FAQs - Workers' Compensation

Workers' Compensation Claims Management and Budget Allocation

How are Workers' Compensation Budgets Allocated and Costed?

All schools receive a Student Resource Package (SRP) Workers' Compensation budget allocation based on the average claims cost rate for each school type. The average claims cost rate for each school type is applied to the remuneration of each school to determine each school’s Workers' Compensation budget allocation.

The amount charged against a school’s Workers' Compensation budget allocation is based on the actual incurred costs of claims that have been lodged at the school during the three previous financial years. If the actual incurred costs of claims lodged are greater than a school’s Workers' Compensation budget allocation the school is required to pay part of the difference, capped at 0.5% of its remuneration up to a maximum of $10,000. Savings capped at 0.5% of remuneration, up to a maximum of $10,000 accrue to those schools with actual incurred claims costs less than their Workers' Compensation budget allocations.

Schools may request exemptions for the costs of certain categories of claims, e.g., claims with injury dates prior to 1 July 2000.

Further information on SRP Workers' Compensation costs and budget allocations can be found in the Indicative Guide to the Student Resource Package on the SRP Website.

 

The budget allocation and cost details for each school are also available in the Workers' Compensation Summary Statement on the SRP Website.

 

What is the role of Gallagher Bassett?

Gallagher Bassett is the Department’s Workers' Compensation Agent. All claims received from Department employees should be sent to Gallagher Bassett for management.

Gallagher Bassett's key responsibilities are to:

  • contact the principal within two days of receiving an employees Workers' Compensation claim;
  • advise the principal on obligations and steps to be taken on the claim and to discuss the matter of liability;
  • take account of information provided by principals concerning the circumstances of the claim when determining liability for the claim;
  • advise the principal and claimant within 28 days of receiving a claim whether it has been accepted or rejected;
  • facilitate the early return to work of injured employees through timely advice to principals on rehabilitation obligations and options;
  • arrange independent medical examinations for employees following consultation with principals and advise principals of the results of medical examinations;
  • advise principals of changes in employee’s compensation entitlements and or rates;
  • contact and advise principals when disputed claims are scheduled for a Conciliation Conference;
  • process and pay medical accounts within 30 days.

Comprehensive information on the Department’s Workers' Compensation procedures are available in the Workers' Compensation Management Manual.

Further information is also available at the Victorian WorkCover Authority.

What should I do if I receive a Workers' Compensation Claim?

Employers are required to complete an Employer's Claim Report form upon receiving a completed Worker’s Claim Form from an employee.
 
The 'Employer's Claim Report' provides an opportunity for the principal to supply information about the circumstances of the claim. This information will assist the insurer to determine liability for the claim.
 

What is a Minor Workers' Compensation Claim?

Employers are liable to meet the cost of the first ten days of absence and up to $682 (indexed annually) of medical expenses for all Workers' Compensation claims. Claims that do not exceed these thresholds are known as Minor Claims.

The Department has an arrangement with Gallagher Bassett whereby they pay all medical and like accounts, including those accounts that fall within the employer threshold medical and like expenses component (indexed annually). Schools should not pay any medical accounts.

All medical accounts should be sent to Gallagher Bassett for payment.

What is a Standard Workers' Compensation Claim?

A Workers' Compensation claim is standard when the employer liability period, 10 days lost and/or $682 (indexed annually) medical expenses, has been exceeded. Once a claim becomes standard it affects the Workers' Compensation premium. Comprehensive information for principals concerning management and administration of Workers' Compensation claims is in the Workers' Compensation Management Manual, Part A and Appendix 2.

Who accepts or rejects a Worker's Compensation Claim?

If an employee has a work related injury or illness he/she may be entitled to receive worker's compensation. If a Workers' Compensation claim is lodged the key question that needs to be addressed when considering whether a claim should be accepted or rejected is, "...was employment a significant contributing factor to the illness or injury?"

In determining this, the following factors should be taken into account:

  • Duration of employment
  • Nature of the work performed
  • Particular tasks of employment
  • Probability of the injury occurring if that employment had not taken place
  • Existence of any hereditary risks
  • Lifestyle of the employee
  • Activities of the employee outside the workplace
  • Was a pre-existing injury or condition disclosed in the employee’s pre-employment health declaration.

N.B. The Department’s Workers' Compensation Agent, Gallagher Bassett, determines whether a claim for compensation will be accepted or rejected. If an employee lodges a Workers' Compensation claim the manager must forward this on to Gallagher Bassett as per legislative requirements.

A principal can recommend to Gallagher Bassett that an employee’s Workers' Compensation claim should be rejected, the principal (or delegate) should complete the Workers' Compensation Circumstance Report form, see Workers' Compensation Management Manual and forward it with the other documentation as advised in the Appendix to Gallagher Bassett.

When does a Workers' Compensation Circumstance Investigation occur?

If a principal recommends to Gallagher Bassett that an employee’s Workers' Compensation claim should be rejected, the principal (or delegate) should complete the Workers' Compensation Circumstance Report form and forward it with the other documentation as advised in the Appendix to Gallagher Bassett.

Details on the Incident Report Form from eduSafe and the Certificate of Work Capacity as well as consultation with any witnesses to the incident will be of assistance when completing the Workers' Compensation Circumstance Report form.

A clear factual account of the circumstances of the injury will assist Gallagher Bassett to make a prompt decision on whether to accept or reject the claim.

What should I do with a Workers' Compensation Current Weekly Earnings Form?

The Worker's Compensation Current Weekly Earnings Form located in Workers' Compensation Management Manual ( - 1 (pdf - 1.03mb) should be completed and forwarded to Gallagher Bassett whenever Certificates of Work Capacity are submitted by employees who have returned to work, or are about to return to work.

 

What are my responsibilities in relation to Workers' Compensation Records Management?

It is a legal requirement that employers keep comprehensive and accurate Workers' Compensation claims records.

 

Details of schools' responsibilities regarding Workers' Compensation are available in the Department's Workers' Compensation Policy Guide.

 

What happens after 130 Weeks of Workers' Compensation?

Where an employee’s Workers' Compensation weekly benefit payment entitlement has been terminated in writing by Gallagher Bassett and the employee indicates that he or she wishes to resume duty, the worker should not be permitted to resume duty unless a medical practitioner has certified he or she is fit to resume work.

If the employee is unable to return to work due to medical reasons and wishes to access personal leave, he/she must make a written application to the principal requesting a period of personal leave. Applications for personal leave must be supported by a medical certificate confirming that the worker is not fit for duty. Applications for personal leave will be considered by the principal and will not be unreasonably refused.

Also, after 130 weeks an employee may apply to Gallagher Bassett for their weekly benefits to continue if they have returned to work and are working at least 15 hours per week and are not capable, because of their injury, of working beyond this level. 

Advice concerning the arrangement of medical examinations and health related resumption of duty issues can be obtained from the Department's Medical Advisory Service on 1300 031 057 or email DET@injurynet.com.au or alternatively, you can log in at www.injurynet.com.au/DET.

Who is covered by the Department's Workers' Compensation Policy

Are School Council Employees covered by the Department's Workers Compensation Policy?

School council employees are not covered by the Department’s Workers' Compensation Insurance Policy.
 
Any school council that has an annual payroll in excess of $7,500, or employs an apprentice/s, is required by law to have a Workers' Compensation Insurance policy.
 
 

Are School Volunteers covered by the Department's Workers' Compensation Policy?

Claims lodged by school Volunteers are covered by a Workers' Compensation policy with Gallagher Bassett and are processed as standard claims.

Forms should be clearly marked 'volunteer' in the Worker Details section of the Worker’s Claim Form and in the Employment Details section of the Employer’s Claim Report Form. The employer's scheme registration number for volunteer claims is 6464297.

Enquiries concerning volunteer claims should be directed to Gallagher Bassett on 9297 9100 or 1300 975 609.

Completed forms should be forwarded to: educlaims@gbtpa.com.au

Are Workplace Learning Students covered by the Department's Workers' Compensation Policy?

Structured workplace learning, work experience and practical placement students are deemed workers under the Department’s Workers' Compensation Insurance Policy with Gallagher Bassett.

Claims are processed in the same manner as for an employee claim, except that the claim form must be filled in by the placement employer and is forwarded to the school for counter-signature by the principal. When the claim is forwarded to Gallagher Bassett, a copy of the Department’s Work Experience/Placement Arrangement Form must also be provided with the claim. The claim form should be clearly marked ‘work experience/placement student’ in the ‘Worker Details’ section. The workplace number is 9573347.

Is this a Workers' Compensation or TAC Claim?

Injuries sustained while travelling to and from work that involve a motor vehicle, train or tram are covered by the Transport Accident Act 1986. To make a claim telephone 1300 654 329 or visit: TAC.

Employees are entitled to claim Workers'' Compensation if they are:

  • injured when they are travelling in the course of their employment for approved activities; or
  • authorised to carry out a specific task or duty that requires them to travel.

For further information on Workers' Compensation claims refer to Workers' Compensation Management Manual and the Workers' Compensation Policy Guide.

Weekly Compensation, Leave and Payroll

Who manages Workers' Compensation Payments?

Schools are responsible for managing any over/underpayments of salary to Workers' Compensation claimants as well as ensuring employee entitlements are paid/ceased where appropriate.
 

 

How should I manage an Employees Workers' Compensation Leave and Payroll?

When an employee lodges a Worker's Compensation claim for weekly benefits (a time lost claim) and presents a Workers' Compensation Certificate of Capacity, leave is recorded by schools on eduPay as being ‘personal leave pending Workers' Compensation’. The dates entered on certificates are the dates used for leave recording purposes.

For these claims Gallagher Bassett will notify the claimant and the principal in writing of the acceptance or rejection of the claim within 28 days of having received the claim. If the claim is rejected by Gallagher Bassett, leave will continue to be recorded as ‘personal leave’ on eduPay.

If the claim is accepted by Gallagher Bassett the employee’s leave and payroll record should be immediately adjusted to the appropriate Workers' Compensation leave code.

It is schools who are responsible for the recording of Workers' Compensation leave and related payroll transactions on eduPay. When schools receive Workers' Compensation certificates capacity, they are responsible to record the leave on eduPay and forward the Workers' Compensation certificates of capacity to Gallagher Bassett.

For operational information of Workers'' Compensation leave recording refer to Workers' Compensation Leave and Payroll Procedures.

When are employees entitled to Workers' Compensation Weekly Benefit Payments?

Injured employees may be entitled to compensation for loss of earnings (weekly benefits) by lodging a Worker’s Compensation Claim Form and a Workers' Compensation Certificate of Capacity with their principal.

Workers' Compensation weekly benefits are calculated as a percentage of the employee’s average gross weekly wage.

Comprehensive information concerning management and administration of Workers' Compensation Claims is the in Workers' Compensation Management Manual and Workers' Compensation Policy Guide.

How are Worker’s Earning Details Calculated (PIAWE)?

The 'Employer’s Claim Report' form (section 6 Workers Earnings detail) requires details of the injured worker's weekly pay prior to injury. This is the pre-injury average weekly earnings (PIAWE).

This is calculated on an individual basis and includes Higher Duties allowances.

When calculating the PIAWE for Principal Class Officers’ Workers' Compensation claims, deduct the Employer Superannuation Contribution from their total remuneration package.

Please contact the Schools People Services on 1800 641 943 for advice on the PIAWE calculation.

What is Workers' Compensation “Make-Up Pay” (MUP)?

The Department is required to pay Make-Up Pay (MUP) to injured employees to bridge the gap between the legislated Workers' Compensation weekly benefit and what the injured worker would be entitled to be paid had they not been injured.

Make-Up Pay is payable in respect of a particular injury or incapacity for an aggregate of 1984 hours for a full time worker or pro-rata for part-time workers.

For further details refer to the Workers' Compensation Management Manual and the Workers' Compensation Policy Guide.

If an Employee is ceased does it affect their Workers' Compensation Entitlement

Workers' Compensation legislation requires employers to provide employment for 52 weeks from the date of the decision to pay weekly payments. If the worker has a current work capacity during this period the employer must provide suitable employment.

Termination of a worker’s employment does not cease the employee’s entitlement to receive Workers' Compensation weekly benefits. Schools HR Services (contact number 1800 641 943) is responsible for the payment of weekly benefits to ceased employees.

If a school is aware that a Workers' Compensation claimant with an ongoing entitlement to weekly compensation payments employment will or has ceased, they should contact Schools HR Services to provide leave and payroll details to ensure the Workers' Compensation claimant continues to receive their weekly compensation payments in accordance with the legislation.

Legal and Conciliation Matters

What happens when an Employee Appeals against a Workers' Compensation Decision?

Employees have the right to appeal against Workers' Compensation insurers’ decisions concerning their  Workers' Compensation claim/s.

To appeal against the Workers' Compensation insurers’ decision a ‘Request for Conciliation’ form needs to be completed and sent to the Accident Compensation Conciliation Service (ACCS) within 60 days of receiving the decision with which you disagree.

If an employee appeals against a decision a Conciliation Conference will be arranged. The purpose of the conference is to resolve the dispute through discussion thus avoiding a costly formal legal process.

If a decision has been appealed and the matter has been referred to conciliation the principal will be advised by the ACCS of the arrangements for the Conciliation Conference.

It is expected that principals, or a delegate, will represent the Department as the employer representative at conciliation conferences.

A Gallagher BassettInjury Claims Consultant will also attend the Conference and will contact the principal at least 3-5 days prior to the conference and also arrange a pre-conference briefing.

For further details refer to the Workers' Compensation Management Manual and the Workers' Compensation Policy Guide.

What are Worker’s Impairment Benefits?

A worker who believes they have suffered a permanent impairment as a result of work related injury may be entitled to a lump sum payment.

For more information, see: Impairment Benefits 

What should I do if I receive a Workers' Compensation Subpoenas or Writ?

As a consequence of a Workers' Compensation claim various courts may issue a summons or subpoena to provide personal information about a staff member. It is a legal requirement to comply with a subpoena or writ.

Where a subpoena in relation to a Workers' Compensation matter is received directly by a principal, a copy should be immediately forwarded to Schools HR Services and their advice sought as to the procedures that should be followed.

Where a subpoena is issued in relation to other matters, (e.g.: Family Court matter, repayment of debts) advice should be sought from Schools HR on telephone number 1800 641 943 or the Legal Services Branch of the Department before taking any action.