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SIRA equipment and workplace modifications program guidance material

Introduction

There is strong evidence that work promotes recovery and reduces the risk of long term disability and work loss. The focus of the NSW workers compensation system is to support workers to recover at, or return to, work following a work-related injury.

Section 53 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) allows the State Insurance Regulatory Authority (SIRA) to develop, administer and coordinate vocational rehabilitation schemes for workers.

The SIRA equipment and workplace modifications program provides funding for workplace equipment or modifications that may assist a worker to remain at work with their pre-injury employer or to commence work with a new employer.

Eligibility

A worker is eligible if:

  • they are receiving, or are entitled to receive, weekly payments under the Workers Compensation Act 1987 (1987 Act)
  • a commutation or work injury damages settlement has not been accepted.

Note: A worker who has received a work capacity decision notice advising weekly compensation payments are to cease may be eligible if the equipment is to be provided, or workplace modifications completed, prior to cessation of weekly payments.

Principles

An application for equipment and/or workplace modifications must address the following principles:

  1. It is not an item that should be provided by the employer as part of their obligations under the Work Health and Safety Act 2011 (WHS Act).
  2. The cost is reasonable and other alternatives have been explored and considered to be inappropriate.
  3. It will be used for a reasonable period of time and is solely or mainly for the use of the worker.
  4. The existing equipment or lack of the required item was not a contributing factor to the initial injury (where the worker is returning to the pre-injury employer).
  5. It is essential to allow the worker to return to or remain at work, or to commence a new work role eg tools of the trade such as a basic toolkit.
  6. Workplace modifications are particular and specific to the worker’s functional requirements in allowing them to return to work.

Application process

Preparing an application

A worker’s return to work coordinator, insurer, or approved workplace rehabilitation provider (provider) may prepare an application.

The person developing the application must determine whether a worker has an entitlement to new employment assistance (under section 64B of the 1987 Act)1. It may be appropriate to confirm this with the insurer. Where the worker is entitled to claim such assistance, this entitlement must be exhausted before accessing funding under the SIRA equipment and workplace modifications program.

A worker who has an entitlement to new employment assistance may be eligible for funding under the SIRA equipment and workplace modifications program where:

  • they have exhausted their entitlement to new employment assistance (this includes where an application exceeds $1,000), or
  • the insurer disputes liability for the new employment assistance (including where the insurer does not notify the worker of a decision within the required time period).

A combined new employment assistance and equipment and/or workplace modifications application may be developed where costs required exceed $1,000. In this instance it will be necessary to demonstrate the application meets the requirements for both a new employment assistance claim and the SIRA equipment and workplace modifications program. If any requirements cannot be met, justification must be provided outlining why the proposal is necessary to assist the worker to return to work.

A SIRA equipment and/or workplace modifications application is submitted using the Vocational program details form together with:

  • evidence utilised to address the relevant principles (this may be within a workplace assessment report completed by a suitably qualified professional or other appropriate documentation)
  • confirmation that the intervention and associated costs are reasonable
  • confirmation that the strategy is appropriate to address the worker’s needs and functional capacity
  • evidence that the employer has agreed to the installation of the proposed equipment/ modification and ongoing maintenance.

SIRA does not prescribe an application form for new employment assistance.

Figure 1 below aims to guide decision making relating to the development of an application.

Figure 1. Decision making flowchart for the equipment and workplace modification program

Assessing an application

Applications $500 or less

A provider can assess applications that are $500 or less. The provider must follow their service provision and internal quality assurance processes to confirm the application meets the SIRA equipment and workplace modifications requirements and relevant principles.

The provider can arrange supply of equipment and/or workplace modifications without seeking formal approval from the insurer. However, the provider must inform the insurer in writing of the specific costs relating to the application.

Applications above $500

Nominal Insurer scheme agent

When the worker’s claim is with a Nominal Insurer scheme agent, the agent will assess applications that are above $500.

The agent will advise the worker, and the person submitting the application, in writing of their decision to approve or decline the request and the reason for their decision within 14 days.

If the application is not approved, the agent must advise the worker of the SIRA appeal process.

SICorp insurance agent, self insurer or specialised insurer

When the worker’s claim is with a SICorp insurance agent, the agent will assess applications for funding that cost more than $500 but less than $10,000.

When the worker’s claim is with a self insurer or specialised insurer, the insurer will assess applications for funding that cost more than $500 but less than $2,000.

The agent/insurer will advise the worker, and the person submitting the application, in writing of their decision to approve or decline the request and the reasons for their decision within 14 days.

If the application is not approved, the agent/insurer must advise the worker of the SIRA appeal process.

SIRA

If the application exceeds the cost a SICorp insurance agent, or self or specialised insurer may approve, the application must be sent by email to SIRA within 14 days to vocprograms@sira.nsw.gov.au

The application must include the insurer’s opinion on whether they support the equipment and/or workplace modifications application with reference to the equipment and workplace modifications principles.

SIRA will then assess the application for funding in light of the insurer’s recommendation. The insurer will be advised of the outcome of the assessment in writing within 10 working days of receiving a complete application. The insurer will advise the worker of the outcome of the assessment, and the SIRA application appeal process if the application is not approved.

Payment

Nominal Insurer scheme agent

When the worker’s claim is with a Nominal Insurer scheme agent, the agent is responsible for administering payment of vocational program expenses.

SICorp insurance agent

When the worker’s claim is with a SICorp insurance agent, the agent is responsible for administering payment of vocational program expenses less than $10,000.

Self insurer or specialised insurer

When the worker’s claim is with a self insurer or specialised insurer, the insurer is responsible for administering payment of vocational program expenses less than $2,000.

SIRA

When a worker’s claim is with a SICorp insurance agent, self insurer or specialised insurer and costs exceed the amounts above, SIRA will make payments to the supplier/service provider or, in certain circumstances, to the worker.

Payment will be made by electronic transfer within 10 days of receiving a Vocational program claim for payment form and relevant invoices or receipts. Send relevant documentation to SIRA: vocprograms@sira.nsw.gov.au.

Following approval

Installation

Following approval, the person who developed the application is responsible for confirming:

  • the equipment or workplace modifications are installed correctly
  • the worker (and employer where relevant) has been adequately trained in using the equipment or modifications
  • the original need for equipment or workplace modifications has been addressed.

Ownership and maintenance

If the equipment is small, customised or movable, it will belong to the worker. Larger items, such as permanent fixtures or modifications to the workplace, will be owned by the employer – however they may be asked to contribute to the cost where appropriate.

If the worker is re-employed elsewhere within the first six months and still requires the equipment, SIRA may cover reasonable and necessary transport costs to relocate the equipment to a new workplace.

The employer will be responsible for normal maintenance, repairs and insurances in line with obligations under the WHS Act which requires an employer to provide and maintain a work environment that is without risks to health and safety.

When equipment is no longer required

If equipment is no longer required within six months of the date of issue and the provider is still in contact with the worker, re-issue of the equipment to another worker may be negotiated. If the worker is no longer in contact with the provider, the worker should contact SIRA on 13 10 50.

Appeal process

Prior to submission of an application, if there is disagreement about use of the SIRA equipment and workplace modifications program, the worker should firstly try to resolve the problem directly with the insurer. If the problem cannot be resolved, contact us on 13 10 50 or email contact@sira.nsw.gov.au. For more information regarding the complaints process, visit www.sira.nsw.gov.au.

Where an equipment and/or workplace modifications application has been submitted and has not been approved, the worker can request an internal review by the insurer. If following an internal review the application is not approved, a SIRA review of the insurer’s decision can be requested by writing to: Manager, RTW Operations, State Insurance Regulatory Authority (SIRA), Locked Bag 2906, Lisarow NSW 2250 or vocprograms@sira.nsw.gov.au.

The appeal must outline the reasons a review is requested and provide any additional information to support the request. If the application includes funding for new employment assistance under section 64B, documentation outlining the insurer’s decision should be attached including, if relevant, details of any dispute action being undertaken.

SIRA will review the appeal application. We may request additional information from the worker, person submitting the application, and/or insurer. If additional information is provided that is likely to change the insurer’s decision, SIRA may request a review of the new information by the insurer before progressing the appeal.

SIRA will notify the worker and the insurer of the outcome of the appeal within 10 working days of receiving a complete appeal application and all necessary supporting information.

Further information

Vocational rehabilitation programs resources are available:

Other references:

Footnotes

  1. Refer to the Guidelines for claiming workers compensation – B4.1 Return to work assistance (new employment assistance).