Workers' Compensation and Injury Management Regulations 1982 (WA)
Western Australia
Workers’ Compensation and Injury Management Act 1981
These regulations were repealed by the
Western Australia
Workers’ Compensation and Injury Management Act 1981
These regulations may be cited as the
These regulations shall come into operation on the date of the coming into operation of the
In these regulations —
Notes in these regulations are provided to assist understanding and do not form part of the regulations.
(1) If the minimum award rates that would be relevant to calculating the redemption amount (as defined in Schedule 5 clause 1 of the Act) for a particular financial year are not published, the amount to be calculated for that financial year (the
relevant year ) is to be obtained by varying the amount for the preceding financial year as described in subregulation (2).(2) The amount is varied by the percentage by which the December WPI varies from the previous December WPI.
(1) For the purposes of the definition of
company in section 5(1) of the Act, the following registered bodies are specified —(a) a registered Australian body that was formed or incorporated in the State;
(b) a registered Australian body that was not formed or incorporated in the State and that does not have its head office or principal place of business in the State.
(2) In this regulation —
For the purposes of paragraph (d) of the definition of
(a) a fair work instrument as defined in the
Fair Work Act 2009 (Commonwealth) section 12;(b) an award‑based transitional instrument as defined in the
Fair Work (Transitional Provisions and Consequential Amendments) Act 2009 (Commonwealth) Schedule 2 item 2 that continues in existence under Schedule 3 Part 2 of that Act.
(1) The classes of mine that are prescribed for the purposes of the definition of
mine ormining operation in section 5(1) of the Act are those mines that are a mine as defined in theMines Safety and Inspection Act 1994 section 4(1).(2) The classes of mining operation that are prescribed for the purposes of the definition of
mine ormining operation in section 5(1) of the Act are those mining operations that are mining operations as defined in theMines Safety and Inspection Act 1994 section 4(1).
(1) The form of election referred to in section 24B of the Act shall be in Form 1 or, in the case of a worker suffering from noise induced hearing loss, Form 2C in Appendix I.
(2) The form of election referred to in section 31H of the Act must be in the form of Form 1A in Appendix I or, in the case of a worker suffering from noise induced hearing loss, in the form of Form 2CA in Appendix I.
Pursuant to section 38(2) of the Act, the form of the determination of the medical panel shall, as far as practicable in each case, be as set out in Form 2 in Appendix I.
(1) Form 2B or, in the case of a worker suffering from noise induced hearing loss, Form 2C or Form 2CA, as the case requires, in Appendix I is prescribed for the purposes of a claim made by a worker in accordance with section 178(1)(b) of the Act.
[(2),(3) deleted]
A certificate of currency in respect of the employer’s insurance policy referred to in section 160(7) of the Act is prescribed under section 180(1)(j) of the Act as a relevant document.
(1) Form 3 in Appendix I is the prescribed form under sections 57A(1)(b)(i) and 57B(1)(b)(i) of the Act.
(2) In addition to the details prescribed in Form 3 as being necessary to make a valid claim for compensation under sections 57A and 57B, the “Consent authority” is prescribed under section 292(1)(a) as expedient for the purposes of the Act, and must be completed accordingly.
Form 3A in Appendix I is the prescribed form under section 57A(3)(a) of the Act.
Form 3B in Appendix I is the prescribed form under section 57A(3)(b) of the Act.
Form 3C in Appendix I is the prescribed form under section 57A(3)(c) of the Act.
Form 3D in Appendix I is the prescribed form under section 57B(2)(b) of the Act.
Form 3E in Appendix I is the prescribed form under section 57B(2)(c) of the Act.
(1) A notice under section 57A or 57B of the Act or regulation 25 may be given to a worker or an employer by emailing the notice to an email address nominated by the worker or employer (whichever is relevant).
(2) A worker or employer is taken to have nominated an email address as described in subregulation (1) if the email address is included in the worker’s claim for compensation.
(1) The certificate of capacity required by section 61 of the Act, before discontinuance of weekly payments, shall be in the form of Form 4 in Appendix I, or in the form of Form 3 in Appendix I if that form has been marked to indicate that it is to be regarded as both a first and final certificate of capacity.
(2) Notice to the worker referred to in section 61 of the Act shall be in the form of Form 5 in Appendix I.
(3) The period commencing on the making of an application for conciliation of a dispute about the intention of an employer to discontinue or reduce weekly payments to a worker and ending when a certificate under section 182H or 182O is issued in respect of the dispute is to be disregarded for the following purposes —
(a) calculating the period of notice of the intention of the employer under section 61(1);
(b) calculating the time within which the worker may apply for an order of an arbitrator under section 61(3).
Form 4A in Appendix 1 is prescribed as a certificate for the purposes of section 61(1) of the Act.
(1) A worker who receives a first certificate of capacity (Form 3) under the Act which nominates a medical review of the worker within a period of 14 days from the date the certificate is issued cannot be required, under section 64 or 65 of the Act, to submit himself for examination by a medical practitioner provided by the employer before a period of one month has elapsed from the date the certificate is issued.
(2) A worker who receives a first certificate of capacity (Form 3) under the Act which does not nominate a medical review of the worker within a period of 14 days from the date the certificate is issued may be required, under section 64 or 65 of the Act, to submit himself for examination by a medical practitioner provided by the employer at any time from the date the certificate is issued.
(3) A worker who fails to attend a medical review, nominated on a first certificate of capacity in accordance with subregulation (1), may be required, under section 64 or 65 of the Act, to submit himself for examination by a medical practitioner provided by the employer at any time from the date of that non‑attendance.
(4) An employer shall not require a worker to attend an examination under section 64 or 65 of the Act —
(a) more frequently than once every 2 weeks; or
(b) at any time other than during reasonable hours.
(5) A worker must not, under section 64 or 65 of the Act, be required to attend medical examinations by more than 3 medical practitioners who are specialists in the same field of medicine.
(6) Nothing in subregulation (5) limits the number of times a worker may be required to attend a medical examination by a medical practitioner.
The compound discount table required to be prescribed by section 68(3) of the Act is set out in Appendix II.
When calculating a lump sum redemption under section 68 of the Act the following formula shall be applied for use in conjunction with a compound discount table as set out in Appendix II.
DISCOUNT FORMULA UNDER SECTION 68(4)
Discounted sum = P x 52 x A |
Where — |
S = prescribed amount less the sum of weekly payments made |
P = the weekly payment |
Y = the whole number equal to or next below |
W = T — (52 x Y) |
A = the present value of $1.00 per annum payable weekly for Y years and W weeks obtained from the compound discount tables set out in Appendix II. |
(1) For the purposes of section 69, a worker must send to the employer or the employer’s insurer a declaration by the worker and a medical practitioner in the form of Appendix I Form 6 —
(a) within 3 months after the date on which the worker is no longer residing in the State; and
(b) for each subsequent period during which the worker continues to receive weekly payments while not residing in the State, within 3 months after the date of the previous declaration by the worker and a medical practitioner.
(2) A declaration under subregulation (1) is taken to have been sent to an employer or an employer’s insurer at the time it was —
(a) delivered personally to the last known business address of the employer or the employer’s insurer; or
(b) posted to the last known business address of the employer or the employer’s insurer; or
(c) sent by electronic means to the last known email address or fax number of the employer or the employer’s insurer.
(3) An employer or an employer’s insurer who disputes the identity or entitlement, or both, of a worker may apply —
(a) under section 182E of the Act for resolution of the dispute by conciliation; and
(b) under section 182ZT of the Act for determination of the dispute by arbitration, if the dispute is not resolved by conciliation.
(1) In the event of the death of a worker who dies outside the State and who was receiving or was entitled to receive weekly payments at the date of his death, his representatives shall, for the purpose of obtaining payment of the arrears (if any) due to the worker, forward to the Director a certificate of the death of the worker, and documents showing that they are entitled to such arrears, verified by declaration before a person having authority to administer an oath, with a request for payment of such arrears, specifying the place where and the manner in which the amount is to be remitted to them.
(2) For the purposes of this regulation the expression
representatives means —(a) if the worker leaves a will, the executors of the will; or
(b) where the worker dies intestate, the persons who are according to law entitled to his personal estate, and payment of the arrears may be made to the persons without the production of letters of administration.
(3) On receipt of the certificate of death and the documents mentioned in this regulation, the Director shall examine them, and may, if not satisfied that they are in order, return them to the representatives for correction.
(4) When the Director is satisfied that the certificate and documents are in order, or when they are returned to him in order, he shall send to the employer a notice requesting him to forward the amount due, and the employer shall thereupon forward the amount to the Director, who shall remit that amount, to the representatives of the worker at the address and in the manner requested by them, such remittance being in all cases at the risk of the representatives.
(1) In this regulation —
(2) For the purposes of section 72J(5) of the Act, the amount to be paid to WorkCover WA is to be calculated as follows —
where —
C is the child’s allowance (as defined in Schedule 1A clause 5 of the Act);
W is the percentage by which WPI varied between the second-last December quarter before the relevant year commenced and the last December quarter before the relevant year commenced;
N is the number of weeks until the child attains the age of 21 years.
(1AA) In this regulation —
(1) A memorandum of an agreement referred to in section 76 of the Act is sent to the Director in accordance with that section by lodging it as soon as practicable after the agreement has been entered into.
(1a) A memorandum of an agreement referred to in section 76 of the Act shall be in the form of Form 15C in Appendix I.
(2) The memorandum is to include full particulars of matters for which the agreement provides and, in the case of an agreement as to the compensation that is to be paid under Schedule 2 of the Act, is to identify each item for which the compensation is to be paid and, for each item —
(a) if the Act Part III Division 2 applies in respect of the personal injury or noise induced hearing loss that is the subject of the agreement —
(i) the percentage loss of the full efficient use of a part or faculty of the body for which compensation is to be paid; and
(ii) the amount of compensation;
or
(b) if the Act Part III Division 2A applies in respect of the personal injury or noise induced hearing loss that is the subject of the agreement —
(i) the degree of permanent impairment of a part or faculty of the body for which compensation is to be paid; and
(ii) the amount of compensation.
(3) The memorandum is to be signed by or on behalf of each party to the agreement.
(3a) A memorandum of an agreement lodged for the purposes of a redemption amount under section 67(l) shall be accompanied by Form 15D in Appendix I signed and dated by the worker, as acknowledgment that he/she is aware of the consequences of the recording of the memorandum.
(4) The notice despatched by the Director to each interested party, under section 76(2) of the Act, is to be in the form of Form 15A in Appendix I.
(4a) Where any interested party disputes the genuineness of the memorandum, or the adequacy of the compensation agreed upon or otherwise objects to the recording of the agreement that party shall, within the 7 days allowed in section 76(2), lodge a notice in the form of Form 15E in Appendix I.
(4b) On receipt of an objection from any party in the manner prescribed in subregulation (4a), the Director shall send to each other party a notice, in the form of Form 15F, informing such parties that the memorandum will not be recorded except with the consent in writing of the objector.
(5) If the Director records the memorandum, the Director is to notify each interested party accordingly in the form of Form 15B in Appendix I.
(6) The Director may vary or amend a memorandum if all parties first lodge written consent to make that variation or amendment.
(7) For the purpose of providing a statement of benefits paid, under section 67(2) of the Act, Part 4 of the Memorandum of Agreement form (Form 15C), may be used for this purpose.
(1) This regulation applies to a notice of intention to dismiss a worker to which section 84AB of the Act refers.
(2) Form 15G in Appendix I is the form prescribed for the notice.
(1) The amount prescribed for the purposes of section 109(1) of the Act is $100 000.
(2) The amount prescribed for the purposes of section 109(4) of the Act is $40 000.
(1) WorkCover WA may approve an application by an employer for reimbursement under section 154AC(1) of the Act.
(2) The amount that WorkCover WA is to reimburse to an approved applicant under section 154AC(1) of the Act is to be calculated by subtracting the estimated total cost from the actual total cost.
(3) In this regulation —
(1) Interest payable under an order made under section 222(1) of the Act must be calculated at a rate of 6% per annum.
(2) Interest payable under section 223(1) of the Act must be calculated at a rate of 6% per annum.
(3) Interest payable under section 224(1) of the Act in respect of a sum agreed to be paid must be calculated at a rate of 6% per annum.
(1) Section 160(1) of the Act does not require an employer to obtain or keep current a policy of insurance for liability to pay compensation under the Act or damages arising out of —
(a) a claim directly or indirectly occasioned by any event happening through or in consequence of —
(i) war; or
(ii) invasion; or
(iii) acts of foreign enemies; or
(iv) hostilities whether war be declared or not; or
(v) civil war; or
(vi) rebellion; or
(vii) revolution; or
(viii) insurrection; or
(ix) military or usurped power;
or
(b) a claim in respect of —
(i) pneumoconiosis; or
(ii) mesothelioma; or
(iii) lung cancer; or
(iv) diffuse pleural fibrosis,
arising from employment in any mine or mining operation; or
(c) a claim in respect of any other industrial disease for the time being specified by the Minister under section 151(a)(iii) of the Act.
(2) Section 160(1) of the Act does not require an employer to obtain or keep current a policy of insurance for liability to pay damages arising out of —
(a) a claim brought in respect of an injury occurring outside Australia; or
(b) a claim brought outside Australia.
(3) Section 160(1) of the Act does not require an employer to obtain or keep current a policy of insurance for liability to pay —
(a) exemplary or punitive damages; or
(b) an aggregate amount of damages exceeding $50 000 000 arising out of all claims in respect of a single event.
Note for this regulation:
The
The statements required to be transmitted to WorkCover WA under section 171 of the Act shall be in the form of Forms 16 and 17 in Appendix 1.
(1A) This regulation applies only if the injury of a worker occurred and the worker died before 1 July 2018.
(1) The form of notification for the purposes of the Act Schedule 1 clause 1C(1) must be in the form of Form 29 in Appendix I.
(2) The form of notification for the purposes of the Act Schedule 1 clause 1C(4)(a) must be in the form of Form 30 in Appendix I.
(3) An election for the purposes of the Act Schedule 1 clause 1C(2) or clause 1C(4) or (6) must —
(a) be made in writing; and
(b) specify —
(i) the name and address of the dependant; and
(ii) the relationship (child or step‑child) of the dependant to the deceased worker; and
(iii) the name of the deceased worker, and the address of the deceased worker at the time of death; and
(iv) whether the dependant elects to receive an apportionment of the notional residual entitlement or a child’s allowance under the Act Schedule 1 clause 1A; and
(v) whether the worker died leaving any spouse or de facto partner wholly dependent on the workers’ earnings, and whether that spouse or de facto partner is a parent of the dependant making the election; and
(vi) that the dependant has been independently advised of the financial consequences of the election, and the name, title, address and phone number of the person who gave that advice; and
(vii) the date on which the election is made;
and
(c) be signed by the dependant or, in the case of an election by a person under a legal disability, the parent or guardian of that person; and
(d) include the signature and full name and address of a witness to the signature of the dependant or his or her parent or guardian; and
(e) be given to the Director.
The Hospital Allowance provided for under the
(1) For the purposes of the Act Schedule 1 clause 19(1), the prescribed rate for vehicle running expenses (irrespective of engine capacity) is —
(a) for the period up to and including 30 June 2005, 34 cents per kilometre; and
(b) for a financial year commencing on or after 1 July 2005, the amount per kilometre obtained by —
(i) varying the amount applying at the end of the preceding financial year by the percentage by which the March CPI varies from the previous March CPI; and
(ii) rounding the amount to the nearest whole number of cents (with an amount that is.5 of a cent being rounded off to the next highest whole number of cents).
[(2) deleted]
(1) For the purposes of the Act Schedule 1 clause 18A(2aa)(c)(ii) the circumstances in relation to the medical and associated conditions, treatment and management of a worker are exceptional if operative intervention and reasonable post‑operative treatment of a kind related to an MBS item are required to alleviate substantially the consequences of serious impairment and improve the worker’s physical condition.
(2) For the purposes of the Act Schedule 1 clause 18A(2aa)(c)(ii) the applicant must produce the following evidence in writing of the exceptional circumstances —
(a) clear medical opinion from a treating specialist that operative intervention and reasonable post‑operative treatment of a kind related to an MBS item are required to alleviate the consequences of serious impairment and improve the worker’s physical condition; and
(b) a management plan provided by the treating specialist that indicates that substantial medical improvement to the worker’s physical condition is anticipated as a result of operative intervention and reasonable post‑operative treatment.
(3) In this regulation —
(a) is treating the applicant; and
(b) is a specialist in a relevant field of medicine.
A reference in the Act Schedule 1 clause 18A(2ac) to a management plan is a reference to a management plan produced under regulation 17AB(2)(b).
(1) A worker may apply to the Director to extend the final day under the Act Schedule 1 clause 18B.
(2) The application is made by —
(a) lodging with the Director a completed application in the form of Form 31 in Appendix I; and
(b) providing to the Director, with the application form, anything that this regulation requires to be provided with the application form.
(3) When the application form is lodged —
(a) if the worker has, in writing, requested an approved medical specialist to assess the worker’s degree of permanent whole of person impairment, the Director must be provided with a copy of the worker’s request; and
(b) if the approved medical specialist has notified the worker, in writing, that more time is or was required to give the worker the documents required to make an application under the Act Schedule 1 clause 18A(1b) before the final day, the Director must be provided with a copy of the notification.
(4) The Director may, within the limits imposed by the Act Schedule 1 clause 18B(4), extend the final day until a day that the Director, having regard to the further time needed by the approved medical specialist, considers will give the worker a reasonable opportunity to make an application under the Act Schedule 1 clause 18A(1b).
(1A) This regulation applies only if the injury of a worker occurred and the worker died before 1 July 2018.
(1) For the purposes of the Act Schedule 1 clause 17(2), the amount prescribed for funeral expenses is —
(a) for the period up to and including 30 June 2007, $7 547; and
(b) for a financial year commencing on or after 1 July 2007, the amount obtained by —
(i) varying the amount applying at the end of the preceding financial year by the percentage by which the March CPI varies from the previous March CPI; and
(ii) rounding the amount to the nearest whole number of cents (with an amount that is .5 of a cent being rounded off to the next highest whole number of cents).
[(2) deleted]
[(1) deleted] (2) For the purposes of Schedule 1A clause 5(b) of the Act, the child’s allowance is —
(a) for the financial year commencing on 1 July 2018, the amount of $135 per week; and
(b) for a financial year commencing on or after 1 July 2019 (the
relevant year ), the amount per week determined by —(i) varying the amount for the preceding financial year by the percentage by which WPI varied between the second-last December quarter before the relevant year commenced and the last December quarter before the relevant year commenced; and
(ii) rounding the amount to the nearest whole number of dollars (with an amount that is 50 cents more than a whole number being rounded up to the next highest whole number).
(3) Despite subregulation (2)(b), if the amount determined under that subregulation would result in a decrease in the amount prescribed for the child’s allowance, the amount prescribed is the same amount as the amount for the preceding financial year.
[(1) deleted] (2) For the purposes of Schedule 1A clause 9(2)(b) of the Act, the amount prescribed for funeral expenses is —
(a) for the financial year commencing on 1 July 2018, $9 903; and
(b) for a financial year commencing on or after 1 July 2019 (the
relevant year ), the amount determined by —(i) varying the amount for the preceding financial year by the percentage by which CPI varied between the second-last March quarter before the relevant year commenced and the last March quarter before the relevant year commenced; and
(ii) rounding the amount to the nearest whole number of dollars (with an amount that is 50 cents more than a whole number being rounded up to the next highest whole number).
(3) Despite subregulation (2)(b), if the amount determined under that subregulation would result in a decrease in the amount prescribed for funeral expenses, the amount prescribed is the same amount as the amount for the preceding financial year.
(1) The supplementary amount referred to in the Schedule 5 clause 1 of the Act is —
(a) for the period up to and including 30 June 2008 —
(i) in relation to a worker with a dependant spouse or dependant de facto partner, or both, $228; and
(ii) in relation to a worker without a dependant spouse or dependant de facto partner, $128;
and
(b) for a financial year commencing on or after 1 July 2008, the amount obtained by —
(i) varying the amount applying at the end of the preceding financial year by the percentage by which the March CPI varies from the previous March CPI; and
(ii) rounding the amount to the nearest whole number of cents (with an amount that is 0.5 of a cent being rounded off to the next highest whole number of cents).
[(2) deleted]
A person who appears before the Registrar or an arbitrator to give evidence is entitled to any allowance for that appearance set by the Costs Committee established under section 269 of the Act.
(1) The election to receive the redemption amount as a lump sum, referred to in Schedule 5 to the Act shall be in the form of Form 14 in Appendix I.
(2) The election to receive the supplementary amount, referred to in Schedule 5 to the Act shall be in the form of Form 15 in Appendix I.
This Part applies in relation to any costs incurred on or after 14 November 2005 in relation to a proceeding determined, or otherwise dealt with, by a dispute resolution authority.
In this Part —
(1) A person who has paid or is liable to pay, or who is entitled to receive or who has received, costs as a result of an order for the payment of an unspecified amount of costs made by a dispute resolution authority before commencement day may apply under the
Workers’ Compensation and Injury Management Arbitration Rules 2011 for an assessment of the whole of, or any part of, those costs by a taxing officer.(2) A person who has paid or is liable to pay, or who is entitled to receive or has received, costs as a result of an order for the payment of an unspecified amount of costs made by a dispute resolution authority on or after commencement day may apply under the
Workers’ Compensation and Injury Management Conciliation Rules 2011 or theWorkers’ Compensation and Injury Management Arbitration Rules 2011 , as relevant, for an assessment of the whole of, or any part of, those costs by a taxing officer.
(1) A taxing officer may, by written notice, require an applicant to give a copy of the application to —
(a) a party to the proceeding in respect of which the relevant order for costs was made; or
(b) a legal practitioner, agent or other interested party,
specified by the taxing officer.
(2) The application must be given in accordance with the
Workers’ Compensation and Injury Management Conciliation Rules 2011 or theWorkers’ Compensation and Injury Management Arbitration Rules 2011 as relevant.(3) If a person fails, without reasonable excuse, to comply with a notice given under subregulation (1) the taxing officer may decline to deal with the application.
(1) A taxing officer may, by written notice, require a person (including the applicant, a party to the proceeding in which the relevant order for costs was made, the legal practitioner or agent concerned or any other legal practitioner or agent) to produce any relevant documents of or held by the person in respect of the matter.
(2) A taxing officer may, by written notice, require an applicant to give to the taxing officer further particulars as to any item of costs claimed.
(3) A notice given under subregulation (1) or (2) must specify the period within which the notice is to be complied with.
(4) If a person fails, without reasonable excuse, to comply with a notice given under subregulation (1) or (2) the taxing officer may decline to deal with the application or may continue to deal with the application on the basis of the information provided.
(5) Nothing in this regulation prevents a person from objecting to the production of a document on the grounds of legal professional privilege.
(1) A taxing officer must not determine an application unless the taxing officer —
(a) has given the applicant and any other party to the proceeding in which the relevant order for costs was made a reasonable opportunity to make oral or written submissions in relation to the application; and
(b) has given due consideration to any submissions so made.
(2) In considering an application a taxing officer is not bound by the rules of evidence and may inform himself or herself on any matter in such manner as the taxing officer thinks fit.
An assessment of costs must be made in accordance with, and so as to give effect to, orders of the dispute resolution authority and any costs determination published under section 273 of the Act.
(1) When dealing with an application the taxing officer must consider —
(a) whether or not it was reasonable to carry out the work to which the costs relate; and
(b) what is a fair and reasonable amount of costs for the work concerned.
(2) In assessing what is a fair and reasonable amount of costs, the taxing officer may have regard to any or all of the following matters —
(a) the skill, labour and responsibility displayed on the part of the legal practitioner or agent responsible for the matter;
(b) the complexity, novelty or difficulty of the matter;
(c) the quality of the work done and whether the level of expertise was appropriate to the nature of the work done;
(d) the place where and circumstances in which the legal services or agent services were provided;
(e) the time within which the work was required to be done;
(f) the outcome of the matter.
(3) If the dispute resolution authority has ordered that the costs are to be assessed on a specified basis, the taxing officer must assess the costs on that basis.
The costs of and incidental to an assessment are at the discretion of the taxing officer.
(1) The taxing officer must issue to each party a certificate that sets out the amount in which costs have been assessed and allowed by the taxing officer.
(2) The costs are payable under the order made by the dispute resolution authority as to the costs.
At any time after making a determination a taxing officer who made the determination may, for the purpose of correcting an inadvertent error in the determination —
(a) make a new determination in substitution for the previous determination; and
(b) issue a certificate under regulation 18J that sets out the new determination.
(1) In this regulation —
(a) made under the
Workers’ Compensation (DRD) Rules 2005 2 before commencement day; and(b) which has not been determined by a taxing officer before commencement day.
(2) A pending application is to be dealt with and determined under this Part as if it were an application made under the
Workers’ Compensation and Injury Management Arbitration Rules 2011 .
In this Part —
(a) the worker’s name and address and any other details necessary to identify the worker; and
(b) details sufficient to enable the worker to be contacted; and
(c) the worker’s date of birth; and
(d) the date on which the worker’s injury occurred; and
(e) a description of the worker’s injury; and
(f) if a claim for compensation has been made under the Act with respect to the worker’s injury — details sufficient to identify the claim, including any claim number that has been given to the claim; and
(g) the employer’s name and address and any other details necessary to identify the employer; and
(h) details sufficient to enable the employer to be contacted; and
(i) the insurer’s name, if any;
(a) Part III Division 2A of the Act (which provides for lump sum payments for specified injuries); or
(b) Part IV Division 2 Subdivision 3 of the Act (which provides for restrictions on awarding, and the amount of, damages); or
(c) Part IXA of the Act (which provides for specialised retraining programs); or
(d) (except in regulation 18R(3)(e)) clause 18A of Schedule 1 to the Act (which provides for additional sums to be allowed for medical expenses).
For the purposes of section 146A(3) of the Act, a request for a worker’s degree of impairment to be assessed by an approved medical specialist has to be given in writing to the approved medical specialist, specifying —
(a) the prescribed details in relation to the worker; and
(b) the approved medical specialist’s name; and
(c) the relevant provisions of the Act for the purposes of which the assessment is to be made; and
(d) the date of the request for the assessment.
For the purposes of section 146G(1)(a) of the Act, the requirement for a worker to attend at a place specified by an approved medical specialist —
(a) has to be given in writing to the worker and sent to the worker’s address specified in the request for assessment referred to in regulation 18M; and
(b) has to specify —
(i) the prescribed details in relation to the worker; and
(ii) the approved medical specialist’s name; and
(iii) details sufficient to enable the approved medical specialist to be contacted; and
(iv) the relevant provisions of the Act for the purposes of which the assessment is to be made; and
(v) the time when and the place where the worker is to submit to examination, as required under section 146G(1)(d) of the Act.
(1) For the purposes of section 146G(1)(c)(i) of the Act, the requirement to produce to an approved medical specialist any relevant document or information has to be given in writing to the worker, the employer, or the employer’s insurer, specifying —
(a) the prescribed details in relation to the worker; and
(b) details of any relevant document or information to which the requirement applies; and
(c) the approved medical specialist’s name; and
(d) details sufficient to enable the approved medical specialist to be contacted; and
(e) the relevant provisions of the Act for the purposes of which the assessment is to be made.
(2) For the purposes of section 146G(1)(c)(ii) of the Act, the requirement to consent to another person who has any relevant document or information producing it to an approved medical specialist has to be given in writing to the worker, the employer, or the employer’s insurer, specifying —
(a) the prescribed details in relation to the worker; and
(b) details of any relevant document or information to which the requirement applies; and
(c) the name of the person who has the relevant document or information; and
(d) the approved medical specialist’s name; and
(e) details sufficient to enable the approved medical specialist to be contacted; and
(f) the relevant provisions of the Act for the purposes of which the assessment is to be made.
If the time for complying with a requirement referred to in regulation 18O is not specified in the requirement, the requirement has to be complied with within 7 days after the day on which the person who is to comply with the requirement receives it.
(1) On being requested in writing to do so by the approved medical specialist, a worker who has requested an approved medical specialist to assess his or her degree of impairment is required to produce to the approved medical specialist for use in dealing with the requested assessment, within 7 days after the day on which the worker receives the approved medical specialist’s request, any information that —
(a) relates to the injury from which the impairment resulted; and
(b) is specified in the approved medical specialist’s request.
(2) A request by an approved medical specialist under subregulation (1) has to include —
(a) the approved medical specialist’s name; and
(b) details sufficient to enable the approved medical specialist to be contacted.
(3) A person who contravenes a requirement under subregulation (1) commits an offence and is liable to a fine of $2 000.
(4) Subregulation (1) does not apply to any information that is the subject of a requirement referred to in regulation 18O(1).
(1) A report of a worker’s degree of impairment given by an approved medical specialist under section 146H(1)(a) of the Act has to include —
(a) the prescribed details in relation to the worker; and
(b) the approved medical specialist’s name; and
(c) details sufficient to enable the approved medical specialist to be contacted; and
(d) the date of the examination of the worker by, or at the request of, the approved medical specialist; and
(e) the relevant provisions of the Act for the purposes of which the assessment was made.
(2) A certificate specifying a worker’s degree of impairment given by an approved medical specialist under section 146H(1)(b) of the Act has to include —
(a) the prescribed details in relation to the worker; and
(b) the approved medical specialist’s name; and
(c) details sufficient to enable the approved medical specialist to be contacted; and
(d) the date of the examination of the worker by, or at the request of, the approved medical specialist.
(3) A report given by an approved medical specialist under section 146H(2)(c) of the Act has to include —
(a) the prescribed details in relation to the worker; and
(b) the approved medical specialist’s name; and
(c) details sufficient to enable the approved medical specialist to be contacted; and
(d) the date of the examination of the worker by, or at the request of, the approved medical specialist; and
(e) the relevant provisions of the Act for the purposes of which the relevant certificate under section 146H(2) of the Act was given.
For the purposes of section 146L(2)(a) of the Act, the requirement for a worker to attend at a place specified by an approved medical specialist panel has to be given in writing to the worker, specifying —
(a) the prescribed details in relation to the worker; and
(b) the names of the members of the approved medical specialist panel; and
(c) the time when and the place where the worker is to submit to examination, as required under section 146L(2)(d) of the Act.
(1) For the purposes of section 146L(2)(c)(i) of the Act, the requirement to produce to an approved medical specialist panel any relevant document or information has to be given in writing to the worker, the employer, or the employer’s insurer, specifying —
(a) the prescribed details in relation to the worker; and
(b) details of any relevant document or information to which the requirement applies; and
(c) the names of the members of the approved medical specialist panel.
(2) For the purposes of section 146L(2)(c)(ii) of the Act, the requirement to consent to another person who has any relevant document or information producing it to an approved medical specialist panel has to be given in writing to the worker, the employer, or the employer’s insurer, specifying —
(a) the prescribed details in relation to the worker; and
(b) details of any relevant document or information to which the requirement applies; and
(c) the name of the person who has the relevant document or information; and
(d) the names of the members of the approved medical specialist panel.
If the time for complying with a requirement referred to in regulation 18T is not specified in the requirement, the requirement has to be complied with within 7 days after the day on which the person who is to comply with the requirement receives it.
(1) On being requested to do so by the approved medical specialist panel, a worker in respect of whom a question as to degree of impairment has been referred to an approved medical specialist panel is required to produce to the approved medical specialist panel for use in dealing with the referral, within 7 days after the day on which the worker receives the request, any information that —
(a) relates to the injury from which the impairment resulted; and
(b) is specified in the approved medical specialist panel’s request.
(2) A request by an approved medical specialist panel under subregulation (1) has to include the names of the members of the approved medical specialist panel.
(3) A person who contravenes a requirement under subregulation (1) commits an offence and is liable to a fine of $2 000.
(4) Subregulation (1) does not apply to any information that is the subject of a requirement referred to in regulation 18T(1).
A report of a worker’s degree of impairment given by an approved medical specialist panel under section 146O(2)(a) of the Act, or a certificate specifying a worker’s degree of impairment given by an approved medical specialist panel under section 146O(2)(b) of the Act, has to include —
(a) the prescribed details in relation to the worker; and
(b) the names of the members of the approved medical specialist panel; and
(c) the date of the examination of the worker by, or at the request of, the members of the approved medical specialist panel.
In this Part unless the contrary intention appears —
(1) The chief executive officer may approve, either generally or in a particular case, the following persons to carry out audiometric testing —
(a) a medical practitioner; and
(b) an audiologist who is either a full member or qualified to be a full member of the Audiological Society of Australia; and
(c) a person who, in the opinion of the chief executive officer, has appropriate qualifications to enable that person to carry out audiometric testing as an audiometric officer.
(2) An audiometric test for the purposes of sections 24A and 24B of the Act shall be carried out by a person approved under subregulation (1).
(3) The chief executive officer may at any time cancel an approval given under subregulation (1).
(4) The chief executive officer shall serve on each person to whom an approval, or cancellation of approval, relates a certificate of approval or notification of cancellation, as the case requires.
(1) An approved person shall carry out an audiometric test —
(a) using an audiometer which meets the standards specified in writing by the chief executive officer; and
(b) in an approved hearing booth or other approved testing environment.
(2) An approved person using an audiometer under subregulation (1) shall —
(a) check the audiometer on each day of use, both before and after the series of measurements carried out and after any relocation of the audiometer, to ensure that the audiometer is in satisfactory working order; and
(b) ensure that the audiometer has been calibrated at an approved calibration laboratory within the 12 months preceding each day of use and that the audiometric officer has received a copy of the report prepared on that calibration.
(3) An approved person shall ensure that the background noise levels during the testing of the hearing of a worker do not exceed those values listed in Table 5.1 in Section 5 of Australian Standard 1269‑1989, or an approved equivalent, for the type of earphone/cushion or earphone enclosure combination connected to the audiometer used for the testing.
(4) Subject to subregulation (5), an approved person shall test the hearing of a worker by means of a pure tone air conduction hearing threshold test carried out separately for the left and right ears —
(a) in accordance with —
(i) the procedure described in Section E2 of Appendix E of Australian Standard 1269‑1989 as modified by written direction of the chief executive officer; or
(ii) any procedure which establishes a higher testing procedure than that specified in subparagraph (i) and which is approved in writing by the chief executive officer;
and
(b) if the test is conducted in accordance with the procedure referred to in paragraph (a)(i), at the frequencies 500, 1 000, 1 500, 2 000, 3 000, 4 000, 6 000, 8 000 Hz except that where an audiometer does not possess a 1 500 Hz tone the hearing threshold for that frequency shall be calculated by drawing a straight line on an audiogram connecting the points of threshold for 1 000 and 2 000 Hz, marking the point of intersection with the 1 500 Hz line, and adjusting this value to the nearest 5dB increment.
(5) If, in the opinion of the chief executive officer, a worker has an injury which will prevent the effective use of an audiometric test referred to in subregulation (4), the hearing of that worker may be tested by any other method approved for the purposes of this subregulation.
(6) In instances where audiometric testing is carried out by an audiometric officer and the audiometric officer believes that the worker meets the criteria specified in Item 4 of Waugh & Macrae’s criteria for medical referral in Table 1 of National Acoustic Laboratories Report No. 80 “Criteria for assessing hearing conservation audiograms”, the audiometric officer shall refer the worker to a medical practitioner and the audiometric officer shall defer audiometric testing until the worker has complied with the referral and the audiometric officer is satisfied that the worker does not meet those criteria.
(7) Where an initial audiometric test is carried out by an audiometric officer and the results of an air conduction test meet the criteria specified in Item 1, 2 or 3 of Waugh and Macrae’s criteria for medical referral in Table 1 of National Acoustic Laboratories Report No. 80, the audiometric officer shall refer the worker to an audiologist or an approved medical practitioner for full audiometric testing.
(8) Where the results of an air conduction test carried out after an initial audiometric test show —
(a) at least a 10% loss of hearing from the initial audiometric test; or
(b) at least a 5% loss of hearing from the loss shown by the audiometric test which resulted in a successful election by the worker under section 24A or 31E of the Act; or
(c) where the worker has reached the age of 65 years or on the worker’s retirement from work before that age, any further percentage loss of hearing from the loss shown by the audiometric test which resulted in a successful election by the worker under section 24A or 31E of the Act,
the worker shall be referred by WorkCover WA to an audiologist or an approved medical practitioner for full audiometric testing, and the audiologist or medical practitioner shall, upon completion of that testing refer the worker to a medical practitioner registered in the specialty of otorhinolaryngology for full otorhinolaryngological assessment to determine the percentage of noise induced hearing loss.
(9) Where the results of a further air conduction test, carried out after those tests referred to in subregulation (8), show a further loss of hearing, the worker shall be referred by WorkCover WA to an audiologist or an approved medical practitioner for full audiometric testing and the audiologist or medical practitioner shall, if a further hearing loss is confirmed, refer the worker to a medical practitioner registered in the speciality of otorhinolaryngology for a full otorhinolaryngological assessment to determine the percentage of noise induced hearing loss.
(10) Where a worker is referred to an approved medical practitioner, audiologist or medical practitioner registered in the speciality of otorhinolaryngology under subregulation (6), (7), (8) or (9), the audiometric test of that worker is completed on the date that —
(a) if the referral is under subregulation (6), the audiometric officer completes the audiometric test; and
(b) if the referral is under subregulation (7), the medical practitioner or audiologist completes the audiometric test; and
(c) if the referral is under subregulation (8) or (9), the medical practitioner or audiologist completes the audiometric test, or if the worker is further referred, the medical practitioner registered in the speciality of otorhinolaryngology determines the percentage of noise induced hearing loss.
(1) The employer of a worker who is required, or who makes a request, to undergo an audiometric test under clause 2 shall give written notice of the test to the worker in the form of Form 18 in Appendix I.
(2) The employer of a worker given a notice under subregulation (1) shall ensure that the worker is not knowingly exposed in the workplace, and the worker shall not knowingly permit himself to be exposed, to noise levels above 80dB(A) during the 16 hours preceding an audiometric test.
(3) A worker given a notice under subregulation (1) shall not, without reasonable excuse, proof of which is on the worker, fail to submit himself for testing so notified.
(1) In sections 24A(2) and 31E(3) of the Act, loss of hearing means loss of hearing calculated in accordance with the hearing loss tables RB and EB published in Appendices 3 and 7 of Report No. 118 of the National Acoustic Laboratories as annexed in Appendix III.
(2) The method of determining percentage loss of hearing occurring during the interval between 2 audiometric tests shall be by subtraction.
(1) A person who carries out an audiometric test shall ensure that the results are prepared and delivered to WorkCover WA and the worker in the form of Form 19A or Form 19B in Appendix I, as the case requires.
(2) WorkCover WA shall, on the written request of the worker tested, communicate the results of an audiometric test delivered to it under clause 4(2) to any person specified by the worker in that request.
(3) A person who receives the results of an audiometric test under subregulation (2) shall ensure that the results of the test, and any information derived from those results are not communicated to any person other than the worker except at the written request of the worker tested.
Penalty: a fine of $1 000.
(4) WorkCover WA shall store the results of audiometric tests delivered to it under clause 4(2) for a period ending the day after the 70th birthday of the worker to whom the results relate.
(1) A worker or employer who disputes the results of an audiometric test shall give notice in the form of Form 21 in Appendix I to WorkCover WA.
(2) A retest of a worker’s hearing under clause 7(1) shall be carried out in the manner prescribed under regulation 19C by —
(a) an approved medical practitioner; or
(b) an audiologist; or
(c) a medical practitioner registered in the speciality of otorhinolaryngology,
nominated in writing by the chief executive officer.
(3) A retest of a worker’s hearing under clause 7(1) may include —
(a) a physical examination; and
(b) any other appropriate investigation the approved medical practitioner or audiologist considers necessary to determine —
(i) whether the worker’s hearing loss is noise induced; and
(ii) whether the worker’s hearing loss is due, or partly due, to ear disease; and
(iii) whether the worker’s hearing loss is due, or partly due, to a hearing loss which is noise induced but of a type which is not due to the nature of any employment in which the worker was or is engaged; and
(iv) any other causes of the hearing loss.
(4) Having regard to the results obtained under subregulation (3), the medical practitioner registered in the speciality of otorhinolaryngology may determine the noise induced hearing loss of the worker as a binaural noise induced hearing loss expressed as a percentage loss of hearing.
(1) For the purposes of clause 10 a prescribed workplace is a workplace or part of a workplace where a worker is receiving, or is likely to receive, noise above the action level specified in subregulation (2).
(2) For the purposes of this regulation —
(a) an L peak of 140dB(lin); or
(b) a representative LAeq,8h of 90dB(A);
(1) The first edition is prescribed for the purposes of the definition of
AMA Guides in section 93CA of the Act.(2) To the extent, if any, that neither section 93D(2)(a) nor (b) of the Act applies to the assessment of the degree of disability of a worker for the purposes of section 93E, the degree of disability is to be assessed in accordance with the American Medical Association’s
Guides to the Evaluation of Permanent Impairment (4th Edition).
(1) Subject to regulations 19JA and 19JB, a referral under section 93D(5) of the Act —
(a) is to be made in the form of Form 22 in Appendix I; and
(b) is to nominate one, and only one, relevant level of the degree of disability in respect of which the referral is made.
(2) A notification under section 93D(7) of the Act is to be —
(a) made in the form of Form 23 in Appendix I; and
(b) accompanied by a copy of the medical evidence produced to the Director under section 93D(6) of the Act.
(3) Subject to regulations 19JA and 19JB, a notification under section 93D(8) of the Act is to be made in the form of Form 23 in Appendix I.
(1) A referral under section 93D(5) of the Act in combination with section 93EA(3) of the Act (due to the application of section 93EA(3) of the Act) is to be made in the form of Appendix I Form 22A.
(2) When completing Form 22A, the worker is to nominate one, and only one, relevant level of the degree of disability in respect of which the referral is made, and provide details of the medical evidence relied upon to support the referral.
(3) If section 93EA(3) of the Act applies because of a referral that was made before 14 December 1999 and, in that earlier referral —
(a) the worker nominated both relevant levels of the degree of disability on the same form; and
(b) the worker is still seeking to nominate both relevant levels of the degree of disability in the present referral,
the worker is to complete a separate Form 22A for each of the previously nominated relevant levels of the degree of disability.
(4) A notification under section 93EA(5)(a) and (b)(i) of the Act is to be given in the form of Appendix I Form 23A.
(5) The Director is to include a copy of any medical evidence that was produced and that complies with section 93D(6) of the Act, when giving notification under subregulation (4).
(6) A notification under section 93D(8) of the Act that relates to a referral under section 93D(5) of the Act, due to the application of section 93EA(3) of the Act, is to be made in the form of Appendix I Form 23A.
(7) A notification under section 93EA(5)(b)(ii) of the Act is to be given in writing.
(1) A referral under section 93D(5) of the Act in combination with section 93EB(3) of the Act (due to the application of section 93EB(3) of the Act) is to be made in the form of Appendix I Form 22B.
(2) When completing Form 22B, the worker is to nominate one, and only one, relevant level of the degree of disability in respect of which the referral is made, and provide details of the medical evidence relied upon to support the referral.
(3) If section 93EB(3) of the Act applies because of a referral that was made before 14 December 1999 and, in that earlier referral —
(a) the worker nominated both relevant levels of the degree of disability on the same form; and
(b) the worker is still seeking to nominate both relevant levels of the degree of disability in the present referral,
the worker is to complete a separate Form 22B for each of the previously nominated relevant levels of the degree of disability.
(4) A notification under section 93EB(5)(a) and (b)(i) of the Act is to be given in the form of Appendix I Form 23B.
(5) The Director is to include a copy of any medical evidence that was produced and that complies with section 93D(6) of the Act, when giving notification under subregulation (4).
(6) A notification under section 93D(8) of the Act that relates to a referral under section 93D(5) of the Act, due to the application of section 93EB(3) of the Act, is to be made in the form of Appendix I Form 23B.
(7) A notification under section 93EB(5)(b)(ii) of the Act is to be given in writing.
(1) An agreement as to the level of the degree of disability for the purposes of section 93E(3)(a), (4) or (9) of the Act is to be made in the form of Form 24 in Appendix I and lodged with the Director.
(2) On receipt of the agreement the Director is to —
(a) record the agreement in a register kept for that purpose; and
(b) complete the relevant section of the agreement form and give a copy of it to the worker and the employer.
(1) The Director is to be notified as soon as practicable after the determination of —
(a) a dispute that arises under section 93D(8) of the Act; or
(b) a question referred to a medical panel under section 93D(11) of the Act.
(2) Upon becoming aware of a determination described in subregulation (1), the Director is to, as soon as practicable —
(a) record the determination in a register kept for that purpose; and
(b) give a copy of the determination to the worker, the employer and the employer’s insurer advising that the determination has been recorded.
(1) An election under section 93E(3)(b) of the Act —
(a) is made by completing an election form in the form of Form 25 in Appendix I and lodging it with the Director; and
(b) cannot be made unless —
(i) it is agreed that the degree of disability is not less than 16%; or
(ii) it is determined that the degree of disability is not less than 16%.
(2) If it is agreed that the degree of disability is not less than 16% the election form is to be accompanied by Form 24 in Appendix I unless an agreement as to the degree of disability for the purposes of section 93E(3)(a), (4) or (9) of the Act was recorded under regulation 19K before the lodgment of the election form.
(3) If it is determined that the degree of disability is not less than 16% the election form is to be accompanied by evidence of the determination unless a determination of a dispute as to the degree of disability was recorded under regulation 19L before the lodgment of the election form.
(4) Subject to subregulation (5), on the day on which the Director receives the election form the Director is to —
(a) record —
(i) under regulation 19K(2)(a) the agreement (if any) accompanying the election form; or
(ii) under regulation 19L(2)(a) the determination (if any) accompanying the election form;
and
(b) register the election in a register kept for that purpose; and
(c) complete the relevant section of the election form and give a copy of it to the worker and the employer.
(5) The Director may refuse to register an election if not satisfied that the worker has been properly advised of the consequences of the election.
(6) This regulation applies to an election under section 93E(3)(b) of the Act that is commenced on or after the day on which the
Workers’ Compensation and Rehabilitation Amendment Regulations (No. 11) 1999 come into operation.
(1) In this regulation —
(2) For the purposes of section 93E(7) of the Act, the circumstances in which the Director may extend the period of time within which an election can be made under section 93E(3)(b) of the Act exist, whether or not the period being extended has already expired, if —
(a) the Director is satisfied that the worker will require major surgery in respect of the injury in the extension period; or
(aa) upon an application described in subregulation (3a), the Director is satisfied that an extension should be given for a period ending not more than 8 weeks after the termination day to give time for a specialist in a relevant field of medicine to prepare a report, based on treatment or medical investigation of the worker, as to whether the worker will require major surgery in respect of the injury in the extension period; or
(b) no extension has been given under paragraph (aa) and the Director is satisfied that medical evidence that the worker will require major surgery in respect of the injury in the extension period has not been obtained from a medical practitioner who is a specialist in a relevant field of medicine despite all reasonably practicable steps having been taken by or on behalf of the worker to obtain that evidence; or
(c) the Director is satisfied that a medical panel under section 36 of the Act has determined that the worker’s injury is of a kind mentioned in section 33 or 34 of the Act.
(3) An application for an extension of time under subregulation (2)(a) is to be —
(a) made in the form of Form 26 in Appendix I; and
(b) accompanied by medical evidence from a medical practitioner who is a specialist in a relevant field of medicine; and
(c) lodged with the Director at least 21 days before —
(i) the termination day; or
(ii) if an extension of time has been granted under subregulation (2)(aa) or (b), the last day of the period as extended.
(3a) An application for an extension of time under subregulation (2)(aa) to give time for the preparation of a specialist’s report, based on treatment or medical investigation of the worker, is to be —
(a) made in the form of Form 28 in Appendix I; and
(b) accompanied by medical evidence from a specialist in a relevant field of medicine indicating that —
(i) a report could not be satisfactorily prepared without the treatment or investigation having been carried out; and
(ii) the extension sought is needed to give sufficient time for the preparation of the report;
and
(c) lodged with the Director at least 21 days before the termination day.
(4) An application for an extension of time under subregulation (2)(b) is to be —
(a) made in the form of Form 27 in Appendix I; and
(b) accompanied by such evidence, in addition to that provided in the Form 27, as may be requested by the Director about —
(i) the requirement for the worker to have the surgery mentioned in subregulation (2)(b); or
(ii) the action taken by or on behalf of the worker to obtain the medical evidence mentioned in subregulation (2)(b);
and
(c) lodged with the Director at least 21 days before the termination day.
(5) An application for an extension of time under subregulation (2)(c) is to be —
(a) made in the form of Form 26 in Appendix I; and
(b) accompanied by evidence of the medical panel’s determination; and
(c) lodged with the Director at least 21 days before —
(i) the termination day; or
(ii) if an extension of time has been granted under subregulation (2)(aa) or (b), the last day of the period as extended.
(6) Within 14 days of receiving the application the Director is to —
(a) decide whether to extend the period within which the election can be made; and
(b) set the extension period in accordance with section 93E(7); and
(c) complete the relevant section of the application form and give a copy of it to the worker and the employer.
An application for compensation under section 93E(11) of the Act is to be made and dealt with in accordance with the
(1) The employer of a worker who has an unfinalised claim for compensation under the Act is to give the worker written notice, in a form approved by the chief executive officer, of —
(a) the requirement under section 93E(3)(b) of the Act for the worker to elect to retain the right to seek damages; and
(b) the date by which the election is to be made.
(2) The employer is to give the notice mentioned in subregulation (1) —
(a) if a dispute resolution authority orders that weekly payments of compensation are to commence, within 7 days of the day of the order; or
(b) in any other case, 3 and 5 months from the day on which weekly payments commenced.
(3) An employer’s obligation under this regulation to give a worker notice is fulfilled if the notice is given, within the time required, by an insurer with which the employer has a policy indemnifying the employer against liability to pay the compensation claimed.
(1) If —
(a) the worker and the employer agree —
(i) that the worker’s degree of permanent whole of person impairment is at least 15%; and
(ii) as to whether or not the worker’s degree of permanent whole of person impairment is at least 25%;
and
(b) the worker, in writing, requests the Director to record the agreement,
the Director is required to record the agreement in a register kept for the purpose unless an agreement or assessment as to the worker’s degree of permanent whole of person impairment has already been recorded under this regulation or regulation 21.
(2) The request under subregulation (1)(b) for the Director to record the agreement has to include —
(a) the worker’s name and any other details necessary to identify the worker; and
(b) details sufficient to enable the worker to be contacted; and
(c) the worker’s date of birth; and
(d) the date on which the injury occurred and a description of the injury; and
(e) if a claim for compensation under the Act for the injury has been made, the date on which the worker’s claim was made and sufficient other details to identify the claim (including any claim number that may have been given to the claim); and
(f) the employer’s name and any other details necessary to identify the employer; and
(g) details sufficient to enable the employer to be contacted; and
(h) the name of the insurer, if any.
(3) The Director’s record in the register is to be in the form of Form 32 in Appendix I, and the Director is required to give a copy of the record to each of the worker and the employer.
(1) If —
(a) the worker’s degree of permanent whole of person impairment has been assessed to be a percentage that is not less than 15%; and
(b) the Director has been given —
(i) a copy of the certificate given to the worker under section 146H(1)(b) of the Act; and
(ii) if the assessment involves a special evaluation as defined in section 146C(4) of the Act, a copy of the certificate referred to in section 93N(1) of the Act on the basis of which the special evaluation was requested;
and
(c) the worker, in writing, requests the Director to record the assessment,
the Director is required to record the assessment in a register kept for the purpose unless an agreement or assessment as to the worker’s degree of permanent whole of person impairment has already been recorded under regulation 20 or this regulation.
(2) The Director’s record in the register is to be in the form of Form 33 in Appendix I, and the Director is required to give a copy of the record to each of the worker and the employer.
(1) An election under section 93K(4)(a) of the Act is made by completing an election form in the form of Form 34 in Appendix I and lodging it in accordance with regulation 57.
(2) Unless under subregulation (3) the Director refuses to register the election, the Director is to —
(a) register the election in a register kept for that purpose as soon as practicable after the election form is lodged; and
(b) complete the relevant section of the election form and give a copy of it to the worker and the employer.
(3) The Director may refuse to register the election if not satisfied that the worker has been properly advised of the consequences of the election.
An approved medical specialist can reasonably be expected to take 6 weeks, after a worker requests an assessment of the worker’s degree of permanent whole of person impairment, to give the worker the documents that the approved medical specialist is required by section 146H of the Act to give the worker.
(1) In this regulation —
(2) This regulation applies in relation to a claim by a worker for compensation by way of weekly payments.
(3) If an insurer notifies the worker under section 57A of the Act that liability is accepted in relation to the claim, the insurer must at the same time notify the worker, in the approved form, of the effect of the provisions of Part IV Division 2 Subdivision 3.
Penalty for this subregulation: a fine of $1 000.
(4) If a self‑insurer accepts liability in relation to the claim, the self‑insurer must on or before making the 1
st weekly payment notify the worker, in the approved form, of the effect of the provisions of Part IV Division 2 Subdivision 3.
Penalty for this subregulation: a fine of $1 000.
In this Part —
(a) by which the applicant or registered agent is employed or engaged; and
(b) as an employee or officer of which the applicant proposes to act as a registered agent, or of which the registered agent acts as a registered agent;
(a) by reason of qualification or experience or both, has sufficient knowledge of the workers’ compensation jurisdiction to represent a party effectively; and
(b) is of good character;
The following organisations are prescribed for the purposes of section 277(1)(e) of the Act —
(a) the Asbestos Diseases Advisory Service of Australia;
(b) UnionsWA;
(c) the Chamber of Commerce and Industry of Western Australia.
The following classes of persons are prescribed for the purposes of section 277(1)(f) of the Act —
(a) persons employed or engaged by a person or body that is engaged to provide claims management services to a self‑insurer;
(b) persons engaged by a self‑insurer to provide claims management services to the self‑insurer;
(c) persons to whom section 277 of the Act does not otherwise apply and who act, or propose to act, as independent agents in the Conciliation Service or the Arbitration Service.
(1) An application for registration must be made to WorkCover WA in a form approved by WorkCover WA.
(2) Unless an application is made by a person in a class of persons prescribed under regulation 27A(b) or (c), it must include a nomination of the applicant signed by the applicant’s employer.
(2a) An application by an independent agent must be accompanied by —
(a) a criminal record check in respect of the applicant issued not more than 3 months before the application is made;
(b) if the criminal record check shows details of a conviction, a statement detailing the grounds on which the applicant believes that, having regard to the conduct required under the code of conduct, the conviction is of a kind that does not relate to whether or not the applicant is a fit and proper person to be registered;
(c) a statement setting out the qualifications of the applicant, or any experience of the applicant, that demonstrates sufficient knowledge of the workers’ compensation jurisdiction to enable the applicant to represent a party effectively;
(d) a statutory declaration verifying the particulars contained in the application and accompanying material.
(2b) An application by a person in a class of persons prescribed under regulation 27A(a) or (b) must be accompanied by —
(a) a statement identifying the self‑insurers to whom the agent, or the employer of the agent, is engaged to provide claims management services; and
(b) a statutory declaration verifying the particulars contained in the statement.
(3) The application must be accompanied by evidence satisfactory to WorkCover WA that —
(a) there is, or upon registration under this Part will be, in force with respect to the applicant a policy of professional indemnity insurance for not less than $1 million for any one claim; or
(b) within the meaning of subregulation (4), the applicant has sufficient material resources to provide professional indemnity.
(4) A person has sufficient material resources to provide professional indemnity if —
(a) the person is nominated by an employer who —
(i) maintains professional indemnity insurance for not less than $1 million for any one claim; or
(ii) holds legal or equitable estates or interests of not less than $1 million in real or personal property;
or
(b) the person holds legal or equitable estates or interests of not less than $1 million in real or personal property.
(5) The applicant must provide WorkCover WA with any additional information or document that WorkCover WA may ask for.
(6) In subregulation (2a)(a) —
(1) WorkCover WA may refuse to register an applicant if —
(a) the application is not duly made; or
(b) in the case of an application by an independent agent, the applicant is not a fit and proper person to be a registered agent.
(2) WorkCover WA cannot refuse an application unless it has —
(a) given the applicant written notice of the intention to refuse the application, and of the grounds for the proposed refusal; and
(b) allowed at least 21 days for the applicant to show cause why the application should not be refused.
(3) In the case of a registered agent other than a person in a class of persons prescribed under regulation 27A(b) or (c), registration has effect to the extent that the person acts as a registered agent as an employee or officer of the employer that nominates the person in the application under regulation 28(2), and not otherwise.
(4) In the case of a registered agent who is a person in a class of persons prescribed under regulation 27A(a) or (b), registration has effect to the extent that the person acts as a registered agent for —
(a) a self‑insurer identified in the agent’s application under regulation 28(2b); or
(b) a self‑insurer identified in a statement —
(i) provided to WorkCover WA after registration by the agent; and
(ii) verified by statutory declaration of the agent; and
(iii) accepted by WorkCover WA.
(1) It is a condition of registration that the professional indemnity insurance or material resources of the registered agent referred to in regulation 28(3) must be maintained during the period of registration.
(2) It is a condition of registration that the registered agent must comply with the code of conduct.
(3) In the case of a registered agent other than a person in a class of persons prescribed under regulation 27A(b) or (c), it is a condition of registration that the person will not act as a registered agent other than as an employee or officer of the employer who nominated the agent in the application for registration.
(4) In the case of a registered agent who is a person in a class of persons prescribed under regulation 27A(a) or (b), it is a condition of registration that the person will not act as a registered agent other than for —
(a) a self‑insurer identified in the agent’s application under regulation 28(2b); or
(b) a self‑insurer identified in a statement —
(i) provided to WorkCover WA after registration by the agent; and
(ii) verified by statutory declaration of the agent; and
(iii) accepted by WorkCover WA.
(1) Except as provided in subregulation (3), a registration has effect from the day it is granted and continues in force until the following 30 June.
(2) An application for the renewal of registration may be made at any time before the registration expires and, except as provided in subregulation (3), any such renewal has effect for the period 1 July to 30 June.
(3) If a registered agent is removed from the register under regulation 36, or has his or her registration suspended or cancelled under regulation 38 or 39, the registration or renewal has effect until that removal or suspension, as the case requires.
(1) An application for renewal of registration must be made in the same manner and form as an application for registration.
(2) An application for renewal must be made not later than 28 days before the day on which the registration is due to expire.
(3) WorkCover WA may shorten the period referred to in subregulation (2) and may do so either before or after the application is required to be made under that subregulation.
(4) WorkCover WA may refuse to renew the registration if —
(a) the application is not duly made; or
(b) in the case of an application by an independent agent, the applicant is not a fit and proper person to be a registered agent.
(5) WorkCover WA cannot refuse to renew the registration unless it has —
(a) given the applicant written notice of the intention to refuse the application, and of the grounds for the proposed refusal; and
(b) allowed at least 21 days for the applicant to show cause why the application should not be refused.
(1) WorkCover WA must issue a person with a certificate of registration —
(a) on the registration of the person; and
(b) on the renewal of the person’s registration.
(2) The period for which the registration of the person has effect must be entered on the certificate.
(3) In the absence of evidence to the contrary a certificate of registration is evidence that the person to whom the certificate is issued is registered for the period specified in the certificate.
A person must not in relation to an application for registration or renewal of registration give information orally or in writing that the person knows to be —
(a) false or misleading in a material particular; or
(b) likely to deceive in a material way.
Penalty: a fine of $1 000.
(1) WorkCover WA must keep a register in a manner and form determined by it.
(2) WorkCover WA is to record in the register —
(a) the name and address of each registered agent; and
(b) the name and address of the employer, if any, of the registered agent; and
(c) the date of the initial registration and each date of renewal of registration of each registered agent; and
(d) such other particulars as WorkCover WA may determine.
(3) WorkCover WA must allow any person —
(a) to inspect the register; and
(b) to take copies of, or extracts from, any part of it.
(4) A person may, on application to WorkCover WA, obtain a certified copy of a part of, or entry in, the register.
(5) WorkCover WA must make the amendments, additions and corrections to the register that are necessary to make the register an accurate record of the particulars in relation to all registered agents.
(1) WorkCover WA may, on the written request of a registered agent and the return of the relevant certificate of registration, remove the name of the registered agent from the register.
(2) WorkCover WA may remove the name of a registered agent from the register if the employer who nominated the registered agent under regulation 28(2) notifies WorkCover WA in writing that the employer has withdrawn the nomination.
WorkCover WA cannot take disciplinary action under regulation 38 or 39 unless it has given the registered agent and the employer, if any, who nominated the registered agent under regulation 28(2) an opportunity to show cause why the action should not be taken.
WorkCover WA may cancel the registration of a registered agent if WorkCover WA is satisfied that the registered agent has ceased to be an employee or officer of the employer who nominated the registered agent under regulation 28(2).
(1) Proper causes for disciplinary action in respect of a registered agent are that the registered agent —
(a) improperly obtained registration; or
(b) has contravened a condition of that person’s registration; or
(c) has done or omitted to do something, or engaged in conduct, that renders the person unfit to be registered.
(2) WorkCover WA may, on receiving a written complaint about a registered agent, carry out any investigation necessary to decide whether there is proper cause for disciplinary action in respect of a registered agent.
(3) If WorkCover WA is satisfied that proper cause exists for disciplinary action, WorkCover WA may —
(a) reprimand or caution the registered agent; or
(b) attach a condition to the registration; or
(c) suspend the registration for a period not exceeding 12 months; or
(d) cancel the registration.
(1) If WorkCover WA suspends or cancels a person’s registration it must give directions in writing to the person as to the return to it of the certificate of registration.
(2) A person given a direction under subregulation (1) must comply with the direction.
Penalty: a fine of $1 000.
A person aggrieved by a decision of WorkCover WA to —
(a) refuse an application for registration or for renewal of registration; or
(b) suspend or cancel the person’s registration,
may apply to the State Administrative Tribunal for a review of that decision.
In all courts and before all persons and bodies authorised to receive evidence, in the absence of evidence to the contrary —
(a) a certificate purporting to be issued by WorkCover WA and stating —
(i) that a person was or was not registered;
(ii) that a person’s registration was suspended or cancelled,
on any day or days or during a period mentioned in the certificate is evidence of the matters so stated; and
(b) a copy of, or extract from the register or any statement that purports to reproduce matters entered in the register and that is certified by WorkCover WA as a true copy, extract or statement, is evidence of the facts appearing in that copy, extract or statement.
The services listed in column 2 of the Table to this regulation and described in column 3 are services the provision of which, if they are for the purpose of enabling the worker to return to work, may be “vocational rehabilitation” as defined in section 5(1) of the Act.
1 | support counselling | activities to assist the worker to adjust to the injury and to the worker’s return to work; family counselling related to vocational rehabilitation; progress counselling related to the progress of, and problems with, the worker’s return to work |
2 | vocational counselling | activities focussed on problems the worker has in selecting and preparing for vocational change |
3 | purchase of aids and appliances | advising and assisting the worker with the purchase of aids and appliances |
4 | case management | activities associated with the management of the worker’s return to work, which may include liaising and negotiating with the parties, developing, coordinating and otherwise managing, and reviewing, the service delivery plan, and arranging for interpreter services |
5 | retraining criteria assistance | assisting a worker to explore eligibility to participate in a specialised retraining program and to prepare information to show that the retraining criteria are satisfied |
6 | specialised retraining program assistance | services to assist a worker undertake a specialised retraining program |
7 | training and education | assisting to develop the worker’s skills and knowledge, which may include providing training courses or other aspects of injury management |
8 | workplace activities | activities involving analysis of work behaviour and analysis and design of job duties |
9 | placement activities | activities focussed on obtaining a new job for the worker, which may include assistance with the preparation of a resume and preparation for an interview and research and other assistance in finding jobs |
10 | assessments: | |
(a) | functional capacity | activities associated with assessing the worker’s functional capacity, which may include preparing a report |
(b) | vocational | activities associated with assessing the worker’s vocational and retraining options, which may include preparing a report |
(c) | ergonomic | activities associated with assessing how a particular work environment would affect the worker, which may include preparing a report |
(d) | job demands | activities associated with identifying and assessing the physical and cognitive demands of a job, which includes preparing a report |
(e) | workplace | activities associated with assessing the suitability of various workplace alternatives and other job options, which may include preparing a report |
(f) | aids and appliances | activities associated with developing recommendations for aids and appliances to assist the worker, which may include preparing a report |
11 | travel | travel that is associated with providing vocational rehabilitation |
12 | medical | discussion with specialists and other medical practitioners about vocational rehabilitation, which may include preparing a report |
13 | general reports | status reports relating to vocational rehabilitation |
(1) In this regulation —
(2) Where counselling psychology is approved under section 5(1) of the Act as an “approved treatment” for workers suffering disabilities that are compensable under the Act, that treatment can only be provided by a counselling psychologist.
(1) In this regulation —
(2) Where exercise physiology is approved under section 5(1) of the Act as an “approved treatment” for workers suffering disabilities that are compensable under the Act, that treatment can only be provided by an exercise physiologist.
(1) In this regulation —
(a) a person whose name is entered on the Register of Chinese Medicine Practitioners kept under the
Health Practitioner Regulation National Law (Western Australia) in the Division of acupuncture; or(b) a health practitioner registered under the
Health Practitioner Regulation National Law (Western Australia) to practice a health profession and whose registration is endorsed for acupuncture.(2) Where acupuncture is approved under section 5(1) of the Act as an
approved treatment for workers suffering an injury that is compensable under the Act, that treatment can only be provided by an acupuncturist.
(1) Subregulation (2) specifies the action that section 155D(1) of the Act requires an insurer to take to make an employer aware of the employer’s obligations under section 155B and section 155C(1) and (3) of the Act.
(2) Whenever the insurer issues to an employer, or renews, a policy of insurance against the employer’s liability to pay compensation under the Act, the insurer has to give the employer a written notice informing the employer of the things described in subregulation (3).
(3) The notice has to inform the employer that —
(a) section 155A(1) of the Act authorises WorkCover WA to issue a code of practice (injury management) and WorkCover WA will, on request, provide a copy of a code it issues; and
(b) section 155B of the Act requires the employer to establish and implement an injury management system in accordance with the code; and
(c) section 155C of the Act requires the employer to establish and implement a return to work program for a worker in accordance with the code in circumstances described in that section.
(1) If —
(a) the worker and the employer agree that the worker’s degree of permanent whole of person impairment is at least 10% but less than 15%; and
(b) the worker, in writing, requests the Director to record the agreement,
the Director is required to record the agreement in a register kept for the purpose.
(2) If —
(a) the worker and the employer agree that the worker satisfies all of the retraining criteria; and
(b) the worker, in writing, requests the Director to record the agreement,
the Director is required to record the agreement in a register kept for the purpose.
(3) A request under subregulation (1)(b) or (2)(b) for the Director to record an agreement has to include —
(a) the worker’s name and any other details necessary to identify the worker; and
(b) details sufficient to enable the worker to be contacted; and
(c) the worker’s date of birth; and
(d) the date on which the injury occurred and a description of the injury; and
(e) if a claim for compensation under the Act for the injury has been made, the date on which the worker’s claim was made and sufficient other details to identify the claim (including any claim number that may have been given to the claim); and
(f) the employer’s name and any other details necessary to identify the employer; and
(g) details sufficient to enable the employer to be contacted; and
(h) the name of the insurer, if any.
(4) The Director’s record in the register is to be in the form of —
(a) if subregulation (1) requires the record, Form 37 in Appendix I;
(b) if subregulation (2) requires the record, Form 38 in Appendix I,
and the Director is required to give a copy of the record to each of the worker and the employer.
(1) A worker may apply for the Director to extend the final day under section 158B of the Act.
(2) The application is made by —
(a) lodging with the Director a completed application form in the form of Form 39 in Appendix I; and
(b) providing to the Director, with the application form, particulars about —
(i) the action taken by the worker to obtain from the employer by the final day any agreement that the worker was unable to obtain as to —
(I) the worker’s degree of permanent whole of person impairment; or
(II) whether the worker satisfies all of the retraining criteria;
and
(ii) the worker’s having, at least 8 weeks before the final day, requested an approved medical specialist to assess the worker’s degree of permanent whole of person impairment; and
(iii) the action taken by the worker towards applying under section 158C or 158D of the Act to have a matter in dispute determined by an arbitrator.
(3) The Director may, within the limits imposed by the Act, extend the final day until a day that the Director considers will give the worker a reasonable opportunity to take the action referred to in section 158B(1) of the Act.
(1) A person seeking that, under section 158F of the Act, WorkCover WA direct an employer or an insurer to make a payment may, in accordance with this regulation, request WorkCover WA to give the direction.
(2) The request has to be made to WorkCover WA in writing, giving —
(a) the date on which the request is made; and
(b) the worker’s name and any other details necessary to identify the worker; and
(c) details sufficient to enable the worker to be contacted; and
(d) reasons justifying the giving of the direction; and
(e) the date, if any, by which the payment needs to be made.
(3) If the payment is to satisfy a debt incurred or to recoup the cost of any payment that has been made, the request has to be accompanied by copies of relevant invoices or other sufficient evidence of the debt or cost, showing details of each item charged and the rate at which it was charged, if applicable.
The offences described in Appendix V are the offences for which an infringement notice may be given under section 175G(1) of the Act.
A penalty specified in Appendix V is the modified penalty for the corresponding offence in Appendix V for the purposes of section 175H(2)(b) of the Act.
The form of an infringement notice is set out in Appendix I Form 40 for the purposes of section 175H(1) of the Act.
The form of a notice to withdraw an infringement notice is set out in Appendix I Form 41 for the purposes of section 175J(1) of the Act.
In this Part —
(a) an agreement referred to in section 76(1) of the Act; or
(b) an agreement referred to in section 92(f) of the Act;
(a) an election, determination, agreement, notice, application or other thing in the form of a Form 1, 1A, 2, 2C, 2CA, 14, 15C, 15D, 15E, 34 or 35 in Appendix I;
(b) written consent referred to in regulation 12(6);
(c) a written request referred to in regulation 20 or 21;
(d) a memorandum referred to in section 92(f) of the Act;
(e) any document accompanying a document referred to in paragraphs (a) to (d);
(f) any document the Director considers relevant to an agreement or application.
Every Part 8 document —
(a) where relevant, must be clearly written, typed or reproduced; and
(b) must be properly completed.
(1) A person is EDS exempt in relation to an agreement or application at a particular time if, at that time —
(a) the person —
(i) is a party to the agreement or the person who lodged the application; and
(ii) is self‑represented in relation to the agreement or application; and
(iii) is neither an insurer nor a self‑insurer;
or
(b) the person is exempt in relation to the agreement or application under subregulation (3).
(2) A person is self‑represented in relation to an agreement or application if —
(a) in the case of a worker — a legal practitioner is not engaged by or on behalf of the worker in relation to the agreement or application; or
(b) in the case of an employer — the employer is uninsured.
(3) The Director may exempt a person from a requirement to use the EDS in relation to —
(a) an agreement or application, if satisfied that it would be unreasonable for the person to be required to use the EDS in relation to the agreement or application; or
(b) all agreements and applications, if satisfied that it would be unreasonable for the person to be required to use the EDS in relation to the agreements and applications.
(1) A Part 8 document in relation to an agreement or application must be lodged using the EDS unless —
(a) the person lodging the document is EDS exempt in relation to the agreement or application; or
(b) the EDS is unavailable at the time of lodging.
(2) A person who is EDS exempt in relation to an agreement or application may lodge a Part 8 document in relation to the agreement or application with the Director in the following manner —
(a) by presenting it at the office of the Director when the office is open for business; or
(b) by sending it to the office of the Director by pre‑paid post; or
(c) by sending it to the Director by email in accordance with regulation 58(2) and (3); or
(d) by using the EDS.
(3) While the EDS is unavailable for use a Part 8 document may be lodged in the manner referred to in subregulation (2)(a), (b) or (c).
(4) The Director may at any time require a person who has lodged a Part 8 document by email or by using the EDS to lodge the document in person or by post.
(5) A person who lodges an agreement under this regulation must confirm that the agreement has been executed in accordance with the laws of the State.
(1) For the purposes of regulation 57(2)(c), the Director may —
(a) approve and publish an email address for the lodgment of documents under this regulation; and
(b) determine and publish requirements as to the permissible format and the maximum size of documents that may be lodged under this regulation.
(2) An email by which documents are lodged under this regulation must —
(a) state the sender’s name; and
(b) state a telephone number by which the sender can be contacted; and
(c) list and describe the documents being lodged by the email.
(3) Documents lodged under this regulation must comply with any published requirements as to format and size.
(1) In this regulation —
(2) A document is taken to have been lodged —
(a) if the whole document is received before 5 pm on a particular working day, on that day; or
(b) otherwise, on the next working day.
(1) In this regulation —
(2) A requirement for the Director to notify a person, or give them a copy of a document, in relation to an agreement or application is satisfied, on a day, if —
(a) before 5 pm on that day —
(i) the notice or document becomes accessible to the person by using the EDS; and
(ii) electronic notification that the notice or document is accessible is sent to the person;
or
(b) the notice or document is sent to the person by pre‑paid post 2 business days before that day; or
(c) the notice or document is sent to an email address provided by the person before 5 pm on that day.
(3) Subregulation (2)(a) does not apply if the person —
(a) is EDS exempt in relation to the agreement or application; and
(b) does not have access to the EDS in relation to the agreement or application.
For the purposes of paragraph (c) of the definition of
Note for this regulation:
Under section 5A(5) of the Act a variation that would reduce the amount has no effect.
For the purposes of paragraph (c) of the definition of
Note for this regulation:
Under section 5A(5) of the Act a variation that would reduce the amount has no effect.
(1) This regulation has effect for the purposes of assessing the value of board or board and lodging under Schedule 1 clause 15 of the Act for a financial year commencing on or after 1 July 2021.
(2) For the purposes of section 5A(1)(c) of the Act, the amount, which the sum assessed for the board or board and lodging is not to exceed, is the amount per day worked out by varying the amount per day for the previous financial year by the percentage by which the March CPI varies from the previous March CPI.
Notes for this regulation:
1. The amount for the financial year commencing on 1 July 2020 is $157 per day.
2. Under section 5A(5) of the Act a variation that would reduce the amount has no effect.
(1) This regulation has effect for the purposes of assessing the reasonable expenses incurred or likely to be incurred in respect of the purchase or supply of a wheeled chair or similar appliance under Schedule 1 clause 17(4) of the Act for a financial year commencing on or after 1 July 2021.
(2) For the purposes of section 5A(1)(c) of the Act, the amount, which the sum payable for those expenses is not to exceed, is the amount worked out by varying the amount for the previous financial year by the percentage by which the March CPI varies from the previous March CPI.
Notes for this regulation:
1. The amount for the financial year commencing on 1 July 2020 is $12 180.
2. Under section 5A(5) of the Act a variation that would reduce the amount has no effect.
(1) This regulation has effect for the purposes of assessing the reasonable costs incurred for meals and lodging under Schedule 1 clause 19(1) of the Act for a financial year commencing on or after 1 July 2021.
(2) For the purposes of section 5A(1)(c) of the Act, the amount, which the amount payable for those costs is not to exceed, is the amount per day worked out by varying the amount per day for the previous financial year by the percentage by which the March CPI varies from the previous March CPI.
Notes for this regulation:
1. The amount for the financial year commencing on 1 July 2020 is $121 per day.
2. Under section 5A(5) of the Act a variation that would reduce the amount has no effect.
An amount worked out under this Part must be rounded to the nearest whole dollar with an amount that is 50 cents more than a whole dollar being rounded up to the next whole dollar.
For the purposes of Schedule 4A item 13 of the Act —
(a) each kind of cancer listed in column 1 of the Table is prescribed; and
(b) the period listed in column 2 of the Table opposite the kind of cancer is the qualifying period for that cancer.
Malignant mesothelioma | 15 years |
Primary site cervical cancer | 10 years |
Primary site lung cancer | 15 years |
Primary site ovarian cancer | 10 years |
Primary site pancreatic cancer | 10 years |
Primary site penile cancer | 15 years |
Primary site skin cancer | 15 years |
Primary site thyroid cancer | 10 years |
(1) In this regulation —
(2) For the purposes of section 49F(1)(a) of the Act, COVID‑19 is specified as a prescribed disease.
(3) For the purposes of section 49F(1)(b) of the Act, the following kinds of employment are specified as prescribed employment for COVID‑19 —
(a) employment as a health professional;
(b) employment, of any kind, in a hospital, medical practice, clinic or facility where persons attend for health related screening, testing or treatment;
(c) employment as an ambulance officer.
(4) For the purposes of section 49F(3) of the Act, a worker who suffers an injury by contracting COVID‑19 is taken to have suffered the injury —
(a) if paragraph (b) does not apply — on the day on which the worker is diagnosed as having COVID‑19 by a medical practitioner on the basis of a test result described in subregulation (6); or
(b) if the worker dies as a result of contracting COVID‑19 before they are diagnosed as described in paragraph (a) — on the day on which the worker dies.
(5) Section 49F(3) of the Act does not apply to a worker who suffers an injury by contracting COVID‑19 if —
(a) the day on which the worker is taken, under subregulation (4), to have suffered the injury is before 16 February 2020; or
(b) the worker is not in prescribed employment for COVID‑19 on the day on which the worker is taken, under subregulation (4), to have suffered the injury.
(6) For the purposes of subregulation (4)(a), the test results are as follows —
(a) detection of SARS‑CoV‑2 using a SARS‑CoV‑2 specific nucleic acid test by a NATA accredited laboratory;
(b) isolation of SARS‑CoV‑2 in a cell culture, with confirmation using a SARS‑CoV‑2 specific nucleic acid test, by a NATA accredited laboratory;
(c) confirmation of SARS‑CoV‑2 specific antibodies by a NATA accredited laboratory.
(1) In this regulation —
(a) to receive telephone calls for emergency ambulance attendance; and
(b) to provide instructions and advice, including first aid advice, prior to the arrival of an ambulance;
(a) employed by the department of the Public Service principally assisting in the administration of the
Fire and Emergency Services Act 1998 ; and(b) whose primary duties in that employment include to receive telephone calls and dispatch emergency services in response to incidents;
(2) For the purposes of section 49F(1)(a) of the Act, post‑traumatic stress disorder is specified as a prescribed disease.
(3) For the purposes of section 49F(1)(b) of the Act, the following kinds of employment are specified as prescribed employment for post‑traumatic stress disorder —
(a) employment as a paramedic;
(b) employment as an ambulance officer;
(c) employment as an ambulance emergency communications officer;
(d) employment by or under the Crown in right of the State —
(i) to which an industrial award or industrial agreement relating to firefighting applies; and
(ii) that is in a firefighter classification under the award or agreement;
(e) employment as a communications systems officer.
(4) Section 49F(3) of the Act does not apply to a worker who suffers an injury by contracting post‑traumatic stress disorder unless —
(a) the worker is diagnosed as having post‑traumatic stress disorder by a psychiatrist in accordance with the diagnostic criteria in DSM‑5 for post‑traumatic stress disorder; and
(b) in the case of a worker who is working or worked in employment prescribed in subregulation (3)(a), (b) or (c) — the worker is first diagnosed as having post‑traumatic stress disorder (whether in accordance with paragraph (a) or otherwise) on or after the day on which the
Workers’ Compensation and Injury Management Amendment Regulations 2021 regulation 4 comes into operation; and(c) in the case of a worker who is working or worked in employment prescribed in subregulation (3)(d) or (e) — the worker is first diagnosed as having post‑traumatic stress disorder (whether in accordance with paragraph (a) or otherwise) on or after the day on which the
Workers’ Compensation and Injury Management Amendment Regulations 2023 regulation 5 comes into operation.
[r. 4(1)]
(Section 24B)
I, ..................................................................................................................
(name in full block letters)
of .................................................................................................................
(address)
suffered compensable personal injury by accident in the employment of ..........
.....................................................................................................................
(name of employer)
on the....................................... day of............................................ 20 ................
The injury/injuries suffered by me was/were:
..... (state nature of injury and percentage loss of use or loss of efficient use of a part or faculty of the body)
*Before that injury was suffered I had previously suffered compensable personal injury by accident to that part or faculty of the body resulting in............... % loss of use of that part or faculty.
I elect to receive compensation under Part III Division 2 of the
(state the part or faculty of the body affected)
In making this election and upon an agreement being registered under Division 7 of Part 3 of the Act or an award being made by a dispute resolution authority, I acknowledge that after registration or the making of the award:
(1) I shall have no further entitlement to compensation under the Act for weekly payments arising out of that injury;
(2) I shall have no further entitlement in respect of that injury subsequent to the date of this election, to payment of expenses under the
Workers’ Compensation and Injury Management Act 1981 Schedule 1 clauses 9, 17, 18, 18A and 19 (that is, in general terms, medical or surgical, dental, physiotherapy or chiropractic advice or treatment, first aid and ambulance expenses, medical requisites, charges for attendance and treatment by way of injury management, charges for hospital treatment and maintenance, cost of artificial aids and travelling expenses);(3) I shall have no entitlement to further moneys upon any increase to the prescribed amount for this percentage loss of the part or faculty of the body the subject of this election.
Dated the day of 20 .
..........................................
(Signature)
in the presence of:
...........................................
(Signature and full names
and address of witness)
___________________________________________________________
*Delete if not applicable.
[r. 4(2)]
(Section 31H)
Surname Mr/Mrs/Miss/Ms ................................................................................................................. Other Names ................................................................................................................. Address ................................................................................................................. ................................................................................................................. ......................................................................Postcode................................... Phone No.(H).........................(W).......................(Mb)................................... Occupation (e.g. boiler maker, underground miner)....................................................... Main tasks or duties performed .................................................................. (e.g. welding, drilling) Employer at date of injury.......................................................................... Address of employer.................................................................................. ................................................................................................................. .......................................................................Postcode.................................. |
WORKER’S DECLARATION
Date of injury/injuries....................................................................................
Type of injury/injuries...................................................................................
Degree of permanent impairment ...................................................................
* Before that impairment was suffered I had previously suffered a permanent impairment from a compensable personal injury by accident to that part or faculty of the body resulting in................ degree of permanent impairment of that part or faculty.
I elect to receive compensation under the
(state the part or faculty of the body affected)
In making this election and upon an agreement being registered under Part III Division 7 of the Act or an award being made by a dispute resolution authority, I acknowledge that after registration or the making of the award:
(1) I shall have no further entitlement to compensation under the Act for weekly payments arising out of that injury.
(2) I shall have no further entitlement in respect of that injury subsequent to the date of this election, to payment of expenses under the
Workers’ Compensation and Injury Management Act 1981 Schedule 1 clauses 9, 17, 18, 18A and 19 (that is, in general terms, medical or surgical, dental, physiotherapy or chiropractic advice or treatment, first aid and ambulance expenses, medical requisites, charges for attendance and treatment by way of injury management, charges for hospital treatment and maintenance, cost of artificial aids and travelling expenses).(3) I shall have no entitlement to further moneys upon any increase to the prescribed amount for this degree of permanent impairment the subject of this election.
Dated the....................day of....................................20......
..........................................
(Signature of worker)
in the presence of:
.....................................................................................................................
.....................................................................................................................
(Signature and full names and address of witness)
______________________________________________________________
*Delete if not applicable.
[r. 5]
(Sections 36 and 38)
Particulars of Claimant
Surname ...........................................................................................................................................
Christian Names .............................................................................................................................
Address .............................................................................................................................................
Date of Birth ....................................................................................................................................
__________
DETERMINATION
1. Is, or was, the worker suffering from pneumoconiosis, mesothelioma or lung cancer?
2. If so, is, or was, the worker thereby less able to earn full wages?
3. To what extent if any does, or did —
(i) pneumoconiosis;
(ii) mesothelioma;
(iii) lung cancer;
(iv) diffuse pleural fibrosis,
adversely affect the worker’s ability to undertake physical effort?
4. What other, if any, disease or physical condition is, or was, contributing to the worker’s being less able to earn full wages, or death and to what extent?
5. Is, or was, the worker fit for work? If so, at what level — light, moderate, or heavy?
Signed:
................................................
(Chairman)
................................................
(Member)
................................................
(Member)
Date........................................
Attendance of Medical Practitioner.
I hereby certify that ........................................................................................................................
of ........................................................................................................................................................
a Medical Practitioner, attended the examination of the above claimant.
................................................
(Chairman)
[r. 6AA]
(Section 178(1)(b))
Date form received from employer:
ASCO (office use only):
Insurer name:
Claim number:
ANZSIC code:
Policy number:
WorkCover number:
Has employer contacted medical practitioner?
Estimated time off work:
r less than one day
r 1-4 work days (inclusive)
r 5-9 work days (inclusive)
r 10-20 work days (inclusive)
r more than 20 work days
r fatality
Name of policy holder/employer:
Trading as (if different to above):
Address:
Postcode:
Contact person:
Name:
Phone number:
Email:
Address of injured worker’s usual workplace or base:
Postcode:
Major activity of workplace: (e.g. sheep farming, plumbing)
Date employer received the completed claim form from the injured worker:
Date employer received first certificate of capacity from the injured worker:
Date employer sent the claim form and certificate/s of capacity to insurer:
Surname:
Other names:
Date of birth:
r Male r Female
Preferred language (if not English):
Address
Postcode
Email:
Daytime contact phone number:
Occupation (e.g. first class welder):
Main tasks/duties performed (e.g. welding of high pressure steam pipes):
At the time of the injury I was working as a:
r direct employee
r working director
r contractor
r employee of a contractor
r subcontractor
r visa worker
r other
At the time of the injury I was engaged as:
r full-time
r part-time
r permanent
r temporary
r casual
Do you have any other job?
If yes, please give details:
Employer name:
Contact phone number:
Hours of work per week:
Day of occurrence:
Date of occurrence:
Time of occurrence:
At what address did the occurrence happen?
Did you have to stop working?
If so when?
Date:
Time:
Were you:
r working — at your normal workplace
r working — away from normal workplace
r working — road traffic accident
r on work break — at normal workplace
r on work break — away from normal workplace
r other duty status
r commuting/journey
Describe the occurrence. Include:
(i) What action was involved (i.e. fall, struck by object,): [Mechanism]
(ii) What object/machine/substance was involved (i.e. fumes, door frame): [Agency]
(iii) The most serious injury or disease caused (i.e. fracture, burn, abrasion): [Nature]
(iv) The bodily location of the injury or disease (i.e. upper arm, eye): [Bodily location]
Where did the occurrence happen? (i.e. store room, machinery shop):
What were you doing at the time of the occurrence?
What were the normal working hours for that day?
Starting time:
Finish time:
When did you first report the occurrence?
Date:
Time:
Who did you report the occurrence to?
Name:
Position:
Phone number:
If you didn’t report the occurrence immediately, please state the reason if any:
Please provide the name and daytime contact phone number of witnesses of the occurrence:
Name:
Phone number:
Name:
Phone number:
When did you first seek medical attention?
Date:
Time:
If not immediately, please state the reason:
Was the part of the body affected by this occurrence healthy before this occurrence?
If not, please give details:
Is the present injury completely related to this occurrence?
If not, please give details:
Please give details of any similar injury prior to this occurrence:
Name and contact details of your usual medical practitioner and any health provider who has treated you for a similar injury:
Name:
Address:
Phone number:
Are you claiming compensation from any other source?
If yes, from whom?
Have you had any similar or related workers’ compensation claims?
If yes, please give details:
Name of employer:
Address of employer:
Name of insurer (if known):
Type of injury or disease:
I solemnly and sincerely declare that each and every answer above and the particulars contained herein or annexed hereto relating to myself and the occurrence are true both in substance and in fact to the best of my knowledge and belief.
I take notice that, under the provisions of section 59(2) of the
Dated this day of: Year:
Signature of worker
Signature of witness
I authorise any doctor who treats me (whether named in this certificate or not) to discuss my medical condition, in relation to my claim for workers’ compensation and return to work options, with my employer and with their insurer.
Signed:
Date:
Print your name:
Witness signature:
Witness print name:
I consent to my employer’s insurer and its appointed service providers collecting personal information, inclusive of sensitive information such as medical information about me and using it for the purpose of assessing and managing my workers’ compensation claim, including determining liability and whether my claim is true.
This consent extends to my employer’s insurer disclosing my personal information, inclusive of sensitive information, to other insurers, medical practitioners, rehabilitation providers, investigators, legal practitioners and other experts or consultants for the purpose of assessing and managing my claim.
My personal information, inclusive of sensitive information, may also be disclosed as required or permitted by law. I also consent to my employer’s insurer disclosing my personal details to WorkCover WA which is authorised to use this information to fulfil its functions and obligations under the
I have read all the information on this form regarding the consent authority and I consent to the Insurer dealing with my personal information in the manner described.
Signed:
Date:
Print your name:
Witness signature:
Witness print name:
[regs 4(1), 6AA]
(Sections 24B, 178(1)(b))
Surname Mr/Mrs/Miss/Ms ............................................................................... ............................................................................... Other Names ............................................................................... ............................................................................... Address ............................................................................... ............................................................................... ............................................................................... ........................ Postcode ....................................... Phone No. (H).................... (W) ........................... Occupation ............................................................ (e.g. boiler maker, underground miner) Main tasks or duties performed ............................ (e.g. welding, drilling) | Date of Birth / / | Age | Sex M/F | |
If you have difficulty understanding English what is your preferred language? ............................................................ | ||||
office use only | ||||
NIHL FILE No....................... (Office Use Only) Date of compensable test....../....../...... Compensable noise induced hearing loss...........% (of item 6) Entitlement $............... Employer at time of test................................................................................................... Address....................................................................................... Post Code...................... Previous settlement date....../....../...... PLH................................................................ |
I elect to accept under Part III Division 2 of the 1. I shall have no further entitlement to compensation under the Act for the percentage loss of hearing which is the subject of this election; 2. I shall have no entitlement to further monies upon any increase to the prescribed amount for the percentage loss of hearing which is the subject of this election. DATED the.................... day of.............. 20........ ............................................................... (Signature of worker) in the presence of: ...................................................................................................................... ....................................................................................................................................................... (Signature and full name and address of witness) |
Trading name of employer (e.g. Browns Welding; E.J. Drilling Service) | Local Gov. | |
Insurance Co. | ||
Address of worker’s usual workplace or base | Policy No. | |
Name of Policy Holder ______________________________________________ Address Suburb/Town Post Code | Claim No: Insurer/self insurer to complete |
Insurer/self insurer’s date stamp ______________________ |
Major activity or workplace (e.g. metal fabrication; gold mining, engineering.) |
office use only |
Nameofworker. ............................................... File # ............................
Periodofinsurance. Name of insurer.................. ................. Policy No. ...................
Periodofinsurance. Name of insurer.................. ................. Policy No. ...................
Periodofinsurance. Name of insurer.................. ................. Policy No. ...................
Periodofinsurance. Name of insurer.................. ................. Policy No. ...................
Employer at March 1, 1991: .........................................................................................................
(Name)
Address .............................................................................................................................
............................................................................................................................
(Postcode)
Telephone Number (.........)..............................
Type of work engaged in............................................. Prescribed o Yes o No
Baseline Test Date......./......../........ PLH o o. o o /
(if worker has had a Full Audiological Baseline Test use the date please circle if applicable
and PLH of the full audiological test)
Date......./......../........ Subsequent Test PLH o o. o o
Date......./......../........ Subsequent Test PLH o o. o o
Date......./......../........ Subsequent Test PLH o o. o o
Date......./......../........ Subsequent Test PLH o o. o o
Date......./......../........ Subsequent Test PLH o o. o o
Date......./......../........ Subsequent Test PLH o o. o o
Date......./......../........ Subsequent Test PLH o o. o o
Subsequent Full
Date......./......../........ Audio Test PLH o o. o o
Otorhinolarynigological
Date......./......../........ assessment NIHLPLH o o. o o
Number of years with this employer since the baseline test/March 1, 1991 o o
Termination Date......./......../........
Subsequent test
Date......./......../........ at termination PLH o o. o o
NIHL Claims Officer
Date......./......../........ check: Signature .....................................................................
NIHL Manager
Date......./......../........ check: Signature .....................................................................
[regs 4(2), 6AA]
(Sections 31H, 178(1)(b))
Surname Mr/Mrs/Miss/Ms ......................................................................... Other Names ......................................................................... Address ......................................................................... ......................................................................... Postcode ........................................................ Phone No. (H) .............................................. (W) ............................................. Occupation ................................................... (e.g. boiler maker, underground miner) Main tasks or duties performed ................ ......................................................................... (e.g. welding, drilling) | Date of Birth / / | Age | Sex M/F | |
If you have difficulty understanding English what is your preferred language? ............................................................... | ||||
__________________________ office use only | ||||
NIHL FILE No....................... (Office Use Only) Date of compensable test....../....../...... Compensable noise induced hearing loss........% (of item 44) Entitlement $...........
Address................................................... Post Code ............................................ Previous settlement date....../....../......PLH ......................................................................... |
I elect to accept under the 1. I shall have no further entitlement to compensation under the Act for the percentage loss of hearing which is the subject of this election; 2. I shall have no entitlement to further monies upon any increase to the prescribed amount for the percentage loss of hearing which is the subject of this election. DATED the.................... day of.............. 20........ ........................................................ (Signature of worker) in the presence of: ...................................................................................................................................... ...................................................................................................................................... (Signature and full name and address of witness) |
Trading name of employer (e.g. Browns Welding; E.J. Drilling Service) | Local Gov. | |
Insurance Co. | ||
Address of worker’s usual workplace or base | Policy No. | |
Name of Policy Holder ______________________________________ Address Suburb/Town Post Code | Claim No: Insurer/self insurer to complete |
Insurer/self‑insurer’s date stamp _________________ | |
Major activity or workplace (e.g. metal fabrication, gold mining, engineering) | |
office use only |
Name of worker................................................. File No. ..........................................
Periodofinsurance. Name of insurer...................... ................. Policy No. ..............
Periodofinsurance. Name of insurer...................... ................. Policy No. ..............
Periodofinsurance. Name of insurer...................... ................. Policy No. ..............
Periodofinsurance. Name of insurer...................... ................. Policy No. ..............
Employer at 1 March 1991............................................................................................................
(Name)
Address .............................................................................................................................................
............................................................................................................................................................
(Postcode)
Telephone Number (.........)..............................
Type of work engaged in............................................. Prescribed o Yes o No
Baseline Test Date....../......./....... PLH o o. o o /
(if worker has had a Full Audiological Baseline Test (please circle if applicable)
use the date and PLH of the full audiological test)
Date Subsequent Test ....../......./....... PLH o o. o o
Date Subsequent Test ....../......./....... PLH o o. o o
Date Subsequent Test ....../......./....... PLH o o. o o
Date Subsequent Test ....../......./....... PLH o o. o o
Date Subsequent Test ....../......./....... PLH o o. o o
Date Subsequent Test ....../......./....... PLH o o. o o
Date Subsequent Test ....../......./....... PLH o o. o o
Date Subsequent Full Audio Test ....../......./....... PLH o o. o o
Date Otorhinolaryngological assessment ....../......./....... NIHLPLH o o. o o
Number of years with this employer since the baseline test/1 March 1991 o o
Termination Date......./......../........
Date Subsequent test at termination ......./......../........ PLH o o. o o
Date NIHL Claims Officer check ......./......../........ Signature...................................
Date NIHL Manager check ......./......../........ Signature..................................
[r. 6A and 7(1)]
(Sections 57A(1)(b), 57B(1)(b) and 61(1))
First name | Last name | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of birth | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Phone | Mobile | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Worker’s job title | Employer’s name | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Employer’s address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
I consent to any medical practitioner who treats me (whether named on this certificate or not) to discuss my medical condition with my employer, insurer and other medical or allied health professionals for the purpose of my claim for workers’ compensation and return to work options. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Worker’s signature | Print name | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of injury | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
What happened? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Worker’s symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of this assessment | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Clinical findings | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Diagnosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The injury is consistent with worker’s description | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
of how injury occurred | yes | no | uncertain | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The injury is: | a new condition | a recurrence of a pre‑existing condition | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Worker’s usual duties | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Having considered the health benefits of work, I find this worker to have: | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
full capacity for work from | / / | but requires further treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
some capacity for work from | / / | to | / / | performing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
pre‑injury duties | modified or alternative duties | workplace modifications | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
pre‑injury hours | modified hours of | hrs/day | days/wk | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
no capacity for any work from | / / | to | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Worker has capacity to: | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
lift up to | kg | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
sit up to | mins | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
stand up to | mins | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
walk up to | m | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
work below shoulder height | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Activities/interventions | Purpose/goal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
I would like: | more information about available duties | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
a RTW program to be established | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
to be involved in developing the RTW program | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
• | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Worker does not need to be reviewed again (FIRST and FINAL certificate of capacity) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
I will review worker again on | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Comments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Name | AHPRA no. MED | |||||||||||||||||
Address | ||||||||||||||||||
Signature | ||||||||||||||||||
Phone | ||||||||||||||||||
Fax | Date | / / | ||||||||||||||||
[r. 6B]
(Section 57A(3)(a))
To:
1. .........................................................................................................................................................
[name and address of worker to whom the claim relates]
............................................................................................................................................................
2. .........................................................................................................................................................
[name and address of employer]
............................................................................................................................................................
From: ..................................................................................................................................................
[name and address of insurer]
............................................................................................................................................................
* Claim Number:.............................................
Date of injury by accident or approximate date of onset of condition: .........................................................
Nature of incapacity: .............................................................................................................................
............................................................................................................................................................
Date claim made by employer:...........................................................
In respect of the above claim you are notified that liability is accepted in respect of the weekly payments claimed by the worker.
Date on which weekly payments are proposed to commence: ....................................................................
[
Signed on behalf of the insurer: ..............................................................................................................
Date:......................................................
* Please provide this claim number to your general practitioner at your next appointment in relation to this claim
[r. 6C]
(Section 57A(3)(b))
To:
1. .........................................................................................................................................................
[name and address of worker to whom the claim relates]
............................................................................................................................................................
2. .........................................................................................................................................................
[name and address of employer]
............................................................................................................................................................
From: ..................................................................................................................................................
[name and address of insurer]
............................................................................................................................................................
Claim Number:.............................................
Date of injury by accident or approximate date of onset of condition: .........................................................
Nature of incapacity: .............................................................................................................................
............................................................................................................................................................
Date claim made by employer: ...............................................................................................................
In respect of the above claim you are notified that liability is disputed in respect of:
* all the weekly payments claimed by the worker.
* the following weekly payments claimed by the worker.
[provide details]
The reasons why liability is disputed are as follows: .................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
If a reason is that the applicant is not a worker, state the grounds upon which this assertion is made:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
If a reason is that the applicant did not suffer an injury as defined in section 5(1) of the Act, state the grounds upon which this assertion is made:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
If a reason is that the injury was not suffered in the course of employment, state the grounds upon which this assertion is made:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
The provisions of the
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Signed on behalf of the insurer. ..............................................................................................................
(signature of senior officer responsible for claim)
Date:......................................................
[*delete if appropriate]
NOTE THAT if you wish you may —
discuss this notice with the insurer or apply to have the matter heard under any internal dispute resolution process of the insurer;
seek advice in relation to the dispute from WorkCover WA;
if reasonable attempts have been made to resolve the dispute by negotiation with the employer and the insurer, apply to the Director under section 182E of the Act for resolution of a dispute by conciliation;
seek advice or assistance in relation to the dispute from your trade union organisation, a legal practitioner or a registered agent.
[r. 6D]
(Section 57A(3)(c))
To:
1. .........................................................................................................................................................
[name and address of worker to whom the claim relates]
............................................................................................................................................................
2. .........................................................................................................................................................
[name and address of employer]
............................................................................................................................................................
3. Director
From: ..................................................................................................................................................
[name and address of insurer]
............................................................................................................................................................
Claim Number:.............................................
Date of injury by accident or approximate date of onset of condition: .........................................................
Nature of incapacity: .............................................................................................................................
............................................................................................................................................................
Date claim made by employer:.......................................
In respect of the above claim you are notified that a decision as to whether or not liability is to be accepted in respect of the weekly payments claimed by the worker is not able to be made within the time allowed by section 57A(3) of the Act.
The reasons why the decision is not able to be made are as follows: ...........................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Where further medical information is required to make a decision about liability, state the nature and substance of the medical information and whether a written authority from the worker is required:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Where further information on the worker’s weekly earnings is required to make a decision about liability, state the nature and substance of the information:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Where other particulars are required to help make a decision about liability, specify the particulars required:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Signed on behalf of the insurer: ..............................................................................................................
Date:........................................................
NOTE THAT if you wish you may —
discuss this notice with the insurer or employer or apply to have the matter heard under any internal dispute resolution process of the insurer;
seek advice in relation to the dispute from WorkCover WA;
if reasonable attempts have been made to resolve the dispute by negotiation with the employer and the insurer, apply to the Director under section 182E of the Act for resolution of a dispute by conciliation;
seek advice or assistance in relation to the dispute from your trade union organisation, a legal practitioner or a registered agent.
[r. 6E]
(Section 57B(2)(b))
To: ......................................................................................................................................................
[name and address of worker to whom the claim relates]
............................................................................................................................................................
From: ..................................................................................................................................................
[name and address of uninsured or self-insured employer]
............................................................................................................................................................
Date of injury by accident or approximate date of onset of condition: .........................................................
Nature of incapacity: .............................................................................................................................
............................................................................................................................................................
Date claim made by worker:..........................................................
In respect of the above claim you are notified that liability is disputed in respect of the weekly payments claimed by you.
The reasons why liability is disputed are as follows: .................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
If a reason is that the applicant is not a worker, state the grounds upon which this assertion is made:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
If a reason is that the applicant did not suffer an injury as defined in section 5(1) of the Act, state the grounds upon which this assertion is made:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
If a reason is that the injury was not suffered in the course of employment, state the grounds upon which this assertion is made:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
The provisions of the
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Signed on behalf of the uninsured or self-insured employer .......................................................................
(signature of senior officer responsible for claim)
Date:................................................................
NOTE THAT if you wish you may —
discuss this notice with the employer or, if the employer is self insured, apply to have the matter heard under any internal dispute resolution process of the employer;
seek advice in relation to the dispute from WorkCover WA;
if reasonable attempts have been made to resolve the dispute by negotiation with the employer, apply to the Director under section 182E of the Act for resolution of a dispute by conciliation;
seek advice or assistance in relation to the dispute from your trade union organisation, a legal practitioner or a registered agent.
[r. 6F]
(Section 57B(2)(c))
To:
1. .........................................................................................................................................................
[name and address of worker to whom the claim relates]
............................................................................................................................................................
2. Director
From: ..................................................................................................................................................
[name and address of uninsured or self‑insured employer]
............................................................................................................................................................
Claim number:.....................................
Date of injury by accident or approximate date of onset of condition: .........................................................
Nature of incapacity: .............................................................................................................................
............................................................................................................................................................
Date claim made by worker:..........................................
In respect of the above claim you are notified that a decision as to whether or not liability to make the weekly payments claimed by the worker is not able to be made within the time allowed by section 57B(2) of the Act.
The reasons why the decision is not able to be made are as follows: ...........................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Where further medical information is required to make a decision about liability, state the nature and substance of the medical information and whether a written authority from the worker is required:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Where further information on the worker’s weekly earning is required to make a decision about liability, state the nature and substance of the information:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
Where other particulars are required to help make a decision about liability, specify the particulars required:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................ Signed on behalf of the uninsured or self‑insured employer: ............................................................................................................................................
Date:.................................................
NOTE THAT if you wish you may —
seek advice in relation to the dispute from WorkCover WA;
if reasonable attempts have been made to resolve the dispute by negotiation with the employer, apply to the Director under section 182E of the Act for resolution of a dispute by conciliation;
seek advice or assistance in relation to the dispute from your trade union organisation, a legal practitioner or a registered agent.
[r. 7(1)]
(Section 61(1))
First name | Last name | ||||||||||||||||||||||||||||||||||||||||
Date of birth | / / | Claim no. | |||||||||||||||||||||||||||||||||||||||
Phone | |||||||||||||||||||||||||||||||||||||||||
Address | |||||||||||||||||||||||||||||||||||||||||
Employer’s name | Employer’s phone | ||||||||||||||||||||||||||||||||||||||||
Employer’s address | |||||||||||||||||||||||||||||||||||||||||
Date of this assessment | / / | Date of injury | / / | ||||||||||||||||||||||||||||||||||||||
The worker’s condition is unlikely to change substantially in the next 12 months. | |||||||||||||||||||||||||||||||||||||||||
Having considered the health benefits of work, I find this worker to have: | |||||||||||||||||||||||||||||||||||||||||
full capacity for work from | / / | but requires further treatment | |||||||||||||||||||||||||||||||||||||||
capacity for work performing | hours per day and | days per week from | / / | ||||||||||||||||||||||||||||||||||||||
as outlined below: | |||||||||||||||||||||||||||||||||||||||||
lift up to | kg | ||||||||||||||||||||||||||||||||||||||||
sit up to | mins | ||||||||||||||||||||||||||||||||||||||||
stand up to | mins | ||||||||||||||||||||||||||||||||||||||||
walk up to | m | ||||||||||||||||||||||||||||||||||||||||
work below shoulder height | |||||||||||||||||||||||||||||||||||||||||
The worker’s incapacity is no longer a result of the injury. | |||||||||||||||||||||||||||||||||||||||||
Please outline your clinical reason for the worker’s capacity/incapacity: | |||||||||||||||||||||||||||||||||||||||||
Name | AHPRA no. MED | ||||||||||||||||||||||||||||||||||||||||
Address | |||||||||||||||||||||||||||||||||||||||||
Signature | |||||||||||||||||||||||||||||||||||||||||
Phone | |||||||||||||||||||||||||||||||||||||||||
Fax | Date | / / | |||||||||||||||||||||||||||||||||||||||
[r. 7A]
(Section 61(1))
First name | Last name | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of birth | / / | Claim no. | |||||||||||||||||||||||||||||||||||||||||||||||||||
Phone | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Employer’s name | Employer’s phone | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Employer’s address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of this assessment | / / | Date of injury | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||
Diagnosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Activities/interventions | Actual outcome | Still required?* | |||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||
* | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Other factors appear to be impacting recovery and return to work. | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Comment | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Worker’s usual duties | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Having considered the health benefits of work, I find this worker to have: | |||||||||||||||||||||||||||||||||||||||||||||||||||||
full capacity for work from | / / | but requires further treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||
some capacity for work from | / / | to | / / | performing | |||||||||||||||||||||||||||||||||||||||||||||||||
pre‑injury duties | modified or alternative duties | workplace modifications | |||||||||||||||||||||||||||||||||||||||||||||||||||
pre‑injury hours | modified hours of | hrs/day | days/wk | ||||||||||||||||||||||||||||||||||||||||||||||||||
no capacity for any work from | / / | to | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||
Worker has capacity to: | |||||||||||||||||||||||||||||||||||||||||||||||||||||
lift up to | kg | ||||||||||||||||||||||||||||||||||||||||||||||||||||
sit up to | mins | ||||||||||||||||||||||||||||||||||||||||||||||||||||
stand up to | mins | ||||||||||||||||||||||||||||||||||||||||||||||||||||
walk up to | m | ||||||||||||||||||||||||||||||||||||||||||||||||||||
work below shoulder height | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Activities/interventions | Purpose/goal | ||||||||||||||||||||||||||||||||||||||||||||||||||||
I support the RTW program established by the employer/insurer/WRP dated | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||
I would like more information about available duties | |||||||||||||||||||||||||||||||||||||||||||||||||||||
I would like to be involved in developing the RTW program | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Please engage a workplace rehabilitation provider | |||||||||||||||||||||||||||||||||||||||||||||||||||||
• further assessment — diagnostic imaging, medical specialist consults, worksite assessment; • intervention — physiotherapy, clinical psychology, exercise physiology, prescribed medications, workplace mediation; • return to work planning — identify suitable duties, establish return to work program. | |||||||||||||||||||||||||||||||||||||||||||||||||||||
I will review worker again on | / / | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Comments | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Name | AHPRA no. MED | |||||||||||||||
Address | ||||||||||||||||
Signature | ||||||||||||||||
Phone | ||||||||||||||||
Fax | Date | / / | ||||||||||||||
[r. 7(2)]
(Section 61(1) and (2))
TO: ......................................................................................................................................................
(Name and address of worker)
............................................................................................................................................................
TAKE NOTICE that your employer .......................................................................................................
(name of employer)
intends, after 21 clear days from the date of service upon you of this notice, to *discontinue the weekly payments of compensation/reduce the weekly payments on the following basis —
(1) this notice is based upon the certificates of capacity or report(s) of .............................................
............................................................................................................................................
......................................... dated......................................... 20................................
(names of medical practitioners and dates of reports)
sent with this notice, in which it is said that (state concisely the ground relied upon by the employer);
(2) you may, if you dispute the employer’s right to discontinue or reduce the weekly payments within the 21 days referred to in this notice apply for an order of an arbitrator that the weekly payments shall not be discontinued or reduced;
(3) if you do not so apply, weekly payments may be lawfully discontinued or reduced;
(5) you may obtain information from WorkCover WA situated at ......................................................... as to the ways and means available to you to establish or protect your rights in respect of your injury.
dayof Dated the 20 .
...............................................................
Signed on behalf of the employer.
______________________________________________________________________________________
* Delete whichever is inapplicable.
[r. 10(1)]
(Section 69)
IF A WORKER RESIDES OUTSIDE THE STATE, PROOF OF THE WORKER’S IDENTITY AND CONTINUING INCAPACITY IS REQUIRED EVERY 3 MONTHS
WORKER’S DETAILS | |||||||||||||||||||||||||||
First name | Last name | ||||||||||||||||||||||||||
Date of birth | / / | Claim no. | |||||||||||||||||||||||||
Phone | |||||||||||||||||||||||||||
Address | |||||||||||||||||||||||||||
Date of injury | |||||||||||||||||||||||||||
DETAILS OF EMPLOYER or EMPLOYER’S INSURER | |||||||||||||||||||||||||||
Name | |||||||||||||||||||||||||||
Address | |||||||||||||||||||||||||||
DECLARATION BY WORKER | |||||||||||||||||||||||||||
I have truthfully answered all the questions I have been asked and have fully cooperated to the best of my ability during the course of the medical examination by the medical practitioner named in PART 2 of this declaration. | |||||||||||||||||||||||||||
Worker | |||||||||||||||||||||||||||
Worker’s signature | |||||||||||||||||||||||||||
Date of declaration | / / | Date sent to employer or employer’s insurer | / / | ||||||||||||||||||||||||
Sent by: | Email c | Post c | Fax c | ||||||||||||||||||||||||
MEDICAL ASSESSMENT | |||||||||||||||||||||||||||
Date of this assessment | / / | Date of injury | / / | ||||||||||||||||||||||||
I declare that I have examined the person named in PART 1 of this declaration and I have confirmed that the person who I examined was that person through the sighting of an official document of the government of the country in which the person resides. | |||||||||||||||||||||||||||
The document I used to confirm the identification of the person was | |||||||||||||||||||||||||||
MEDICAL MANAGEMENT | |||||||||||||||||||||||||||
Clinical findings/ diagnosis | |||||||||||||||||||||||||||
Medication | |||||||||||||||||||||||||||
Imaging | |||||||||||||||||||||||||||
Referral to specialist or hospital | |||||||||||||||||||||||||||
Approved health treatments ( | |||||||||||||||||||||||||||
WORK CAPACITY | |||||||||||||||||||||||||||
Worker’s usual duties | |||||||||||||||||||||||||||
I find this worker to have: | |||||||||||||||||||||||||||
c | / / | c but requires further treatment | |||||||||||||||||||||||||
c | / / | to | / / | performing: | |||||||||||||||||||||||
c pre‑injury duties | c modified or alternative duties | c workplace modifications | |||||||||||||||||||||||||
c pre‑injury hours | c modified hours of | hours/day | days/week | ||||||||||||||||||||||||
c | / / | to | / / | ||||||||||||||||||||||||
MEDICAL PRACTITIONER’S DETAILS | |||||||||||||||||||||||||||
Name | Medical registration number/country | ||||||||||||||||||||||||||
Address | Medical specialty | ||||||||||||||||||||||||||
Phone | Signature | ||||||||||||||||||||||||||
Date | / / | |
[r. 18(1)]
(Schedule 5 clause 3)
I,...............................................................of ..............................................................................................
(nameofworker) (address)
having attained the age of 65 years on the.............. day of.................................... 20....., having suffered from pneumoconiosis/mesothelioma/lung cancer and being entitled to weekly payments of compensation in accordance with Schedule 1 of the Act, elect to receive the redemption amount of $..................... as a lump sum.
I acknowledge that, by making this election: —
1. I shall have no other claim to redemption of weekly payments.
2. I shall have no claim after the date of this election to weekly payments of compensation.
3. I shall have no further entitlement from the date of this election, to payment of expenses under the
Workers’ Compensation and Injury Management Act 1981 Schedule 1 clauses 9, 17, 18, 18A and 19 (that is, in general terms, medical and other expenses, hospital charges and travelling costs).4. Upon my death the provisions of the
Workers’ Compensation and Injury Management Act 1981 Schedule 1A shall not apply: that is, in general terms dependants of mine, whether totally or partially dependent, shall have no entitlement to payment, benefit, allowance or expenses (funeral or otherwise).• Dated the day of 20 .
Signed by the worker
in the presence of:
...................................................................
...................................................................
...................................................................
(Signature and full names of witness).
[r. 18(2)]
(Schedule 5 clause 3)
I,............................................................of..........................................................................................................
(name of worker) (address)
having attained the age of 65 years on the........... day of................................. 20............ having suffered from pneumoconiosis/mesothelioma/lung cancer and being entitled to weekly payments of compensation in accordance with Schedule 1 of the Act, elect to receive the supplementary amount having *a/*no dependant spouse or dependant de facto partner, being currently the sum of $......................
I acknowledge that, by making this election: —
1. I shall have no other claim to redemption of weekly payments.
2. I shall have no claim after the date of this election to weekly payments of compensation.
3. If my death results from that injury and a dependant spouse or/and a dependant de facto partner survives me then that person is, or those persons are, entitled to all or part of a lump sum calculated in accordance with the
Workers’ Compensation and Injury Management Act 1981 Schedule 5 clause 7 of the supplementary amount for a worker with a dependent spouse or dependent de facto partner.4. Upon my death the provisions of the
Workers’ Compensation and Injury Management Act 1981 Schedule 1A shall not apply: that is, in general terms, dependants of mine, whether totally or partially dependent, shall have no entitlement to any payment, benefit, allowance or expense (funeral or otherwise).• Dated the day of 20 .
Signed by the worker
in the presence of:
...................................................................
...................................................................
...................................................................
(Signature and full names of witness).
* Delete whichever is inapplicable.
[r. 12(4)]
Ref.
TAKE NOTICE
1. That a Memorandum of Agreement has been sent to me for registration. The Memorandum appears to affect you.
2. I therefore request you to inform me within 7 days from this date whether you admit the genuineness of the Memorandum, or whether you dispute it, and if so, in what particulars, or object to its being recorded, and if so, on what ground.
3. If the Memorandum is recorded it is enforceable as an award or order.
4. If you have any doubts as to the effect of the agreement, or your rights to compensation generally you should contact me immediately.
Dated this................ day of........................................ 20...............
...............................................................
Director
[r. 12(5)]
Ref.
YOU ARE NOTIFIED
That a memorandum of the agreement entered into between
............................................................................................................................................................
and
............................................................................................................................................................
the abovenamed parties, and dated the................ day of................................. 20............. has now been recorded in the Register under section 76 of the
The Agreement has been numbered..................................
You may, without fee, obtain a certificate of the memorandum and its recording.
Dated this.............................. day of....................................... 20.............
............................................................
Director
[r. 12(1a)]
(Section 76 & 67(2))
TO: the Director
Perth, Western Australia
In the matter of an Agreement made the day of
Between
of (
(
and
of (
Claim No:
Upon the Agreement being recorded pursuant to section 76 of the
Which occurred by:
* a personal injury by accident arising out of or in the course of the employment, or whilst the worker was acting under the employer’s instructions;
* a disabling disease to which Part III Division 3 applies;
* a disease contracted by a worker in the course of his/her employment at or away from his/her place of employment and to which the employment was a contributing factor and contributed to a significant degree;
* the recurrence, aggravation, or acceleration of any pre‑existing disease where the employment was a contributing factor to that recurrence, aggravation, or acceleration and contributed to a significant degree; or
* a disabling loss of function to which Part III Division 4 applies.
(a) the worker was years of age. Date of Birth ...........................
(b) the worker was employed by the employer as a ........................................................................
............................................................................................................................................
(c) his or her weekly earnings were .............................................................................................
and now is:
and it occurred in the following circumstances —
(a) weekly payments in respect of that injury totalling $
(b) expenses payable under the
Totalling $
=========
*(a) weekly payments of compensation:
(i) by way of redemption of liability to make future
weekly payments as for permanent total incapacity; $
(ii) by way of redemption of liability to make future
weekly payments as for permanent partial incapacity; $
(iii) otherwise; $
*(b) expenses as are provided for in the
Workers’ Compensation and Injury Management Act 1981 Schedule 1 clauses 9, 10, 17, 18, 18A and 19 namely; $*(c) the worker having elected under s. 24 of the Act by a form of
election dated , compensation payable under
Part III Division 2, representing % loss of Item
being for the permanent loss of the efficient use of the
Totalling: $
*(ca) the worker having elected under section 31C of the Act by a form of election dated............., compensation payable under the Act Schedule 2 Division 2A, in respect of an impairment mentioned in Schedule 2 item....., representing........ degree of permanent impairment from the injury.
Totalling: $
*(d) redemption amount under the
*(e) supplementary amount under the
TOTAL LUMP SUM $
=========
SIGNED by the worker:
SIGNED by or on behalf of the employer:
*
[r. 12(3a)]
(Section 76(2)(a))
In making an agreement for the purposes of section 67(l) of the
(1) The worker will have no further entitlement to compensation under the Act for weekly payments arising out of the injury referred to in the agreement.
(2) The worker will not have any other claim to redemption of weekly payments arising out of the injury referred to in the agreement.
(3) The worker will not have any further entitlement in respect of the injury referred to in the agreement (after the date the agreement is recorded) to payment of expenses under the
(4) The worker forfeits any entitlement he/she may have under the Act Part III to compensation for a permanent impairment from a compensable personal injury by accident referred to in the agreement.
(5) The worker forfeits any chance of a court awarding common law damages against the employer in respect of the injury referred to in the agreement (see section 93E(13) and section 93K(1) of the Act).
That is, in general terms, the worker forfeits any chance to recover civil damages from the employer.
I , confirm that I have read the above information and I acknowledge that I am aware of the consequences of the recording of a memorandum under section 67(l) of the Act.
Dated the day of
.......................................
Signature of the worker
[r. 12(4a)]
(Section 76)
In the matter of an Agreement between
Employer
and
Worker
Ref. AG
TAKE NOTICE that the genuineness of the Memorandum in the abovementioned matter sent to you for registration is disputed by
a party affected by such Memorandum, in the following particulars:
(Or that
of a party interested in the Memorandum in the above mentioned matter sent to you for registration, objects to the same being recorded, on the following grounds:)
Dated this day of
[r. 12(4b)]
(Section 76)
In the matter of an Agreement between
Employer
and
Worker
Ref. AG
TAKE NOTICE that the genuineness of the Memorandum in the abovementioned matter left with me (or sent to me) for registration is disputed by
a party affected by such Memorandum, in the following particulars:
(Or that
a party interested in the Memorandum in the abovementioned matter, left (or sent to) me for registration objects to the same being recorded, on the following grounds:)
The Memorandum will therefore not be recorded, except with the consent in writing of
or by order of the Registrar.
Dated this day of ,
Director
[r. 12AA]
TO: ( |
The employer described below intends to dismiss the worker described below with effect from the following date. |
Date dismissal effective: |
[ |
Surname | Other names | |||
Date of birth | Sex | Occupation | ||
Address | ||||
Postcode | ||||
Telephone no. | WorkCover claim number (WCCN) | |||
Name | ||
Address | ||
Postcode | ||
Telephone no. | WorkCover number (WCN) | |
Contact person | ||
Title | Telephone no. | |
Name | ||
Address | ||
Postcode | ||
Policy no. | ||
Contact person | Telephone no. | |
Description of injury | ||
Date injury occurred | Claim number given by insurer (if known) | |
Date | / / | |
(signed on behalf of employer) | ||
Date | / / | |
(signed on behalf of employer) |
[r. 15]
CONFIDENTIAL
(Section 171(1)(a))
NEW/RENEWED POLICIES/COVER NOTES
Name of approved insurance office.............................................................................................................
Address.........................................................................................................................................................
Chief executive officer, WorkCover WA.
The following are the names, addresses and industries of each employer who has during the month of........................................................... 20.................................... effected or renewed a policy or contract of insurance with the above office against liability under the Act.
Position held by officer.............................................................. Date....................................................
...............................................
Signature of responsible officer
[r. 15]
CONFIDENTIAL
(Section 171(1)(b))
LAPSED POLICIES
Name of approved insurance office...................................................................................................................
Address:.......................................................................................... Date approved..........................................
Chief executive officer, WorkCover WA.
The following are the names and addresses of each employer in respect to whom, during the month of.............................................. 20..................... the above approved insurance office has, in its books, lapsed a policy of insurance under the Act: —
Position held by officer............................................................. Date......................................................
....................................................
Signature of responsible officer
[r. 19D]
TO: ....................................................................................................................................................
(full name of worker)
of: ......................................................................................................................................................
............................................................................................................................................................
(full address of worker)
Notice is hereby given that I have arranged for you to undergo an audiometric test to be conducted by
............................................................................................................................................................
(name of person approved under regulation 19B)
of ........................................................................................................................................................
(full address at which test is to be conducted)
at................................................ am/pm on ...............................................................................
....................................................................
(Signature of person arranging test)
............................................................................................... ...................................................
(nameofemployer) (date)
NON‑ATTENDANCE: A worker shall not, without reasonable excuse, fail to submit himself for an audiometric test of which the worker has notice (regulation 19D(3)).
PERIOD OF QUIET: An employer shall ensure that the worker is not knowingly exposed in the workplace, and the worker shall not knowingly permit himself to be exposed, to noise levels above 80dB(A) during the 16 hours immediately preceding the audiometric test (regulation 19D(2)).
[r. 19F]
TO: Chief executive officer, WorkCover WA.
Notice is hereby given that I have conducted an audiometric *test/retest of:
| ||||||||||||||||||||||||||||||||
(Please tick only if worker fails)
Item 1 | Item 2 | Item 3 |
HERTZ (Hz) | 500 | 1000 | 1500 | 2000 | 3000 | 4000 | 6000 | 8000 | ||||||||||||||||
RT EAR | ||||||||||||||||||||||||
RT EAR **MASKED | ||||||||||||||||||||||||
AIR | ||||||||||||||||||||||||
CONDUCTION | LT EAR | |||||||||||||||||||||||
LT EAR **MASKED | ||||||||||||||||||||||||
RT EAR | ||||||||||||||||||||||||
RT EAR MASKED | ||||||||||||||||||||||||
**BONE | ||||||||||||||||||||||||
CONDUCTION | LT EAR | |||||||||||||||||||||||
LT EAR MASKED | ||||||||||||||||||||||||
CALCULATED PLH | % | ||||
OFFICE USE | |||||
INITIAL SURNAME REG. NO.
EQUIPMENT REG. NO. | BOOTH REG. NO. |
I hereby certify, that I have personally conducted an audiometric test in accordance with the
DATE OF TEST | ||||||
SIGNATURE | DAY | MONTH | YEAR | |||
* Delete which doesn’t apply
** Approved Medical Practitioners or Audiologists Only
[r. 19F]
TO: Chief executive officer, WorkCover WA.
Notice is hereby given that I have conducted an audiometric *test/retest of:
HERTZ (Hz) | 500 | 1000 | 1500 | 2000 | 3000 | 4000 | 6000 | 8000 | ||||||||||||||||
RT EAR | ||||||||||||||||||||||||
RT EAR **MASKED | ||||||||||||||||||||||||
AIR | ||||||||||||||||||||||||
CONDUCTION | LT EAR | |||||||||||||||||||||||
LT EAR **MASKED | ||||||||||||||||||||||||
RT EAR | ||||||||||||||||||||||||
RT EAR MASKED | ||||||||||||||||||||||||
**BONE | ||||||||||||||||||||||||
CONDUCTION | LT EAR | |||||||||||||||||||||||
LT EAR MASKED | ||||||||||||||||||||||||
Practitioner .................................................................................. Address ........................................................................................ ......................................................................................................... Signature......................................... Date................... | ||||||
CALCULATED PLH | % | |||||
OFFICE USE | ||||||
***CALCULATED | ||||||
NOISE INDUCED | % | |||||
PLH SINCE BASELINE TEST/PREVIOUS ELECTION* | ||||||
SURNAME INITIALS REG. NO.
EQUIPMENT REG. NO. | BOOTH REG. NO. |
I hereby certify, that I have personally conducted an audiometric test in accordance with the
DATE OF TEST | ||||||
SIGNATURE | DAY | MONTH | YEAR | |||
* Delete which doesn’t apply
** Approved Medical Practitioners or Audiologists Only
*** Registered Otorhinolaryngologist Only
[r. 19H]
TO: Chief executive officer, WorkCover WA
NAME OF WORKER:.......................................................................................................
ADDRESS OF WORKER:................................................................................................
NAME OF EMPLOYER:..................................................................................................
ADDRESS OF EMPLOYER:............................................................................................
I, being an *employer/worker hereby notify you that I dispute the results of an audiometric test conducted on the above worker on (date)............/............/20.................
and request that you arrange a retest of hearing under regulation 19H.
........................................................................................ ...................................
Signature of Applicant Date
* Strike out whichever does not apply.
[r. 19J(1)]
Surname | Other names | |||
Date of birth | Sex | Occupation | ||
Address | ||||
Postcode | ||||
Telephone no. | ||||
Name | ||
Address | ||
Postcode | ||
Telephone no. | WorkCover no. (if known) | |
Contact person | ||
Title | Telephone no. | |
Name | ||
Address | ||
Postcode | ||
Date weekly payments commenced (if applicable). | Claim no. (if known) | |
Contact person | ||
Telephone no. | ||
Description of injury | ||
Date injury occurred | Date weekly payments commenced | |
Degree of disability as assessed by medical practitioner | Degree of disability (see s. 93E(3) of the Act) Nominate r not less than 30% r not less than 16% | |
Tick if the worker and the employer cannot agree on whether the degree of disability is not less than the relevant level | r |
The action taken by or on behalf of the worker to obtain the employer’s agreement |
Date | / / |
This form should be lodged with — Director WorkCover WA Perth, Western Australia You must also give to the Director medical evidence from a medical practitioner indicating that, in his or her opinion, your degree of disability is not less than the relevant level. |
[r. 19JA]
Surname | Other names | |||
Date of birth | Sex | Occupation | ||
Address | ||||
Postcode | ||||
Telephone no. | ||||
Name | ||
Address | ||
Postcode | ||
Telephone no. | WorkCover no. (if known) | |
Contact person | ||
Title | Telephone no. | |
Name | ||
Address | ||
Postcode | ||
Date weekly payments commenced (if applicable) | Claim no. (if known) | |
Contact person | ||
Telephone no. | ||
Description of injury | ||
Date injury occurred | Date weekly payments commenced | |
Degree of disability as assessed by medical practitioner | Degree of disability (see s. 93E(3) of the Act) Nominate r not less than 30% r not less than 16% | |
Tick if the worker and the employer cannot agree on whether the degree of disability is not less than the relevant level | r |
The action taken by or on behalf of the worker to obtain the employer’s agreement |
If, on or before 30 September 2001, you sought to refer a question to the Director under section 93D(5) of the Act, and in order to satisfy section 93D(6) of the Act you produced to the Director anything that, even though it may not have constituted evidence of the kind required by that subsection, was accepted by the Director as evidence of that kind, then a copy of the Form 22 that was referred to and accepted by the Director should be attached. If, based on a failure to satisfy the requirements of section 93D(6), a review officer did not deal with the substance of the question referred to above, a copy of the review officer’s decision should be attached; or If, based on a failure to satisfy the requirements of section 93D(6), a court set aside or quashed a decision of a review officer that dealt with the substance of the question referred to in the first paragraph above, a copy of the court decision should be attached. | r r r |
18.138 52 18.595 30 19.038 77 19.469 33 19.887 35 | 18.147 43 18.603 95 19.047 17 19.477 49 19.895 27 | 18.156 34 18.612 60 19.055 57 19.485 64 19.903 18 | 18.165 24 18.621 24 19.063 96 19.493 78 19.911 09 | 18.174 14 18.629 88 19.072 35 19.501 93 19.918 99 | 18.183 03 18.638 51 19.080 73 19.510 06 19.926 89 | 18.191 92 18.647 14 19.089 10 19.518 20 19.934 79 | 18.200 80 18.655 76 19.097 48 19.526 32 19.942 68 | 18.209 67 18.664 38 19.105 84 19.534 45 19.950 57 | 18.218 55 18.672 99 19.114 21 19.542 57 19.958 45 | 18.227 41 18.681 60 19.122 56 19.550 68 19.966 33 | 18.236 27 18.690 21 19.130 92 19.558 79 19.974 20 | 18.245 13 18.698 80 19.139 26 19.566 90 19.982 07 | |
20.293 19 20.687 21 21.069 76 21.441 16 21.801 74 | 20.300 88 20.694 67 21.077 00 21.448 19 21.808 57 | 20.308 56 20.702 13 21.084 24 21.455 23 21.815 40 | 20.316 24 20.709 59 21.091 48 21.462 25 21.822 22 | 20.323 91 20.717 04 21.098 72 21.469 28 21.829 04 | 20.331 58 20.724 49 21.105 95 21.476 30 21.835 86 | 20.339 25 20.731 93 21.113 17 21.483 31 21.842 67 | 20.346 91 20.739 37 21.120 39 21.490 32 21.849 48 | 20.354 57 20.746 80 21.127 61 21.497 33 21.856 28 | 20.362 22 20.754 23 21.134 83 21.504 33 21.863 08 | 20.369 87 20.761 66 21.142 03 21.511 33 21.869 87 | 20.377 51 20.769 08 21.149 24 21.518 33 21.876 67 | 20.385 15 20.776 50 21.156 44 21.525 32 21.883 45 | |
22.151 83 22.491 71 22.821 70 23.142 08 23.453 12 | 22.158 46 22.498 15 22.827 95 23.148 14 23.459 01 | 22.165 09 22.504 59 22.834 20 23.154 21 23.464 90 | 22.171 71 22.511 02 22.840 44 23.160 27 23.470 79 | 22.178 33 22.517 45 22.846 68 23.166 33 23.476 67 | 22.184 95 22.523 87 22.852 92 23.172 39 23.482 55 | 22.191 56 22.530 29 22.859 15 23.178 44 23.488 42 | 22.198 17 22.536 71 22.865 38 23.184 48 23.494 29 | 22.204 77 22.543 12 22.871 61 23.190 53 23.500 16 | 22.211 38 22.549 53 22.877 83 23.196 57 23.506 03 | 22.217 97 22.555 93 22.884 05 23.202 61 23.511 89 | 22.224 57 22.562 33 22.890 26 23.208 64 23.517 75 | 22.231 16 22.568 73 22.896 48 23.214 67 23.523 60 | |
23.755 10 24.048 29 24.332 94 24.609 30 24.877 61 | 23.760 83 24.053 85 24.338 34 24.614 54 24.882 69 | 23.766 54 24.059 40 24.343 72 24.619 77 24.887 77 | 23.772 26 24.064 95 24.349 11 24.625 00 24.892 85 | 23.777 97 24.070 49 24.354 49 24.630 22 24.897 92 | 23.783 67 24.076 03 24.359 87 24.635 45 24.903 00 | 23.789 38 24.081 57 24.365 25 24.640 67 24.908 06 | 23.795 08 24.087 10 24.370 62 24.645 88 24.913 13 | 23.800 78 24.092 64 24.375 99 24.651 10 24.918 19 | 23.806 47 24.098 16 24.381 36 24.656 31 24.923 25 | 23.812 16 24.103 69 24.386 73 24.661 52 24.928 31 | 23.817 85 24.109 21 24.392 09 24.666 72 24.933 36 | 23.823 54 24.114 73 24.397 45 24.671 93 24.938 41 | |
25.138 11 25.391 01 25.636 55 25.874 94 26.106 39 | 25.143 04 25.395 80 25.641 21 25.879 46 26.110 77 | 25.147 97 25.400 59 25.645 85 25.883 97 26.115 16 | 25.152 90 25.405 38 25.650 50 25.888 48 26.119 54 | 25.157 83 25.410 16 25.655 14 25.892 99 26.123 91 | 25.162 75 25.414 94 25.659 78 25.897 50 26.128 29 | 25.167 67 25.419 72 25.664 42 25.902 00 26.132 66 | 25.172 59 25.424 49 25.669 06 25.906 50 26.137 03 | 25.177 50 25.429 26 25.673 69 25.911 00 26.141 39 | 25.182 42 25.434 03 25.678 32 25.915 49 26.145 76 | 25.187 32 25.438 80 25.682 95 25.919 99 26.150 12 | 25.192 23 25.443 56 25.687 57 25.924 48 26.154 48 | 25.197 13 25.448 32 25.692 19 25.928 96 26.158 84 |
Appendix II
0.249 01 | 0.268 09 | 0.287 15 | 0.306 21 | 0.325 26 | 0.344 29 | 0.363 32 | 0.382 33 | 0.401 33 | 0.420 32 | 0.439 30 | 0.458 27 | 0.477 23 | |
1.226 84 2.176 19 3.097 89 3.992 75 4.861 54 | 1.245 36 2.194 18 3.115 35 4.009 70 4.878 00 | 1.263 88 2.212 15 3.132 80 4.026 64 4.894 44 | 1.282 38 2.230 11 3.150 24 4.043 57 4.910 88 | 1.300 87 2.248 06 3.167 67 4.060 49 4.927 31 | 1.319 35 2.266 01 3.185 09 4.077 41 4.943 73 | 1.337 82 2.283 94 3.202 50 4.094 31 4.960 14 | 1.356 28 2.301 86 3.219 90 4.111 20 4.976 54 | 1.374 73 2.319 77 3.237 29 4.128 09 4.992 94 | 1.393 17 2.337 67 3.254 67 4.144 96 5.009 32 | 1.411 59 2.355 56 3.272 04 4.161 82 5.025 69 | 1.430 01 2.373 45 3.289 40 4.178 68 5.042 05 | 1.448 42 2.391 32 3.306 75 4.195 52 5.058 41 | |
5.705 03 6.523 95 7.319 01 8.090 92 8.840 35 | 5.721 00 6.539 46 7.334 07 8.105 55 8.854 55 | 5.736 97 6.554 96 7.349 13 8.120 16 8.868 73 | 5.752 93 6.570 46 7.364 17 8.134 76 8.882 91 | 5.768 88 6.585 94 7.379 20 8.149 36 8.897 09 | 5.784 82 6.601 42 7.394 23 8.163 95 8.911 25 | 5.800 76 6.616 89 7.409 25 8.178 53 8.925 41 | 5.816 68 6.632 35 7.424 26 8.193 10 8.939 55 | 5.832 60 6.647 80 7.439 26 8.207 67 8.953 69 | 5.848 50 6.663 24 7.454 25 8.222 22 8.967 83 | 5.864 40 6.678 67 7.469 23 8.236 77 8.981 95 | 5.880 28 6.694 10 7.484 21 8.251 31 8.996 06 | 5.896 16 6.709 51 7.499 18 8.265 84 9.010 17 | |
9.567 95 10.274 36 10.960 19 11.626 05 12.272 51 | 9.581 73 10.287 74 10.973 18 11.638 66 12.284 75 | 9.595 51 10.301 11 10.986 16 11.651 26 12.296 99 | 9.609 27 10.314 48 10.999 14 11.663 86 12.309 22 | 9.623 03 10.327 84 11.012 11 11.676 45 12.321 45 | 9.636 78 10.341 19 11.025 07 11.689 04 12.333 67 | 9.650 53 10.354 53 11.038 03 11.701 62 12.345 88 | 9.664 26 10.367 87 11.050 97 11.714 19 12.358 08 | 9.677 99 10.381 19 11.063 91 11.726 75 12.370 28 | 9.691 71 10.394 51 11.076 85 11.739 30 12.382 47 | 9.705 42 10.407 83 11.089 77 11.751 85 12.394 65 | 9.719 13 10.421 13 11.102 69 11.764 39 12.406 83 | 9.732 82 10.434 43 11.115 60 11.776 93 12.419 00 | |
12.900 14 13.509 49 14.101 10 14.675 47 15.233 12 | 12.912 03 13.521 04 14.112 31 14.686 35 15.243 68 | 12.923 91 13.532 57 14.123 51 14.697 23 15.254 24 | 12.935 79 13.544 10 14.134 70 14.708 09 15.264 79 | 12.947 66 13.555 63 14.145 89 14.718 96 15.275 33 | 12.959 52 13.567 14 14.157 07 14.729 81 15.285 87 | 12.971 37 13.578 65 14.168 24 14.740 66 15.296 41 | 12.983 22 13.590 16 14.179 41 14.751 50 15.306 93 | 12.995 06 13.601 65 14.190 57 14.762 34 15.317 45 | 13.006 90 13.613 14 14.201 73 14.773 17 15.327 97 | 13.018 73 13.624 63 14.212 88 14.784 00 15.338 48 | 13.030 55 13.636 10 14.224 02 14.794 81 15.348 98 | 13.042 36 13.647 57 14.235 16 14.805 63 15.359 48 | |
15.774 52 16.300 15 16.810 48 17.305 94 17.786 96 | 15.784 77 16.310 11 16.820 14 17.315 32 17.796 08 | 15.795 02 16.320 06 16.829 80 17.324 70 17.805 18 | 15.805 27 16.330 01 16.839 46 17.334 08 17.814 28 | 15.815 51 16.339 95 16.849 11 17.343 44 17.823 38 | 15.825 74 16.349 88 16.858 75 17.352 81 17.832 47 | 15.835 96 16.359 81 16.868 39 17.362 17 17.841 56 | 15.846 19 16.369 73 16.878 03 17.371 52 17.850 64 | 15.856 40 16.379 65 16.887 66 17.380 87 17.859 71 | 15.866 61 16.389 56 16.897 28 17.390 21 17.868 79 | 15.876 81 16.399 47 16.906 90 17.399 55 17.877 85 | 15.887 01 16.409 37 16.916 51 17.408 88 17.886 91 | 15.897 20 16.419 26 16.926 12 17.418 21 17.895 97 | |
18.253 98 18.707 40 19.147 61 19.575 00 19.989 94 | 18.262 83 18.715 99 19.155 95 19.583 09 19.997 80 | 18.271 67 18.724 57 19.164 28 19.591 18 20.005 65 | 18.280 51 18.733 15 19.172 61 19.599 27 20.013 50 | 18.289 34 18.741 72 19.180 93 19.607 35 20.021 35 | 18.298 16 18.750 29 19.189 25 19.615 43 20.029 19 | 18.306 99 18.758 86 19.197 57 19.623 50 20.037 03 | 18.315 80 18.767 42 19.205 88 19.631 57 20.044 86 | 18.324 61 18.775 97 19.214 18 19.639 63 20.052 69 | 18.333 42 18.784 52 19.222 49 19.647 69 20.060 51 | 18.342 22 18.793 07 19.230 78 19.655 75 20.068 33 | 18.351 02 18.801 61 19.239 07 19.663 80 20.076 15 | 18.359 81 18.810 14 19.247 36 19.671 84 20.083 96 | |
20.392 79 20.783 91 21.164 64 21.532 31 21.890 24 | 20.400 42 20.791 32 21.170 83 21.539 29 21.897 02 | 20.408 05 20.798 72 21.178 02 21.546 27 21.903 79 | 20.415 67 20.806 12 21.185 21 21.553 25 21.910 57 | 20.423 29 20.813 52 21.192 39 21.560 22 21.917 34 | 20.430 90 20.820 91 21.199 56 21.567 19 21.924 10 | 20.438 51 20.828 30 21.206 74 21.574 15 21.930 86 | 20.446 12 20.835 68 21.213 90 21.581 11 21.937 62 | 20.453 72 20.843 06 21.221 07 21.588 06 21.944 37 | 20.461 31 20.850 44 21.228 23 21.595 02 21.951 12 | 20.468 91 20.857 81 21.235 39 21.601 96 21.957 87 | 20.476 49 20.865 18 21.242 54 21.608 91 21.964 61 | 20.484 08 20.872 54 21.249 69 21.615 85 21.971 35 | |
22.237 74 22.575 13 22.902 68 23.220 70 23.529 46 | 22.244 33 22.581 52 22.908 89 23.226 73 23.535 30 | 22.250 90 22.587 91 22.915 09 23.232 75 23.541 15 | 22.257 48 22.594 29 22.921 29 23.238 76 23.546 99 | 22.264 05 22.600 67 22.927 48 23.244 78 23.552 83 | 22.270 62 22.607 05 22.933 67 23.250 79 23.558 67 | 22.277 18 22.613 42 22.939 86 23.256 79 23.564 50 | 22.283 74 22.619 79 22.946 04 23.262 80 23.570 33 | 22.290 30 22.626 15 22.952 22 23.268 80 23.576 15 | 22.296 85 22.632 51 22.958 40 23.274 79 23.581 97 | 22.303 40 22.638 87 22.964 57 23.280 79 23.587 79 | 22.309 95 22.645 23 22.970 74 23.286 78 23.593 61 | 22.316 49 22.651 58 22.976 91 23 292 76 23.599 42 | |
23.829 22 24.120 25 24.402 80 24.677 12 24.943 46 | 23.834 89 24.125 76 24.408 15 24.682 32 24.948 50 | 23.840 57 24.131 27 24.413 50 24.687 51 24.953 55 | 23.846 24 24.136 78 24.418 85 24.692 71 24.958 59 | 23.851 91 24.142 28 24.424 19 24.697 89 24.963 62 | 23.857 58 24.147 78 24.429 53 24.703 08 24.968 66 | 23.863 24 24.153 28 24.434 87 24.708 26 24.973 69 | 23.868 90 24.158 77 24.440 20 24.713 44 24.978 71 | 23.874 55 24.164 26 24.445 53 24.718 61 24.983 74 | 23.880 20 24.169 75 24.450 86 24.723 79 24.988 76 | 23.885 85 24.175 23 24.456 19 24.728 96 24.993 78 | 23.891 50 24.180 72 24.461 51 24.734 12 24.998 80 | 23.897 14 24.186 19 24.466 83 24.739 29 25.003 81 | |
25.202 04 25.453 08 25.696 81 25.933 45 26.163 19 | 25.206 93 25.457 84 25.701 43 25.937 93 26.167 54 | 25.211 83 25.462 59 25.706 05 25.942 41 26.171 89 | 25.216 72 25.467 34 25.710 66 25.946 89 26.176 24 | 25.221 61 25.472 09 25.715 27 25.951 36 26.180 58 | 25.226 50 25.476 83 25.719 87 25.955 84 26.184 93 | 25 231 38 25.481 57 25.724 48 25.960 31 26.189 27 | 25.236 26 25.486 31 25.729 08 25.964 77 26.193 60 | 25.241 14 25.491 05 25.733 68 25.969 24 26.197 94 | 25.246 02 25.495 78 25.738 27 25.973 70 26.202 27 | 25.250 89 25.500 51 25.742 87 25.978 16 26.206 60 | 25.255 76 25.505 24 25.747 46 25.982 62 26.210 93 | 25.260 63 25.509 97 25.752 04 25.987 07 26.215 25 |
Appendix II
0.496 18 | 0.515 12 | 0.534 05 | 0.552 96 | 0.571 87 | 0.590 76 | 0.609 65 | 0.628 52 | 0.647 38 | 0.666 24 | 0.685 08 | 0.703 91 | 0.722 73 | |
1.466 82 2.409 18 3.324 09 4.212 36 5.074 75 | 1.485 20 2.427 03 3.341 42 4.229 19 5.091 09 | 1.503 58 2.444 87 3.358 74 4.246 00 5.107 42 | 1.521 94 2.462 70 3.376 06 4.262 81 5.123 73 | 1.540 30 2.480 52 3.393 36 4.279 61 5.140 04 | 1.558 64 2.498 33 3.410 65 4.296 39 5.156 34 | 1.576 98 2.516 13 3.427 93 4.313 17 5.172 63 | 1.595 30 2.533 92 3.445 20 4.329 94 5.188 91 | 1.613 61 2.551 70 3.462 46 4.346 70 5.205 18 | 1.631 92 2.569 47 3.479 72 4.363 45 5.221 44 | 1.650 21 2.587 23 3.496 96 4.380 19 5.237 70 | 1.668 49 2.604 98 3.514 19 4.396 92 5.253 94 | 1.686 76 2.622 72 3.531 41 4.413 64 5.270 17 | |
5.912 03 6.724 92 7.514 14 8.280 36 9.024 27 | 5.927 89 6.740 32 7.529 08 8.294 88 9.038 36 | 5.943 74 6.755 71 7.544 03 8.309 38 9.052 45 | 5.959 58 6.771 09 7.558 96 8.323 88 9.066 52 | 5.975 42 6.786 46 7.573 88 8.338 37 9.080 59 | 5.991 24 6.801 83 7.588 80 8.352 85 9.094 65 | 6.007 06 6.817 18 7.603 71 8.367 32 9.108 70 | 6.022 86 6.832 53 7.618 60 8.381 79 9.122 74 | 6.038 66 6.847 86 7.633 50 8.396 25 9.136 78 | 6.054 45 6.863 19 7.648 38 8.410 69 9.150 81 | 6.070 23 6.878 51 7.663 25 8.425 13 9.164 83 | 6.086.00 6.893 82 7.678 12 8.439 57 9.178 84 | 6.101 76 6.909 12 7.692 97 8.453 99 9.192 84 | |
9.746 51 10.447 72 11.128 50 11.789 46 12.431 16 | 9.760 19 10.461 00 11.141 40 11.801 98 12.443 32 | 9.773 87 10.474 28 11.154 29 11.814 49 12.455 46 | 9.787 53 10.487 55 11.167 17 11.827 00 12.467 61 | 9.801 19 10.500 81 11.180 04 11.839 49 12.479 74 | 9.814 84 10.514 06 11.192 91 11.851 99 12.491 87 | 9.828 48 10.527 30 11.205 77 11.864 47 12.503 99 | 9.842 12 10.540 54 11.218 62 11.876 95 12.516 10 | 9.855 75 10.553 77 11.231 46 11.889 42 12.528 21 | 9.869 36 10.566 99 11.244 30 11.901 88 12.540 31 | 9.882 98 10.580 21 11.257 13 11.914 34 12.552 40 | 9.896 58 10.593 41 11.269 95 11.926 79 12.564 49 | 9.910 18 10.606 61 11.282 77 11.939 23 12.576 57 | |
13.054 17 13.659 04 14.246 29 14.816 43 15.369 97 | 13.065 97 13.670 50 14.257 41 14.827 23 15.380 46 | 13.077 77 13.681 95 14.268 53 14.838 03 15.390 94 | 13.089 56 13.693 39 14.279 64 14.848 81 15.401 41 | 13.101 34 13.704 83 14.290 75 14.859 60 15.411 88 | 13.113 11 13.716 26 14.301 84 14.870 37 15.422 34 | 13.124 88 13.727 69 14.312 94 14.881 14 15.432 79 | 13.136 64 13.739 11 14.324 02 14.891 90 15.443 24 | 13.148 40 13.750 52 14.335 10 14.902 66 15.453 69 | 13.160 14 13.761 92 14.346 18 14.913 41 15.464 13 | 13.171 89 13.773 32 14.357 24 14.924 16 15.474 56 | 13.183 62 13.784 72 14.368 30 14.934 90 15.484 98 | 13.195 35 13.796 10 14.379 36 14.945 63 15.495 40 | |
15.907 39 16.429 15 16.935 72 17.427 53 17.905 02 | 15.917 57 16.439 03 16.945 31 17.436 84 17.914 06 | 15.927 74 16.448 91 16.954 90 17.446 16 17.923 10 | 15.937 91 16.458 78 16.964 49 17.455 46 17.932 14 | 15.948 07 16.468 65 16.974 07 17.464 76 17.941 16 | 15.958 23 16.478 51 16.983 64 17.474 06 17.950 19 | 15.968 38 16.488 37 16.993 21 17.483 35 17.959 21 | 15.978 53 16.498 22 17.002 77 17.492 63 17.968 22 | 15.988 67 16.508 06 17.012 33 17.501 91 17.977 23 | 15.998 80 16.517 90 17.021 88 17.511 18 17.986 23 | 16.008 93 16.527 73 17.031 43 17.520 45 17.995 23 | 16.019 05 16.537 56 17.040 97 17.529 72 18.004 23 | 16.029 17 16.547 38 17.050 51 17.538 97 18.013 22 | |
18.368 60 18.818 67 19.255 64 19.679 88 20.091 77 | 18.377 38 18.827 20 19.263 92 19.687 92 20.099 57 | 18.386 15 18.835 72 19.272 19 19.695 95 20.107 37 | 18.394 93 18.844 24 19.280 46 19.703 98 20.115 16 | 18.403 69 18.852 75 19.288 72 19.712 00 20.122 95 | 18.412 45 18.861 25 19.296 98 19.720 02 20.130 73 | 18.421 21 18.869 75 19.305 24 19.728 03 20.138 51 | 18.429 96 18.878 25 19.313 48 19.736 04 20.146 29 | 18.438 71 18.886 74 19.321 73 19.744 05 20.154 06 | 18.447 45 18.895 23 19.329 97 19.752 04 20.161 83 | 18.456 19 18.903 71 19.338 20 19.760 04 20.169 59 | 18.464 92 18.912 19 19.346 43 19.768 03 20.177 35 | 18.473 64 18.920 66 19.354 66 19.776 02 20.185 10 | |
20.491 66 20.879 90 21.256 83 21.622 78 21.978 08 | 20.499 23 20.887 25 21.263 97 21.629 72 21.984 81 | 20.506 80 20.894 60 21.271 11 21.636 64 21.991 54 | 20.514 37 20.901 95 21.278 24 21.643 57 21.998 26 | 20.521 93 20.909 29 21.285 37 21.650 49 22.004 98 | 20.529 49 20.916 63 21.292 49 21.657 41 22.011 69 | 20.537 04 20.923 96 21.299 61 21.664 32 22.018 40 | 20.544 59 20.931 29 21.306 73 21.671 23 22.025 11 | 20.552 13 20.938 61 21.313 84 21.678 13 22.031 81 | 20.559 68 20.945 94 21.320 94 21.685 03 22.038 51 | 20.567 21 20.953 25 21.328 05 21.691 93 22.045 21 | 20.574 74 20.960 56 21.335 15 21.698 82 22.051 90 | 20.582 27 20.967 87 21.342 24 21.705 71 22.058 59 | |
22.323 03 22.657 93 22.983 07 23.298 75 23.605 23 | 22.329 56 22.664 27 22.989 23 23.304 73 23.611 03 | 22.336 09 22.670 61 22.995 39 23.310 70 23.616 84 | 22.342 62 22.676 95 23.001 54 23.316 68 23.622 64 | 22.349 14 22.683 28 23.007 69 23.322 65 23.628 43 | 22.355 66 22.689 61 23.013 83 23.328 61 23.634 22 | 22.362 18 22.695 94 23.019 97 23.334 57 23.640 01 | 22.368 69 22.702 26 23.026 11 23.340 53 23.645 80 | 22.375 20 22.708 58 23.032 25 23.346 49 23.651 58 | 22.381 70 22.714 89 23.038 38 23.352 44 23.657 36 | 22.388 20 22.721 20 23.044 51 23.358 39 23.663 14 | 22.394 70 22.727 51 23.050 63 23.364 34 23.668 91 | 22.401 19 22.733 82 23.056 75 23.370 28 23.674 68 | |
23.902 78 24.191 67 24.472 14 24.744 45 25.008 82 | 23.908 42 24.197 14 24.477 46 24.749 61 25.013 83 | 23.914 05 24.202 61 24.482 77 24.754 76 25.018 83 | 23.919 68 24.208 08 24.488 07 24.759 91 25.023 84 | 23.925 31 24.213 54 24.493 38 24.765 06 25.028 84 | 23.930 93 24.219 00 24.498 68 24.770 21 25.033 83 | 23.936 55 24.224 46 24.503 98 24.775 35 25.038 83 | 23.942 17 24.229 91 24.509 27 24.780 49 25.043 82 | 23.947 78 24.235 36 24.514 56 24.785 63 25.048 80 | 23.953 40 24.240 81 24.519 85 24.790 77 25.053 79 | 23.959 00 24.246 25 24.525 14 24.795 90 25.058 77 | 23.964 61 24.251 69 24.530 42 24.801 03 25.063 75 | 23.970 21 24.257 13 24.535 70 24.806 15 25.068 73 | |
25.265 49 25.514 69 25.756 63 25.991 52 26.219 57 | 25.270 36 25.519 41 25.761 21 25.995 97 26.223 89 | 25.275 22 25.524 13 25.765 79 26.000 42 26.228 21 | 25.280 07 25.528 84 25.770 37 26.004 86 26.232 53 | 25.284 93 25.533 56 25.774 95 26.009 31 26.236 84 | 25.289 78 25.538 27 25.779 52 26.013 74 26.241 15 | 25.294 63 25.542 97 25.784 09 26.018 18 26.245 46 | 25.299 47 25.547 68 25.788 66 26.022 62 26.249 76 | 25.304 31 25.552 38 25.793 22 26.027 05 26.254 06 | 25.309 15 25.557 08 25.797 78 26.031 48 26.258 36 | 25.313 99 25.561 78 25.802 34 26.035 90 26.262 66 | 25.318 83 25.566 47 25.806 90 26.040 33 26.266 96 | 25.323 66 25.571 16 25.811 45 26.044 75 26.271 25 |
Appendix II
Years | 39 $ | 40 $ | 41 $ | 42 $ | 43 $ | 44 $ | 45 $ | 46 $ | 47 $ | 48 $ | 49 $ | 50 $ | 51 $ |
0.741 54 | 0.760 34 | 0.779 12 | 0.797 90 | 0.816 67 | 0.835 42 | 0.854 17 | 0.872 90 | 0.891 63 | 0.910 34 | 0.929 04 | 0.947 73 | 0.966 41 | |
1.705 02 2.640 45 3.548 63 4.430 35 5.286 40 | 1.723 27 2.658 17 3.565 83 4.447 06 5.302 62 | 1.741 52 2.675 88 3.583 02 4.463 75 5.318 82 | 1.759 75 2.693 58 3.600 21 4.480 43 5.335 02 | 1.777 97 2.711 27 3.617 38 4.497 11 5.351 21 | 1.796 17 2.728 94 3.634 55 4.513 77 5.367 39 | 1.814 37 2.746 61 3.651 70 4.530 42 5.383 56 | 1.832 56 2.764 27 3.668 84 4.547 07 5.399 72 | 1.850 74 2.781 92 3.685 98 4.563 71 5.415 87 | 1.868 91 2.799 56 3.703 10 4.580 33 5.432 01 | 1.887 07 2.817 19 3.720 22 4.596 95 5.448 14 | 1.905 21 2.834 81 3.737 33 4.613 56 5.464 27 | 1.923 35 2.852 42 3.754 42 4.630 15 5.480 38 | |
6.117 51 6.924 42 7.707 82 8.468 41 9.206 84 | 6.133 26 6.939 70 7.722 66 8.482 81 9.220 83 | 6.148 99 6.954 98 7.737 49 8.497 21 9.234 81 | 6.164 72 6.970 25 7.752 31 8.511 60 9.248 78 | 6.180 43 6.985 50 7.767 13 8.525 99 9.262 74 | 6.196 14 7.000 75 7.781 93 8.540 36 9.276 70 | 6.211 84 7.016 00 7.796 73 8.554 73 9.290 65 | 6.227 53 7.031 23 7.811 52 8.569 09 9.304 59 | 6.243 21 7.046 45 7.826 30 8.583 44 9.318 52 | 6.258 88 7.061 67 7.841 07 8.597 78 9.332 44 | 6.274 54 7.076 88 7.855 84 8.612 11 9.346 36 | 6.290 20 7.092 07 7.870 59 8.626 44 9.360 27 | 6.305 84 7.107 26 7.885 34 8.640 76 9.374 17 | |
9.923 76 10.619 81 11.295 58 11.951 66 12.588 64 | 9.937 34 10.632 99 11.308 38 11.964 09 12.600 71 | 9.950 92 10.646 17 11.321 17 11.976 51 12.612 77 | 9.964 48 10.659 34 11.333 96 11.988 93 12.624 82 | 9.978 04 10.672 50 11.346 74 12.001 33 12.636 87 | 9.991 59 10.685 66 11.359 51 12.013 73 12.648 90 | 10.005 13 10.698 80 11.372 27 12.026 13 12.660 94 | 10.018 66 10.711 94 11.385 03 12.038 51 12.672 96 | 10.032 19 10.725 08 11.397 78 12.050 89 12.684 98 | 10.045 71 10.738 20 11.410 52 12.063 26 12.696 99 | 10.059 22 10.751 32 11.423 26 12.075 63 12.709 00 | 10.072 72 10.764 43 11.435 99 12.087 99 12.720 99 | 10.086 22 10.777 53 11.448 71 12.100 34 12.732 98 | |
13.207 07 13.807 48 14.390 41 14.956 35 15.505 82 | 13.218 78 13.818 86 14.401 45 14.967 08 15.516 23 | 13.230 49 13.830 22 14.412 49 14.977 79 15.526 63 | 13.242 19 13.841 58 14.423 52 14.988 50 15.537 03 | 13.253 89 13.852 94 14.434 54 14.999 20 15.547 42 | 13.265 58 13.864 28 14.445 56 15.009 90 15.557 80 | 13.277 26 13.875 63 14.456 57 15.020 59 15.568 18 | 13.288 93 13.886 96 14.467 57 15.031 27 15.578 55 | 13.300 60 13.898 29 14.478 57 15.041 95 15.588 92 | 13.312 26 13.909 61 14.489 56 15.052 62 15.599 28 | 13.323 92 13.920 93 14.500 55 15.063 29 15.609 63 | 13.335 56 13.932 23 14.511 53 15.073 95 15.619 98 | 13.347 21 13.943 54 14.522 50 15.084 60 15.630 33 | |
16.039 28 16.557 20 17.060 04 17.548 23 18.022 20 | 16.049 38 16.567 01 17.069 56 17.557 47 18.031 18 | 16.059 48 16.576 82 17.079 08 17.566 72 18.040 15 | 16.069 58 16.586 61 17.088 59 17.575 95 18.049 12 | 16.079 66 16.596 41 17.098 10 17.585 19 18.058 08 | 16.089 75 16.606 20 17.107 61 17.594 41 18.067 04 | 16.099 82 16.615 98 17.117 10 17.603 63 18.075 99 | 16.109 89 16.625 76 17.126 60 17.612 85 18.084 94 | 16.119 96 16.635 53 17.136 08 17.622 06 18.093 88 | 16.130 02 16.645 30 17.145 57 17.631 27 18.102 82 | 16.140 07 16.655 06 17.155 04 17.640 47 18.111 75 | 16.150 12 16.664 81 17.164 51 17.649 66 18.120 68 | 16.160 16 16.674 56 17.173 98 17.658 85 18.129 60 | |
18.482 37 18.929 13 19.362 88 19.784 00 20.192 85 | 18.491 08 18.937 59 19.371 10 19.791 98 20.200 60 | 18.499 79 18.946 05 19.379 31 19.799 95 20.208 34 | 18.508 50 18.954 50 19.387 52 19.807 92 20.216 07 | 18.517 20 18.962 95 19.395 72 19.815 88 20.223 80 | 18.525 90 18.971 40 19.403 92 19.823 84 20.231 53 | 18.534 59 18.979 83 19.412 11 19.831 79 20.239 25 | 18.543 28 18.988 27 19.420 30 19.839 74 20.246 97 | 18.551 96 18.996 70 19.428 48 19.847 69 20.254 69 | 18.560 64 19.005 12 19.436 66 19.855 63 20.262 39 | 18.569 31 19.013 54 19.444 83 19.863 57 20.270 10 | 18.577 98 19.021 96 19.453 00 19.871 50 20.277 80 | 18.586 64 19.030 37 19.461 17 19.879 42 20.285 50 | |
20.589 79 20.975 18 21.349 33 21.712 59 22.065 27 | 20.597 31 20.982 48 21.356 42 21.719 48 22.071 96 | 20.604 83 20.989 77 21.363 51 21.726 35 22.078 63 | 20.612 34 20.997 07 21.370 59 21.733 23 22.085 31 | 20.619 85 21.004 35 21.377 66 21.740 10 22.091 97 | 20.627 35 21.011 64 21.384 73 21.746 96 22.098 64 | 20.634 85 21.018 92 21.391 80 21.753 82 22.105 30 | 20.642 34 21.026 19 21.398 86 21.760 68 22.111 96 | 20.649 83 21.033 46 21.405 92 21.767 53 22.118 61 | 20.657 31 21.040 73 21.412 98 21.774 38 22.125 26 | 20.664 79 21.047 99 21.420 03 21.781 23 22.131 91 | 20.672 27 21.055 25 21.427 08 21.788 07 22.138 55 | 20.679 74 21.062 51 21.434 12 21.794 91 22.145 19 | |
22.407 68 22.740 12 23.062 87 23.376 22 23.680 44 | 22.414 17 22.746 41 23.068 98 23.382 15 23.686 21 | 22.420 65 22.752 71 23.075 09 23.388 09 23.691 97 | 22.427 13 22.759 00 23.081 20 23.394 02 23.697 72 | 22.433 60 22.765 28 23.087 30 23.399 94 23.703 48 | 22.440 08 22.771 57 23.093 40 23.405 86 23.709 22 | 22.446 54 22.777 85 23.099 50 23.411 78 23.714 97 | 22.453 01 22.784 12 23.105 59 23.417 70 23.720 71 | 22.459 47 22.790 39 23.111 68 23.423 61 23.726 45 | 22.465 92 22.796 66 23.117 77 23.429 52 23.732 19 | 22.472 38 22.802 93 23.123 85 23.435 42 23.737 92 | 22.478 83 22.809 19 23.129 93 23.441 33 23.743 65 | 22.485 27 22.815 45 23.136 00 23.447 22 23.749 38 | |
23.975 81 24.262 57 24.540 98 24.811 28 25.073 70 | 23.981 40 24.268 00 24.546 25 24.816 40 25.078 67 | 23.986 99 24.273 43 24.551 52 24.821 51 25.083 64 | 23.992 58 24.278 85 24.556 79 24.826 63 25.088 61 | 23.998 17 24.284 28 24.562 05 24.831 74 25.093 57 | 24.003 75 24.289 70 24.567 32 24.836 85 25.098 53 | 24.009 33 24.295 11 24.572 57 24.841 95 25.103 49 | 24.014 90 24.300 53 24.577 83 24.847 06 25.108 44 | 24.020 48 24.305 94 24.583 08 24.852 16 25.113 39 | 24.026 05 24.311 34 24.588 33 24.857 25 25.118 34 | 24.031 61 24.316 75 24.593 58 24.862 35 25.123 29 | 24.037 18 24.322 15 24.598 82 24.867 44 25.128 23 | 24.042 74 24.327 55 24.604 06 24.872 53 25.133 17 | |
25.328 49 25.575 85 25.816 01 26.049 17 26.275 54 | 25.333 31 25.580 53 25.820 55 26.053 59 26.279 83 | 25.338 14 25.585 22 25.825 10 26.058 00 26.284 11 | 25.342 96 25.589 90 25.829 65 26.062 41 26.288 40 | 25.347 77 25.594 57 25.834 19 26.066 82 26.292 68 | 25.352 59 25.599 25 25.838 73 26.071 23 26.296 96 | 25.357 40 25.603 92 25.843 26 26.075 63 26.301 23 | 25.362 21 25.608 59 25.847 80 26.080 03 26.305 51 | 25.367 02 25.613 26 25.852 33 26.084 43 26.309 78 | 25.371 82 25.617 92 25.856 86 26.088 83 26.314 05 | 25.376 63 25.622 59 25.861 38 26.093 22 26.318 31 | 25.381 42 25.627 24 25.865 91 26.097 61 26.322 57 | 25.386 22 25.631 90 25.870 43 26.102 00 26.326 84 |
[r. 19E]
January, 1988
It is recommended that the following procedure be used to assess binaural percentage loss of hearing.
1. Measure the hearing threshold levels (HTLs) of the person at the audiometric frequencies 500, 1000, 1500, 2000, 3000 and 4000 Hz.
2. Determine the better and worse ears at each of these frequencies. At a particular frequency, the better ear is the ear with the smaller HTL. The better ear at one frequency may be the worse at another.
3. Using the HTLs of the better and worse ears, read the percentage loss of hearing (PLH) at each frequency from the appropriate table (Table RB‑500, RB‑1000, RB‑1500, RB‑2000, RB‑3000 or RB‑4000) and add these 6 values together to obtain the overall binaural PLH.
500 40 10 10 40 1.7 1000 45 25 25 45 4.2 1500 50 40 40 50 7.1 2000 55 55 55 55 8.4 3000 60 70 60 70 6.5 4000 65 85 65 85 7.1 |
Overall Binaural PLH = 35.0% |
£15 | 20 | 25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | £95 | |
£15 | 0 | ||||||||||||||||
20 | 0.4 | 0.6 | |||||||||||||||
25 | 0.6 | 1.0 | 1.4 | ||||||||||||||
30 | 1.0 | 1.4 | 2.0 | 2.8 | |||||||||||||
35 | 1.3 | 1.8 | 2.5 | 3.4 | 4.5 | ||||||||||||
40 | 1.7 | 2.2 | 3.0 | 3.9 | 5.1 | 6.4 | |||||||||||
45 | 2.0 | 2.6 | 3.4 | 4.3 | 5.5 | 6.8 | 8.1 | ||||||||||
50 | 2.3 | 2.9 | 3.7 | 4.7 | 5.8 | 7.1 | 8.4 | 9.7 | |||||||||
55 | 2.5 | 3.2 | 4.0 | 5.0 | 6.1 | 7.3 | 8.6 | 9.9 | 11.2 | ||||||||
60 | 2.7 | 3.4 | 4.2 | 5.2 | 6.3 | 7.5 | 8.8 | 10.0 | 11.3 | 12.6 | |||||||
65 | 2.8 | 3.5 | 4.4 | 5.4 | 6.5 | 7.7 | 8.9 | 10.2 | 11.5 | 12.7 | 14.0 | ||||||
70 | 2.9 | 3.7 | 4.5 | 5.5 | 6.6 | 7.8 | 9.1 | 10.3 | 11.6 | 12.9 | 14.2 | 15.5 | |||||
75 | 3.0 | 3.8 | 4.7 | 5.7 | 6.8 | 8.0 | 9.2 | 10.5 | 11.8 | 13.1 | 14.5 | 15.7 | 16.9 | ||||
80 | 3.1 | 3.9 | 4.8 | 5.8 | 6.9 | 8.1 | 9.3 | 10.6 | 12.0 | 13.3 | 14.7 | 16.0 | 17.2 | 18.2 | |||
85 | 3.2 | 4.0 | 4.9 | 5.9 | 7.0 | 8.2 | 9.4 | 10.7 | 12.1 | 13.5 | 14.9 | 16.2 | 17.4 | 18.4 | 19.1 | ||
90 | 3.4 | 4.1 | 5.0 | 6.0 | 7.1 | 8.3 | 9.5 | 10.8 | 12.2 | 13.6 | 15.0 | 16.3 | 17.6 | 18.5 | 19.2 | 19.7 | |
£95 | 3.4 | 4.2 | 5.1 | 6.1 | 7.1 | 8.3 | 9.5 | 10.8 | 12.2 | 13.6 | 15.0 | 16.4 | 17.6 | 18.6 | 19.3 | 19.7 | 20.0 |
£15 | 20 | 25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | £95 | |
£15 | 0 | ||||||||||||||||
20 | 0.5 | 0.8 | |||||||||||||||
25 | 0.8 | 1.2 | 1.8 | ||||||||||||||
30 | 1.2 | 1.7 | 2.5 | 3.5 | |||||||||||||
35 | 1.7 | 2.3 | 3.1 | 4.3 | 5.7 | ||||||||||||
40 | 2.1 | 2.8 | 3.7 | 4.9 | 6.3 | 8.0 | |||||||||||
45 | 2.5 | 3.3 | 4.2 | 5.4 | 6.9 | 8.5 | 10.2 | ||||||||||
50 | 2.8 | 3.6 | 4.7 | 5.9 | 7.3 | 8.8 | 10.5 | 12.1 | |||||||||
55 | 3.1 | 3.9 | 5.0 | 6.2 | 7.6 | 9.1 | 10.7 | 12.4 | 14.0 | ||||||||
60 | 3.3 | 4.2 | 5.3 | 6.5 | 7.9 | 9.4 | 11.0 | 12.6 | 14.2 | 15.7 | |||||||
65 | 3.5 | 4.4 | 5.5 | 6.7 | 8.1 | 9.6 | 11.2 | 12.8 | 14.4 | 15.9 | 17.5 | ||||||
70 | 3.7 | 4.6 | 5.7 | 6.9 | 8.3 | 9.8 | 11.3 | 12.9 | 14.6 | 16.2 | 17.8 | 19.4 | |||||
75 | 3.8 | 4.7 | 5.8 | 7.1 | 8.5 | 10.0 | 11.5 | 13.1 | 14.8 | 16.4 | 18.1 | 19.7 | 21.1 | ||||
80 | 3.9 | 4.9 | 6.0 | 7.3 | 8.6 | 10.1 | 11.7 | 13.3 | 15.0 | 16.7 | 18.4 | 20.0 | 21.5 | 22.7 | |||
85 | 4.1 | 5.0 | 6.2 | 7.4 | 8.8 | 10.3 | 11.8 | 13.4 | 15.1 | 16.9 | 18.6 | 20.3 | 21.7 | 23.0 | 23.9 | ||
90 | 4.2 | 5.2 | 6.3 | 7.5 | 8.9 | 10.3 | 11.9 | 13.5 | 15.2 | 17.0 | 18.7 | 20.4 | 21.9 | 23.2 | 24.1 | 24.6 | |
£95 | 4.3 | 5.3 | 6.4 | 7.6 | 8.9 | 10.3 | 11.9 | 13.5 | 15.2 | 17.0 | 18.7 | 20.5 | 22.0 | 23.3 | 24.2 | 24.7 | 25.0 |
£15 | 20 | 25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | £95 | |
£15 | 0 | ||||||||||||||||
20 | 0.4 | 0.6 | |||||||||||||||
25 | 0.6 | 1.0 | 1.4 | ||||||||||||||
30 | 1.0 | 1.4 | 2.0 | 2.8 | |||||||||||||
35 | 1.3 | 1.8 | 2.5 | 3.4 | 4.5 | ||||||||||||
40 | 1.7 | 2.2 | 3.0 | 3.9 | 5.1 | 6.4 | |||||||||||
45 | 2.0 | 2.6 | 3.4 | 4.3 | 5.5 | 6.8 | 8.1 | ||||||||||
50 | 2.3 | 2.9 | 3.7 | 4.7 | 5.8 | 7.1 | 8.4 | 9.7 | |||||||||
55 | 2.5 | 3.2 | 4.0 | 5.0 | 6.1 | 7.3 | 8.6 | 9.9 | 11.2 | ||||||||
60 | 2.7 | 3.4 | 4.2 | 5.2 | 6.3 | 7.5 | 8.8 | 10.0 | 11.3 | 12.6 | |||||||
65 | 2.8 | 3.5 | 4.4 | 5.4 | 6.5 | 7.7 | 8.9 | 10.2 | 11.5 | 12.7 | 14.0 | ||||||
70 | 2.9 | 3.7 | 4.5 | 5.5 | 6.6 | 7.8 | 9.1 | 10.3 | 11.6 | 12.9 | 14.2 | 15.5 | |||||
75 | 3.0 | 3.8 | 4.7 | 5.7 | 6.8 | 8.0 | 9.2 | 10.5 | 11.8 | 13.1 | 14.5 | 15.7 | 16.9 | ||||
80 | 3.1 | 3.9 | 4.8 | 5.8 | 6.9 | 8.1 | 9.3 | 10.6 | 12.0 | 13.3 | 14.7 | 16.0 | 17.2 | 18.2 | |||
85 | 3.2 | 4.0 | 4.9 | 5.9 | 7.0 | 8.2 | 9.4 | 10.7 | 12.1 | 13.5 | 14.9 | 16.2 | 17.4 | 18.4 | 19.1 | ||
90 | 3.4 | 4.1 | 5.0 | 6.0 | 7.1 | 8.3 | 9.5 | 10.8 | 12.2 | 13.6 | 15.0 | 16.3 | 17.6 | 18.5 | 19.2 | 19.7 | |
£95 | 3.4 | 4.2 | 5.1 | 6.1 | 7.1 | 8.3 | 9.5 | 10.8 | 12.2 | 13.6 | 15.0 | 16.4 | 17.6 | 18.6 | 19.3 | 19.7 | 20.0 |
£15 | 20 | 25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | £95 | |
£15 | 0 | ||||||||||||||||
20 | 0.3 | 0.5 | |||||||||||||||
25 | 0.5 | 0.7 | 1.1 | ||||||||||||||
30 | 0.7 | 1.0 | 1.5 | 2.1 | |||||||||||||
35 | 1.0 | 1.4 | 1.9 | 2.5 | 3.4 | ||||||||||||
40 | 1.3 | 1.7 | 2.2 | 2.9 | 3.8 | 4.8 | |||||||||||
45 | 1.5 | 1.9 | 2.5 | 3.3 | 4.1 | 5.1 | 6.1 | ||||||||||
50 | 1.7 | 2.2 | 2.8 | 3.5 | 4.4 | 5.3 | 6.3 | 7.3 | |||||||||
55 | 1.9 | 2.4 | 3.0 | 3.7 | 4.6 | 5.5 | 6.4 | 7.4 | 8.4 | ||||||||
60 | 2.0 | 2.5 | 3.1 | 3.9 | 4.7 | 5.6 | 6.6 | 7.5 | 8.5 | 9.4 | |||||||
65 | 2.1 | 2.6 | 3.3 | 4.0 | 4.9 | 5.7 | 6.7 | 7.6 | 8.6 | 9.6 | 10.5 | ||||||
70 | 2.2 | 2.7 | 3.4 | 4.1 | 5.0 | 5.9 | 6.8 | 7.8 | 8.7 | 9.7 | 10.7 | 11.6 | |||||
75 | 2.3 | 2.8 | 3.5 | 4.3 | 5.1 | 6.0 | 6.9 | 7.9 | 8.9 | 9.9 | 10.8 | 11.8 | 12.7 | ||||
80 | 2.4 | 2.9 | 3.6 | 4.4 | 5.2 | 6.1 | 7.0 | 8.0 | 9.0 | 10.0 | 11.0 | 12.0 | 12.9 | 13.6 | |||
85 | 2.4 | 3.0 | 3.7 | 4.4 | 5.3 | 6.1 | 7.1 | 8.1 | 9.1 | 10.1 | 11.1 | 12.1 | 13.0 | 13.8 | 14.3 | ||
90 | 2.5 | 3.1 | 3.8 | 4.5 | 5.3 | 6.2 | 7.1 | 8.1 | 9.1 | 10.2 | 11.2 | 12.2 | 13.2 | 13.9 | 14.4 | 14.8 | |
£95 | 2.6 | 3.2 | 3.8 | 4.6 | 5.4 | 6.2 | 7.1 | 8.1 | 9.1 | 10.2 | 11.3 | 12.3 | 13.2 | 14.0 | 14.5 | 14.8 | 15.0 |
£15 | 20 | 25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | £95 | |
£15 | 0 | ||||||||||||||||
20 | 0.2 | 0.3 | |||||||||||||||
25 | 0.3 | 0.5 | 0.7 | ||||||||||||||
30 | 0.5 | 0.7 | 1.0 | 1.4 | |||||||||||||
35 | 0.7 | 0.9 | 1.2 | 1.7 | 2.3 | ||||||||||||
40 | 0.8 | 1.1 | 1.5 | 2.0 | 2.5 | 3.2 | |||||||||||
45 | 1.0 | 1.3 | 1.7 | 2.2 | 2.7 | 3.4 | 4.1 | ||||||||||
50 | 1.1 | 1.4 | 1.9 | 2.3 | 2.9 | 3.5 | 4.2 | 4.8 | |||||||||
55 | 1.2 | 1.6 | 2.0 | 2.5 | 3.0 | 3.6 | 4.3 | 4.9 | 5.6 | ||||||||
60 | 1.3 | 1.7 | 2.1 | 2.6 | 3.1 | 3.7 | 4.4 | 5.0 | 5.6 | 6.3 | |||||||
65 | 1.4 | 1.8 | 2.2 | 2.7 | 3.2 | 3.8 | 4.4 | 5.1 | 5.7 | 6.4 | 7.0 | ||||||
70 | 1.5 | 1.8 | 2.3 | 2.8 | 3.3 | 3.9 | 4.5 | 5.2 | 5.8 | 6.5 | 7.1 | 7.7 | |||||
75 | 1.5 | 1.9 | 2.3 | 2.8 | 3.4 | 4.0 | 4.6 | 5.2 | 5.9 | 6.6 | 7.2 | 7.8 | 8.4 | ||||
80 | 1.6 | 2.0 | 2.4 | 2.9 | 3.4 | 4.0 | 4.7 | 5.3 | 6.0 | 6.6 | 7.3 | 8.0 | 8.6 | 9.1 | |||
85 | 1.6 | 2.0 | 2.5 | 3.0 | 3.5 | 4.1 | 4.7 | 5.4 | 6.0 | 6.7 | 7.4 | 8.1 | 8.7 | 9.2 | 9.5 | ||
90 | 1.7 | 2.1 | 2.5 | 3.0 | 3.5 | 4.1 | 4.7 | 5.4 | 6.1 | 6.8 | 7.5 | 8.2 | 8.8 | 9.2 | 9.6 | 9.8 | |
£95 | 1.7 | 2.1 | 2.6 | 3.0 | 3.6 | 4.1 | 4.7 | 5.4 | 6.1 | 6.8 | 7.5 | 8.2 | 8.8 | 9.3 | 9.6 | 9.8 | 10.0 |
£20 | 25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | £95 | |
£20 | 0 | |||||||||||||||
25 | 0.1 | 0.2 | ||||||||||||||
30 | 0.2 | 0.3 | 0.5 | |||||||||||||
35 | 0.3 | 0.4 | 0.6 | 0.9 | ||||||||||||
40 | 0.4 | 0.5 | 0.8 | 1.0 | 1.5 | |||||||||||
45 | 0.5 | 0.7 | 0.9 | 1.2 | 1.6 | 2.1 | ||||||||||
50 | 0.6 | 0.8 | 1.0 | 1.4 | 1.7 | 2.2 | 2.6 | |||||||||
55 | 0.6 | 0.8 | 1.1 | 1.5 | 1.8 | 2.2 | 2.7 | 3.1 | ||||||||
60 | 0.7 | 0.9 | 1.2 | 1.5 | 1.9 | 2.3 | 2.7 | 3.2 | 3.6 | |||||||
65 | 0.7 | 1.0 | 1.3 | 1.6 | 2.0 | 2.4 | 2.8 | 3.2 | 3.6 | 4.0 | ||||||
70 | 0.8 | 1.0 | 1.3 | 1.6 | 2.0 | 2.4 | 2.8 | 3.2 | 3.7 | 4.1 | 4.5 | |||||
75 | 0.8 | 1.1 | 1.4 | 1.7 | 2.1 | 2.5 | 2.9 | 3.3 | 3.7 | 4.1 | 4.5 | 4.9 | ||||
80 | 0.9 | 1.1 | 1.4 | 1.7 | 2.1 | 2.5 | 2.9 | 3.3 | 3.8 | 4.2 | 4.6 | 5.0 | 5.3 | |||
85 | 0.9 | 1.2 | 1.4 | 1.8 | 2.1 | 2.5 | 2.9 | 3.4 | 3.8 | 4.3 | 4.7 | 5.1 | 5.4 | 5.7 | ||
90 | 0.9 | 1.2 | 1.5 | 1.8 | 2.2 | 2.6 | 3.0 | 3.4 | 3.8 | 4.3 | 4.7 | 5.1 | 5.5 | 5.7 | 5.9 | |
£95 | 1.0 | 1.2 | 1.5 | 1.8 | 2.2 | 2.6 | 3.0 | 3.4 | 3.9 | 4.3 | 4.8 | 5.2 | 5.5 | 5.7 | 5.9 | 6.0 |
£25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | 90 | £95 | |
£25 | 0 | ||||||||||||||
30 | 0.1 | 0.2 | |||||||||||||
35 | 0.2 | 0.3 | 0.4 | ||||||||||||
40 | 0.3 | 0.4 | 0.5 | 0.7 | |||||||||||
45 | 0.3 | 0.4 | 0.6 | 0.8 | 1.0 | ||||||||||
50 | 0.4 | 0.5 | 0.7 | 0.9 | 1.1 | 1.3 | |||||||||
55 | 0.4 | 0.5 | 0.7 | 0.9 | 1.1 | 1.3 | 1.5 | ||||||||
60 | 0.4 | 0.6 | 0.7 | 0.9 | 1.1 | 1.4 | 1.6 | 1.8 | |||||||
65 | 0.5 | 0.6 | 0.8 | 1.0 | 1.2 | 1.4 | 1.6 | 1.8 | 2.0 | ||||||
70 | 0.5 | 0.6 | 0.8 | 1.0 | 1.2 | 1.4 | 1.6 | 1.8 | 2.0 | 2.2 | |||||
75 | 0.5 | 0.7 | 0.8 | 1.0 | 1.2 | 1.4 | 1.7 | 1.9 | 2.1 | 2.3 | 2.5 | ||||
80 | 0.6 | 0.7 | 0.9 | 1.1 | 1.3 | 1.5 | 1.7 | 1.9 | 2.1 | 2.3 | 2.5 | 2.7 | |||
85 | 0.6 | 0.7 | 0.9 | 1.1 | 1.3 | 1.5 | 1.7 | 1.9 | 2.1 | 2.3 | 2.5 | 2.7 | 2.8 | ||
90 | 0.6 | 0.7 | 0.9 | 1.1 | 1.3 | 1.5 | 1.7 | 1.9 | 2.2 | 2.4 | 2.6 | 2.7 | 2.8 | 2.9 | |
£95 | 0.6 | 0.8 | 0.9 | 1.1 | 1.3 | 1.5 | 1.7 | 1.9 | 2.2 | 2.4 | 2.6 | 2.7 | 2.8 | 2.9 | 3.0 |
January, 1988
These tables replace Table RB‑4000 in the binaural tables given in Appendix 3 when it is necessary to determine binaural PLH over the range 500 to 8000 Hz. The weighting of 10% given to 4000 Hz in Appendix 3 has been split between 4000, 6000 and 8000 Hz, with 4000 Hz receiving 6%, 6000 Hz 3% and 8000 Hz 1%. When determining binaural PLH over the range 500 to 8000 Hz, the appropriate tables from Appendix 3 are used for the frequencies 500, 1000, 1500, 2000 and 3000 Hz and the relevant tables given in this Appendix are used for the frequencies 4000, 6000 and 8000 Hz.
500 | 40 | 10 | 10 | 40 | 1.7 |
1000 | 45 | 25 | 25 | 45 | 4.2 |
1500 | 50 | 40 | 40 | 50 | 7.1 |
2000 | 55 | 55 | 55 | 55 | 8.4 |
3000 | 60 | 70 | 60 | 70 | 6.5 |
4000 | 65 | 85 | 65 | 85 | 4.3 |
6000 | 55 | 75 | 55 | 75 | 1.7 |
8000 | 45 | 65 | 45 | 65 | 0.4 |
Overall Binaural PLH = 34.3% | |||||
£30 | 35 | 40 | 45 | 50 | 55 | 60 | 65 | 70 | 75 | 80 | 85 | £90 | |
£30 | 0 | ||||||||||||
35 | 0.1 | 0.1 | |||||||||||
40 | 0.1 | 0.2 | 0.2 | ||||||||||
45 | 0.1 | 0.2 | 0.3 | 0.3 | |||||||||
50 | 0.2 | 0.2 | 0.3 | 0.3 | 0.4 | ||||||||
55 | 0.2 | 0.2 | 0.3 | 0.4 | 0.4 | 0.5 | |||||||
60 | 0.2 | 0.2 | 0.3 | 0.4 | 0.4 | 0.5 | 0.6 | ||||||
65 | 0.2 | 0.3 | 0.3 | 0.4 | 0.5 | 0.5 | 0.6 | 0.7 | |||||
70 | 0.2 | 0.3 | 0.3 | 0.4 | 0.5 | 0.5 | 0.6 | 0.7 | 0.7 | ||||
75 | 0.2 | 0.3 | 0.3 | 0.4 | 0.5 | 0.5 | 0.6 | 0.7 | 0.8 | 0.8 | |||
80 | 0.2 | 0.3 | 0.3 | 0.4 | 0.5 | 0.6 | 0.6 | 0.7 | 0.8 | 0.8 | 0.9 | ||
85 | 0.2 | 0.3 | 0.4 | 0.4 | 0.5 | 0.6 | 0.6 | 0.7 | 0.8 | 0.8 | 0.9 | 0.9 | |
£90 | 0.2 | 0.3 | 0.4 | 0.4 | 0.5 | 0.6 | 0.6 | 0.7 | 0.8 | 0.8 | 0.9 | 0.9 | 1.0 |
[r. 26]
It is the duty of a registered agent —
(a) to comply with the provisions of the Act, any subsidiary legislation made under the Act and the conditions of registration; and
(b) not to engage in conduct which is illegal or dishonest or which may otherwise bring registered agents into disrepute or which is prejudicial to the administration of the workers’ compensation and injury management system; and
(c) to be competent as a registered agent.
(1) A registered agent must not attempt to further a client’s case by unethical or dishonest means.
(2) A registered agent must not knowingly assist or seek to induce another person to breach this code of conduct.
(3) A registered agent must treat clients fairly and in good faith, giving due regard to a client’s position of dependence upon the agent, and the high degree of trust which a client is entitled to place on the agent.
(4) A registered agent must always be completely frank and open with a client and with all others so far as the interests of the client permit and must at all times give a client a candid opinion on any matter in which the agent acts for that client.
(5) A registered agent must take such action consistent with the agent’s retainer as is necessary and reasonably available to protect and advance a client’s interests.
(6) A registered agent must at all times use his or her best endeavours to complete work on behalf of a client as soon as is reasonably possible, and if a registered agent accepts instructions and it is, or becomes, apparent to the agent that the work cannot be done within a reasonable time, the agent must so inform the client.
(7) A registered agent must not take unnecessary steps or do work in such a manner as to increase proper costs to the client.
(8) If it is in the best interests of the client of a registered agent to do so, the agent must endeavour to reach a solution by settlement rather than commence or continue proceedings.
(1) A registered agent must strive to establish and maintain a relationship of trust and confidence with clients.
(2) A registered agent must impress upon a client that the agent cannot adequately serve the client without knowing everything that might be relevant to the client’s interests and that the client should not withhold information that the client might think is embarrassing or harmful to the client’s interests.
(3) A registered agent must not, without the client’s consent, directly or indirectly reveal a client’s confidence, or use the confidence in any way detrimental to the interests of that client, or lend or reveal the contents of the confidence in any brief or instructions to any person except to the extent —
(a) required by law, rules of court or court order; or
(b) necessary for replying to or defending any charge or complaint of criminal conduct or misconduct contrary to this code brought against the agent.
(4) A registered agent’s duties under this clause towards a particular client continue after the agent has ceased to act for the client.
(1) A registered agent must at all times make a full and frank disclosure to a client of any conflict of interest that the registered agent has or may have in any matter concerning that client.
(2) A registered agent must not act or continue to act on behalf of a client if to do so would or may give rise to a conflict of interest adverse to the client unless the client has been fully informed of the nature and implications of the conflict and consents to the registered agent acting or continuing to act on behalf of the client.
(3) A registered agent must not give advice or guidance to a person where the registered agent knows that the interests of that person are in conflict or likely to be in conflict with the interests of the agent’s client, other than advice to secure the services of another representative.
(1) Subject to this code of conduct, a registered agent must provide advice and conduct each case and matter in the manner the agent considers most advantageous to the agent’s client.
(2) A registered agent must not knowingly deceive or mislead the Director, the Registrar, an officer of the Conciliation Service or the Arbitration Service or any other officer of WorkCover WA, a client or any other person involved in a matter in respect of which the agent has been retained.
(3) A registered agent must at all times —
(a) act with due courtesy to the Director, the Registrar, officers of the Conciliation Service and the Arbitration Service and other officers of WorkCover WA, legal practitioners, other registered agents, their own clients and other parties to the dispute; and
(b) use his or her best endeavours to avoid unnecessary expense and waste of a dispute resolution authority’s time; and
(c) when so requested, inform the Director or Registrar of the probable length of a proceeding; and
(d) inform the Director or Registrar of the possibility of a settlement provided the agent can do so without revealing the existence or content of “without prejudice” communications; and
(e) subject to this code of conduct, inform the Director or Registrar of any development that affects the information already before a dispute resolution authority.
(4) In cross examination which goes to a matter in issue, a registered agent may put questions suggesting fraud, misconduct or the commission of an offence provided that the agent is satisfied that the matters suggested are part of the case of the agent’s client and the agent has no reason to believe that they are only put forward for the purpose of impugning the witness’s character.
(5) Questions which affect the credibility of a witness by attacking the witness’s character, but which are otherwise not relevant to the actual inquiry, must not be put in cross examination unless there are reasonable grounds to support the imputation conveyed by such questions.
A registered agent must not engage in promotional conduct or advertising about the agent’s skills, experience, fees or results in a manner which is misleading or deceptive, or likely to mislead or deceive.
(1) A registered agent must recognise that a client is entitled to change representative at any time without giving a reason and must take all reasonable steps to facilitate such a change should a client so request.
(2) If a client engages another registered agent in a matter and that agent is of the opinion that the conduct of a preceding representative in the matter warrants the making of a complaint, the agent must so advise the client.
(3) A registered agent may withdraw from representing a client —
(a) at any time and for any reason if withdrawal will cause no significant harm to the client’s interests and the client is fully informed of the consequences of withdrawal and voluntarily assents to it; or
(b) if the registered agent reasonably believes that continued engagement in the case or matter would be likely to have a seriously adverse effect upon the agent’s health; or
(c) if the client, without lawful excuse, refuses or fails to comply with a written agreement regarding fees or expenses; or
(d) if the client made material misrepresentations about the facts of the case or matter to the agent; or
(e) if the agent has an interest in any case or matter which the agent is concerned may be adverse to that of the client; or
(f) if such action is necessary to avoid the agent breaching this code of conduct; or
(g) if any other good cause exists.
(4) If a registered agent withdraws from representing a client the agent must take reasonable care to avoid foreseeable harm to the client including —
(a) giving due notice to the client; and
(b) allowing reasonable time for the substitution of a new agent; and
(c) cooperating with the new agent; and
(d) promptly turning over all papers and property and paying to the client any moneys to which the client is entitled.
(5) If a registered agent withdraws from representing a client the agent must give written notice of the withdrawal to the Director and other parties to the proceeding.
(1) A registered agent must before commencing to act for a client inform the client in writing of the maximum costs the registered agent can charge and the basis for calculation of the costs of the agent.
(2) Upon receiving the advice the client must sign an acknowledgment of the information.
(3) During the course of a retainer, a registered agent must promptly advise the client of any circumstances likely to have a substantial effect on the amount, or basis of calculation, of such costs or any disbursements.
(4) A registered agent must issue appropriate receipts for services provided to a client.
(5) A registered agent must not charge more than is reasonable for his or her services, having regard to the complexity of the matter, the time and skill involved, and any costs determination published under section 273 of the Act.
(1) A registered agent must keep adequate records of —
(a) moneys received on behalf of clients; and
(b) disbursement made on behalf of clients; and
(c) time spent on cases.
(2) Records kept under this clause must be available for inspection by WorkCover WA.
A registered agent must not hold for or on behalf of a client or other party any moneys in trust without the written authorisation of that person.
(1) A registered agent must not, in the course of his or her business give, or agree to give, an allowance in the nature of an introduction fee or spotter’s fee to any person for introducing business to him or her and must not receive any similar allowance from any person for introducing or recommending clients to that person.
(2) A registered agent must, as soon as practicable after being requested by a client, render a bill of costs covering all work performed for the client to which the request relates.
[r. 50, 51]
1A. | 57A(2A) | Failing to claim under policy of insurance............................................. | $200.00 |
1. | 57A(3) | Failing to provide notice ...................... | $200.00 |
2. | 57A(4) | Failing to cause notification to be accompanied by means for conveying information in machine‑readable form .. | $200.00 |
3A. | 57A(8A) | Failing to make weekly payment .......... | $400.00 |
3B. | 57A(8) | Failing to make weekly payment having received payment from insurer ............. | $400.00 |
3. | 57B(2) | Failing to make first weekly payment or give notice .......................................... | $200.00 |
4. | 57B(2b) | Failing to notify WorkCover WA of having declined to indemnify employer .. | $200.00 |
5. | 57B(3) | Failing to cause notification to be accompanied by means for conveying information in machine‑readable form .. | $200.00 |
6A. | 57B(8) | Failing to make weekly payment .......... | $400.00 |
6. | 57C(2) | Failing to notify WorkCover WA after weekly payments commenced .............. | $200.00 |
7. | 57C(4) | Failing to notify WorkCover WA of discontinuance of weekly payments ..... | $200.00 |
8. | 61(2a)(a) | Failing to give notice of intention to discontinue or reduce weekly payments .. | $400.00 |
9. | 61(2a)(b) | Failing to give notice that complies with section 61(2) of the Act ....................... | $400.00 |
10. | 70(2) | Failing to furnish worker with copy of report.................................................. | $400.00 |
11. | 75(2) | Giving notice contrary to section 75(1) of the Act ........................................... | $200.00 |
12. | 103A(2) | Furnishing WorkCover WA with false information or return ........................... | $400.00 |
13. | 109(3) | Failing to pay contribution or instalment . | $400.00 |
14. | 109(4b) | Failing to send particulars to WorkCover WA .................................. | $400.00 |
15. | 109(6) | Failing to send return or statutory declaration to WorkCover WA ............. | $400.00 |
16. | 152 | Charging a premium rate loading of more than 75% without permission ...... | $200.00 |
17. | 155D(3) | Failing to take reasonable action to discharge and comply with employer’s obligations .......................................... | $400.00 |
18. | 160(3) | Failing to insure employer for full amount of liability to pay compensation ............. | $400.00 |
19. | 160(3a) | Failing to notify employer of cancellation of insurance ..................... | $200.00 |
20. | 160(5) | Declining to indemnify employer ......... | $400.00 |
21. | 162(1a) | Issuing or renewing policy in respect of certain industrial diseases .................... | $200.00 |
22. | 165(5) | Failing to give securities to State as directed by Minister ............................ | $200.00 |
23. | 170(1)(a) | Failure to keep a current policy of insurance under section 160(1) of the Act ..................................................... | $400.00 in respect of each worker to whom the alleged offence relates |
24. | 170(1)(a) | Failing to comply with section 160(2)(a) or (b) of the Act .................................. | $400.00 |
25. | 171(1) | Failing to transmit to WorkCover WA statements and means for conveying information in machine‑readable form .. | $200.00 |
26. | 175D(1)(a) | Obstructing or interfering with inspector performing functions ........................... | $500.00 |
27. | 175D(1)(b) | Contravening requirement made by inspector ............................................ ........................................................... | $500.00 |
28. | 175D(1)(c) | Providing answer or information to inspector that is false or misleading in a material particular ............................... | $500.00 |
29. | 175D(1)(d) | Giving false or misleading information in a certificate under section 175B(1)(f) of the Act ........................................... | $500.00 |
30. | 175D(1)(e) | Preventing another person from complying with a requirement under the Act ..................................................... | $500.00 |
31. | 180(5) | Failing to comply with request to provide copy of relevant document ....... ........................................................... | $200.00 |
This is a compilation of the
8 Apr 1982 p. 1229‑50 (corrigendum 23 Apr 1982 p. 1384) | 3 May 1982 (see r. 2 and | |
14 May 1982 p. 1519 | 14 May 1982 | |
27 Aug 1982 p. 3427‑9 | 27 Aug 1982 | |
30 Dec 1983 p. 5121 | 30 Dec 1983 | |
25 Jul 1986 p. 2484‑5 | 25 Jul 1986 (see r. 2 and | |
22 May 1987 p. 2193 | 22 May 1987 (see r. 2 and | |
19 Jun 1987 p. 2410 | 1 Jul 1987 (see r. 2) | |
2 Sep 1988 p. 3464 | 2 Sep 1988 | |
22 Sep 1989 p. 3490‑1 | 22 Sep 1989 | |
26 Feb 1991 p. 931‑56 | 1 Mar 1991 (see r. 2 and | |
8 Mar 1991 p. 1071‑6 | 8 Mar 1991 (see r. 2 and | |
28 Jun 1991 p. 3291‑4 | 1 Jul 1991 (see r. 2) | |
6 Dec 1991 p. 6118‑19 | 6 Dec 1991 | |
3 Apr 1992 p. 1540‑1 | 3 Apr 1992 | |
3 Apr 1992 p. 1541‑5 | 3 Apr 1992 | |
16 Oct 1992 p. 5201 | 16 Oct 1992 | |
5 Feb 1993 p. 1059‑60 | 5 Feb 1993 (see r. 2 and | |
17 Sep 1993 p. 5182 | 17 Sep 1993 | |
29 Oct 1993 p. 5929‑30 | 29 Oct 1993 | |
24 Dec 1993 p. 6844‑50 | 24 Dec 1993 (see r. 2 and | |
18 Feb 1994 p. 660‑4 | 1 Mar 1994 (see r. 2) | |
31 Mar 1994 p. 1444 | 31 Mar 1994 | |
24 Jun 1994 p. 2888‑9 | 24 Jun 1994 | |
23 Aug 1994 p. 4394‑5 | 23 Aug 1994 | |
25 Aug 1995 p. 3885‑7 | 25 Aug 1995 | |
15 Sep 1995 p. 4358 | 15 Sep 1995 | |
17 Jan 1997 p. 444 | 17 Jan 1997 | |
12 Aug 1997 p. 4568 | 12 Aug 1997 | |
12 Jun 1998 p. 3205 | 1 Jul 1998 (see r. 2) | |
13 Apr 1999 p. 1529‑41 (correction 16 Apr 1999 p. 1598) | 3 May 1999 (see r. 2) | |
22 Jun 1999 p. 2692‑3 | 1 Jul 1999 (see r. 2) | |
15 Oct 1999 p. 4890‑8 | 15 Oct 1999 (see r. 2) | |
15 Oct 1999 p. 4899 | 15 Oct 1999 (see r. 2 and | |
15 Oct 1999 p. 4900‑2 | 15 Oct 1999 (see r. 2 and | |
15 Oct 1999 p. 4903 | 15 Oct 1999 (see r. 2 and | |
15 Oct 1999 p. 4904 | 15 Oct 1999 (see r. 2 and | |
15 Oct 1999 p. 4905 | 15 Oct 1999 (see r. 2 and | |
15 Oct 1999 p. 4906‑12 | 15 Oct 1999 (see r. 2) | |
14 Dec 1999 p. 6145‑63 | 14 Dec 1999 | |
17 Nov 2000 p. 6307‑22 | 17 Nov 2000 | |
28 Sep 2001 p. 5353‑8 | 15 Jul 2001 (see r. 2 and Cwlth | |
8 Mar 2002 p. 948‑9 | 8 Mar 2002 | |
30 Jun 2003 p. 2581‑638 | 1 Jul 2003 (see r. 2 and | |
16 Sep 2003 p. 4103‑4 | 16 Sep 2003 | |
8 Apr 2004 p. 1177 | 8 Apr 2004 | |
26 Oct 2004 p. 4895‑913 | 26 Oct 2004 (see r. 2) | |
29 Oct 2004 p. 4939‑40 | 29 Oct 2004 | |
21 Jan 2005 p. 275‑7 | 21 Jan 2005 | |
28 Oct 2005 p. 4853‑972 | 14 Nov 2005 (see r. 2) | |
9 Dec 2005 p. 5891‑7 | 9 Dec 2005 | |
4 Aug 2006 p. 2855‑6 | 4 Aug 2006 | |
15 Dec 2006 p. 5636‑7 | 15 Dec 2006 | |
2 Nov 2007 p. 5933‑4 | r. 1 and 2: 2 Nov 2007 (see r. 2(a)); Regulations other than r. 1 and 2: 3 Nov 2007 (see r. 2(b)) | |
17 Dec 2008 p. 5331‑4 | r. 1 and 2: 17 Dec 2008 (see r. 2(a)); Regulations other than r. 1 and 2: 18 Dec 2008 (see r. 2(b)) | |
19 Mar 2010 p. 1038‑9 | r. 1 and 2: 19 Mar 2010 (see r. 2(a)); Regulations other than r. 1 and 2: 20 Mar 2010 (see r. 2(b)) | |
10 Sep 2010 p. 4351-7 | r. 1 and 2: 10 Sep 2010 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Oct 2010 (see r. 2(b)) | |
18 Nov 2011 p. 4819‑26 | r. 1 and 2: 18 Nov 2011 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Dec 2011 (see r. 2(b) and | |
27 Jul 2012 p. 3664‑6 | r. 1 and 2: 27 Jul 2012 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Aug 2012 (see r. 2(b) and | |
14 Dec 2012 p. 6209‑12 | r. 1 and 2: 14 Dec 2012 (see r. 2(a)); Regulations other than r. 1 and 2: 15 Dec 2012 (see r. 2(b)) | |
25 Feb 2014 p. 505‑8 | r. 1 and 2: 25 Feb 2014 (see r. 2(a)); Regulations other than r. 1 and 2: 26 Feb 2014 (see r. 2(b)) | |
25 Mar 2014 p. 820‑8 | r. 1 and 2: 25 Mar 2014 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Jul 2014 (see r. 2(b)) | |
20 Mar 2015 p. 910‑11 | r. 1 and 2: 20 Mar 2015 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Apr 2015 (see r. 2(b)) | |
15 Apr 2016 p. 1184‑5 | r. 1 and 2: 15 Apr 2016 (see r. 2(a)); Regulations other than r. 1 and 2: 16 Apr 2016 (see r. 2(b)) | |
4 Oct 2016 p. 4242-5 | r. 1 and 2: 4 Oct 2016 (see r. 2(a)); Regulations other than r. 1 and 2: 17 Oct 2016 (see r. 2(b)) | |
29 Jun 2018 p. 2442‑6 | r. 1 and 2: 29 Jun 2018 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Jul 2018 (see r. 2(b) and | |
SL 2020/149 1 Sep 2020 | r. 1 and 2: 1 Sep 2020 (see r. 2(a)); Regulations other than r. 1 and 2: 2 Sep 2020 (see r. 2(b)) | |
SL 2020/188 9 Oct 2020 | r. 1 and 2: 9 Oct 2020 (see r. 2(a)); Regulations other than r. 1, 2 and 15: 12 Oct 2020 (see r. 2(c) and SL 2020/187 cl. 2); r. 15: 16 Nov 2020 (see r. 2(b)) | |
SL 2021/221 24 Dec 2021 | r. 1 and 2: 24 Dec 2021 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Feb 2022 (see r. 2(b)(i)) | |
SL 2023/37 5 May 2023 | r. 1 and 2: 5 May 2023 (see r. 2(a)); Regulations other than r. 1 and 2: 6 May 2023 (see r. 2(b)) | |
SL 2023/113 26 Jul 2023 | r. 1 and 2: 26 Jul 2023 (see r. 2(a)); Regulations other than r. 1 and 2: 27 Jul 2023 (see r. 2(b)) | |
SL 2023/123 9 Aug 2023 | r. 1 and 2: 9 Aug 2023 (see r. 2(a)) Regulations other than r. 1 and 2: 10 Aug 2023 (see r. 2(b)) | |
action level............................................................................................................... 19I(2)
actual total cost......................................................................................................... 13(3)
acupuncturist.......................................................................................................... 44C(1)
agent service................................................................................................................ 18B
agreement........................................................................................................................ 54
ambulance emergency communications officer.................................................. 68(1)
applicant................................................................................................................ 18B, 26
application............................................................................................................. 18B, 54
approved....................................................................................................................... 19A
approved form........................................................................................................... 25(1)
approved medical practitioner.................................................................................. 19A
approved person.......................................................................................................... 19A
approved treatment................................................................................................ 44C(2)
audiologist.................................................................................................................... 19A
audiometric officer..................................................................................................... 19A
Australian Standard.................................................................................................... 19A
clause............................................................................................................................ 19A
code of conduct.............................................................................................................. 26
commencement day .................................................................................................. 18B
communications systems officer............................................................................ 68(1)
counselling psychologist...................................................................................... 44A(1)
CPI............................................................................................................................. 2AAA
criminal record check.............................................................................................. 28(6)
December WPI........................................................................................................ 2AAA
dispute resolution authority...................................................................................... 18B
DSM-5........................................................................................................................ 68(1)
EDS.................................................................................................................................. 54
EDS exempt.................................................................................................................... 54
electronic notification.............................................................................................. 60(1)
employer.......................................................................................................................... 26
estimated total cost................................................................................................... 13(3)
exercise physiologist............................................................................................. 44B(1)
extension period..................................................................................................... 19N(1)
fit and proper person..................................................................................................... 26
former provisions........................................................................................................ 18B
health professional.................................................................................................... 67(1)
incident....................................................................................................................... 68(1)
independent agent.......................................................................................................... 26
Insurer/Self-Insurer Electronic Data Specification (Edition Q1)..................... 13(3)
legal service................................................................................................................. 18B
lodge..................................................................................................................... 12(1AA)
L peak....................................................................................................................... 19I(2)
March CPI................................................................................................................ 2AAA
MBS item............................................................................................................. 17AB(3)
NATA......................................................................................................................... 67(1)
notify........................................................................................................................... 60(1)
paramedic................................................................................................................... 68(1)
Part 8 document............................................................................................................. 54
pending application............................................................................................ 18LA(1)
prescribed details........................................................................................................ 18L
psychiatrist................................................................................................................. 68(1)
registered Australian body........................................................................................ 3(2)
registration...................................................................................................................... 26
relevant provisions of the Act................................................................................... 18L
relevant year.............................................................................................. 2A(1), 11A(1)
representative LAeq,8h.......................................................................................... 19I(2)
representatives........................................................................................................... 11(2)
taxing officer............................................................................................................... 18B
termination day...................................................................................................... 19N(1)
treating specialist................................................................................................ 17AB(3)
working day............................................................................................................... 59(1)
WPI............................................................................................................................ 2AAA
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0
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