Insurance and Care NSW | icare - Summary of services for Small Business Employers · 2020. 6....
Transcript of Insurance and Care NSW | icare - Summary of services for Small Business Employers · 2020. 6....
Summary of services for Small Business Employers
What you can expect from icare and our Claims Service Providers
We are committed to continuing our focus to provide high-quality standards of service and value for all policy holders. As a small business 1 employer insured under the Nominal Insurer Workers Compensation Scheme in NSW there are services included in the cost of your premium that are available to you.
Injury prevention and trainingServices that focus on providing you with preventative tools, education and advice to develop a sustainable culture of workplace safety and awareness.
The safety and wellbeing of you and your people are
paramount and so we have developed a range of
preventative programs and training to assist you and
your employees to better understand how to maximise
workplace health and safety outcomes.
Þ Improved safety outcomes through our scalable and bespoke prevention programs: As a policy holder
you have exclusive access to scalable and bespoke
prevention programs that improve workplace health
and safety and help to reduce injury rates through our
prevention team: [email protected]
Þ Training to support you with managing workers insurance: Access a range of training to make
managing workers insurance easy. Developed with
your needs in mind, you can access: Mental Health
First Aid, PIAWE training, Return to Work Programs
& Injury Management Planning and Policy, premium
and underwriting training.
Þ Access to our latest education and training programs: We’re optimising our education and training programs
to help you improve workplace safety culture. This
includes continually expanding our online knowledge
base with industry-leading information, insights and
tools, so you feel empowered to maximise workplace
health and safety outcomes.
Policy, underwriting and performanceServices to ensure your policy works for you and your business.
When it comes to workers insurance for small business
employers, we understand that every business is different,
and some employers may make more claims than others.
So, as part of our standard services, we give you access
to our policy and underwriting teams to provide you with
the best-fit policy solution to better support you and
your specific business needs.
Þ Get covered quicker: If you’re new to icare, you can
get a quick quote on your workers insurance premium
on the icare website (48 hours if requested in writing)
and receive a Certificate of Currency within 48
business hours of request.
Þ Support when you need it: Our customer support
team is focused on resolving your policy and claims
queries in a timely manner whether you email or call
icare’s Customer Support Centre from 7am – 7pm (Mon – Fri).
Þ Support to improve your premium and performance: When you first apply for cover, the cost of your
premium is based on the industry you work in and how
much your business pays in wages. To help you better
understand and manage your premium, you will have
access to icare’s Underwriting team who will review
opportunities to factor in any incentives, discounts or
premium adjustments, to ensure you’re getting the
best-fit workers insurance solution for your business.
Þ Peace of mind knowing you’re always covered: You will automatically have your policy renewed
within six (6) weeks of renewal date and receive
a Certificate of Currency at the time of your renewal,
or you can confirm your cover at any time via
the ‘Employer Lookup function’ on our website
employerlookup.icare.nsw.gov.au
1. You are considered a small employer if your average performance premium is $30,000 or less. This means that your premium will not be impacted by your claims cost.
This document outlines a summary of the services included in your premium, which you can expect from icare and our Claims Service Providers. To see the full list of the services available, please read the Service catalogue for small business employers document.
Resources and industry insightsServices that deliver insights and resources that speak to you and your industry.
As a small business employer, you need easy access
to workers insurance information that supports your
industry and business needs. So, we are continuing
our commitment to deliver a range of industry-specific
resources to help you make better informed decisions
about workers insurance and to help keep your
workplace safer.
Þ Benchmark your performance using the latest insurance data anytime, anywhere: Use the
Industry Insights tool to access the latest insurance
data including volume of claims, cost of injury
and frequency by industry for NSW to be better
informed for better outcomes: www.icare.nsw.gov.au/employers/industry-insights/interactive-tools/
Þ Tailored industry resources and insights: Access
a wide range of knowledge articles and tools on
our ihub (industry hub): your one-stop-shop, full
of workers-insurance information to help you and
your industry make better informed decisions about
workers insurance and to help keep your workplace
safer. www.icare.nsw.gov.au/ihub
Claims management, support and return to workServices that support you and your worker during the full lifecycle of a claim.
We want to be with you every step of the claims journey,
which is why you have full support with managing
claims: from lodgement and contact, to return-to-work
intervention and payment. To make the process simpler
and faster, we’ve developed a segmented approach to
claims management that ensures appropriate levels of
care and management are matched to the circumstances
and complexities of the claim.
Þ Greater control over the management of your claims: Access claim information anytime, anywhere with
our Claims Portal. Through this online tool, you, your
workers and any third-party representatives can easily
manage claims from one central location.
Þ Take the guess work out of knowing the cost of your claim: We provide you with ongoing claims estimates
throughout the duration of your claim, from the first
week of lodging a claim through to 104 weeks after
the date of injury, so you have complete transparency
of the potential costs.
Þ Timely dedicated support during the claim: We will
contact injured workers and treatment professionals
within three (3) days of reporting an injury and keep
you updated through the life of the claim, delivering
an initial liability decision within seven (7) days of
reporting a claim.
Claims management, support and return to work (continued)
Þ Strategic Case Management to deliver best outcomes for you and your worker: Your Claims Service Provider
will work with you to develop a tailored claims strategy
to help you manage all aspects of a claim, including:
• Return to Work (RTW) & Recovery Goals
• Capacity for work
• Medical Treatment
• Liability and benefits
• Identification of barriers affecting RTW and recovery
• Identification of actions or strategies to overcome
barriers and progress the claim
Þ Tailored claim management to maximise recovery and return-to-work: Your claim will be triaged based on
a variety of factors including the injury type, industry
and worker age to ensure the appropriate team or
Case Manager is applied to maximise opportunities
for recovery and return to work. As more information
is gathered during the claim lifecycle, we will
continuously triage your claim to ensure you receive
the right level of support every step of the way.
Þ Specialised support to meet complex claims: Receive tailored case management support to meet
the needs of: primary psychological injury claims,
medically complex claims and fatality claims, through
a dedicated and experienced Case Manager who will
remain involved throughout the claims journey, and
who has lower caseloads to dedicate more time to
each claim.
Þ Transparent and timey medical treatment decision-making: Receive medical treatment decisions
within 21 days from the submission of a request. You
also have access to support with complex treatment
requests through our Medical support panel (MSP)
who offer medical advice and expertise to fast-track
decision-making for both the injured worker and
their employer.
Þ Control over the management of weekly payments: You can choose to have your Claims Service
Provider calculate and pay the appropriate amount
of weekly payments (within 5 days of receiving
the appropriate documentation) or you can enter
a Wage Reimbursement Agreement 2 (pay weekly
entitlements up front and claim reimbursement from
the insurer). This means you have the option to choose
the method that best supports your business and the
injured worker.
Þ Comprehensive workplace rehabilitation support: You have access to icare’s panel of 22 appointed
providers located throughout Metropolitan Sydney
and NSW that are available to support injured
workers in, or returning them to, pre-injury or suitable
employment. icare monitors the service of the
provider panel to continuously improve stakeholder
relationships and achieve consistent best practice in
rehabilitation services.
Þ Timely complaint resolutions: Complaints provide
valuable feedback to enable us to improve our
service, to improve customer experience, clarify any
misunderstanding or rectify a mistake we may have
made. If, in the first instance, the Claims Service
Provider is unable to resolve your complaint within
two (2) days, the complaint is escalated to icare for
management and resolution. Workers or employers
can also dispute a decision on a claim through an
optional internal review, which is conducted by icare.
2. The employer must guarantee financial and administrative resources available to make payments of weekly compensation in a timely manner and consistent with the legislative requirements.
Supporting you with managing workers insurance icare website: Get the latest workers insurance news,
helpful tools and more: https://www.icare.nsw.gov.au
Premium calculation: Find out how your premium is
calculated https://www.icare.nsw.gov.au/employers/premiums/calculating-the-cost-of-your-premium/premium-calculation-small-employer/
Get a policy quote: Take out a policy or get an estimate
of your premium online: https://portal.icare.nsw.gov.au/policy/quote/apply/
Employer look up: Search for employers registered with
icare: https://employerlookup.icare.nsw.gov.au/
Industry hub (ihub): A one-stop-shop hub full of
information to help you and your industry manage
workers insurance: https://www.icare.nsw.gov.au/ihub
Contact us: Þ Policy enquiries Call: 13 44 22 (M-F, 7am-7pm)
Þ New claim notification Call: 13 77 22 (M-F, 7am-7pm)
Þ Website: www.icare.nsw.gov.au
Icare offices:Sydney
Þ 321 Kent St
Sydney NSW 2000
Parramatta
Þ 56 Station Street East
Parramatta NSW 2150
Newcastle
Þ Level 6, 18 Honeysuckle Drive
Newcastle NSW 2300
DefinitionsClaim Estimation: A Claims estimate is the process
of applying a monetary value to a claim based on
the anticipated future cost of that claim (also known
as a Reserve).
Claims Investigations: Investigations including Factual
Investigations and Desktop investigations. Factual
Investigation are independent investigations to determine
the facts surrounding the injury or incident.
Claims portal: The Claims Portal is an online tool
developed by icare that allows workers, employers and
third-party representatives to lodge a claim and complete
tasks related to the management of claims.
Claim strategy: A claims strategy is a plan for managing
all aspects of a claim.
Commutation: A commutation is a settlement of a
worker’s remaining entitlement to weekly benefits and
medical expenses by way of sump sum payment.
Complaints: A complaint is any expression of
dissatisfaction made to an organisation related
to its products, service or the complaints handling
process where a response or resolution is explicitly
or implicitly implied.
Determined weekly benefit amount: The determined
weekly benefit amount is the amount payable for
a full week of weekly payments not including earnings
or deductions.
Disputes / Internal Review: A dispute arises when there
is a disagreement with a Service Provider's decision on
a claim.
Fatality Claims: Fatality claims include claims where
the worker has passed away prior to claim lodgement
and circumstances where the worker dies because of
their injury during the course of the claim. Services for
fatality claims are designed to support the employer
and the worker’s family following the death of a worker.
Services include:
Þ Grief Support and Information Pack
Þ Assistance in guiding the family through
the claim process
Þ Assistance in guiding the employer through
the claim process
Injury Management Plans: An Injury Management Plan
is a written plan for coordinating and managing the
treatment, rehabilitation and retraining of an injured
worker, for the purpose of achieving a timely, safe and
sustainable return to work for the worker.
Liability determination: A liability determination is the
process of assessing whether an injured person is eligible
for workers’ compensation benefits for their injury.
Litigation: Litigated matters are disputes which have
been escalated to involve legal action.
Medically Complex Claim: Medically complex claims refer
to claims which require significant medical management.
Generally, workers with this type of injury may need
significant periods of hospitalisation and prolonged
assistance with daily living activities.
Primary Psychological Injury Claims: Psychological
injuries include post-traumatic stress disorder, anxiety/
stress disorder, depression, short term shock from
exposure to disturbing circumstances, reasons to
stressors, and other mental diseases.
Triaging and Segmentation: The claim is triaged to
determine the risk profile based on psychosocial risk
factors. Segmentation refers to allocation of the claim to
an appropriate team or Case Manager to ensure suitable
resources and intervention measures are applied to
maximise opportunities for recovery and return to work.
Wage Reimbursement Agreement: The wage payment
agreement is where an employer opts to pay weekly
entitlements up front and claim reimbursement from
the insurer.