workers compensation commission self-insurers forum

Workers Compensation Workers Compensation CommissionCommission

Self-Insurers ForumSelf-Insurers Forum

Workers Compensation Workers Compensation CommissionCommission

Self-Insurers ForumSelf-Insurers Forum

2

Recent developments in the Commission

New President and Registrar appointed in late 2007

Major client survey and organisational review conducted in 2008

Number of significant changes introduced or being implemented

3

Some recent changes

Professional Development Framework for Arbitrators and Approved Medical Specialists

Consolidated Medical Appeal Panels

Key Performance Indicators Framework

Regional Venues Review

Forms Review

New Recording Software

4

Future changes

Internal restructure

Transition from contractors to in-

house Arbitrators

Coordination of regional

hearings

Electronic lodgment

5

Professional Development Frameworks

AIM – to improve the quality of decision-making

Key Components

Competency Framework

Performance indicators / measures linked to framework

Self Development Plans

Peer Review

Performance Appraisal

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Uses of the competency framework

The foundation for: self assessment peer review Appraisal design and development of professional

developments opportunities including conferences

7

Arbitrator Framework of Competency

A. Knowledge and values

B. Communication

C. Conduct of cases

D. Evidence

E. Decision-making

F. Facilitation, case management and administrative skills

8

AMS Framework of Competency

A. Knowledge and values

B. Communication

C. Conduct of Medical Assessment

D. Report of Medical Assessment

E. Case management and administrative skills

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Consolidated Medical Appeal Panels

Aim – to improve consistency and timeframes of Medical Appeal Panels

Significantly reduced number of Arbitrators and Approved Medical Specialists who sit on panels.

2007 Approx. 50 Arbitrators, 120 AMS

2008 15 Arbitrators, 20 AMS (Primary)

Preliminary results:

decrease in average time taken from 106 days to 95 days

decrease in medical appeal rate from 21 per cent (Feb 08 to 11 per cent (Jan 09)

decrease in revocation rate from 21 per cent (Feb 08) to 5 per cent (Jan 09)

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Key Performance Indicators

Aim – to provide information targeted at various levels

1.Corporate Key Performance Indicators

2. Management Performance Indicators

3. Operational Performance Indicators

4. Support Performance Indicators

5. Service Standards

The framework provides for both outcome and output based performance indicators

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Key Performance Indicators

Measures performance of Commission against legislative objectives

Basis for formal reporting to Minister

Public release in the Annual Review

External publication includes statistics on workloads and throughputs e.g. counts of new and finalised applications by type, outcomes for applications and work in progress

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Time taken to resolve matters

Disputes finalised within 3 months(including matters with appeals)

42.0% 42.1% 41.7%39.9%

44.3%

40.9%

34.6%

30.6%

42.2% 41.6%

39.7%41.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08

Cu

mu

lati

ve %

3 months

Performance Target

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Time taken to resolve mattersDisputes finalised within 6 months

(including matters with appeals)

82.8%

86.5%

82.3%

84.7%

77.8%

84.0%

82.4%82.9%

85.6%

87.5%

86.5%

83.2%

75.0%

76.0%

77.0%

78.0%

79.0%

80.0%

81.0%

82.0%

83.0%

84.0%

85.0%

86.0%

87.0%

88.0%

Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08

Cu

mu

lati

ve %

6 months

Performance Target

14

Time taken to resolve mattersDisputes finalised within 9 months

(including matters with appeals)

95.2%

94.0%

93.4%

96.3%

94.9% 95.0%94.4%

93.0%

97.5%

95.5%

90.5%

94.8%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08

Cu

mu

lati

ve %

9 months

Performance Target

15

Regional VenuesAim: Regional service provision to be better

coordinated and more efficiently delivered

Reduce number of approved locations from 48 to 16 locations across New South Wales

Review quality and adequacy of existing venues at each location

Better coordination of regional hearings

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New Recording Software

2008 - piloted the use of two voice recording hearing rooms on level 21 of the Commission’s Oxford St premises.

2009 – progressive roll out of the new technology to the remaining hearing and conference rooms on level 21.

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Some observations for Respondents

Some insurers are briefing too late (leads to problems at t/c with respondent lawyers being unavailable or not properly prepared)

Focus on early exchange – don’t wait unit you’re in the Commission before seeking GP / hospital notes

Lack of clarity around lead agent provisions

Scatter gun approach – don’t say it’s in dispute if it isn’t!

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Some observations for Respondents

Parties can agree on an Approved Medical Specialist

Check the AMS referral document – don’t wait until after a Medical Assessment Certificate has been issued to make objections

Reconsideration power

Uplift in costs for complexity

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General Points to remember At no stage do any of the parties contact the

AMS

The insurer does not arrange the examination or instruct the AMS

The WCC makes all arrangements with the AMS instructs the AMS and informs the parties of the outcome

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WPI Thresholds

1% - 9% WPI entitled to s66 only 6% binaural hearing loss to be entitled to a lump

sum – s69A 10% WPI and over to receive s67 15% WPI to receive Ss66 or 67 for psychiatric

injury 15% WPI to get domestic assistance – s60AA 15% WPI to make a Work Injury Damages claim 15% WPI to commute HIV/AIDS automatically pays 100% WPI and

maximum amount for Pain & Suffering

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Deduction for Pre-existing condition or injury For injuries before 1 Jan 2002 and

For injuries on and after 1 Jan 2002

deductions are now governed by S323 of the WIM Act & the WorkCover Guides

under s323 if it is too difficult or expensive to assess pre-existing impairment the AMS will deduct 10 per cent

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Section 8 – Work Injury Damages

Before a worker can bring a claim for damages the worker must have 15% WPI

This applies no matter when the injury occurred

If the injury occurred before 1 Jan 2002 worker must be re-assessed on WPI basis

– i.e. % loss converted to WPI

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Contact Details

Telephone: 8281 6350

Email: sian.leathem@wcc.nsw.gov.au

Website: www.wcc.nsw.gov.au