What changes are happening to my workers compensation insurer?

In 2000, the NSW Government announced a program of reforms to improve the NSW workers compensation Scheme. These reforms are aimed at producing a sustainable, financially viable Scheme that improves outcomes for injured workers and is fair and affordable for employers.

These reforms have delivered substantial benefits to the Scheme so far. As well as significant improvements in the Scheme’s valuation, WorkCover has increased the focus on claims management to deliver better services to injured workers and employers.

To sustain the delivery of better services, the insurance management arrangements in the Scheme need to be improved.

The NSW Government is introducing a new workers compensation insurance framework in NSW which will make providers of insurance claims and policy services accountable to a single new insurance entity. Previously, six insurers provided claims and policy management services to NSW employers and workers, but now there is a new insurance entity (trading as the ‘NSW WorkCover Scheme’). This new entity will appoint Agents to deliver policy and claims services on its behalf.

In March 2005, WorkCover released a tender for suitable organisations to provide workers compensation claims and policy services in NSW under commercial contracts to assist improve service delivery and outcomes for injured workers and employers. Ten organisations, including five former workers compensation insurers, responded to the tender. The tender process to select Agents has been completed and seven Agents will begin operating in early 2006.

The seven Agents that have been awarded contracts are:

• Allianz Australia Ltd
• Cambridge Integrated Services Pty Ltd
• CGU Insurance Ltd
• Employers Mutual Ltd
• Gallagher Bassett Services Workers Compensation New South Wales
• GIO Insurance Ltd
• QBE Insurance Ltd.

Why was my claim selected for transfer to another Agent?

WorkCover has introduced changes to the delivery of services to injured workers and employers. Over time, you will see a permanent and consistent improvement in the level of service provided.

The nature of the workers compensation insurance system requires change to be introduced in controlled stages to avoid destabilising the system. To implement these new arrangements a number of claims and policies will be transferred from their existing insurer to another Agent.

Your claim has been selected for transfer based on our information that your injury date was prior to 1 January 2004. Your claim has been selected because your claim can benefit from the new arrangements. You will be switching to an Agent who has demonstrated experience in looking after injured workers.

Please contact your new Agent if the information on your date of injury is incorrect and you should have been excluded from the switch.

The majority of workers will remain with their existing insurer.

I don’t want my claim to move to another Agent. What can I do?

These changes are designed to improve medical and return to work programs, and the service workers and employers receive.

Agents who have demonstrated experience in looking after injured workers have been appointed under contract. Over time, workers will experience an improved level of service in the management of their claim. Agent performance will be evaluated around several indicators, including providing better service delivery and treatment for injured workers.

If your injury was not prior to 1 January 2004, contact your new Agent and they will resolve the matter.

Will moving my claim disadvantage me?

No. Agents have been awarded contracts based on, among other things, their demonstrated experience looking after injured workers. When the Agent receives your claim, your new case manager will contact you to introduce themselves and provide you with their personal contact details.

Your claim will be reviewed to ensure your recovery is progressing. The Agent will assess your injury management plan and talk with you about the most effective and appropriate treatment available to improve your health outcomes and assist your return to work. If you are unable to return to work, the Agent will focus on improving your health outcomes where possible and providing certainty about the future management of your claim.

Will I be able to keep my treating doctor or service provider?

Yes. You have the right to continue to choose your treating doctor or health provider. The Agent is responsible for providing case management of your claim, including managing and coordinating health and treatment providers. Your Agent will review your file to ensure your recovery is progressing. If your Agent believes an alternative approach will be beneficial, they will review your injury management plan and discuss the matter with you and your treating doctor.

I still have authorised future treatments. Will they continue?

Yes. Your treatments will continue as planned. If your Agent believes an alternative approach will be beneficial, they will review your injury management plan and discuss the matter with you and your treating doctor.

Will I continue to receive benefits?

Your benefits will continue as usual while your claim is transferred. If you receive your benefits directly by Electronic Funds Transfer and you have changed your bank account details since your last payment, advise your new Agent of these changes.

Privacy and tax laws prevent your previous case manager from passing on your Tax File Number (TFN). If you receive your benefits directly from your Agent, you will receive a TFN form with your ‘notice of transfer’ letter. Fill in the form and send it to your new Agent in the post-paid envelope. This will ensure your new Agent has your TFN and can continue making compensation payments at the correct tax rate – therefore, you will not pay extra tax unnecessarily.

Will my benefits change?

Your benefits will continue to be calculated in accordance with the legislation. Depending on your eligibility and the status of your claim, you should continue to receive the same weekly benefits as previously, unless there has been a change in your circumstances. If your circumstances have changed, advise your Agent so they can update your file.

Who is my case manager or contact person?

Your new case manager will contact you within 21 days of your claim transfer date. They will introduce themselves and provide you with their personal contact details.

How will WorkCover ensure my full claims history is transferred?

WorkCover is working closely with Agents to ensure that file transfers occur in a transparent and seamless manner. Your previous insurer and your new Agent will follow detailed protocols for the transfer of your claim and WorkCover will oversee the transfer process to ensure your claim history is transferred successfully.

How will I know if I am going to be moved to a new Agent?

If you are moving to a new Agent, WorkCover will notify you two weeks in advance of the transfer. You will receive an information pack outlining the transition process and what the new Scheme arrangements mean for you. The pack also includes information on your new Agent.

Does my doctor/treatment provider/legal representative know my claim has been transferred?

Yes. Your previous insurer will notify the other service providers involved in your claim.

I received a tax declaration form with the transfer letter from WorkCover. What do I do with it and where should I send it?

Complete the form and return it to your new Agent. This will ensure your new Agent has your TFN and can continue making compensation payments at the correct tax rate – therefore, you will not pay extra tax unnecessarily.

What do I do if my case manager has a problem receiving my medical certificates and payslips?

Advise your new Agent of any special circumstances you may have regarding your documentation (eg. your nominating treating doctor always faxes your medical certificate and the case manager calls back to confirm receipt) to ensure they are able to follow the same procedure. Or perhaps they may suggest an improved method that suits both parties.

I’m not happy with my treatment provider or case manager. Who can I talk to?

All Agents have a complaints management system in their operations. Initially, speak with the treatment provider or case manager. If you are not satisfied with the response speak with the case manager’s team leader, or the Agent’s team leader, and put your complaint in writing to the Agent’s complaints manager.

If you are not satisfied with the response or need further assistance, contact WorkCover on 13 10 50.

I thought my claim was moving, but I haven’t been notified who my new Agent is and now my benefits are late?

If you are moving to a new Agent, WorkCover will notify you two weeks in advance of the transfer. You will receive an information pack outlining the transition process and what the new Scheme arrangements mean for you. The pack also includes information on your new Agent.

If WorkCover didn’t notify you then your claim has not been moved.

If you have moved to another Agent and have trouble with your benefits, contact WorkCover on 13 10 50.

Does my union know my file has been transferred?

In the lead up to the changes to the NSW workers compensation Scheme WorkCover has met regularly with Union representatives to keep them abreast of the changes.

Only your employer and those service providers directly involved in your claim have been contacted about the move. If you feel your union needs to be advised, please contact your representative.