Workers’ Compensation and Rehabilitation Regulation 2014 (Qld)
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Workers’ Compensation and Rehabilitation Regulation 2014
Part 1 Preliminary
1 Short title
This regulation may be cited as the Workers’ Compensation and Rehabilitation Regulation 2014.
2 Commencement
This regulation commences on 1 September 2014.
3 Definitions
Schedule 13 defines particular words used in this regulation.
4 WorkCover’s capital adequacy—Act, s 453(b)
For section 453(b) of the Act, WorkCover maintains capital adequacy if WorkCover’s total assets are at least equal to its total liabilities.
Part 2 Employer insurance
Division 1 Policies and premium assessments
5 Application for policy
An application for a WorkCover policy must be made to WorkCover in the approved form.
6 Policies and renewals
(1)On payment of the premium shown as payable in a premium notice issued by WorkCover to an employer, WorkCover must issue to the employer a policy, in the approved form, for the period of insurance stated in the notice.(2)A policy has no effect until—(a)WorkCover receives the premium payable to WorkCover for the policy or the policy’s renewal; or(b)WorkCover enters into an instalment plan.
7 Assessment of premium
(1)This section does not apply to a policy for household workers.(2)WorkCover must assess the premium payable under a policy for each period of insurance shown in a premium notice.
8 Declaration of wages
(1)This section does not apply to an employer who employs only household workers.(2)Each employer, other than a self-insurer, must, on or before 31 August in each year, lodge with WorkCover a declaration of wages so WorkCover can assess the employer’s premium.(3)The declaration must be in—(a)the approved form; or(b)with WorkCover’s approval—another form acceptable to WorkCover.(4)If an employer does not comply with subsection (2), the employer must pay an additional premium under schedule 1.(5)The additional premium payable under schedule 1 is the amount specified opposite the time after 31 August in a year when the employer complies with subsection (2).
9 Value of board and lodging
(1)This section applies if an employer provides, or is to provide, board to a worker during a period of insurance.(2)The value of board provided is taken to be wages paid, or to be paid, by the employer to the worker.(3)For each week the employer provides, or is to provide, board, the value of board is at least equal to—(a)the weekly allowance for board provided for under the industrial instrument governing the calling in which the worker is engaged; or(b)if paragraph (a) does not apply—6% of QOTE.(4)In this section—board means accommodation, meals, laundry services or any other entitlement having a monetary value provided when lodging.
10 Payment of premium by instalments
(1)WorkCover may accept payment of a premium by instalments under an instalment plan approved by WorkCover if WorkCover is satisfied that payment of the premium by the due date would impose financial hardship on the employer.(2)The instalment plan is subject to the following conditions—(a)interest at a rate specified by WorkCover’s board by gazette notice must be added to the amount of each instalment;(b)interest must be calculated from the due date;(c)the interest rate that applies at the start of the instalment plan remains constant until the plan ends;(d)on acceptance of the instalment plan, the employer must, if required by WorkCover, enter into a payment arrangement acceptable to WorkCover;(e)if an instalment of premium is not paid on or before the due date for payment of the instalment—(i)the total amount of unpaid instalments and interest on outstanding instalments to that day immediately becomes payable to WorkCover; and(ii)an additional premium under section 11 applies to the unpaid instalments and interest; and(iii)the policy for which the premium is payable stops having effect; and(iv)the employer contravenes section 48 of the Act.
11 Additional premium for late payment of premium—Act, ss 61 and 62
(1)This section applies if, on or before the due date, an employer does not pay—(a)the amount of premium payable under a premium notice; or(b)the amount by which a final assessment of premium by an industrial magistrate or the Industrial Court is more than the amount of premium paid under section 551(4) of the Act.(2)However, this section does not apply if—(a)the employer employs only household workers; or(b)WorkCover has accepted payment of the amount under an instalment plan and instalments are paid under the plan.(3)For sections 61 and 62 of the Act, the additional premium payable is—(a)if the amount is paid to WorkCover within 30 days after the due date—5% of the amount; or(b)if the amount is paid to WorkCover after 30 days but within 60 days after the due date—10% of the amount; or(c)if the amount is paid to WorkCover after 60 days after the due date or if no payment is made—10% of the amount plus interest at the annual rate mentioned in section 10(2)(a) for the period from the due date, or a later date decided by WorkCover, until the amount and all additional premium is paid to WorkCover.
12 Premium for appeals—Act, s 569(2)(a)
(1)For section 569(2)(a) of the Act, premium, for an employer for a period of insurance, is an amount calculated using the formula—(2)In subsection (1)—rate means the rate for the employer’s industry or business specified in the notice under section 54 of the Act that applies to the period of insurance.wages means—(a)the wages of the employer for the preceding period of insurance; or(b)if the employer has only been insured for part of a period of insurance—a reasonable estimate of the wages of the employer for the period of insurance.
13 Former employer may apply to cancel policy
(1)This section applies if a person (a former employer) wishes to cancel a policy because the person has stopped employing workers.(2)This section does not apply to a former employer of only household workers.(3)The former employer must give WorkCover—(a)written notice that the former employer—(i)stopped employing workers on and from a date stated in the notice; and(ii)wishes to cancel the policy; and(b)written details of—(i)the address to which any document addressed to the former employer may be sent; and(ii)the former employer’s wages in relation to the period (last employment period) starting on 1 July last preceding the day on which employment of workers stopped and ending on that day.
14 Cancellation of policy if workers no longer employed
(1)This section applies if—(a)a person (a former employer) has notified WorkCover under section 13(3) that the former employer has stopped employing workers; or(b)WorkCover is satisfied, after making reasonable enquiries, that a person (also a former employer) has stopped employing workers.(2)WorkCover may cancel the former employer’s policy.(3)WorkCover must assess the premium payable by the former employer for the period during which the Act required the former employer to maintain a policy.(4)If the premium paid by the former employer for the last employment period is—(a)greater than the amount of premium assessed under subsection (3)—WorkCover must refund the amount overpaid to the former employer; or(b)less than the amount of premium assessed under subsection (3)—the former employer must pay WorkCover the amount of the deficit on or before the due date under a final premium notice issued for the amount of the deficit.(5)Nothing in this section is taken to limit chapter 2, part 3, division 2 of the Act.
Division 2 Employer excess
15 Excess period—Act, s 65(2)
For section 65(2) of the Act, the prescribed amount is the lesser of the following—(a)QOTE;(b)the amount of weekly compensation payable to a worker under chapter 3, part 9 of the Act.
Division 3 Self-insurance
16 Application fees—Act, s 70(c)
For section 70(c) of the Act, the prescribed fee is—(a)for a single employer—15,000 fee units; or(b)for a group employer—20,000 fee units.
17 Annual levy—Act, s 81(2)
(1)For section 81(2) of the Act, the prescribed way to calculate the annual levy is using the formula—(2)In subsection (1)—estimated claims liability means estimated claims liability calculated under part 3, division 4 stated in the most recent actuarial report agreed by the Regulator, or decided by the arbiter, under that division, before a date fixed by the Regulator by gazette notice.rate means the rate published in the gazette notice under section 81 of the Act for the particular financial year.
18 Provisional annual levy—not agreed or decided
(1)This section applies if—(a)the Regulator and the self-insurer have not agreed on the calculation of estimated claims liability under part 3, division 4; and(b)the arbiter has not decided the estimated claims liability.(2)The Regulator may use the estimated claims liability amount (the provisional annual levy) assessed by the approved actuary to ensure the self-insurer’s compliance with section 81 of the Act.
19 Adjusted annual levy—agreed
(1)If the Regulator and the self-insurer agree under section 62 on the estimated claims liability amount (agreed amount), the Regulator must give the self-insurer an adjusted levy notice based on the agreed amount within 14 days after the Regulator and the self-insurer agree to the amount.(2)If the agreed amount is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the provisional annual levy and the amount of the annual levy actually payable by the self-insurer.(3)If the agreed amount is less than the provisional annual levy paid by the self-insurer, the Regulator must pay the self-insurer the difference between the actual annual levy payable and the amount paid as the provisional annual levy.
20 Adjusted annual levy—not agreed but decided
(1)This section applies if the Regulator and the self-insurer do not agree to an amount under section 19 and the amount (the decided adjusted amount) decided by the arbiter under section 63(1) is not the same as the amount of the estimated claims liability used to calculate the provisional annual levy.(2)If subsection (1) applies, the Regulator must give the self-insurer an adjusted levy notice based on the decided adjusted amount within 14 days after the Regulator or the self-insurer receives notice of the amount.(3)If the amount of the adjusted levy is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the provisional annual levy and the amount of the annual levy actually payable by the self-insurer.(4)If the amount of the adjusted levy is less than the provisional annual levy paid by the self-insurer, the Regulator must pay the self-insurer the difference between the actual annual levy payable and the amount paid as the provisional annual levy.
21 Additional amount for late payment of levy—Act, s 82(1)
For section 82(1) of the Act, the additional amount payable is—(a)if the amount is paid to the Regulator within 30 days after the due date—5% of the amount; or(b)if the amount is paid to the Regulator after 30 days but within 60 days after the due date—10% of the amount; or(c)if the amount is paid to the Regulator after 60 days after the due date or if no payment is made—10% of the amount plus interest at a rate specified by the Regulator by gazette notice for the period from the due date, or a later date decided by the Regulator, until the amount and all additional amounts are paid to the Regulator.
22 Conditions of licence—Act, s 83
For section 83(1)(a) of the Act, a self-insurer’s licence is subject to the condition that the self-insurer must lodge with the Regulator, for each year or part of a year of the licence, a declaration in the approved form of the self-insurer’s wages.
23 Premium payable after cancellation of self-insurer’s licence—Act, s 98
(1)For section 98 of the Act, the premium payable by the former self-insurer for the first 2 periods of insurance after cancellation is to be calculated according to the method and at the rate specified by WorkCover, by gazette notice under section 54 of the Act, as if the employer were a new employer.(2)However, the rate under subsection (1) must not be less than the rate calculated using the formula—(3)In subsection (2)—administrative costs means the administrative costs associated with claims incurred during the final period of licence, calculated by multiplying payments + liability by 0.095.final period of licence means—(a)for an employer licensed as a self-insurer for 3 or more years immediately before cancellation of the licence—3 years; or(b)for an employer licensed as a self-insurer for less than 3 years immediately before cancellation of the licence—the period of the licence.liability means an actuarial estimate of the outstanding liability at the end of the self-insurer’s licence for claims incurred during the final period of licence, excluding liability for the excess period.payments means the actual payments made by the former self-insurer, less recoveries received and payments made that are the equivalent of amounts payable for the excess period, for claims incurred during the final period of licence.wages means the wages of the self-insurer during the final period of licence.
24 Deemed levy for appeals—Act, s 569(2)(a)
(1)The deemed levy, for a self-insurer for a financial year of the self-insurer’s licence, is an amount calculated using the formula—(2)In this section—estimated claims liability means estimated claims liability calculated under part 3, division 4 that was used to calculate the annual levy under section 17.rate means the rate published in the gazette under section 81 of the Act for the particular financial year.
Part 3 Calculation of self-insurer’s liability
Division 1 Outstanding liability
Subdivision 1 Preliminary
25 Calculation of outstanding liability—Act, s 87(2)
For section 87(2) of the Act, the amount of a self-insurer’s outstanding liability must be calculated under this division.
Subdivision 2 Actuarial calculations and reports
26 Appointment of actuary
WorkCover and the employer must each appoint an actuary to calculate an outstanding liability amount.
27 Regulator to give actuary information
The Regulator must give each appointed actuary the information necessary to enable the actuaries to calculate the employer’s outstanding liability within the time mentioned in section 29(3).
28 Actuarial calculation
A calculation of the outstanding liability must—(a)be prepared under the actuarial standard; and(b)apply a central estimate of the liability; and(c)apply the risk free rate of return; and(d)include claims administration expenses of 7% of the outstanding liability; and(e)not include a prudential margin; and(f)be based, as far as practicable, on the employer’s claims experience from claims incurred before the employer becomes or became a self-insurer; and(g)be based on data as at the assessment day.
29 Actuarial report
(1)For each calculation of an outstanding liability amount the appointed actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must state the following—(a)the amount;(b)the key assumptions made for the calculation;(c)how the key assumptions have been derived, including—(i)the average amount of claims for compensation against the employer; and(ii)the average amount of claims for damages against the employer; and(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and(iv)the frequency of claims for compensation against the employer; and(v)the frequency of claims for damages against the employer; and(vi)the net amount of the claims after allowing for future inflation (inflated value); and(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and(viii)the rate of inflation used;(d)the nature of the data used in the calculation;(e)the actuary’s assessment of the data, including accuracy of the data;(f)how the actuary interpreted the data;(g)the actuarial model used in the calculation;(h)the results of the calculation;(i)the actuary’s confidence in the results of the calculation.(3)Each appointed actuary must prepare the actuarial report within 35 days after the day a self-insurer lodges an application for self-insurance.
30 Summary report
(1)The appointed actuaries must jointly prepare a summary report that—(a)includes the individual actuarial reports; and(b)states how the individual reports agree or differ and the reasons for the difference.(2)The actuaries must give a copy of the completed summary report to the Regulator, WorkCover and the employer within 2 months after the day the application for self-insurance is lodged.
31 Agreement on amount
WorkCover and the employer may agree on the employer’s outstanding liability having regard to the summary report.
32 Reference to arbiter if no agreement on amount
(1)WorkCover or the employer may advise the Regulator that WorkCover and the employer do not agree on the outstanding liability amount.(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the outstanding liability amount.
33 Payment of amount
(1)WorkCover must pay the outstanding liability amount—(a)agreed to by WorkCover and the employer; or(b)if there is no agreement—decided by the arbiter.(2)WorkCover must pay the employer—(a)75% of the outstanding liability amount on the day the licence commences; and(b)the balance within 1 month after the day the licence commences.(3)WorkCover’s actuary must adjust the outstanding liability amount paid to the employer to take into account—(a)compensation and damages payments made between the assessment day and the day the employer becomes liable for the employer’s outstanding liability amount; and(b)claims lodged against the employer between the assessment day and the day the employer becomes liable for the employer’s outstanding liability amount.
34 Transfer of claims information
WorkCover must give the employer claims information in relation to the employer’s outstanding liability before the day the licence commences.
Division 2 Total liability
Subdivision 1 Preliminary
35 Calculation of total liability after change in self-insurer’s membership—Act s 90(9)
For section 90(9) of the Act, the amount of total liability after a change in the self-insurer’s membership must be calculated under this division.
Subdivision 2 Actuarial calculations and reports
36 Appointment of actuary
The relevant parties must each appoint an actuary to calculate the total liability amount.
37 Relevant parties to give actuaries information
The relevant parties must give each appointed actuary, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 39(3).
38 Actuarial calculation
A calculation of the total liability amount must—(a)be prepared under the actuarial standard; and(b)apply a central estimate of the liability; and(c)apply the risk free rate of return; and(d)include claims administration expenses of 7% of the outstanding liability; and(e)not include a prudential margin; and(f)be based, as far as practicable, on the claims experience of the employer or member of a group employer that is the subject of the transfer of liability; and(g)be based on data as at the assessment day.
39 Actuarial report
(1)For each calculation of a total liability amount the appointed actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must state the following—(a)the amount;(b)the key assumptions made for the calculation;(c)how the key assumptions have been derived, including—(i)the average amount of claims for compensation against the employer; and(ii)the average amount of claims for damages against the employer; and(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and(iv)the frequency of claims for compensation against the employer; and
(v)the frequency of claims for damages against the employer; and(vi)the net amount of the claims after allowing for future inflation (inflated value); and(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and(viii)the rate of inflation used;(d)the nature of the data used in the calculation;(e)the actuary’s assessment of the data, including its accuracy;(f)how the actuary interpreted the data;(g)the actuarial model used in the calculation;(h)the results of the calculation;(i)the actuary’s confidence in the results of the calculation.(3)Each appointed actuary must prepare the actuarial report within 35 days after the consent day.
40 Summary report
(1)The actuaries must jointly prepare a summary report that—(a)includes the individual actuarial reports; and(b)states how the individual reports agree or differ.(2)The actuaries must give a copy of the completed summary report to the parties and the Regulator within 2 months after the consent day.
41 Agreement on amount
The relevant parties may agree on the total liability amount having regard to the summary report.
42 Reference to arbiter if no agreement on amount
(1)A relevant party may advise the Regulator that the parties do not agree on the total liability amount.(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the total liability amount.
43 Payment of amount
(1)The old insurer must pay the total liability amount to the new insurer for the total liability—(a)agreed to by the old insurer and the new insurer; or(b)if there is no agreement—decided by the arbiter.(2)The old insurer must pay the total liability amount—(a)within 3 months after the consent day; or(b)on a later day agreed to by the parties.(3)The old insurer’s actuary must adjust the liability amount paid to the new insurer to take into account—(a)compensation and damages payments made between the assessment day and the day the new insurer assumes liability; and(b)claims lodged against the employer or member between the assessment day and the day the new insurer assumes liability.(4)The old insurer must advise the Regulator of the following no later than the day the total liability amount is paid—(a)the total liability amount;(b)the day the new insurer assumes liability;(c)details of the parties and the member leaving or becoming part of the self-insurer.
44 Transfer of claims information
The old insurer must give the new insurer claims information in relation to the liability no later than the day the total liability amount is paid.
Division 3 Liability after cancellation of self-insurer’s licence
Subdivision 1 Preliminary
45 Calculation of liability after cancellation—Act, s 102(3)
For section 102(3) of the Act, the amount for a former self-insurer’s liability must be calculated under this division.
Subdivision 2 Actuarial calculations and reports
46 Appointment of actuary
WorkCover and a former self-insurer must each appoint an actuary to calculate the former self-insurer’s liability amount.
47 Former self-insurer to give actuaries information
The former self-insurer must give the actuaries, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 49(3).
48 Actuarial calculation
A calculation of a former self-insurer’s liability amount must—(a)be prepared under the actuarial standard; and(b)apply a central estimate of the liability; and(c)apply the risk free rate of return; and(d)include claims administration expenses of 7% of the outstanding liability; and(e)not include a prudential margin; and(f)be based, as far as practicable, on the employer’s claims experience from claims incurred before the employer becomes or became a self-insurer; and(g)be based on data as at the assessment day.
49 Actuarial report
(1)For each calculation of a former self-insurer’s liability amount the appointed actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must state the following—(a)the amount;(b)the key assumptions made for the calculation;(c)how the key assumptions have been derived, including—(i)the average amount of claims for compensation against the employer; and(ii)the average amount of claims for damages against the employer; and(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and(iv)the frequency of claims for compensation against the employer; and(v)the frequency of claims for damages against the employer; and(vi)the net amount of the claims after allowing for future inflation (inflated value); and(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and(viii)the rate of inflation used;(d)the nature of the data used in the calculation;(e)the actuary’s assessment of the data, including its accuracy;(f)how the actuary interpreted the data;(g)the actuarial model used in the calculation;(h)the results of the calculation;(i)the actuary’s confidence in the results of the calculation.(3)Each appointed actuary must prepare an actuarial report within 35 days after the cancellation day.
50 Summary report
(1)The appointed actuaries must jointly prepare a summary report that—(a)includes the individual actuarial reports; and(b)states how the individual reports agree or differ.(2)The appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the former self-insurer within 2 months after the cancellation day.
51 Agreement on amount
WorkCover and the former self-insurer may agree on the former self-insurer’s liability amount having regard to the summary report.
52 Reference to arbiter if no agreement on amount
(1)WorkCover or the former self-insurer may advise the Regulator that WorkCover and the former self-insurer do not agree on the self-insurer’s liability amount.(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the self-insurer’s liability amount.
53 Payment of amount
(1)The former self-insurer’s liability amount the former self-insurer must pay WorkCover is—(a)the amount (the agreed amount) agreed to by WorkCover and the former self-insurer; or(b)if there is no agreement, the amount (the decided amount) decided by the arbiter.(2)The former self-insurer’s actuary must adjust the amount to take into account—(a)compensation and damages payments made between the assessment day and the cancellation day; and(b)claims lodged against the former self-insurer between the assessment day and the cancellation day.
Division 4 Estimated claims liability
Subdivision 1 Preliminary
54 Calculation of estimated claims liability—Act, s 84(3)(b)
For section 84(4)(b) of the Act, the amount of the estimated claims liability must be calculated under this division.
Subdivision 2 Actuarial calculations and reports
55 Approved actuary
The approved actuary must calculate the estimated claims liability amount.
56 Self-insurer to give Regulator and approved actuary information
The self-insurer must give the self-insurer’s data to the Regulator and the approved actuary, in the form approved by the Regulator.
57 Actuarial calculation
A calculation of a estimated claims liability amount must—(a)be prepared under the actuarial standard; and(b)apply a central estimate of the liability; and(c)apply the risk free rate of return; and(d)include claims administration expenses of 7% of the liability; and(e)not include a prudential margin; and(f)be based, as far as practicable, on the self-insurer’s claims experience; and(g)be based on the self-insurer’s data as at—(i)the last day of the financial quarter immediately before the anniversary of the day the renewed licence commences; or(ii)another day fixed by the Regulator.
58 Actuarial report
(1)For each calculation of an estimated claims liability amount the approved actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must state the following—(a)the amount;(b)the key assumptions made for the calculation;(c)how the key assumptions have been derived, including—(i)the average amount of claims for compensation against the employer; and(ii)the average amount of claims for damages against the employer; and(iii)claims anticipated to have been incurred by the employer for which no formal claim has been lodged; and(iv)the frequency of claims for compensation against the employer; and(v)the frequency of claims for damages against the employer; and(vi)the net amount of the claims after allowing for future inflation (inflated value); and(vii)the net present value of the inflated value after allowing for income from assets set aside by the employer to pay the amount; and(viii)the rate of inflation used;(d)the nature of the data used in the calculation;(e)the actuary’s assessment of the data, including its accuracy;(f)how the actuary interpreted the data;(g)the actuarial model used in the calculation;(h)the results of the calculation;(i)the actuary’s confidence in the results of the calculation.
59 Copy of actuarial report to Regulator and self-insurer
The approved actuary must give a copy of the actuarial report to the Regulator and the self-insurer by the day fixed by the Regulator or a later day agreed between the Regulator and the actuary.
60 Regulator to advise self-insurer whether agreement on amount
Within 35 days after the approved actuary gives the Regulator a copy of the actuarial report, the Regulator must advise the self-insurer whether the Regulator agrees or does not agree with the approved actuary’s assessment of the estimated claims liability.
61 Reference to Regulator’s actuary if no agreement on amount
(1)After receiving a copy of the approved actuary’s report, the Regulator may ask an actuary (Regulator’s actuary) to calculate the amount of the self-insurer’s estimated claims liability and give the Regulator an actuarial report made under section 58.(2)The Regulator must give the Regulator’s actuary the approved actuary’s report and the self-insurer’s data.
62 Agreement on amount
If, at any time, the Regulator and the self-insurer agree on the calculation of estimated claims liability, having regard to the approved actuary’s actuarial report or any Regulator’s actuary’s actuarial report, the estimated claims liability is the amount agreed to by the Regulator and the self-insurer.
63 Reference to arbiter
(1)If the Regulator and the self-insurer do not agree on the calculation, the Regulator must refer the approved actuary’s report, the self-insurer’s data and any Regulator’s actuary’s actuarial report to the arbiter for decision.(2)The Regulator must make the referral within 14 days after the day the Regulator advises the self-insurer that the Regulator does not agree with the self-insurer’s approved actuary’s actuarial report under section 60.
Division 5 Self-insurers who become non-scheme employers
Subdivision 1 Preliminary
64 Calculation of non-scheme employer’s liability—Act, s 105I(2)
For section 105I(2) of the Act, the amount for a non-scheme employer’s liability must be calculated under this division.
Subdivision 2 Actuarial calculations and reports
65 Appointment of actuary
WorkCover and the non-scheme employer must each appoint an actuary to calculate a non-scheme employer’s liability amount.
66 Non-scheme employer to give actuaries information
The non-scheme employer must give the actuaries, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 68(3).
67 Actuarial calculation
A calculation of a non-scheme employer’s liability amount must—(a)be prepared under the actuarial standard; and(b)apply a central estimate of the liability; and(c)apply the risk free rate of return; and(d)include claims administration expenses of 7% of the liability; and(e)not include a prudential margin; and(f)be based, as far as practicable, on the non-scheme insurer’s claims experience; and(g)be based on data that only relates to the period before the cancellation day.
68 Actuarial report
(1)For each calculation of a non-scheme employer’s liability amount each appointed actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must state the following—(a)the amount;(b)the key assumptions made for the calculation;(c)how the key assumptions have been derived, including—(i)the average amount of claims for compensation against the non-scheme employer; and(ii)the average amount of claims for damages against the non-scheme employer; and(iii)claims anticipated to have been incurred by the non-scheme employer for which no formal claim has been lodged; and(iv)the frequency of claims for compensation against the non-scheme employer; and(v)the frequency of claims for damages against the non-scheme employer; and(vi)the net amount of the claims after allowing for future inflation (inflated value); and(vii)the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount; and(viii)the rate of inflation used;(d)the nature of the data used in the calculation;(e)the actuary’s assessment of the data, including its accuracy;(f)how the actuary interpreted the data;(g)the actuarial model used in the calculation;(h)the results of the calculation;(i)the actuary’s confidence in the results of the calculation.(3)Each appointed actuary must prepare an actuarial report on the actuary’s calculation within 35 days after the cancellation day.
69 Summary report
(1)The actuaries must jointly prepare a summary report that—(a)includes the individual actuarial reports; and(b)states how the individual reports agree or differ.(2)The actuaries must give a copy of the summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the cancellation day.
70 Agreement on amount
WorkCover and the non-scheme employer may agree on the non-scheme employer’s liability amount having regard to the summary report.
71 Reference to arbiter if no agreement on amount
(1)WorkCover or the non-scheme employer may advise the Regulator that WorkCover and the non-scheme employer do not agree on the non-scheme employer’s liability amount.(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the non-scheme employer’s liability amount.
72 Payment of amount
(1)The amount the non-scheme employer must pay WorkCover for the liability is—(a)the amount (the agreed amount) agreed to by WorkCover and the non-scheme employer; or(b)if there is no agreement—the amount (the decided amount) decided by the arbiter.(2)The agreed amount or decided amount paid to WorkCover must be adjusted by the non-scheme employer’s actuary to take into account—(a)compensation and damages payments made between the assessment day and the cancellation day; and(b)claims lodged against the non-scheme employer between the assessment day and the cancellation day.
Subdivision 3 Calculation—finalised non-scheme employer’s liability
73 Calculation of finalised non-scheme employer’s liability amount—Act, s 105I(2)
For section 105I(2) of the Act, the amount for finalisation of a non-scheme employer’s liability must be calculated under this subdivision.
74 Appointment of actuary
WorkCover and the non-scheme employer must each appoint an actuary, at the end of 4 years after the cancellation day, to calculate the finalised non-scheme employer’s liability amount.
75 WorkCover to give actuaries information
WorkCover must give the appointed actuaries the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 77(3).
76 Actuarial calculation
(1)For each calculation of a finalised non-scheme employer’s liability amount, the appointed actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must—(a)be prepared under the actuarial standard; and(b)apply a central estimate of the liability; and(c)apply the risk free rate of return; and(d)include claims administration expenses of 7% of the liability; and(e)not include a prudential margin; and(f)be based, as far as practicable, on the non-scheme insurer’s claims experience; and(g)apply the same risk free rate of return that was used in the calculation of the non-scheme employer’s liability amount; and(h)have regard to compensation and damages payments made in relation to the liability between the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability and the end of 4 years after that day; and(i)be based on data as at the last day of the last financial quarter for which data is available at the end of 4 years after the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability amount.(3)The data relied on under subsection (2)(i) may only relate to the period before the exit date.
77 Actuarial report
(1)For each calculation of a finalised non-scheme employer’s liability amount, each appointed actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must state the following—(a)the amount;(b)the key assumptions made for the calculation;(c)how the key assumptions have been derived, including—(i)the average amount of claims for compensation against the non-scheme employer; and(ii)the average amount of claims for damages against the non-scheme employer; and(iii)claims anticipated to have been incurred by the non-scheme employer for which no formal claim has been lodged; and(iv)the frequency of claims for compensation against the non-scheme employer; and(v)the frequency of claims for damages against the non-scheme employer; and(vi)the net amount of the claims after allowing for future inflation (inflated value); and(vii)the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the non-scheme employer’s liability amount; and(viii)the rate of inflation used;(d)the nature of the data used in the calculation;(e)the actuary’s assessment of the data, including its accuracy;(f)how the actuary interpreted the data;(g)the actuarial model used in the calculation;(h)the results of the calculation;(i)the actuary’s confidence in the results of the calculation.(3)Each appointed actuary must prepare an actuarial report on the actuary’s calculation within 35 days after the end of 4 years after the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability.
78 Summary report
(1)The actuaries must jointly prepare a summary report that—(a)includes the individual actuarial reports; and(b)states how the individual reports agree or differ.(2)The actuaries must give a copy of the completed summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the end of 4 years after the day WorkCover became liable for compensation and damages for the non-scheme employer’s liability.
79 Agreement on amount
WorkCover and the finalised non-scheme employer liability amount may agree on the finalised non-scheme employer liability amount having regard to the summary report.
80 Reference to arbiter if no agreement on amount
(1)WorkCover or the finalised non-scheme employer may advise the Regulator that WorkCover and the finalised non-scheme employer do not agree on the finalised non-scheme employer’s liability amount.(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the finalised non-scheme employer’s liability amount.
81 Payment of amount
(1)If the amount (the agreed amount) agreed to by WorkCover and the non-scheme employer or, if there is no agreement, the amount (the decided amount) decided by the arbiter, for the calculation is more than the non-scheme employer’s liability amount—
(a)the amount the non-scheme employer must pay WorkCover for the non-scheme employer’s liability is the agreed amount or decided amount; and(b)the non-scheme employer must pay WorkCover—(i)the difference between the amount of the payment (the interim payment) made under section 72 and the agreed amount or decided amount for the non-scheme employer’s liability; and(ii)interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return that was used in the calculation of the non-scheme employer’s liability amount.(2)If the agreed amount or decided amount is less than the interim payment—(a)the amount the non-scheme employer must pay WorkCover for the non-scheme employer’s liability is the agreed amount or decided amount; and(b)WorkCover must pay the non-scheme employer—(i)the difference between the interim payment and the agreed amount or decided amount for the liability; and(ii)interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return that was used in the calculation of an amount for the liability under subdivision 2.(3)WorkCover or the non-scheme employer must pay the amount of the difference within 28 days after—(a)WorkCover and the non-scheme employer agree on the recalculation; or(b)if there is no agreement, WorkCover or the non-scheme employer receives the statement of the arbiter’s decision about the recalculation.(4)On payment of the amount—(a)the non-scheme employer’s liability is finalised for section 105I(5) of the Act; and(b)no further amount is payable for the liability.
Division 6 Total liability—member of a group who becomes non-scheme employer
Subdivision 1 Preliminary
82 Calculation of non-scheme members’ total liability—Act, s 105O(3)(a)
For section 105O(3)(a) of the Act, the amount of total liability after a change in the self-insurer’s membership must be calculated under this division.
Subdivision 2 Actuarial calculations and reports
83 Appointment of actuary
(1)The old insurer and WorkCover must each appoint an actuary to calculate the total liability amount.(2)An actuary appointed by the old insurer must be approved by the non-scheme member.
84 Parties to give actuaries information
The old insurer and WorkCover must give the appointed actuaries, in the form approved by the Regulator, the information necessary to enable the actuaries to complete the calculation within the time mentioned in section 86(3).
85 Actuarial calculation
A calculation of a total liability amount must—(a)be prepared under the actuarial standard; and(b)apply a central estimate of the relevant liability; and(c)apply the risk free rate of return; and(d)include claims administration expenses of 7% of the outstanding liability; and(e)not include a prudential margin; and(f)be based, as far as practicable, on the claims experience of the employer or member of a group employer that is the subject of the transfer of liability; and(g)be based on data as at the assessment day.
86 Actuarial report
(1)For each calculation of a total liability amount each appointed actuary must prepare an actuarial report under the actuarial standard.(2)The actuarial report must state the following—(a)the amount;(b)the key assumptions made for the calculation;(c)how the key assumptions have been derived, including—(i)the average amount of claims for compensation against the non-scheme member; and(ii)the average amount of claims for damages against the non-scheme member; and(iii)claims anticipated to have been incurred by the non-scheme member, for which no formal claim has been lodged; and(iv)the frequency of claims for compensation against the non-scheme member; and(v)the frequency of claims for damages against the non-scheme member; and(vi)the net amount of the claims after allowing for future inflation (inflated value); and(vii)the net present value of the inflated value after allowing for income from assets set aside by the non-scheme member to pay the amount; and(viii)the rate of inflation used;(d)the nature of the data used in the calculation;(e)the actuary’s assessment of the data, including accuracy of the data;(f)how the actuary interpreted the data;(g)the actuarial model used in the calculation;(h)the results of the calculation;(i)the actuary’s confidence in the results of the calculation.(3)Each appointed actuary must prepare an actuarial report within 35 days after the final day.
87 Summary report
(1)The actuaries must jointly prepare a summary report that—(a)includes the individual actuarial reports; and(b)states how the individual reports agree or differ.(2)The actuaries must give a copy of the completed summary report to the Regulator, WorkCover and the old insurer, within 2 months after the final day.
88 Agreement on amount
The old insurer and WorkCover may agree on the liability amount having regard to the summary report.
89 Reference to arbiter if no agreement on amount
(1)WorkCover or the old insurer may advise the Regulator that WorkCover and the old insurer do not agree on the liability amount.(2)If the Regulator is advised under subsection (1), the Regulator must refer the summary report to the arbiter to decide the liability amount.
90 Payment of amount
(1)For section 105O(3)(b) of the Act, the old insurer must pay the agreed amount or decided amount—(a)within 3 months after the final day; or(b)on a later day agreed to by the old insurer and WorkCover.(2)The old insurer must pay WorkCover—(a)the non-scheme member’s total liability amount (the agreed amount) agreed to by the old insurer and WorkCover; or(b)if there is no agreement—the non-scheme member’s total liability amount (the decided amount) decided by the arbiter.(3)The agreed amount or decided amount paid to WorkCover must be adjusted by the actuary of the old insurer to take into account—(a)compensation and damages payments made between the assessment day and the final day; and(b)claims lodged against the non-scheme member between the assessment day and the final day.(4)The old insurer must advise the Regulator of the following no later than the day the total liability amount must be paid—(a)the amount of the total liability;(b)the day WorkCover assumes liability;(c)details of the old insurer and the non-scheme member.
91 Transfer of claims information
The old insurer must give WorkCover claims information in relation to the liability no later than the day the agreed or decided amount is paid.
Division 7 Actuarial arbiter
92 Function of actuarial arbiter
The functions of the actuarial arbiter are—(a)to consider the actuarial reports and the calculations of an amount for liability made under this part; and(b)to decide on an amount for the liability.
93 Selection and appointment of actuarial arbiter
(1)The arbiter is to be selected by a selection panel consisting of—(a)2 individuals nominated by the Regulator; and(b)2 individuals nominated by WorkCover; and(c)2 individuals nominated by the Association of Self Insured Employers of Queensland.(2)The arbiter must be a Fellow of the Institute of Actuaries or be an Accredited Member of the Institute.(3)The Regulator must appoint the arbiter for a term of not more than 3 years.(4)The arbiter’s conditions of appointment are to be set out in the contract made between the Regulator and the arbiter.
94 Arbiter must decide amount
(1)After considering the actuarial reports and the calculations of an amount for the liability by the actuaries, the arbiter must decide on—(a)the central estimate for the liability; and(b)an amount for the liability.(2)An amount for the liability decided by the arbiter must not be—(a)more than the higher of the amounts calculated by the actuaries; and(b)less than the lower of the amounts.(3)The arbiter must give a written statement of the arbiter’s decision, and the reasons for the decision, within 21 days after the summary report is referred to the arbiter.
95 Arbiter’s decision is final
The arbiter’s decision is final.
96 Arbiter’s costs
The arbiter’s costs in deciding a liability amount are to be paid in equal amounts by the following—(a)if the decision is for an amount of outstanding liability—WorkCover and the employer;(b)if the decision is for an amount of the total liability—the relevant parties;(c)if the decision is for an amount of liability after cancellation of the self-insurer’s licence—WorkCover and the former self-insurer;(d)if the decision is for an amount of estimated claims liability—the Regulator and the self-insurer;(e)if the decision is for an amount for non-scheme employer’s liability—WorkCover and the non-scheme employer;(f)if the decision is for an amount for a recalculation of a non-scheme employer’s liability—WorkCover and the non-scheme employer;(g)if the decision is for an amount for the total liability of a non-scheme member—WorkCover and the old insurer.
Part 4 Compensation
Division 1 Calculation of NWE
97 Calculation of NWE—Act, s 106(3)
This division prescribes the way to calculate the NWE for section 106(3) of the Act.
98 What amounts may be taken into account
(1)In calculating the NWE the following may be taken into account—(a)amounts paid to the worker by way of overtime, higher duties, penalties and allowances that are of a regular nature, required by an employer;(b)amounts that would have continued if not for the injury may be taken into account.(2)However, amounts mentioned in the Act, schedule 6, definition wages, paragraphs (a) to (d) must not be taken into account in calculating the NWE.
99 NWE if impracticable to calculate rate of worker’s remuneration
(1)This section applies if it is impracticable, at the date of injury to a worker, to calculate the rate of the worker’s remuneration because of—(a)the period of time for which the worker has been employed; or(b)the terms of the worker’s employment.(2)In calculating the rate of the worker’s remuneration, regard must be had to—(a)the NWE during the 12 months immediately before the date of injury of a person employed by the same employer who—(i)is employed under the same or a comparable relevant industrial agreement or the same or comparable terms and conditions as the worker; and(ii)performs the same or comparable work as the worker; or(b)if paragraph (a) does not apply—the NWE during the 12 months immediately before the date of injury of a person employed by another employer who—(i)is employed under the same or comparable relevant industrial agreement or the same or comparable terms and conditions as the worker; or(ii)receives the same or comparable remuneration as the worker and performs the same or comparable work as the worker.
100 NWE if worker worked for 2 or more employers
(1)This section applies if a worker has worked under concurrent contracts of service with 2 or more employers, under which the worker has worked at 1 time for 1 employer and at another time for another of the employers.(2)The worker’s NWE is to be calculated as if earnings under all the contracts were earnings in the employment of the employer for whom the worker was working when the injury was sustained.
101 NWE if insurer considers calculation unfair
(1)This section applies if an insurer considers that the calculation of NWE under this division would be unfair.(2)The NWE may be calculated in a way the insurer considers to be fair, and the calculation under this subsection is taken to be the worker’s NWE.
Division 2 Compensation application and other procedures
102 Application for compensation to include evidence or particulars—Act, s 132(3)(b)
(1)For section 132(3)(b) of the Act, the following evidence or particulars are prescribed—(a)the injury and its cause;(b)the nature, extent and duration of incapacity resulting from the injury;(c)if the injury is, or results in, the death of a worker, proof of—(i)the worker’s death; and(ii)the identity of the worker; and(iii)the relationship to the worker, and dependency, of persons claiming to be the worker’s dependants;(d)if the injury is a latent onset injury that is a terminal condition and the worker has dependants—proof of the relationship to the worker of persons claiming to be the worker’s dependants.(2)In this section—dependant, of a worker, means a member of the worker’s family who is completely or partly dependent on the worker’s earnings.member of the family, of a worker, means—(a)the worker’s—(i)spouse; or(ii)parent, grandparent or step-parent; or(iii)child, grandchild or stepchild; or(iv)brother, sister, half-brother or half-sister; or(b)if the worker stands in the place of a parent to another person—the other person; or(c)if another person stands in the place of a parent to the worker—the other person.
103 If dentist, doctor or nurse practitioner not available
(1)This section applies if—(a)a person does not lodge a certificate in the approved form with an application made under section 132, 132A or 132B of the Act in relation to a worker; and(b)the certificate can not be provided because the dentist, doctor or nurse practitioner required to give the certificate under the section was not available to attend the worker.(2)The person must complete and lodge with the insurer a declaration in the approved form.(3)For a non-fatal injury, the declaration—(a)may be accepted by the insurer only once for injury to the worker in any 1 event; and(b)is acceptable proof of incapacity of the worker for up to 3 days.(4)The declaration is taken to be a certificate in the approved form for section 132(3)(a), 132A(3)(c)(i) or 132B(3)(c)(i) of the Act.
104 Certificate given by dentist, doctor or nurse practitioner
(1)This section applies if—(a)a certificate in the approved form is not lodged with an application made under section 132, 132A or 132B of the Act in relation to a worker who sustains an injury; and(b)the worker sustained the injury in another State or country.(2)The insurer must accept a written certificate that is substantially to the effect of the approved form from the dentist, doctor or nurse practitioner who attended the worker.(3)The certificate is taken to be a certificate in the approved form for section 132(3)(a), 132A(3)(c)(i) or 132B(3)(c)(i) of the Act.(4)Also, on the insurer’s request, the dentist, doctor or nurse practitioner who attended the worker must give a detailed report on the worker’s condition to the insurer within 10 days after receiving the request.(5)The fee payable to the dentist, doctor or nurse practitioner for the report is an amount that the insurer considers to be reasonable, having regard to the relevant table of costs.
105 Application for compensation for assessment of DPI—Act, s 132A(3)(c)(ii)
For section 132A(3)(c)(ii) of the Act, the following evidence or particulars are prescribed—(a)proof of the injury and its cause;(b)proof of the nature, extent and duration of incapacity resulting from the injury.
105A Application for certificate of dependency—Act, s 132B(3)(c)(ii)
For section 132B(3)(c)(ii) of the Act, the following evidence is prescribed—(a)proof of the injury and its cause;(b)proof of the identity of the worker;(c)proof of the worker’s death;(d)proof of the relationship to the worker, and dependency, of the person claiming to be the worker’s dependant.
106 Request for examination of claimant or worker—Act, ss 135 and 510
(1)A request under sections 135 and 510 of the Act for a personal examination must be made in writing.(2)The request must specify—(a)the name of the doctor or other registered person, who is not employed by the insurer under a contract of service, engaged to make the examination; and(b)if the doctor is a specialist—the field of specialty; and(c)the day, time and place for the examination.(3)A doctor or other registered person who examines a claimant or worker must, within 10 days after the examination, give the insurer—(a)a written report on the examination; and(b)an itemised account for the examination.(4)Fees payable to a doctor or other registered person for the examination—(a)are payable by the insurer; and(b)are payable for—(i)making the examination; and(ii)giving a report to the insurer; and(c)are the costs accepted by the insurer to be reasonable, having regard to the relevant table of costs.
Division 3 Entitlement to compensation for permanent impairment—generally
107 Additional lump sum compensation—workers with latent onset injuries that are terminal—Act, s 128B(2)(c)
For section 128B(2)(c) of the Act, the additional lump sum compensation, and graduated scale, set out in schedule 2 are prescribed.
108 Calculating lump sum compensation—Act, s 180(1)
For section 180(1) of the Act, the lump sum compensation for a worker’s DPI is calculated by multiplying the maximum statutory compensation by the worker’s DPI.Example—
A worker’s DPI is assessed as 10%. The maximum statutory compensation is $307,385. The lump sum compensation is $30,738.50.
109 Additional lump sum compensation for workers with DPI of 30% or more—Act, s 192(2)
For section 192(2) of the Act, the additional lump sum compensation, and graduated scale, set out in schedule 3 are prescribed.
110 Additional lump sum compensation for gratuitous care (occupational therapist’s assessment)—Act, ss 193(4) and 224(3)
For sections 193(4) and 224(3) of the Act, the prescribed way of assessing the worker’s level of dependency is the way stated in the modified barthel index.
111 Additional lump sum compensation for gratuitous care (occupational therapist’s report)—Act, ss 193(5)(b) and 224(4)(b)
For sections 193(5)(b) and 224(4)(b) of the Act, the following information, relating to the level of day to day care (the level of care) provided by a person at the worker’s home, is prescribed—(a)whether the level of care was provided to the worker before the worker sustained the impairment;(b)whether the level of care would ordinarily be provided in the worker’s home;(c)if the level of care is likely to continue to be provided in the worker’s home;(d)the number of hours of the level of care required by the worker.
112 Additional lump sum compensation for gratuitous care—Act, s 193(6)
(1)For section 193(6) of the Act, the additional lump sum compensation, and graduated scale, set out in schedule 4 are prescribed.(2)For section 193(6)(c) of the Act, the occupational therapist’s report is prescribed.(3)In this section—occupational therapist’s report means the report prepared by the occupational therapist under section 193(5) of the Act.
Division 3A Entitlement to additional compensation for permanent impairment—Act, s 193A
Subdivision 1 Preliminary
112A Definitions for div 3A
In this division—injury means an injury mentioned in section 193A(1) of the Act.panel means the panel established under section 112R.qualifying condition means the condition prescribed by section 112D.section 193A compensation, for an injury, means the additional lump sum compensation mentioned in section 193A(2) of the Act for the injury.section 193A notice see section 112G(1).specified worker means a worker to whom section 193A of the Act applies.
112B Operation of div 3A
For section 193A of the Act, this division prescribes the following—(a)the amount of section 193A compensation for an injury;(b)the condition to which an entitlement to section 193A compensation is subject;(c)the process for deciding whether the condition mentioned in paragraph (b) is satisfied for a specified worker;(d)the establishment of a panel to review decisions made by insurers about section 193A compensation.
Subdivision 2 Amount and condition of entitlement
112C Amount of compensation—Act, s 193A(2)(a)
For section 193A(2)(a) of the Act, the amount of section 193A compensation for an injury sustained by a specified worker in relation to whom the qualifying condition is satisfied is the amount provided for under schedule 4A.
112D Qualifying condition—Act, s 193A(2)(b)
(1)For section 193A(2)(b) of the Act, this section prescribes the condition applying to an entitlement to section 193A compensation for an injury sustained by a specified worker.
(2)The worker is entitled to section 193A compensation only if—(a)the insurer is satisfied, on the balance of probabilities, the worker’s employer is, or would have been, liable to pay damages to the worker; but(b)the worker can not seek damages because of the application of former section 237(1)(a)(i).(3)In this section—former section 237(1)(a)(i) means section 237(1)(a)(i) of the Act, as in force from 15 October 2013 until 31 January 2015.
Subdivision 3 Process for deciding qualifying condition
112E Application of sdiv 3
This subdivision applies if—(a)a worker’s DPI has been decided; and(b)the worker is a specified worker.Notes—
1Section 193A of the Act applies only if a worker’s DPI has been decided—see section 191 of the Act.2Also, see chapter 3, part 10 of the Act for provisions about—•assessing a worker’s injury to decide if the injury has resulted in a DPI; and•giving the worker a notice of assessment stating the DPI for the injury; and•an insurer making an offer of compensation to the worker.
112F Insurer to consider qualifying condition
An insurer must decide—(a)whether the insurer has enough information to decide whether the qualifying condition is satisfied for the worker; and(b)if the insurer decides it has enough information—whether the qualifying condition is satisfied for the worker.
112G Notification
(1)After deciding the matters mentioned in section 112F, the insurer must give the worker a notice (a section 193A notice) in the approved form.(2)If the insurer decides the qualifying condition is satisfied for the worker, the section 193A notice must state the amount of section 193A compensation to which the worker is entitled for the worker’s injury.(3)If the insurer decides the qualifying condition is not satisfied for the worker, the section 193A notice must state—(a)the insurer’s decision; and(b)that the worker may ask the insurer for written reasons for the decision; and(c)that the worker may apply to the panel for a review of the decision only if the worker has asked the insurer for the reasons for the decision.(4)If the insurer decides it does not have enough information to decide whether the qualifying condition is satisfied for the worker, the section 193A notice must state—(a)the insurer’s decision; and(b)that the worker may, within 60 business days after receiving the notice, give the insurer information to enable the insurer to decide whether the qualifying condition is satisfied for the worker; and(c)that, if the worker does not give the insurer the information within the period mentioned in paragraph (b)—(i)the qualifying condition will be taken not to be satisfied for the worker; and(ii)the worker will not be entitled to section 193A compensation; and(iii)the worker will not have a right to apply to the panel for a review of the matters mentioned in subparagraphs (i) and (ii).
112H Worker may request reasons
(1)This section applies if an insurer has given the worker a section 193A notice stating the insurer has decided the qualifying condition is not satisfied for the worker.(2)The worker may, within 10 business days after receiving the notice, ask the insurer for written reasons for the decision.(3)The insurer must give the worker the reasons for the decision within 10 business days after receiving the worker’s request.
112I Giving information
(1)This section applies if the insurer has given the worker a section 193A notice stating the insurer does not have enough information to decide whether the qualifying condition is satisfied for the worker.(2)The worker—(a)may give the insurer information relevant to the decision within 60 business days after receiving the section 193A notice; and(b)if the worker gives information to the insurer under paragraph (a)—must advise the insurer whether the worker has engaged a lawyer and incurred legal costs in giving the information.(3)Despite subsection (2)(a), the insurer may, at the worker’s request, decide to allow the worker to give the insurer information after the period mentioned in the subsection has ended if the worker has a reasonable excuse for not giving the information during the period.(4)The qualifying condition is taken not to be satisfied for the worker if the worker does not give the insurer information relevant to the decision during the period—(a)mentioned in subsection (2)(a); or(b)decided by the insurer under subsection (3).
112J Decision based on worker’s information
(1)This section applies if the worker has given the insurer information under section 112I.(2)The insurer must consider the information and decide whether the qualifying condition is satisfied for the worker.(3)The insurer must make the decision within the later of the following periods to end—(a)60 business days after receiving the information from the worker;(b)if the insurer meets with the worker under section 112K—10 business days after the day of the meeting.(4)If the insurer decides the qualifying condition is satisfied for the worker, the insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.(5)If the insurer decides the qualifying condition is not satisfied for the worker, the insurer must give the worker written reasons for the decision.(6)If the insurer does not make a decision within the period mentioned in subsection (3), the insurer is taken to have decided the qualifying condition is not satisfied for the worker.
112K Meeting before decision made
(1)This section applies if—(a)the worker has given the insurer information under section 112I; and(b)the insurer proposes to decide the qualifying condition is not satisfied for the worker.(2)Before making the decision, the insurer must—(a)give the worker an opportunity to meet with the insurer to discuss the proposed decision; and(b)if the worker agrees to meet with the insurer—give the worker any relevant information the insurer holds at least 10 business days before the meeting.(3)The insurer is not required to give the worker more than 1 opportunity to meet with the insurer.(4)In this section—relevant information, in relation to a worker, means information, other than information given to the insurer by the worker, that the insurer intends to consider for making the proposed decision.
Subdivision 4 Review of insurer’s decision
112L Definition for sdiv 4
In this subdivision—decision, of an insurer, includes a decision taken to have been made by the insurer under section 112J(6).
112M Application of sdiv 4
This subdivision applies to a worker—(a)who, under subdivision 3, has received written reasons for an insurer’s decision that the qualifying condition is not satisfied for the worker; or(b)in relation to whom an insurer is taken to have decided that the qualifying condition is not satisfied under section 112J(6).
112N Application for review
(1)The worker may apply to the panel for a review of the decision within 20 business days after—(a)the worker receives written reasons for the decision; or(b)the day on which the worker becomes aware the insurer has failed to decide whether the qualifying condition is satisfied for the worker within the period mentioned in section 112J(3).(2)The application must include the following—(a)the worker’s reasons for asking for a review of the decision;(b)if the worker has received written reasons for the decision—the reasons;(c)if the worker has not already had an opportunity to give the insurer information about whether the qualifying condition is satisfied for the worker—any information the worker wants the panel to consider in support of the worker’s application;(d)if the worker has engaged a lawyer and incurred legal costs in relation to the application—a statutory declaration verifying the worker has engaged the lawyer and incurred legal costs.(3)The worker must give the insurer a copy of the application.
112O Insurer to give information to panel
As soon as practicable after receiving a copy of the worker’s application under section 112N, the insurer must give the panel and the worker any information the insurer has considered in deciding whether the qualifying condition is satisfied for the worker.
112P Review by panel
(1)After considering the application and reviewing the insurer’s decision, the panel must decide to—(a)confirm the decision; or(b)cancel the decision and substitute a new decision.(2)The panel must give the worker and the insurer written notice of its decision and the reasons for its decision.(3)The panel’s decision—(a)is final; and(b)if the decision is to substitute a new decision—is taken to be the insurer’s decision that the qualifying condition is satisfied for the worker.(4)To remove any doubt, it is declared that the panel may review the insurer’s decision without receiving oral submissions.
112Q Insurer must notify amount of entitlement
(1)This section applies if the insurer is notified by the panel that the insurer’s decision is substituted with a new decision that the qualifying condition is satisfied for the worker.(2)The insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.
Subdivision 5 Establishment of panel
112R Panel—Act, s 193A(3)
(1)For section 193A(3) of the Act, there is to be a panel made up of 1 chairperson and 2 other members.(2)The function of the panel is to meet, as required, to review decisions under subdivision 4.
112S Appointment to panel
(1)The Minister must appoint a chairperson and 2 other members to the panel, on terms decided by the Minister.(2)The Minister must ensure that each person appointed to the panel—(a)is qualified, or eligible to qualify, as a lawyer; and(b)has demonstrated significant experience relevant to the laws of personal injury and negligence.
112T Administrative matters
The Regulator may decide administrative matters about the panel that are not provided for under this subdivision, including, for example, the way in which the panel members must meet.
Subdivision 6 Miscellaneous
112U Liability not affected
To remove any doubt, it is declared that a decision made by an insurer or the panel under this division does not impose liability on, or otherwise affect the liability of, the insurer or an employer for any other purpose or proceeding.
Division 3AA Entitlement to compensation for pneumoconiosis
112V Working out pneumoconiosis score—Act, s 36F
For section 36F(b) of the Act, the way set out in schedule 4B is prescribed.
112W Lump sum compensation for workers with pneumoconiosis—Act, s 128G
(1)For section 128G(2) of the Act, the lump sum compensation, and graduated scale, set out in schedule 4C are prescribed.(2)For section 128G(3) of the Act, the pneumoconiosis bands set out in schedule 4C are prescribed.
Division 4 Liability for caring allowance
113 Payment of caring allowance—Act, s 225(a)
(1)For section 225(a) of the Act, if an insurer pays a caring allowance, the prescribed way of payment is for the insurer to—(a)decide the number of hours of the level of care required by the worker having regard to the occupational therapist’s report, and the graduated scale set out in schedule 5; and(b)decide the allowance having regard to the information in the occupational therapist’s report; and(c)pay the allowance at an hourly rate equal to the carer pension rate divided by 35.(2)In this section—carer pension rate means the weekly amount of the maximum single carer pension rate payable from time to time under a Commonwealth law, but does not include an amount for allowances such as rent assistance or family payment.occupational therapist’s report means the report prepared by the occupational therapist under section 224(3) of the Act.
Part 5 Rehabilitation
Division 1 Rehabilitation and return to work coordinators
114 Functions of rehabilitation and return to work coordinator—Act, s 41(b)
For section 41(b) of the Act, the following functions are prescribed—(a)initiate early communication with an injured worker in order to clarify the nature and severity of the worker’s injury;(b)provide overall coordination of the worker’s return to work;(c)if a rehabilitation and return to work plan is developed under section 221 of the Act—(i)consult with the worker and the worker’s employer to develop the suitable duties program component of the plan; and(ii)ensure the program is consistent with the current medical certificate or report for the worker’s injury;(d)liaise with—(i)any person engaged by the employer to help in the worker’s rehabilitation and return to work; and(ii)the insurer about the worker’s progress and indicate, as early as possible, if there is a need for the insurer to assist or intervene.
115 Criteria for employer to appoint rehabilitation and return to work coordinator—Act, s 226(1)
(1)For section 226(1) of the Act, the following criteria is prescribed—(a)for an employer who employs workers at a workplace in a high risk industry—the wages of the employer in Queensland for the preceding financial year were more than 2,600 times QOTE;(b)otherwise—the wages of the employer in Queensland for the preceding financial year were more than 5,200 times QOTE.(2)For the purpose of section 226(3)(a) of the Act, an employer is taken to have established a workplace, or started to employ workers at the workplace, when the employer first meets the criteria.(3)An employer may appoint a person as the rehabilitation and return to work coordinator for more than 1 workplace if the person can reasonably perform the person’s functions as a rehabilitation and return to work coordinator for each workplace.(4)In this section—high risk industry means an industry specified by the Regulator by gazette notice.
Division 2 Guidelines for standard for rehabilitation
116 [Repealed]
117 Availability of guidelines
(1)The Regulator must keep a copy of each guideline, as in force from time to time, available for inspection, free of charge at—(a)the department’s head office; and(b)other places the Regulator considers appropriate.(2)Also, the Regulator must publish each guideline, as in force from time to time, on the department’s website.
Part 5A Treatment, care and support payments
Division 1 Assessing entitlement
Subdivision 1 Preliminary
117A Definitions for division
In this division—childrens functional independence measure instrument means the functional independence measure instrument adapted for paediatrics and described on the department’s website.functional independence measure instrument means a clinical tool used to assess the functional ability of a person by scoring motor and cognitive items against a scale and described on the department’s website.
Subdivision 2 Eligibility criteria
117B Purpose of subdivision
For section 232M(2)(a) of the Act, this subdivision prescribes the eligibility criteria for particular serious personal injuries.
117C Eligibility criteria for permanent spinal cord injury
(1)The eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit are—(a)the permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and(b)the injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.(2)In this section—ASIA impairment scale means the scale, known as the American Spinal Injury Association impairment scale, used for measuring impairment resulting from a spinal cord injury and published by the American Spinal Injury Association.ISAFSCI means the document called ‘International standards to document remaining autonomic function after spinal cord injury’, published by the American Spinal Injury Association.ISNCSCI means the document called ‘International standards for neurological classification of spinal cord injury’, published by the American Spinal Injury Association.
117D Eligibility criteria for traumatic brain injury
(1)The eligibility criteria for a traumatic brain injury resulting in a permanent impairment are—(a)any or all of the following apply—(i)the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;(ii)the worker is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;(iii)brain imaging shows a significant brain abnormality as a result of the injury; and(b)the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—(i)for an adult—the functional independence measure instrument; or(ii)for a child—the childrens functional independence measure instrument.(2)In this section—approved scale, for assessing post-traumatic amnesia, means—(a)the Westmead PTA scale; or(b)a clinically accepted scale similar to the Westmead PTA scale approved by the Regulator for this definition.Westmead PTA scale means the clinical tool, known as the Westmead Post-traumatic Amnesia Scale, used to assess the period a person suffers post-traumatic amnesia.
117E Eligibility criterion for the amputation of a leg through or above the femur
(1)The eligibility criterion for the amputation of a leg through or above the femur is that the amputation involves the loss of 65% or more of the length of the femur.(2)For subsection (1), the percentage of the length of the femur lost must be worked out by—(a)comparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or(b)if X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.(3)To remove any doubt, it is declared that the eligibility criterion in subsection (1) may be satisfied even if the worker suffers from a personal injury that is the amputation of more than 1 limb or parts of different limbs.
117F Eligibility criteria for the amputation of more than 1 limb or parts of different limbs
(1)The eligibility criteria for the amputation of more than 1 limb or parts of different limbs are—(a)the amputations involve the loss of 50% or more of the length of each of the worker’s tibias; or(b)both of the worker’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or(c)the amputations involve—(i)the loss of 50% or more of the length of 1 of the worker’s tibias; and(ii)1 of the worker’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.(2)For subsection (1), the percentage of the length of the tibia lost must be worked out by—(a)comparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or(b)if X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or(c)if the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.
117G Eligibility criteria for a full thickness burn to all or part of the body
The eligibility criteria for a full thickness burn to all or part of the body are—(a)the full thickness burn is to—(i)for a worker younger than 16 years—more than 30% of the total body surface area; or(ii)for a worker 16 years or older—more than 40% of the total body surface area; or(iii)both hands; or(iv)the face; or(v)the genital area; and(b)the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—(i)for an adult—the functional independence measure instrument; or(ii)for a child—the childrens functional independence measure instrument.
117H Eligibility criterion for an inhalation burn resulting in a permanent respiratory impairment
Class | Level of impairment | Examples of indicators of level of impairmentNote— These must be had regard to under schedule 10, section 4(3)(a)(i). | Percentage impairment rangesNote— These may be had regard to under schedule 10, section 4(3)(b). |
Class 1 | Little or no impairment | 0 to 3% | |
• can work full-time in the position (the pre-injury position) in which the injured worker worked immediately before the injury | |||
• the injured worker’s duties at work and performance of the duties are consistent with the worker’s education and training | |||
• can cope with the normal demands of the job | |||
Class 2 | Mild impairment | 4 to 10% | |
• can work in the pre-injury position, but for no more than 20 hours a week, for example, because the injured worker is no longer happy to work with particular persons | |||
• can work full-time in a different position where performance of the relevant duties requires the use of comparable skill and intellect to that required to perform the duties of the pre-injury position | |||
Class 3 | Moderate impairment | 11 to 30% | |
• can not work at all in the pre-injury position | |||
• only able to work less than 20 hours a week in a different position where performance of the relevant duties requires less skill or is otherwise less demanding, for example, less stressful | |||
Class 4 | Severe impairment | 31 to 60% | |
• can not work more than 1 or 2 days at a time | |||
• works less than 20 hours a fortnight | |||
• the pace at which work is done is reduced | |||
• attendance at work is erratic | |||
Class 5 | Totally impaired | more than 60% | |
• needs constant supervision and assistance within an institutional environment |
Schedule 12 General damages calculation provisions
section 130
Table 1—For an injury sustained from 1 July 2010 to 30 June 2011 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,180 |
2 | 10 or less but more than 5 | $5,900 | (Injury scale value - 5) x $1,410 |
3 | 15 or less but more than 10 | $12,950 | (Injury scale value - 10) x $1,650 |
4 | 20 or less but more than 15 | $21,200 | (Injury scale value - 15) x $1,880 |
5 | 25 or less but more than 20 | $30,600 | (Injury scale value - 20) x $2,120 |
6 | 30 or less but more than 25 | $41,200 | (Injury scale value - 25) x $2,360 |
7 | 35 or less but more than 30 | $53,000 | (Injury scale value - 30) x $2,590 |
8 | 40 or less but more than 35 | $65,950 | (Injury scale value - 35) x $2,830 |
9 | 50 or less but more than 40 | $80,100 | (Injury scale value - 40) x $3,040 |
10 | 60 or less but more than 50 | $110,500 | (Injury scale value - 50) x $3,250 |
11 | 70 or less but more than 60 | $143,000 | (Injury scale value - 60) x $3,460 |
12 | 80 or less but more than 70 | $177,600 | (Injury scale value - 70) x $3,680 |
13 | 90 or less but more than 80 | $214,400 | (Injury scale value - 80) x $3,890 |
14 | 100 or less but more than 90 | $253,300 | (Injury scale value - 90) x $4,120 |
Table 2—For an injury sustained from 1 July 2011 to 30 June 2012 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,210 |
2 | 10 or less but more than 5 | $6,050 | (Injury scale value - 5) x $1,450 |
3 | 15 or less but more than 10 | $13,300 | (Injury scale value - 10) x $1,700 |
4 | 20 or less but more than 15 | $21,800 | (Injury scale value - 15) x $1,930 |
5 | 25 or less but more than 20 | $31,450 | (Injury scale value - 20) x $2,180 |
6 | 30 or less but more than 25 | $42,350 | (Injury scale value - 25) x $2,430 |
7 | 35 or less but more than 30 | $54,500 | (Injury scale value - 30) x $2,660 |
8 | 40 or less but more than 35 | $67,800 | (Injury scale value - 35) x $2,910 |
9 | 50 or less but more than 40 | $82,350 | (Injury scale value - 40) x $3,130 |
10 | 60 or less but more than 50 | $113,650 | (Injury scale value - 50) x $3,340 |
11 | 70 or less but more than 60 | $147,050 | (Injury scale value - 60) x $3,560 |
12 | 80 or less but more than 70 | $182,650 | (Injury scale value - 70) x $3,780 |
13 | 90 or less but more than 80 | $220,450 | (Injury scale value - 80) x $4,000 |
14 | 100 or less but more than 90 | $260,450 | (Injury scale value - 90) x $4,240 |
Table 3—For an injury sustained from 1 July 2012 to 30 June 2013 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1270 |
2 | 10 or less but more than 5 | $6,350 | (Injury scale value - 5) x $1,530 |
3 | 15 or less but more than 10 | $14,000 | (Injury scale value - 10) x $1,790 |
4 | 20 or less but more than 15 | $22,950 | (Injury scale value - 15) x $2,030 |
5 | 25 or less but more than 20 | $33,100 | (Injury scale value - 20) x $2,300 |
6 | 30 or less but more than 25 | $44,600 | (Injury scale value - 25) x $2,560 |
7 | 35 or less but more than 30 | $57,400 | (Injury scale value - 30) x $2,800 |
8 | 40 or less but more than 35 | $71,400 | (Injury scale value - 35) x $3,070 |
9 | 50 or less but more than 40 | $86,750 | (Injury scale value - 40) x $3,300 |
10 | 60 or less but more than 50 | $119,750 | (Injury scale value - 50) x $3,520 |
11 | 70 or less but more than 60 | $154,950 | (Injury scale value - 60) x $3,750 |
12 | 80 or less but more than 70 | $192,450 | (Injury scale value - 70) x $3,980 |
13 | 90 or less but more than 80 | $232,250 | (Injury scale value - 80) x $4,210 |
14 | 100 or less but more than 90 | $274,350 | (Injury scale value - 90) x $4,470 |
Table 4—For an injury sustained from 1 July 2013 to 30 June 2014 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,310 |
2 | 10 or less but more than 5 | $6,550 | (Injury scale value - 5) x $1,580 |
3 | 15 or less but more than 10 | $14,450 | (Injury scale value - 10) x $1,840 |
4 | 20 or less but more than 15 | $23,650 | (Injury scale value - 15) x $2,090 |
5 | 25 or less but more than 20 | $34,100 | (Injury scale value - 20) x $2,370 |
6 | 30 or less but more than 25 | $45,950 | (Injury scale value - 25) x $2,640 |
7 | 35 or less but more than 30 | $59,150 | (Injury scale value - 30) x $2,880 |
8 | 40 or less but more than 35 | $73,550 | (Injury scale value - 35) x $3,160 |
9 | 50 or less but more than 40 | $89,350 | (Injury scale value - 40) x $3,400 |
10 | 60 or less but more than 50 | $123,350 | (Injury scale value - 50) x $3,620 |
11 | 70 or less but more than 60 | $159,550 | (Injury scale value - 60) x $3,860 |
12 | 80 or less but more than 70 | $198,150 | (Injury scale value - 70) x $4,100 |
13 | 90 or less but more than 80 | $239,150 | (Injury scale value - 80) x $4,340 |
14 | 100 or less but more than 90 | $282,550 | (Injury scale value - 90) x $4,600 |
Table 5—For an injury sustained from 1 July 2014 to 30 June 2015 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,360 |
2 | 10 or less but more than 5 | $6,800 | (Injury scale value - 5) x $1,640 |
3 | 15 or less but more than 10 | $15,000 | (Injury scale value - 10) x $1,910 |
4 | 20 or less but more than 15 | $24,550 | (Injury scale value - 15) x $2,170 |
5 | 25 or less but more than 20 | $35,400 | (Injury scale value - 20) x $2,460 |
6 | 30 or less but more than 25 | $47,700 | (Injury scale value - 25) x $2,740 |
7 | 35 or less but more than 30 | $61,400 | (Injury scale value - 30) x $2,990 |
8 | 40 or less but more than 35 | $76,350 | (Injury scale value - 35) x $3,280 |
9 | 50 or less but more than 40 | $92,750 | (Injury scale value - 40) x $3,530 |
10 | 60 or less but more than 50 | $128,050 | (Injury scale value - 50) x $3,760 |
11 | 70 or less but more than 60 | $165,650 | (Injury scale value - 60) x $4,010 |
12 | 80 or less but more than 70 | $205,750 | (Injury scale value - 70) x $4,260 |
13 | 90 or less but more than 80 | $248,350 | (Injury scale value - 80) x $4,500 |
14 | 100 or less but more than 90 | $293,350 | (Injury scale value - 90) x $4,770 |
Table 6—For an injury sustained from 1 July 2015 to 30 June 2017 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,390 |
2 | 10 or less but more than 5 | $6,950 | (Injury scale value - 5) x $1,680 |
3 | 15 or less but more than 10 | $15,350 | (Injury scale value - 10) x $1,960 |
4 | 20 or less but more than 15 | $25,150 | (Injury scale value - 15) x $2,220 |
5 | 25 or less but more than 20 | $36,250 | (Injury scale value - 20) x $2,520 |
6 | 30 or less but more than 25 | $48,850 | (Injury scale value - 25) x $2,810 |
7 | 35 or less but more than 30 | $62,900 | (Injury scale value - 30) x $3,060 |
8 | 40 or less but more than 35 | $78,200 | (Injury scale value - 35) x $3,360 |
9 | 50 or less but more than 40 | $95,000 | (Injury scale value - 40) x $3,620 |
10 | 60 or less but more than 50 | $131,200 | (Injury scale value - 50) x $3,850 |
11 | 70 or less but more than 60 | $169,700 | (Injury scale value - 60) x $4,110 |
12 | 80 or less but more than 70 | $210,800 | (Injury scale value - 70) x $4,360 |
13 | 90 or less but more than 80 | $254,400 | (Injury scale value - 80) x $4,610 |
14 | 100 or less but more than 90 | $300,500 | (Injury scale value - 90) x $4,890 |
Table 7—For an injury sustained from 1 July 2017 to 30 June 2018 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,410 |
2 | 10 or less but more than 5 | $7,050 | (Injury scale value - 5) x $1,710 |
3 | 15 or less but more than 10 | $15,600 | (Injury scale value - 10) x $1,990 |
4 | 20 or less but more than 15 | $25,550 | (Injury scale value - 15) x $2,260 |
5 | 25 or less but more than 20 | $36,850 | (Injury scale value - 20) x $2,560 |
6 | 30 or less but more than 25 | $49,650 | (Injury scale value - 25) x $2,860 |
7 | 35 or less but more than 30 | $63,950 | (Injury scale value - 30) x $3,110 |
8 | 40 or less but more than 35 | $79,500 | (Injury scale value - 35) x $3,420 |
9 | 50 or less but more than 40 | $96,600 | (Injury scale value - 40) x $3,680 |
10 | 60 or less but more than 50 | $133,400 | (Injury scale value - 50) x $3,920 |
11 | 70 or less but more than 60 | $172,600 | (Injury scale value - 60) x $4,180 |
12 | 80 or less but more than 70 | $214,400 | (Injury scale value - 70) x $4,440 |
13 | 90 or less but more than 80 | $258,800 | (Injury scale value - 80) x $4,690 |
14 | 100 or less but more than 90 | $305,700 | (Injury scale value - 90) x $4,970 |
Table 8—For an injury sustained from 1 July 2018 to 30 June 2019 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,450 |
2 | 10 or less but more than 5 | $7,250 | (Injury scale value - 5) x $1,760 |
3 | 15 or less but more than 10 | $16,050 | (Injury scale value - 10) x $2,050 |
4 | 20 or less but more than 15 | $26,300 | (Injury scale value - 15) x $2,330 |
5 | 25 or less but more than 20 | $37,950 | (Injury scale value - 20) x $2,640 |
6 | 30 or less but more than 25 | $51,150 | (Injury scale value - 25) x $2,950 |
7 | 35 or less but more than 30 | $65,900 | (Injury scale value - 30) x $3,210 |
8 | 40 or less but more than 35 | $81,950 | (Injury scale value - 35) x $3,530 |
9 | 50 or less but more than 40 | $99,600 | (Injury scale value - 40) x $3,790 |
10 | 60 or less but more than 50 | $137,500 | (Injury scale value - 50) x $4,040 |
11 | 70 or less but more than 60 | $177,900 | (Injury scale value - 60) x $4,310 |
12 | 80 or less but more than 70 | $221,000 | (Injury scale value - 70) x $4,580 |
13 | 90 or less but more than 80 | $266,800 | (Injury scale value - 80) x $4,830 |
14 | 100 or less but more than 90 | $315,100 | (Injury scale value - 90) x $5,120 |
Table 9—For an injury sustained from 1 July 2019 to 30 June 2020 (dates inclusive) | |||
Item | Injury scale value | Base amount | Variable amount |
1 | 5 or less | — | Injury scale value x $1,490 |
2 | 10 or less but more than 5 | $7,450 | (Injury scale value - 5) x $1,810 |
3 | 15 or less but more than 10 | $16,500 | (Injury scale value - 10) x $2,110 |
4 | 20 or less but more than 15 | $27,050 | (Injury scale value - 15) x $2,400 |
5 | 25 or less but more than 20 | $39,050 | (Injury scale value - 20) x $2,720 |
6 | 30 or less but more than 25 | $52,650 | (Injury scale value - 25) x $3,040 |
7 | 35 or less but more than 30 | $67,850 | (Injury scale value - 30) x $3,310 |
8 | 40 or less but more than 35 | $84,400 | (Injury scale value - 35) x $3,640 |
9 | 50 or less but more than 40 | $102,600 | (Injury scale value - 40) x $3,900 |
10 | 60 or less but more than 50 | $141,600 | (Injury scale value - 50) x $4,160 |
11 | 70 or less but more than 60 | $183,200 | (Injury scale value - 60) x $4,440 |
12 | 80 or less but more than 70 | $227,600 | (Injury scale value - 70) x $4,720 |
13 | 90 or less but more than 80 | $274,800 | (Injury scale value - 80) x $4,980 |
14 | 100 or less but more than 90 | $324,600 | (Injury scale value - 90) x $5,270 |
Table 10—For an injury sustained on or after 1 July 2020 | ||
Item | Injury scale value | General damages |
1 | 0 | 0 |
2 | 1 | 0.95 times QOTE |
3 | 2 | 1.90 times QOTE |
4 | 3 | 2.84 times QOTE |
5 | 4 | 3.79 times QOTE |
6 | 5 | 4.74 times QOTE |
7 | 6 | 5.89 times QOTE |
8 | 7 | 7.04 times QOTE |
9 | 8 | 8.19 times QOTE |
10 | 9 | 9.34 times QOTE |
11 | 10 | 10.49 times QOTE |
12 | 11 | 11.83 times QOTE |
13 | 12 | 13.17 times QOTE |
14 | 13 | 14.51 times QOTE |
15 | 14 | 15.85 times QOTE |
16 | 15 | 17.19 times QOTE |
17 | 16 | 18.72 times QOTE |
18 | 17 | 20.24 times QOTE |
19 | 18 | 21.76 times QOTE |
20 | 19 | 23.29 times QOTE |
21 | 20 | 24.81 times QOTE |
22 | 21 | 26.54 times QOTE |
23 | 22 | 28.27 times QOTE |
24 | 23 | 30.00 times QOTE |
25 | 24 | 31.73 times QOTE |
26 | 25 | 33.45 times QOTE |
27 | 26 | 35.39 times QOTE |
28 | 27 | 37.32 times QOTE |
29 | 28 | 39.25 times QOTE |
30 | 29 | 41.18 times QOTE |
31 | 30 | 43.11 times QOTE |
32 | 31 | 45.21 times QOTE |
33 | 32 | 47.32 times QOTE |
34 | 33 | 49.42 times QOTE |
35 | 34 | 51.52 times QOTE |
36 | 35 | 53.63 times QOTE |
37 | 36 | 55.94 times QOTE |
38 | 37 | 58.25 times QOTE |
39 | 38 | 60.56 times QOTE |
40 | 39 | 62.88 times QOTE |
41 | 40 | 65.19 times QOTE |
42 | 41 | 67.67 times QOTE |
43 | 42 | 70.14 times QOTE |
44 | 43 | 72.62 times QOTE |
45 | 44 | 75.10 times QOTE |
46 | 45 | 77.58 times QOTE |
47 | 46 | 80.06 times QOTE |
48 | 47 | 82.53 times QOTE |
49 | 48 | 85.01 times QOTE |
50 | 49 | 87.49 times QOTE |
51 | 50 | 89.97 times QOTE |
52 | 51 | 92.61 times QOTE |
53 | 52 | 95.25 times QOTE |
54 | 53 | 97.90 times QOTE |
55 | 54 | 100.54 times QOTE |
56 | 55 | 103.18 times QOTE |
57 | 56 | 105.82 times QOTE |
58 | 57 | 108.47 times QOTE |
59 | 58 | 111.11 times QOTE |
60 | 59 | 113.75 times QOTE |
61 | 60 | 116.40 times QOTE |
62 | 61 | 119.22 times QOTE |
63 | 62 | 122.04 times QOTE |
64 | 63 | 124.86 times QOTE |
65 | 64 | 127.68 times QOTE |
66 | 65 | 130.50 times QOTE |
67 | 66 | 133.32 times QOTE |
68 | 67 | 136.14 times QOTE |
69 | 68 | 138.96 times QOTE |
70 | 69 | 141.78 times QOTE |
71 | 70 | 144.60 times QOTE |
72 | 71 | 147.60 times QOTE |
73 | 72 | 150.60 times QOTE |
74 | 73 | 153.60 times QOTE |
75 | 74 | 156.60 times QOTE |
76 | 75 | 159.60 times QOTE |
77 | 76 | 162.60 times QOTE |
78 | 77 | 165.60 times QOTE |
79 | 78 | 168.59 times QOTE |
80 | 79 | 171.59 times QOTE |
81 | 80 | 174.59 times QOTE |
82 | 81 | 177.76 times QOTE |
83 | 82 | 180.92 times QOTE |
84 | 83 | 184.08 times QOTE |
85 | 84 | 187.25 times QOTE |
86 | 85 | 190.41 times QOTE |
87 | 86 | 193.58 times QOTE |
88 | 87 | 196.74 times QOTE |
89 | 88 | 199.90 times QOTE |
90 | 89 | 203.07 times QOTE |
91 | 90 | 206.23 times QOTE |
92 | 91 | 209.58 times QOTE |
93 | 92 | 212.93 times QOTE |
94 | 93 | 216.28 times QOTE |
95 | 94 | 219.62 times QOTE |
96 | 95 | 222.97 times QOTE |
97 | 96 | 226.32 times QOTE |
98 | 97 | 229.67 times QOTE |
99 | 98 | 233.02 times QOTE |
100 | 99 | 236.36 times QOTE |
101 | 100 | 239.71 times QOTE |
Schedule 13 Dictionary
section 3
actuarial standard means ‘Professional Standard 300—Actuarial reports and advice on outstanding claims in general insurance’ issued by the Institute of Actuaries of Australia (ACN 000 423 656).
Editor’s note—
A copy of the standard may be inspected at the Regulator’s office.
actuary means an actuary approved by the Regulator.
adverse psychological reaction does not include a mental disorder.
AMA 4 means the ‘Guides to the Evaluation of Permanent Impairment’ (4th edition) published by the American Medical Association.
AMA 5 means the ‘Guides to the Evaluation of Permanent Impairment’ (5th edition) published by the American Medical Association.
ankylosis means fixation of a joint in a specific position.
appointed actuary means—
(a)for part 3, division 3—an actuary appointed under section 49; and
(b)for part 3, division 4—an actuary approved by the Regulator under section 84(4) of the Act to assess the self-insurer’s estimated claims liability.
arbiter means the actuarial arbiter appointed under section 93.
AS/NZS means a standard published jointly by Standards Australia and Standards New Zealand.
assessed premium, for an employer, means premium calculated using the employer’s wages for a period of insurance.
assessment day means—
(a)for part 3, division 1—the last day of the financial quarter immediately before the day the application for self-insurance is lodged; and
(b)for part 3, division 2—the last day of the financial quarter immediately before the day the self-insurer applies to the Regulator under section 89 of the Act for a change in the group membership on the licence; and
(c)for part 3, division 3—last day of the financial quarter immediately before the cancellation day; and
(d)for part 3, division 5—the last day of the financial quarter immediately before the cancellation day; and
(e)for part 3, division 6—the last day of the financial quarter immediately before the final day.
binaural tables means the binaural tables recommended and published by National Acoustic Laboratories.
cancellation day means—
(a)for part 3, division 3—the day the former self-insurer’s licence is cancelled; and
(b)for part 3, division 5—the day the non-scheme employer’s continued licence is cancelled under section 105E of the Act.
category, for schedule 4B, see schedule 4B, section 2(1)(b).
central estimate has the meaning given by the actuarial standard, section 10.
childrens functional independence measure instrument, for part 5A, division 1, see section 117A.
claim means—
(a)an application for compensation; or
(b)a claim for damages.
consecutive categories, for schedule 4B, see schedule 4B, section 3.
consent day means the day the Regulator approves the application for the change in the self-insurer’s membership.
continued licence, for a non-scheme employer, see section 105B(2) of the Act.
corresponding score, for a category, for schedule 4B, see schedule 4B, section 1.
decision, of an insurer, for part 4, division 3A, subdivision 4, see section 112L.
digestive system—
(a)means the organs and other parts of the body forming the alimentary tract, and includes the tongue, throat and abdominal wall; but
(b)does not include an organ or other part of the body mentioned in the injury column of schedule 9.
dominant injury, of multiple injuries, means—
(a)if the highest range for 2 or more of the injuries of the multiple injuries is the same—the injury of those injuries selected as the dominant injury by a court assessing an ISV; or
(b)otherwise—the injury of the multiple injuries having the highest range.
Note—
The selection as a dominant injury of a particular injury from 2 or more injuries having the same highest range will not affect the outcome of the court’s assessment of an ISV for the multiple injuries.
DPI amount, for schedule 4A, see schedule 4A, section 1(a).
DSM 4 means the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) published by the American Psychiatric Association in 2000.
estimated claims liability has the same meaning as in section 84(8) of the Act.
estimated claims liability amount, for part 3, division 3 means the amount of a self-insurer’s estimated claims liability as calculated under division 4.
final day means the day a non-scheme member stops being a member of the old insurer under section 105M of the Act.
finalised non-scheme employer’s liability amount for part 3, division 5 means the finalised amount of a non-scheme employer’s liability as calculated under subdivision 3.
financial quarter means a period of 3 months beginning on 1 January, 1 April, 1 July or 1 October.
former self-insurer’s liability amount, for part 3, division 3, means the amount of the former self-insurer’s liability calculated under this division.
functional independence measure instrument, for part 5A, division 1, see section 117A.
further premium, for an employer, means an amount, other than assessed premium or provisional premium, payable by an employer to WorkCover under the Act, and includes the following—
(a)arrears of premium;
(b)additional premium under section 8(4);
(c)interest on premium under section 10(2);
(d)an amount of unpaid premium or a payment or penalty payable under section 57(2) of the Act;
(e)additional premium for late payment under section 61 or 62 of the Act;
(f)additional premium under section 63 of the Act.
hearing loss tables means Report No. 118—Improved Procedure for Determining Percentage Loss of Hearing (1988) published by National Acoustic Laboratories.
highest range means the range of ISVs having the highest maximum ISV.
household worker means a person employed solely in and about, or in connection with, a private dwelling house or the grounds of the dwelling house.
injured worker means a worker who sustained an injury.
injury, for part 4, division 3A and schedule 4A, see section 112A.
ISV means injury scale value.
last employment period see section 13(3)(b)(ii).
Le Fort I fracture means a horizontal segmented fracture of the alveolar process of the maxilla.
Le Fort II fracture means a unilateral or bilateral fracture of the maxilla—
(a)in which the body of the maxilla is separated from the facial skeleton and pyramidal in shape; and
(b)that may extend through the body of the maxilla down the midline of the hard palate, through the floor of the orbit and into the nasal cavity.
Le Fort III fracture means a fracture in which the entire maxilla and 1 or more facial bones are completely separated from the brain case.
legal cost amount, for schedule 4A, see schedule 4A, section 1(b).
lower extremity see AMA 4.
medical expert, for an assessment of a PIRS rating, means a person—
(a)who is appropriately qualified to perform the assessment, including a psychologist, neuropsychologist or psychiatrist; and
(b)who has had appropriate training in the use of the PIRS.
medical specialty means the branch of medicine that is a recognised specialty under the Health Practitioner Regulation National Law that is relevant to the matters referred to the Tribunal for decision.
mental disorder means a mental disorder recognised under DSM 4.
modified barthel index means the guidelines and modified scoring of the barthel index stated in the article Improving the Sensitivity of the Barthel Index for Stroke Rehabilitation by S Shah, F Vanclay and B Cooper published in the Journal of Clinical Epidemiology, 1989, vol 42 no 8, pp 703-709.
new insurer means the party assuming the liability.
non-scheme employer’s liability amount means an amount for a non-scheme employer’s liability.
nurse means a person registered under the Health Practitioner Regulation National Law to practise in the nursing profession.
old insurer means—
(a)for part 3, division 2—the party with whom the liability currently resides;
(b)for part 3, division 6—the self-insurer of which the non-scheme member was a member.
ophthalmologists guide means the publication Percentage Incapacity—A Guide for Members published by the Royal Australian College of Ophthalmologists in 1992.
Editor’s note—
A copy of the ophthalmologists guide may be obtained at the Regulator’s office.
outstanding liability amount, for part 3, division 1, means the amount of the self-insurer’s outstanding liability calculated under this division.
panel see section 112A.
PIRS means the psychiatric impairment rating scale set out in schedule 11.
PIRS rating, for a mental disorder, means a rating on the PIRS for the permanent impairment caused by the mental disorder.
pre-existing, in relation to an injury, means existing at the time immediately before the injury.
premium includes assessed premium, provisional premium and further premium.
presbycusis correction table means the presbycusis correction table recommended and published by Hearing Australia.
provisional annual levy see section 18.
provisional premium, for an employer, means premium calculated using a reasonable estimate of wages for a period of insurance.
prudential margin has the meaning given by the actuarial standard, section 12.
qualifying condition see section 112A.
range, in relation to an ISV for an injury, means the range of ISVs for the injury set out in schedule 9.
reading, of a chest x-ray, for schedule 4B, see schedule 4B, section 2.
registered training organisation see the Vocational Education, Training and Employment Act 2000, schedule 3.
Regulator’s actuary means an actuary asked by the Regulator to give a report under section 61.
relevant parties, for part 3, division 2, means the old insurer and the new insurer.
risk free rate of return has the meaning given by the actuarial standard, section 13.
section 193A compensation, for an injury, see section 112A.
section 193A notice, for part 4, division 3A, see section 112G(1).
specified worker see section 112A.
self-insurer’s data, for part 3, division 4, means data that will enable the actuary to calculate the self-insurer’s estimated claims liability and prepare and give to the Regulator and the self-insurer an actuarial report on the calculation.
specialty medical assessment tribunal see section 138(1)(b).
total liability amount, means the amount of the total liability after a change in the self-insurer’s membership.
total liability amount means—
(a)for part 3, division 2—an amount of liability after a change in the self-insurer’s membership; and
(b)for part 3, division 6—an amount of liability after a change in the self-insurer’s membership.
upper extremity see AMA 4.
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