Notice of variation of continuing provisions of licence - Medibank Health Solutions (Notice No. 44 of 2016)

Safety, Rehabilitation and Compensation Act 1988

Part VIII
 

MEDIBANK HEALTH SOLUTIONS PTY LTD

NOTICE OF VARIATION OF CONTINUING PROVISIONS OF LICENCE

Notice No 44 of 2016

Background

1. Medibank Health Solutions Pty Ltd, ABN 99 078 934 791 (the Licensee), was declared to be eligible to be granted a licence under Part VIII of the Safety, Rehabilitation and Compensation Act 1988 (Cth) (the SRC Act) by legislative instrument dated 2 June 2014.

B.    The Safety, Rehabilitation and Compensation Commission (the Commission), acting under sections 103 and 104 of the SRC Act, granted a licence (the Licence) to the Licensee on 12 September 2014 for the period commencing on 3 November 2014. 

C.    The Licence was subsequently extended or varied by the Commission on:

• 22 July 2015 as notified by Notice No. 11 of 2015, Gazette reference number C2015G01221, published on 27 July 2015;
• 15 June 2016 as notified by Notice No. 11 of 2016, Gazette reference number C2016G00821, published on 16 June 2016;

D.   On 15 June 2016, the Commission acting under section 107 of the SRC Act revoked the Licence (the Revoked Licence) with effect on and from 12.02am on 1 July 2016.

E.    Section 107A of the SRC Act provides that regulations of the Safety, Rehabilitation and Compensation Regulations 2002 (SRC Regs) may deal with the consequences of revocation of a licence under s 107 of the SRC Act. 

F.     Accordingly, by virtue of regulation 15 of the SRC Regs, the licence provisions that are relevant to the performance of obligations under regulation 15(2)(b) and 15(3)(a) and (c) are taken to survive the

revocation of the Licence.  Those provisions are referred to below as the ‘continuing provisions of licence’.

G.   As indicated by regulation 15(4) of the SRC Regs, the SRC Act continues to apply in relation to the performance of obligations under regulation 15(2)(b) and 15(3)(a) and (c).

H.   Two of the continuing provisions of licence in the Revoked Licence are clause 5 and clause 6. Clause 5 deals with the person authorised to manage claims on behalf of the Licensee, and clause 6 deals with the person that the Licensee must arrange to carry out reconsiderations of determinations on the Licensee’s behalf.  It is now proposed that another person be authorised to undertake those roles.

Variation of continuing provisions of licence

1. The Commission, acting under sections 105 and 108D(2) of the SRC Act, and for the purposes of sections 108B and 62 of the SRC Act, varies the continuing provisions of the Revoked Licence as follows:

(i)               Clause 5 of the Revoked Licence is omitted and replaced by the following:

Scope of Licence – management of claims

5.    Insurance Australia Limited, trading as CGU Self Insurance Services, ABN 11 000 016 722 (“the Claims Manager”) is authorised to manage, on behalf of the Licensee, claims under the SRC Act made by the employees of the Licensee who are covered by the scope of this licence so far as it relates to the Licensee’s acceptance of liability in accordance with clause 4 of this licence.

(ii)             Clause 6 of the Revoked Licence is omitted and replaced by the following:

Scope of licence – reconsiderations

6.    For the purpose of any reconsiderations under Part VI of the SRC Act, except for reconsiderations of own motion of matters in respect of which the outcomes would be no less favourable to the employee than the original decisions, in respect of determinations made by the Licensee, the Licensee must arrange for the person specified below

(the Reviewer) to carry out any reconsiderations of determinations on behalf of the Licensee:

The Reviewer: Insurance Australia Limited, trading as CGU Self Insurance Services, ABN 11 000 016 722

The Licensee is to enter into and maintain a written contract with the Reviewer for the performance of the Reviewer’s reconsideration function and if requested to do so, give a copy of the contract to the Commission.

2.    The variation of these continuing provisions of licence takes effect from 12:00am on 4 November 2016.

3.    The Revoked Licence (as varied) is set out below.

Revoked Licence (as varied)       

Part 1 – Grant and Scope of Licence

Note: Under section 46(1) of the Acts Interpretation Act 1901(Cth), unless the contrary intention appears, expressions used in this instrument have the same meaning as in the Safety, Rehabilitation and Compensation Act 1988 (Cth) (“the SRC Act”).

Eligible applicant

1. Medibank Health Solutions Pty Ltd ABN, 99 078 934 791 (“the Licensee”), was declared to be eligible to be granted a licence under Part VIII of the SRC Act by legislative instrument dated 2 June 2014, registered as F2014L00669 on the Federal Register of Legislation on 5 June 2014. 

Grant of licence

2.    The Safety, Rehabilitation and Compensation Commission (“the Commission”), acting under sections 103 and 104 of the SRC Act, granted a licence to the Licensee on 12 September 2014 and which commenced on 3 November 2014.

Period of licence

3.    Subject to the SRC Act, this licence is for the period commencing at 12.01am (Australian Eastern Daylight Time (“AEST”)) on 3 November 2014 and in accordance with the most recent extension ending at midnight (AEST) on 30 June 2023 (“the period of this licence”).

Scope of licence – acceptance of liability

4.    The Licensee is authorised to accept liability to pay compensation and other amounts under the SRC Act in respect of all injuries, loss or damage suffered by, or in respect of the death of, any of the employees of the Licensee where such injuries, loss, damage or death occur within the period of this licence.

Note: “Employee” is defined in section 5 of the SRC Act.

Scope of licence – management of claims

5.    Insurance Australia Limited, trading as CGU Self Insurance Services, ABN 11 000 016 722 (“the Claims Manager”) is authorised to manage, on behalf of the Licensee, claims under the SRC Act made by the employees of the Licensee who are covered by the scope of this licence so far as it relates to the Licensee’s acceptance of liability in accordance with clause 4 of this licence.

Note 1:  “Claim” is defined in section 99 of the SRC Act.

Note 2:  “Manage”, in relation to a claim for payment of compensation and other amounts under the SRC Act, is defined in section 99 of the SRC Act to include determinations, reconsiderations and subsequent administrative action.

Scope of licence – reconsiderations

6.    For the purpose of any reconsiderations under Part VI of the SRC Act, except for reconsiderations of own motion of matters in respect of which the outcomes would be no less favourable to the employee than the original decisions, in respect of determinations made by the Licensee, the Licensee must arrange for the person specified below

(the Reviewer) to carry out any reconsiderations of determinations on behalf of the Licensee:

The Reviewer: Insurance Australia Limited, trading as CGU Self Insurance Services, ABN 11 000 016 722

The Licensee is to enter into and maintain a written contract with the Reviewer for the performance of the Reviewer’s reconsideration function and if requested to do so, give a copy of the contract to the Commission.

Conditions

7.    This licence is granted subject to the conditions specified in Part 2.

Part 2 – Conditions

Definitions

8.    In this part Licensee includes, where context permits, the Claims Manager and the Reviewer.

General conditions

Communication

9.    The Licensee, when bringing employees under its self-insurance licence, must provide information to those employees regarding the Work Health and Safety Act 2011(Cth) (the WHS Act) and SRC Act prior to those employees becoming employees of the Licensee.

Directions of Commission

10.                     The Licensee must comply with any written directions, whether general or in respect of a particular matter or class of matters, given by the Commission to the Licensee with respect to the performance by the Licensee of its functions or the exercise of its powers under the SRC Act.

Requirements

11.                     The Licensee must comply with the requirements of:

(a)          the SRC Act, its Regulations and any applicable guidelines issued by the Commission under section 73A of the SRC Act;

(b)          any applicable laws of the Commonwealth, States or Territories with respect to the safety, health and rehabilitation of employees, with a particular focus on the statutory requirements for genuine consultation with employees and their representatives; and

(c)          the relevant Privacy legislation.

12.                     The Licensee must have regard to guidelines issued by the Privacy Commissioner under the Privacy Act 1988 (Cth) and must comply with any such guidelines dealing with covert surveillance of employees.

Fees

13.                     The Licensee must pay the licence fee notified in writing to the Licensee under section 104A of the SRC Act within one month of receiving the notification.

Manner of managing claims

14.                     In managing claims, the Licensee:

(a)          must be guided by equity, good conscience and the substantial merits of the case without regard to technicalities;

(b)          is not required to conduct a hearing; and

(c)          is not bound by the rules of evidence.

Audits

15.                     The Licensee must co-operate with, and give reasonable assistance to, the Commission or its representatives in respect of any audits and evaluations of the Licensee to be conducted by the Commission or its representatives.

16.                     On written request of the Commission, the Licensee must demonstrate to the Commission that it has maintained its Claims Management, Rehabilitation and WHS Management systems in accordance with the Commission’s request.

Reviews and proceedings

17.                     Comcare must be informed as soon as practicable of court or tribunal proceedings in relation to a matter arising in respect of a claim managed by a Licensee under the SRC Act.

18.                     The Licensee must not cause, or permit to be made on its behalf, any submission to a court or tribunal in relation to the interpretation of a provision of the SRC Act or associated transitional or consequential provisions that Comcare or the Commission requests the Licensee not to make.

Note 1: If proceedings are brought against the Licensee, subsection 108C(8) requires the Licensee to inform Comcare as soon as practicable and the court or tribunal before which the proceedings have been brought must, on application by Comcare, join Comcare as a party to the proceedings.

Note 2: Section 108D(1)(f) provides that a licence may include a condition that, in all circumstances or specified circumstances, the Licensee will not cause or permit to be made on its behalf to a court or tribunal any submission that Comcare or the Commission has requested the Licensee not to make.

Failure to comply with conditions or change in circumstances

19.                     The Licensee must notify Comcare in writing as soon as practicable of any event or likely event that is relevant to the application of the SRC Act and the WHS Act to the Licensee, this may include but is not limited to:

(a)          the Licensee has not complied with, or is likely to fail to comply with, a condition of this licence; or

(b)          any change that may impact on the Licensee’s capacity to meet its liabilities under the SRC Act, including change to the Licensee’s underlying financial position; or

(c)          changes to its legal structure, ownership or control; or

(d)          any significant change in its employee numbers or significant change in the risk profile of the work undertaken by its employees.

Information and reporting requirements

20.                     On written request of the Commission, the Licensee must give to the Commission, within the timeframe specified in the request, such information relating to the Licensee’s operations under the SRC Act or WHS Act in the form and at the place specified in the request.

Note: Information likely to be requested by the Commission includes information required for the Data Warehouse, the Commission’s annual report, Commission Indicators, the Comparative Performance Monitor and the Return to Work Monitor.

Prudential Conditions

21.                     The Licensee must comply with the Prudential Conditions of Licence at Attachment A.

Performance Conditions

22.                     The Licensee must comply with the Performance Standards at Attachment B.

Dated the 26th Day of October 2016.

Barry Sherriff

Chairperson

Safety, Rehabilitation and Compensation Commission