Administrative scheme
A scheme put in place where no legislation applies.
Attendant care
Services of a person to provide regular and essential personal care to an injured worker.
Benefits
Money paid to injured workers as compensation for economic and non-economic loss arising from work related injury.
Category 1 employers (NSW)
- an employer insured under a policy of insurance to which the Workers Compensation Market Practice and Premiums Guidelines apply and whose basic tariff premium (within the meaning of that order) for that policy would exceed $50,000, if the period of insurance to which the premium relates were 12 months, or
- an employer insured under more than one policy of insurance to which the Workers Compensation Market Practice and Premiums Guidelines apply and whose combined basic tariff premiums (within the meaning of that order) for those policies would exceed $50,000, if the period of insurance to which each premium relates were 12 months, or
- an employer who is self-insured, or
- an employer who is insured with a specialised insurer and who employs more than 20 workers.
Category 2 employer means an employer who is not a Category 1 employer.
Centrally funded schemes
Single public insurer (government agency) that performs most, if not all, workers’ compensation functions. Central insurers underwrite their schemes.
Common law
Provisions that allow, or preclude, injured workers from taking legal action through the courts to sue their employers for the costs of injury arising from negligence leading to unsafe workplaces.
Commutation payment
Depending on the particular legislation of a jurisdiction, and under certain circumstances, an ongoing liability for specified workers’ compensation entitlements can be commuted to a lump sum payment. Following payment of the lump sum, liability for those entitlements ceases. See also redemption payment and settlement payment.
Competitive fund
Insurer functions are provided by the private sector, through approved insurance companies. This includes underwriting and claims management. The degree of regulation of competitive schemes by government varies amongst the competitive schemes.
Cross-border arrangements
Provisions that allow workers who are injured away from their main state or territory of employment are to be covered by workers’ compensation in their main state or territory of employment.
Current work capacity
As the result of an injury, a worker is presently unable to return to pre-injury employment but is able to return to work in suitable employment (compared with partially incapacitated).
Date of injury
The date a worker became injured — in the case of diseases, this may be the first time symptoms became manifest or the first time medical treatment was sought.
Death benefits
Compensation payable to the financial dependants (usually families) of workers who die in work-related circumstances.
Deemed worker
People who provide a service but may not have the status of a worker and are deemed by legislation or regulation to be covered for workers’ compensation as though they were workers.
Diseases
Can include any physical or mental disorder, defect or morbid condition, whether of sudden or gradual development.
Disease (DVA)
- any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development), or
- the recurrence of such an ailment, disorder, defect or morbid condition; but does not include:
- the aggravation of such an ailment, disorder, defect or morbid condition, or
- a temporary departure from:
- the normal physiological state, or
- the accepted ranges of physiological or biochemical measures,
- that results from normal physiological stress (for example, the effect of exercise on blood pressure) or the temporary effect of extraneous agents (for example, alcohol on blood cholesterol levels).
Dispute resolution
Processes for resolving disputes between parties in the claims process.
Employee
A person who works for an employer on a full-time or part-time basis under a contract of service and receives remuneration in wages or salary. See also worker.
Funeral costs
Reimbursement for the cost of a funeral to the family of a deceased worker or to a person who buries a deceased worker.
Home help
Services of a person to provide domestic assistance to an injured worker.
Home jurisdiction
The workers’ compensation authority with responsibility in the state or territory where a workplace rehabilitation provider organisation is registered for Australian Business Number (ABN) purposes. However, where the organisation does not intend to deliver services in that state or territory, the home jurisdiction is the workers’ compensation authority where they intend to deliver the majority of the services.
Hybrid schemes
Essentially a central fund where functions such as claims management and rehabilitation are contracted out to private sector bodies, such as insurers with specialised expertise in injury management.
Income replacement
Payments that enable injured workers to substantially maintain their living standards if they are unable to work due to a work related injury (also known as weekly payments).
Injury
Can include a full range of physical injuries, illnesses, psychological conditions and diseases, as well as aggravations, exacerbations and recurrences of existing injuries.
Injury (DVA)
Means any physical or mental injury (including the recurrence of a physical or mental injury) but does not include:
- a disease, or
- the aggravation of a physical or mental injury.
Instrument of Approval
The document issued by the workers’ compensation authority that has approved the workplace rehabilitation provider. This may be called a certificate, agreement or instrument depending on the particular workers’ compensation authority.
Levy
The term used in New Zealand for Premiums. See Premiums.
Medical and hospital costs
Reimbursement of medical and other treatment costs related to workplace injury which can include hospital stays, ambulance transport, pharmaceuticals, aids and appliances, and household help.
Multi-jurisdiction employer
An employer who conducts their business in more than one jurisdiction and has separate workers’ compensation cover in each jurisdiction.
Net assets
For privately underwritten schemes, the balance sheet claim provisions and for centrally funded schemes, the total current and non-current assets minus the outstanding claims recoveries at the end of each financial year.
Net funding ratio
Ratio of assets to outstanding liabilities.
Net liabilities
Centrally funded schemes are the total current and non-current liabilities minus the outstanding claim recoveries at the end of each financial year, and for privately under written schemes, the central estimate of outstanding claims for the scheme at the end of each financial year.
No current work capacity
The injured worker is unable to perform any duties in the workplace (compared with totally incapacitated).
Non-economic loss
Measure of the impact of an injury on a worker’s lifestyle, such as pain and suffering, disfigurement and reduced expectation of life, normally associated with permanent impairment.
Partially incapacitated
The worker is able to return to work and perform suitable duties, even if it is not the same job they were previously doing before the injury (compared with current work capacity).
Permanent impairment payments
Payment compensating for the permanent loss of a body part or function, for which there is little expectation of recovery or improvement.
Premiums
A percentage of the amount that an employer expects to pay to their workers in a given period paid as premium to a workers’ compensation insurer.
Privately underwritten schemes
Schemes of workers’ compensation where the underwriting function is performed by the private insurers, with varying degrees of government regulation.
Prudential requirements
Ensures that private insurers can operate on a fully funded basis to meet all expected compensation payments and the costs of managing claims.
Psychological injury
A range of conditions relating to the functioning of people’s minds.
Redemption payment
Depending on the particular legislation of a jurisdiction and under certain circumstances, an ongoing liability for specified workers’ compensation entitlements can be redeemed to a lump sum payment. Following payment of the lump sum, liability for those entitlements ceases. See also commutation payment and settlement payment.
Rehabilitation
The process of assisting workers to recover from work related injury and returning to work which can include medical treatment, retraining, the use of aids and appliances, alterations to workplace and home, and gradual return to full time or part time duties. See return to work.
Remuneration
The total amount of gross earnings of workers of an employer. See also premiums.
Return to work
The process of employers or other people or organisations helping injured workers to get back to work or stay at work while they recover from an injury. See also rehabilitation.
Self-insurer
Employers who manage their workers’ compensation arrangements themselves without having to pay annual premiums.
Serious claims
Includes all accepted workers’ compensation claims involving temporary incapacity of one or more weeks plus all accepted claims for fatality or permanent incapacity.
Settlement payment
Depending on the particular legislation of a jurisdiction, and under certain circumstances, an ongoing liability for workers’ compensation entitlements can be settled via a lump sum payment. Following payment of the lump sum liability for those entitlements ceases. See also commutation payment and redemption payment.
State of connection
The jurisdiction decided through applying the test in s5.8, when an injured worker has been working in more than one state or territory.
Suitable duties
Duties for which an injured worker is suited in relation to their capacities at a particular point of time in the workplace rehabilitation service continuum.
Suitable work/employment
Employment in work for which the worker is suited in relation to the worker’s capacities, age, education, skills, work experience and place of residence.
Threshold test
A level of impairment an injured worker must reach.
Totally incapacitated
The injured worker is unable to perform any duties in the workplace (compared with no current work capacity).
Types of damages
Damages that may be suffered by an injured worker and which can include general damages (compensation for pain and suffering), economic loss (compensation for loss of past earnings or future earning capacity), legal costs and medical and hospital costs.
Underwriting
The process of writing and signing a policy of insurance.
Worker
A person who is covered for workers’ compensation benefits.
Workers’ compensation
Financial support to workers who are injured in the course of employment and suffer a consequent loss.
Workplace rehabilitation
A managed process involving timely intervention with appropriate and adequate services based on assessed need, aimed at maintaining injured or ill employees in, or returning them to, suitable employment.
Workplace rehabilitation consultant
Suitably qualified health/behavioural science professional employed by a workplace rehabilitation provider to provide workplace rehabilitations services.
Workplace rehabilitation services
The types of services referred to in the Workplace Rehabilitation Model that may assist a worker return to work with the same (pre-injury) employer or with a new employer.
Workplace rehabilitation provider
An organisation that has been approved by a workers’ compensation authority to provide workplace rehabilitation services to assist injured workers return to work following a workplace injury. Where appropriate within the context of workplace rehabilitation service provision, a reference to a workplace rehabilitation provider also includes a reference to a workplace rehabilitation consultant.
Workers’ compensation authority/authorities
The body responsible for workers’ compensation legislation and policy covering designated employers and their employees within their area of legal authority.