From: eNews, LTA ANZ
Sent: Tuesday, 2 May 2017 10:05 AM
To: Jones, Helen (Legal)
Subject: Workers Compensation Report 1109: QBE to exit icare panel; RMIT to tender incident reports; Inghams fails to prove mistrial argument
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.
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".
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 ,, 12/04/2017) SAET 30
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".
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) , AAT 518, 20/04/2017)
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 , VSC 203, 19/04/2017)
Editor: Peter Angelopoulos. Email: email@example.com Journalist: Eva Wiland. Managing Editor: Helen Jones. Twitter: @WCompReport_TR