Media release and fact sheets from WorkCover NSWGeneral
19 October 2012
Workers compensation changes underway
On 1 October there were some important changes to workers compensation in NSW that medical practitioners need to know about.
Recent reforms to the Workers Compensation Scheme, passed by the NSW Parliament in June, focus on helping injured workers return to work and maximise work capacity.
Evidence shows that staying at work or returning to work improves recovery times and leads to a better health outcome for injured workers.
This is why the reforms have shifted the focus away from incapacity and towards establishing and assessing capacity for work.
New WorkCover certificate of capacity
The WorkCover certificate of capacity replaces the existing WorkCover medical certificate for all workers compensation claims.
The certificate of capacity focuses on what a patient can do rather than what they can’t do. Insurers will take doctors’ recommendations into account when assessing work capacity.
This certificate is now a two page document that focuses on identifying what capacity the injured worker has to work, in order to support a return to safe and durable employment, and what intervention is required to increase capacity. There is no longer a requirement on the certificate for medical practitioners to identify whether employment was a substantial contributing factor to the injury or disease.
The nominated treating doctor or treating specialist medical practitioner is responsible for completing the certificate of capacity. It will continue to be the main way for nominated treating doctors to communicate with all parties involved in the return to work process.
The old medical certificate is no longer available from WorkCover. There is a grace period of six months to allow doctors to make the adjustment, during which time insurers will continue to accept the old medical certificate.
Medical and other treatment expenses
The legislation has also been amended to provide new rules around when benefits for medical and other treatment expenses are payable.
In general an insurer will not be liable to pay for medical treatment unless it is pre-approved. However it should be noted that prior approval is not required for nominated treating doctor consultations or for the first specialist appointment for the injury. If there is a need for subsequent specialist appointments, insurers are encouraged to include them in the injury management plan once approved.
Developed by the insurer, an injury management plan outlines the actions to help a patient improve their capacity. It identifies the patient’s specific treatment and rehabilitation needs. Services that have not been documented, as part of the plan, will require prior approval.
The WorkCover guidelines for claiming compensation benefits, which are available on the WorkCover website, have the full details of treatments that are exempt from prior insurer approval.
The changes to the workers compensation scheme are being introduced in stages, but 1 October is when the most substantial changes took effect. Dates of key changes are as follows: 19 June 2012 – New arrangements for journey claims, lump sum payments and nervous shock, heart attack and stroke and disease injuries commenced. 17 September 2012 – The most seriously injured workers (with greater than 30 per cent whole person impairment) began receiving increased benefits. 1 October 2012 – Workers who make a claim on or after this date receive benefits based on their actual pre-injury earnings under the new legislation. If a dispute cannot be resolved with an insurer or WorkCover, the new WorkCover Independent Review Officer will provide an independent review of the decisions made about work capacity and entitlements.
1 January 2013 – All other injured workers will begin transitioning to the new legislative requirements.
WorkCover recommends that doctors take some time to familiarise themselves with the new certificate of capacity and the workers compensation reforms. More information and the new certificate of capacity are available on the WorkCover website. Visit www.workcover.nsw.gov.au, call 1800 661 111 or email firstname.lastname@example.org.
 The changes affect all new and existing workers compensation claims, except for claims from: – police officers, paramedics and firefighters – workers injured while working in or around a coal mine – emergency service volunteers (Rural Fire Service, Surf Life Savers, SES volunteers) – people with a dust disease claim under the Workers Compensation (Dust Diseases) Act 1942. Claims by these exempt workers will continue to be handled as though the June 2012 changes never occurred.
The fact sheets are also on our website at: