ACT Workers Compensation Insurance

What should I do when an injury occurs?

• Ensure your employee receives appropriate medical treatment immediately
• Notify CGU within 48 hours of becoming aware of an injury in your workplace. A wage penalty applies after this time. The earlier you notify us, the sooner we can provide assistance with managing the claim.

Initial notification of injury

Providing initial notification of an injury couldn't be easier with CGU's online initial injury notification system. If you're new to online notification you can use this quick reference guide or speak with your CGU Account Manager.

You can also notify us of an injury via email, fax or posting a notification of injury form.

How do I lodge a claim?

The employee should complete the Workers Compensation Claim Form and submit it with their medical certificate as soon as practicable. The employer is required to complete the Employer's Claim Form and lodge it with CGU Workers Compensation within three working days.

What should I do following an injury?

• It’s important that you investigate the incident and identify a solution to ensure a similar injury doesn’t occur again. This should become part of your organisational WHS system.
• If the injured worker is unable to immediately return to their pre-injury role, identify suitable duties that you may be able to provide within your workplace.

How is liability determined?

CGU work in consultation with you to determine liability quickly and then assess an injured worker's compensation entitlement for weekly benefits, medical and other expenses. We undertake a thorough review of all information prior to determining initial liability and then work to establish the right claims management strategies.

On receipt of a valid claim, CGU will contact you within five working days or three working days for a significant injury to discuss the circumstances of your employee’s injury including:

• How the injury occurred
• Whether your employee has lost time from work as a result of their injury
• Whether their employment was a contributing factor to the claimed injury
• Whether there are return to work opportunities
• If you need any assistance during the claims management process.

What is paid on a claim?

If the workers' compensation claim is accepted, your injured worker could be eligible for compensation payments including:

• Weekly payments where time off work is required:
  • CGU will reimburse you for these payments upon acceptance of the liability
  • Your employee must obtain a WorkSafe ACT medical certificate from their treating doctor and provide it to you
  • The amount your employee will receive is dependent on your employee’s fitness for work and duration of incapacity.
• Reasonable medical and hospital expenses – these are paid in line with WorkSafe ACT recommended fees. Service providers can apply directly to CGU for payment
• Accommodation costs – if your injured worker is required to be away from home for treatment they may be entitled to have accommodation costs paid
• Travel and transportation costs – reasonable public transport and car travel costs (as per WorkSafe ACT rates) may be reimbursed to your employee for travel to and from medical appointments and treatment. Remember to keep any travel related invoices or receipts.

Whilst entitlements are not limited to the above, we have simply outlined the more common payment groups. If you would like more information please contact CGU.

Personal Injury Plan

Under the workers' compensation Act a personal injury plan (PIP) must be established in agreement with the employer and injured worker, to the maximum extent that their cooperation and participation allow and with the assistance of an approved rehabilitation provider.

The PIP is agreed with all three parties and the injured worker, and, for that purpose, must comply with the obligations imposed on the insurer under the plan.

Injury management training

CGU provides all policy holders with free access to online injury management training.

• An overview of injury management
• Legal requirements
• Roles and responsibilities in injury management
• Responding to injuries
• Claims management and early intervention
• Recovery and returning to the workplace.

CGU also offers classroom style training on injury management. More information is available in our Employer WHS risk management and training section.

Return To Work Plan

You are responsible for preparing a Return To Work Plan for your injured worker that:

• Describes how you will help your employee return to work after an injury
• Is based on the treating doctor’s recommendations and approval
• Is developed in consultation with your employee. You must make it available to them on request.

If the doctor thinks the employee is fit to work, but not in their normal job, you must consider suitable duties such as:

• Parts of the job the employee was doing before the injury
• The same job, but on reduced hours
• Different duties altogether
• Duties at a different site
• Training opportunities
• A combination of some or all the above.

When considering suitable duties, the following must be taken into account:

• The work capabilities the treating doctor has listed
• The age, education and work skills of the injured worker
• Where the worker lives
• What duties are useful within your business
• If the duties comply with the injury management plan
• They must not be demeaning or token duties.

Contact your case manager for more information and to obtain an Employer’s Guide and templates for developing a Return To Work Plan.

Return to work training

CGU offers a range of training courses to help you in the area of return to work. More information is available in our Employer WHS risk management and training section.

Right to choosing a treatment provider

Although medical treatment can only be administered with the consent of the injured worker by their nominated treating doctor, an employer or CGU may require the employee to be examined by an independent medical examiner.

These reviews aim to provide medical opinion and information to assist the return to work process.

CGU provides excellent claims management

• National knowledge and scale that drives outcomes
• Dedicated and experienced claims staff to provide expert advice on all aspects of claims management
• Positive outcomes delivered by maintaining tight control of your claims and regular liaison with all parties
• Proactive claims strategies that meet legislative obligations and deliver flexibility for employers
• Results that drive positive premium impacts
• Early indications of claim trends
• Benchmarking against your peers
• Outstanding customer service.

The information contained in this section is provided as general information only. It must not be considered legal advice. If you have any queries, please contact your case manager or WorkSafe ACT directly on telephone (02) 6205 0760.

What are an employer’s obligations?

As an employer, you must maintain a readily accessible register of injuries for all incidents, accidents and near misses and make sure all employees are aware of it.

You must also:

• Allow the injured worker to visit a doctor
• Consult with the injured worker, their treating doctor and CGU about the plan for assisting them return to work
• Prepare a Return to Work program
• Provide the injured worker with employment that is suitable based on their work capacity, until they are able to return to their pre-injury duties.

For further information about employer obligations, please refer to the Information for Employers Rights and Responsibilities brochure or contact WorkCover ACT on (02) 6207 3000.

When an injury occurs

Following an injury an employer must:

• Attend to the injured worker as soon as possible, ensuring they receive medical treatment if required
• Notify CGU as soon as possible
• Complete your register of injuries as soon as possible
• Implement and monitor a Return To Work Program for the injured worker
• Not dismiss an injured worker within 12 months of the worker becoming unfit as a result of a work injury.

Making a claim

Once a claim form is completed an employer must:

• Forward it to CGU within three working days of receipt
• Forward relevant medical certificates as soon as possible.

Employers also have a number of obligations relating to workplace health and safety.

An injured worker’s obligations

An injured worker must:

• Notify their employer of any injury or illness as soon as they become aware of it
• Make a workers' compensation claim (including providing a WorkCover WA First Medical Certificate) in order to receive payment for medical expenses and any time lost
• Nominate their own treating doctor, usually a GP who agrees to participate in the planning of their return to work
• Actively participate in treatment and planning their return to work
• Participate in assessments to determine their capacity, rehabilitation progress and future employment prospects
• Make every reasonable effort to return to work in suitable employment
• Notify their employer within seven days if they are receiving workers' compensation payments and start working for another employer or start their own business.

If your employee doesn’t meet these obligations, their entitlement to weekly payments and medical and other expenses may be affected.

For more information regarding employee obligations, see the section on Information for Workers Rights and Responsibilities or contact WorkCover ACT. Copies of any posters, can be found at the WorkCover ACT website.

Access online training

Working with you to deliver positive claims results

We take a sustainable, partnership approach to managing your claims. We work with you and your adviser to deliver results that have a positive impact on your premiums.

Our ability to deliver positive results lies in our experience, knowledge and scale. Our processes and systems enable us to maintain tight control of your claims.

We start by learning about your business environment and past claims performance so that we can assist where we identify improvement opportunities.

When claims do occur, we keep you informed every step of the way. From establishing liability and setting claim strategies, through to the treatment program and getting your employees back to work.

For information regarding what to do if an employee is injured at work, refer to our Employer claim information section.

Taking control of your workers compensation

Employers often think there is nothing they can do to control rising workers' compensation premiums or to resolve difficult claims. The reality is that you can – by understanding what affects your premiums and focusing your efforts in the right areas.

CGU has developed an Employer Toolkit to help medium-sized businesses do just that. It provides a self-assessment to identify focus areas as well as guides and templates to help you better understand and address the areas most critical to your performance.

Included in the toolkit are topics such as:

• How your premium is calculated
• The drivers of controllable workers' compensation costs
• The importance of prompt injury notification
• Identifying suitable duties to help get injured workers back to work
• Active management of your RTW programs
• Management of provider relationships.

Contact us for more information and to get started.

CGU can help you to go through the self assessment and take you step-by-step through the toolkit – letting you take the first steps in taking control of your workers' compensation premium.

A growing focus on business transparency and performance metrics has increased the need for excellent reporting tools. We understand that all businesses have unique performance reporting needs, so we’ll work with you to establish your requirements and provide the claims and premium forecasting information to fulfil them.

Workers Compensation Online

Workers Compensation Online is a secure, web-based report management tool that:

• Provides you with information on injury and claims management
• Enables you to compare data and actively plan WHS strategies that will help minimise workplace injuries, improve health outcomes for your employees and produce tangible cost benefits for your business
• Lets you manage your reports in the format that suits you – choose between monthly reports that are automatically emailed to you, or develop your own reports that you can access at any time.

The tool covers areas such as:

• Injury notifications
• Claims durations
• Injury types by bodily location
• Injury trends
• Cost of injury by bodily location.

To register for Workers Compensation Online contact your adviser, or emai wc.live@cgu.com.au.

Who needs a workers’ compensation policy?

Under the Workers' Compensation Act 1951 all employers are required to take out a policy to cover all employees including the following:

• Apprentices
• Sub contractors
• Family members
• Working directors.

For further information, see the WorkSafe ACT website.

Who is covered by a policy?

All employees are covered by a workers' compensation policy and are entitled to compensation for any injury that occurs in the course of their employment (where their employment is deemed to be a significant contributing factor).

If you are a sole proprietor or a member of a partnership, you are not a worker of your own business and therefore you cannot take out a workers' compensation policy for yourself.

Obtaining a policy

When taking out a policy, you will need to submit a proposal form declaring estimated wages for the period of the policy (usually twelve months) and pay the deposit premium based on the estimate. The premium is adjusted at the end of the period based on actual wages.

Premium calculation

Premium rates are reviewed by CGU annually. The rate you pay is determined by your industry or occupation. This rate is then applied to your gross estimated wages for the 12 month period. The rate may be varied subject to your previous claims history and wageroll.

What happens if I am uninsured?

If one of your workers has a work related injury or industrial disease and you are uninsured, you will be liable for the cost of that claim. You may also be liable for the cost of any damages awarded by a court. In addition, you may be liable for triple the amount of premium that would have been payable had a policy been maintained and triple the cost of the claim. For further information, see the WorkSafe ACT website.

Employer obligations

Under the terms of the policy we issue, you have certain policy and claims responsibilities to fulfil. It is important that you take the time to read your policy document so that you are aware of these obligations.

The major obligations you have are to:

• Provide estimated and actual wages declarations for each policy period you are insured with us
• Maintain proper Wages Records for every worker employed
• Allow inspection of your wages records by a duly authorised representative appointed by us
• Give notice of any injury or incident as soon as practicable.

As an employer, you also have obligations when one of your employees is injured at work. For further information, see the claims section for employers.

Managing your policy effectively for large businesses

As a large business, your company structure may mean that you have complex needs when it comes to managing your workers' compensation policy.

We will work with you and your advisor to understand your business structure and strategy and help make the management of your portfolio of policies as effective and efficient as possible.

Request a certificate of currency

Please contact us by phone or email and we will arrange for this to be sent to you.

CGU offers free online courses to all employers holding our workers compensation cover.

CGU, in partnership with Kineo, provides innovative online WHS training solutions. Using a blend of workplace simulations, interactive assessments, audio, images and text, our courses actively engage and involve the user in problem-based learning.

The benefits of online learning include:

• Lower training cost per employee
• Standardised training throughout all business locations
• Reduced administration requirements.

What do I get?

• Free or discounted online training
• An opportunity to trial online learning in your organisation at no cost
• Discounts on future online learning courses.

• Kineo - CGU Partner Cost Savings (PDF, 1.21 MB)

What courses can I choose?

There is a variety of modules in work health and safety, injury management and industrial relations. The following are an example of the types of courses available:

• Alcohol and other drugs in the workplace
• Duty of care
• Incident investigation
• Injury management
• Manual tasks for workers
• Minimising risk using personal protective equipment
• Risk management
• Work health and safety fundamentals.

How do I access the offer?

Please email safetyrisk@cgu.com.au to register your interest and they will create a Kineo profile. Alternatively, contact your Customer Relationship Specialist.

If you already have access, log in via CGU Online Learning Portal - Online Training Portal.

What services are available?

CGU is a work health and safety (WHS) and risk management supplier to Australian businesses. We set the standard for innovative and strategic business solutions to assist our customers with effective risk management strategies. CGU provides consultancy services across Australia. Our experience and capability encompass a wide range of safety and risk services, including:

Online Training

Our online training courses use a blend of interactive workplace simulations, interactive assessments, audio, images and test to actively engage and involve the user. More information is available under OHS risk management and training (requested changed to Safety and Risk Services as per page 2 request) – online training

For further information, please refer to our brochure or contact CGU.

Risk Management Consulting

The experience and capability of our consultants encompass a wide range of safety and risk services. These include:

• Workplace health, safety and injury management systems developed, particularly for small to medium business
• "Health checks" on workplace health and safety (WHS) documentation to facilitate continuous improvement
• Self audit and inspection tools
• Ongoing assistance and advice.

What should I do if I'm injured at work?

• Report the injury immediately to your supervisor or manager or the person responsible for workers' compensation in your workplace
• Seek appropriate medical treatment
• Lodge a Workers' Compensation Form, accompanied by a medical certificate, with your employer. Any further medical certificates or fee invoices should also be forwarded to your employer as soon as possible.

The earlier you notify your employer, the sooner an appropriate treatment program can be established to help you get back to work and the greater the chance of getting you back to your pre-injury lifestyle as soon as possible.

You can provide an initial notification of an injury using CGU's online injury notification system. Alternatively you can download a notification of injury form, and, once completed email, fax or post it to CGU.

How is liability determined?

On receipt of a valid claim, CGU Workers Compensation may contact you and your employer within five working days to discuss your circumstances including:

• How your injury happened
• Whether you have had to take time off as a result of your injury
• What opportunities there are for you to return to work.

CGU works to determine liability quickly and assess any compensation entitlement for weekly benefits, medical and other expenses that you may have.

We undertake a thorough review of all information prior to determining initial liability and then work to establish the right claim management strategies.

What am I covered for?

If your workers’ compensation claim is accepted, you could be eligible for a variety of compensation payments including:

• Weekly payments where time off work is required – to be eligible you need to obtain a WorkCover WA medical certificate from your treating doctor and provide it to your employer
• Reasonable medical and hospital expenses – these are paid in line with WorkCover WA recommended fees
• Accommodation costs – if you are required to be away from home to receive medical treatment, your accommodation costs may be reimbursed up to a maximum amount per day as prescribed by WorkCover WA. Contact CGU should this be required
• Travel and transportation costs – public transport and car travel costs may be reimbursed for travel to and from your appointments and treatment. These costs are based on prescribed Workcover WA rates. Fill out and submit a travel reimbursement form and include any invoices or receipts
• Lump sum payments – if you have a permanent impairment as a result of a workplace injury you may be entitled to a lump sum payment.

Whilst your entitlements are not limited to the above, we have simply outlined the more common payment groups.

Compensation payments can be made via Electronic Funds Transfer (EFT). Contact CGU for full list of your entitlements.

What support will I receive to help manage my injuries?

Your employer must prepare a Return To Work Plan that:

• Describes how they will help you return to work after an injury
• Is based on your doctor’s recommendations of what you can and can’t do, and the hours and days you can return to work
• Is written in consultation with you. A copy will be provided to you for your records.

If your doctor thinks you are fit to work but has placed restrictions on what you can do at work, your employer will consider if you can return to work on suitable duties, such as:

• Parts of the job you were doing before the injury
• The same job, but on reduced hours
• Different duties altogether
• Duties at a different site
• Training opportunities
• A combination of some or all the above.

You must make all reasonable efforts to ensure you actively participate in a return to work plan and co-operate in working towards the goals.

What happens if I disagree with the decision made by CGU?

If you disagree with the decision, you can:

• Contact CGU and request the decision be reviewed. As part of the internal dispute resolution process the review will be conducted by a senior member of staff who was not involved in making the original decision
• Contact WorkSafe ACT on 13 22 81
• Seek assistance from a union or lawyer
• Refer the matter to the Dispute Resolution Directorate of WorkSafe ACT.

Further information on appeal rights is available on the WorkSafe ACT website.

How do I choose a treatment provider?

You can choose your own doctor for treatment, or your employer may have an appointed company doctor or medical centre.

Your employer or CGU may require you to be examined by a doctor of their choice. These reviews are intended to provide medical opinion and information to assist the return to work process. Medical treatment can only be administered with your consent by your nominated treating doctor.

What are your obligations?

Both you and your employer have obligations in relation to any injury you sustain at work.

If you are injured at work, you must:

• Notify your employer of any injury or illness as soon as possible and within 30 days of becoming aware of it
• Make a workers' compensation claim in order to receive payment for medical expenses and time lost due to medical appointments
• Nominate your own treating doctor, usually a GP who agrees to participate in the planning of your return to the workforce
• Forward ongoing medical certificates, receipts and accounts for medical and other treatment to your employer or CGU.
• Actively participate in treatment and planning your return to the workforce
• Participate in assessments to determine your capacity, rehabilitation progress and future employment prospects
• Make every reasonable effort to return to work within suitable duties
• Notify your employer within seven days if you are receiving workers' compensation payments and you start working for another employer or you start your own business
• Comply with all reasonable requests made by CGU with regard to your claim.

If you don’t meet these obligations, your entitlement to weekly payments and medical and other expenses may be affected.

For further information about employee obligations, please refer to the Information for Workers Rights and Responsibilities brochure or contact Worksafe ACT on 13 22 81.

Your employer’s obligations

Your employer must:

• Allow you to visit a doctor
• Consult with you, your treating doctor and CGU about the plan for assisting your return to work
• Prepare a Return to Work program
• Provide you with employment that is suitable based on your work capacity, until you are able to return to your pre-injury duties

For further information about employer obligations, see the section on Information for Workers Rights and Responsibilities brochure or contact Worksafe ACT on 13 22 81.

Your treating doctor's obligations

Your treating doctor should:

• Recommend necessary treatment for your injury
• Fully complete WorkSafe ACT medical certificates
• Monitor your progress regularly
• Consult with CGU and your employer to develop a program for your return to the workforce.

CGU's obligations

CGU's responsibilities include:

• Determining liability for your workers' compensation claim and advising you in writing
• Paying reasonable medical and treatment expenses in accordance with WorkSafe ACT recommended fees
• Keeping you informed of any matters affecting your claim.