Issue 1109
, Tuesday 2 May 2017
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In this issue
[1]
On April 26, Insurance & Care
(icare) NSW announced QBE would exit the state's workers' compensation
claims agent services panel by 2018.
icare said reappointed claims agents Allianz and
GIO would continue to manage their existing claims in 2018. But only EML
would manage new claims from January 1, 2018. CGU withdrew from
the selection process in March (WCR07/03/17).
QBE executive GM, intermediary
distribution, Jason Clarke told WCR
"icare have informed us they have selected EML to be their sole agent
for all new claims services from Jan 1, 2018, with GIO and Allianz
continuing to provide claims services as transition agents".
Clarke said "we are disappointed with icare's
decision, but remain committed to ensuring a seamless transition for
affected customers and injured workers when the new arrangement comes into
effect".
QBE was "working through how this will affect
our people and how we can minimise the ramifications for them", he
said.
Clarke said "QBE will continue to be a major
provider of w/comp insurance across Australia, including underwritten
w/comp, NSW Treasury Managed Funds and self-insurance claims management
services, to deliver the flexible service our customers have come to expect
from us".
EML 'primary'
claims agent from Jan 2018
An icare spokesperson told WCR "EML will be
the primary agent for new claims beyond Jan 1, 2018". "There
will also continue to be three claims services agents (EML, GIO and
Allianz) from Jan 1, 2018," the spokesperson said.
"We expect the relationship with GIO and
Allianz will continue with them providing claims services as transition
agents over a number of years."
icare would "continue working with the three
agents as we develop our claims operating model of the future".
Allianz GM, corporate affairs, Nicholas Scofield
told WCR
"Allianz has been asked to be a 'transition agent' for icare until the
end of 2018. Following the end of our current contract
in December 2017, Allianz has been selected to manage the runoff
of our existing claims, at this stage, until Dec 2018".
Scofield said "separately, all new claims
received from Jan 1, 2018 will be managed under the new single agent
arrangements".
Suncorp executive GM, personal injury portfolio
& products, Chris McHugh told WCR
GIO was "very pleased and committed to continuing our involvement in
the scheme and remaining as a strategic partner of icare. We will assist
icare to realise [its] vision of building a world class w/comp
scheme".
On April 26, icare group executive,
workers' insurance, John Nagle said NSW businesses and injured workers
could expect to experience a "significant enhancement" in service
delivery following the claims service partners selection process beyond
2017 concluding.
"At icare we put our customers at the centre
of all that we do and we are enthusiastic about the next stage of our
customer service enhancements," Nagle said.
"Both injured workers and NSW employers can
expect to have a simplified, empathetic and consistent experience with our
main claims partners moving forward."
Nagle said "our new claims model is about
moving from an adversarial model to empowerment and choice for employers
and injured workers. It is focused on supporting the needs of our customers
in their journey to recover and return to work, regardless of the
simplicity or complexity of their claim".
Move builds on
work; including online purchasing portal: icare
"In EML, GIO and Allianz we are confident we
have selected claims partners with strong experience, expertise and
qualifications in delivering customer-centric workers' insurance services
and outcomes for injured workers and employers, and the willingness and
drive to further improve," Nagle (above)
said.
Nagle said "as we move to further enhance the
claims experience into 2018, these partners are best placed to manage the
transition given their alignment to icare's values and goals".
"This important announcement further builds
on the transfer of all new and renewing workers' insurance policies to
icare, which commenced in March. The new service already delivers on
customers' needs with more than 80% of policies purchased online."
Nagle noted that over 2017 there would be some
change for some customers as they transitioned to the remaining partners.
He assured customers they would be kept fully informed every step of the
way.
"We have a dedicated team in icare working
with our providers to ensure a smooth transition with minimal impact for
employers and injured workers," he said.
CGU and QBE will conclude their roles as icare
scheme agents on Dec 31, 2017. Nagle thanked both companies for their
"longstanding, valued support and commitment" to the NSW w/comp
scheme.
EML committed
to 'shared focus': Coyne
EML CEO Mark Coyne said EML (above) was
"committed to working closely with icare and their partners in
supporting icare's vision to providing NSW business with choice,
flexibility and easy-to-use options when it comes to their workers'
insurance".
Coyne acknowledged the "significant"
contribution of fellow industry agents.
"Over many decades, the collective
contribution of agents within the industry has helped shape the NSW scheme
into a provider of world-class claims services."
Coyne said "we aim to continue this shared
focus and responsibility for customer-centric services and outcomes for
workers' employers which icare has entrusted to us".
icare activated
online platform on February 28
On March 1, a CGU spokesperson told WCR it had informed
icare of its decision to withdraw from the scheme by Dec, 2017, when its
contract ends (above).
On February 28, icare activated
an online platform to allow new businesses to buy w/comp policies directly
from icare.
In a statement around that time, IAG CEO
Australian business division Ben Bessell said the company made the decision
based on changes to the design and distribution of the new model.
He said it was "not commercially viable"
to continue as an agent.
"We have valued our partnership with icare
and have been proud to be an insurer for the employers and workers of NSW
for the past 30 years."
However, "after careful consideration we have
decided it is no longer viable for the business to act as an agent in the
future model of the scheme", Bessell said.
[2]
SA acting IR minister Martin Hamilton-Smith has
told WCR it
is not anticipated any jobs will be lost following the government's plan to
transfer public service workers' compensation claims administration to
Return to Work SA (RTWSA) (WCR
24/04/17).
Hamilton-Smith said "public sector employees
deserve the same access to effective, hands-on, early intervention and
claims management to get them back to work, as private sector
employees".
He said "no jobs are expected to be lost,
however any public service employees declared excess to requirements will
be managed according to the redeployment, retraining and redundancy
guidelines".
On April 12, SA IR minister John
Rau introduced the Return to Work Corporation of SA (Crown Claims
Management) Amendment Bill 2017 to parliament's Legislative Assembly.
In April 12 Hansard, Rau said the Bill
would allow RTWSA to administer the management of state govt employees' RTW
claims.
"Employing over 100,000 South Australians,
our public sector is a significant employer in the state. The changes
proposed in this Bill will bring the public service in line with the rest
of the state with regard to RTW outcomes and services, resulting in greater
consistency and transparency."
But Self Insurers of SA (SISA) manager Robin Shaw
told SISA members Rau's statement in parliament provided "no
meaningful case whatsoever to justify the change other than vague
statements about consistency of approach that say nothing about the results
achieved".
[3]
The SA Employment Tribunal (ET) has rejected two
Inghams Enterprises Pty Ltd applications for a mistrial following an
injured worker's evidence through an interpreter.
ET Deputy President (DP) Steven Dolphin found
Vietnamese-speaker Mai Thi Nguyen sustained a compensable physical injury
from repetitive work as a process worker in Burton, SA. He also found
Nguyen sustained a "partial" psychiatric injury during her
rehabilitation.
Much of the hearing was concerned with the
accuracy of Nguyen's evidence through an interpreter. "While her
evidence was received in a clunky fashion, this, in my opinion, was due to
the well-known difficulties with those illiterate in English and whose
evidence is given through an interpreter," DP Dolphin said. Her "mistakenness
on the topic of who interpreted her statement was a genuine error borne of
confusion and was not, as put by [Inghams], a farce based on her desire to
ascertain an ulterior motive in the questioning of her", he said. In
the hearing, occupational physician Dr David Cullum gave evidence he
diagnosed Nguyen with subacromial bursitis and impingement with a finding
consistent with left arm median nerve irrigation. Cullum said there was a
clear temporal history of her symptoms being associated with cutting
chicken wings and repetitive packing, DP Dolphin recounted. Based on all
the medical evidence, including Inghams' rehabilitation provider and an
orthopaedic surgeon who produced two reports, DP Dolphin accepted Nguyen's
pre-injury work duties required her to constantly move her arms
repetitively and quickly from a fairly low or medium height to a higher eye
level height. "I find the repetitive and fast work duties undertaken
by [Nguyen] causally contributed to her physical injuries to her neck,
right shoulder/arm/hand and her left shoulder/arm." As such, taking
into account the test of compensability under s30 of the Workers
Rehabilitation and Compensation Act 1986, he found Nguyen's "physical
injuries arose from her employment with Inghams".
Psych condition
stemmed from several factors: DP
DP Dolphin (above)
also accepted Nguyen sustained a psychiatric condition, namely an
adjustment disorder with anxiety and depression, after hearing all the
evidence. He said that condition was caused by various factors, including ongoing
pain. Other causative factors included Nguyen's inability to hold down
regular and sustained alternative duties, her "isolating duties"
in an observation hut that kept an eye on a car park, being sent home from
her alternative duties and "the continuing non-provision of suitable
duties". DP Dolphin accepted evidence from psychiatrist Dr Alan
Cotton. In his report, Cotton diagnosed Nguyen as having an adjustment
disorder with anxiety and depression. Cotton believed it was not Nguyen's
actual work at Inghams, "but her being prevented, somewhat against her
will, from continuing with her restricted light duties work, four hours per
day five days per week, and then her claim being rejected", that
caused her condition, DP Dolphin recounted. But DP Dolphin said he was not
obliged to consider the compensability of such injuries under s30A as that
section applied to injuries that were "solely" psychiatric in
nature and not "partial" complications. He concluded Nguyen was
"suffering from physical injuries with psychiatric
complications". The test to be applied was found under s30 and whether
such injuries arose from her employment. "That test is not only
satisfied for her physical injuries but also with her psychiatric
complications." "Having made the findings [Nguyen's] injuries are
compensable, I will hear from the parties" on orders to follow. (Nguyen v Inghams Enterprises Pty
Ltd [2017],, 12/04/2017) SAET 30
[4]
Counselling Appraisal Consultants (CAC)
has acquired the business of Work Health Safety Matters (WHSM).
On May 1 (yesterday), WHSM merged its operations with CAC's NSW
operation IMR. CAC's managing director Paul Serong said the acquisition
placed "IMR in an ideal position to capitalise on [WHSM director] Judy
Gardner and her team's excellent reputation in the occupational
rehabilitation industry".
[5]
The Administrative Appeals Tribunal (AAT) has
affirmed a Comcare decision to refuse a time extension to a Department of
Veterans' Affairs (DVA) employee who delayed his application for
reconsideration more than two years after the due date. AAT member Regina
Perton found there was no acceptable explanation for the lengthy delay and there
would be "considerable prejudice" to Comcare if the extension of
time were granted. She also found the merits of Michael Robert Dabbs's
substantive application were not enough to weigh in favour of granting a
time extension. Dabbs worked at the DVA Melbourne office
on January 23, 2009, when he sustained an acoustic shock injury
in both ears during an Australia Day function because a microphone
malfunctioned. He was exposed to noise from the feedback.
Phone records
show Dabbs contacted Comcare
Dabbs (above)
was subsequently diagnosed with hyperacusis, ie abnormal intolerance of
noise, and later developed major depression and panic disorder. He lodged a
workers' compensation application and Comcare accepted liability under s14
of the Safety, Rehabilitation and Compensation (SRC) Act 1988, for Dabbs's
bilateral hyperacusis and six months later for major depression and panic
disorder. On February 14, 2011, Dabbs resumed his normal duties
but reported hyperacusis symptoms arising from three separate incidents.
Comcare initially accepted liability for two incidents
on March 10, and June 30, 2011, but then reversed
Dabbs's incapacity payments. In a December 6, 2011, determination
after an October 11, 2011, incident, Comcare denied liability for
the Oct and June incidents. In its Dec 6, 2011, determination
Comcare encouraged Dabbs to lodge a separate claim for
the June 2011 incident.
On September 6, 2013, Comcare again
wrote to Dabbs, providing a copy of the Dec 6, 2011, determination. But
Dabbs did not lodge a request for reconsideration of that determination
until April 3, 2014, and Comcare refused a time extension for his
claim.
Member Perton was satisfied Comcare had sent its
decision to Dabbs on Dec 6, 2011, with other relevant documents and he had
received the documents. Phone records showed Dabbs had later contacted
Comcare on several occasions. Dabbs argued his claim was originally
accepted and submitted his situation made his circumstances markedly
different to other claimants in a similar position. But Member Perton
disagreed. Taking all relevant factors into account, she found a time
extension to lodge the request for reconsideration was "not
appropriate".(Dabbs
and Comcare (Compensation) [2017], AAT 518,
20/04/2017)
[6]
An RMIT University employee's application for
further discovery of documents in a negligence claim has partly succeeded
in the Vic Supreme Court. But he has been urged to reconsider the structure
of his statement of claim.
Judicial Registrar (JR) Julie Clayton said
Edward Clark Allon's negligence particulars provided the court with
"little assistance in determining the scope of the precise nature of
his allegations against RMIT".
Despite the lack of information provided to the
court, she found Allon was entitled to discovery of documents directly relevant
to the dispute's central issues. That was whether RMIT had provided Allon
with a safe system of work, to avoid a reasonably foreseeable risk of
injury, and whether he had sustained injuries arising from RMIT's alleged
breach of obligations to provide a safe workplace.
Allon alleged he had sustained several
work-related psychological injuries in a highly stressful environment
from August 2008 to Aug 2009, when RMIT knew he had a
psychological illness and in circumstances where he had no adequate support
to meet his work requirements.
The requested documents for discovery under
dispute were an employment contract; a previously discovered, heavily
redacted spreadsheet of WorkCover claims about RMIT; and incident reports
from Aug 1, 2008 to Aug 31, 2009, relating to RMIT employees' stress,
anxiety, depression, suicidal tendencies and any other psychological
dispositions.
RMIT objected to the discovery request on the
grounds it was "a fishing expedition" and beyond the scope of s55
of the Civil Procedure Act 2010. It said to provide incident reports on its
employees was time consuming, expensive and onerous.
JR Clayton disagreed Allon's request for discovery
was "in effect, fishing". She said other employees' psychological
injury claims were relevant to RMIT's knowledge of the risk to which Allon
was exposed. It was "reasonable" for Allon to seek further
discovery relating to other such injuries before finalising pleading
amendments. She found the spreadsheet and incident reports ought to be
discovered, redacted only as far as any identifying details. She said she
would hear the parties on costs. (Allon
v RMIT University [2017], VSC 203,
19/04/2017)
[7]
Editor:
Peter Angelopoulos. Email:
peter.angelopoulos@thomsonreuters.com
Journalist:
Eva Wiland. Managing
Editor: Helen Jones. Twitter: @WCompReport_TR
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