
[Signature of Employee.]
Signed before me this day
of , 19 .
Signature of witness.
Occupation
and address of witness.
Form E.
Regulation
16.
Commonwealth
Employees' Compensation Act 1930-1948.
RETURN
OF PAYMENTS* MADE DURING THE YEAR ENDED
30TH
JUNE, 19
.
DEPARTMENT or AUTHORITY STATE
£ s. d. |
1. Amount paid under Section 9 (General
Accidents)— |
(a) in cases of
incapacity .............................................. |
(b) in cases of death...................................................... | __________ |
__________ |
2. Amount paid under Section 9a (Travelling)— |
(a) in cases of incapacity............................................... |
(b) in cases of death ...................................................... | __________ |
___________ |
3. Amount paid under Section 10 (Diseases)— |
(a) in cases of
incapacity............................................... |
(b) in cases of death...................................................... | ___________ |
___________ |
4. Amount paid under
Section 12 (Specified Injuries) ............ |
Total
Amount of Compensation Paid During the Year ............................................................... |
5. Amount paid in respect
of medical, surgical, hospital and funeral expenses ........................................ |
Total
Amount Paid Under the Act During the Year ................................................................... |
Number of injuries in
respect of which compensation has been paid under the Act during the year‡ ......... |
Permanent Head or Chief |
Officer of the Department or Authority |
Date |
*Payments made under the Arbitration Determination or under any
other Act should not be
included in this
return.
Donot
include in items 1, 2, 3 or 4 amounts paid in respect of medical, surgical,
hospital and
funeral expenses.
‡ The number here given should not include any injury in
respect of which an amount of payment
has been included in a
previous return.".
By
Authority: L. F. Johnston,
Commonwealth Government Printer, Canberra.