2015 Scheme Agent Deed, schedules and manuals
As the Nominal Insurer, we develop the Scheme agent deed, schedules and manuals which define how we interact together within the terms and conditions of the contract.
This page contains the following documents:
Deed and schedules
The Deed outlines the terms and conditions of the contract between the Nominal Insurer and Scheme Agents.
Schedule 1 describes the engagement framework for the Scheme Agent and consists of three components:
- Code of Conduct
- Customer Service
- Complaint Management.
The provision of underwriting services includes timely calculation and collection of premiums and the provision of other services that relate to policy management, as an agent of the Nominal Insurer.
Schedule 3 sets out the requirements for claims services that must be delivered by the Scheme Agent acting as agent for the Nominal Insurer.
The purpose of Schedule 4 is to set out the requirements for the provision of financial and taxation management for the services including:
- Banking arrangements
- Taxation management, and
- Financial reporting.
Schedule 5 contains two parts:
- Performance management
- Remuneration arrangements, including the Annual Service Fee and the Annual Outcome Fee.
Appendix L.01 details the control procedures that are to be in place to exercise the functions as an agent of the Nominal Insurer.
Appendix L outlines the service standards that Scheme Agents need to meet under Year 1 of the Deed. This includes all reporting requirements, measurement standards, audit requirements and scoring method for each standard.
The purpose of Schedule 6 is to set out the requirements for the scheme governance that must be adhered to by the Scheme Agent during the term of this Deed.
Schedule 6 attachments
- Attachment 6.01 (Quality Management Report Template) PDF File, 552.8 KB, 02/03/15
- Attachment 6.02 (Compliance Matrix) PDF File, 562.5 KB, 02/03/15
- Attachment 6.03 (Fraud Management Report Template) PDF File, 440.5 KB, 02/03/15
- Attachment 6.04 (Wages Audit Report Template) PDF File, 490.2 KB, 02/03/15
- Attachment 6.05 (Reports Matrix) PDF File, 456.5 KB, 02/03/15
- Attachment 6.06 (Recovery Management Report Template) PDF File, 524.6 KB, 02/03/15
Schedule 7 comprises the following parts:
- Part A – IP Deed, and
- Part B – Confidentiality Deed
Schedule 8 provides the framework for the management of project services. It is intended to ensure the Scheme Agent and the Nominal Insurer have a consistent and robust project management methodology for the implementation and management of a project service.
As referred to in clause 36.6, the Scheme Agent must provide annually the Nominal Insurer with a statutory declaration signed by the Scheme Agent Principal.
In clause 36.5 of the Deed, the Scheme Agent must provide biannually to the Nominal Insurer a signed director's declaration, being evidence of a resolution of the board of the Scheme Agent as to its terms.
Schedule 11 sets out the requirements for the Scheme Agent’s Disengagement Plan, as referred to in clause 54 (“Disengagement Services”) of the Deed.
Schedule 12 describes the Scheme Agent’s obligations around the transfer of Policies and/or Claims under clause 8 of the Deed.
The Scheme Agent has agreed to provide scheme agent services to the Nominal Insurer pursuant to the Scheme Agent Deed. In consideration of the Nominal Insurer's entry into the Scheme Agent Deed, the guarantor agrees to guarantee the:
- performance by the Scheme Agent of its obligations under or in connection with the Scheme Agent Deed, and
- payment of the guaranteed money to the Nominal Insurer.
In accordance with Clause 43 of the Deed, the Scheme Agent must provide and maintain a financial security.
The Nominal Insurer acknowledges that a range of deliverables, services or milestones have been delivered by the Scheme Agent and are accepted for the purposes of the Deed, subject to the conditions or qualifications.
The Scheme Agent offers to provide services to an agency in accordance with clause 58 of the Deed.
The manuals provide advice on how to put the requirements of the Deed into practice.
The general manual provides operational guidance on performing scheme services, in addition to the other manuals that form part of the 2015 Deed.
The purpose of this manual is to provide a guide to employers, accountants, Scheme Agents, auditors and other interested parties, on remuneration taken into account for the purposes of assessing an employer’s workers compensation premiums.
This manual describes the requirements of Scheme Agents for the submission of policy data to WorkCover under the scheme arrangements.
This manual outlines the Scheme Agent responsibilities in relation to the legislation and regulations, current at the time. It also sets out the procedures that Scheme Agents need to follow under the Deed - the Scheme Agent’s obligations for the provision of claims services are that it must ensure all notifications and claims are managed to an appropriate outcome through a focus on early initial assessment, appropriate case management and relevant recovery at work or return to work (RTW) initiatives.
Appendix F attachments
- Attachment 1 (Reimbursement Schedule) PDF File, 17.0 KB, 02/03/15
- Attachment 2 (Dec Mgt Hearing Loss Claim Form) PDF File, 286.0 KB, 02/03/15
- Attachment 3 (Statutory Declaration) PDF File, 197.5 KB, 02/03/15
- Attachment 4 (Notice of Judgement) PDF File, 238.7 KB, 02/03/15
- Attachment 5 (Request for a Medicare History) PDF File, 60.8 KB, 02/03/15
- Attachment 6 (Authority to release information) PDF File, 131.6 KB, 02/03/15
- Attachment 7 (Recovery of Centrelink Benefits) PDF File, 119.5 KB, 02/03/15
- Attachment 8 (Commutation Form) PDF File, 1.4 MB, 02/03/15
- Attachment 9 (Death Claims) PDF File, 965.1 KB, 02/03/15
This manual outlines WorkCover’s requirements regarding the estimation of claims.
This manual describes the requirements for Scheme Agents for the submission of claims data and initial notification (incidents involving an injury or illness to workers, where workers compensation is payable or may be payable) data to WorkCover under the Workers Compensation system arrangements.
This manual outlines the banking arrangements provided for the Scheme Agent and how they are required to operate these facilities.
This manual outlines the financial information that needs to be submitted by the Scheme Agent on a monthly basis to evaluate the financial performance and position of NSW WorkCover Scheme.
The purpose of this manual is to outline Nominal Insurer and Scheme Agent responsibilities related to ensuring employers pay the appropriate premium.
This manual contains two parts:
- Part 1 - provides insurers reporting wage audits to WorkCover via batch capture (file transfer) with an enhanced set of reporting requirements
- Part 2 - was developed to enable licensed Scheme Agents to lodge the results of wage audits carried out. It provides a central repository of all wage audit results undertaken across NSW.
This manual describes the proves to be adopted for the transfer of selected claims (both open and closed) and policies from 1 Scheme Agent to another when directed to do so by the Nominal Insurer or in accordance with the terms of the Deed.
This manual refers to the procedures for transferring Claims Management between Scheme Agents and insurers. It provides the requirements and action by scheme agents who have received a notification or claim to determine who may be the liable Scheme Agent or insurer for the management of a claim.