Workplace Insurance Support for New South Wales

How is my premium calculated?

NSW has a set formula it uses to calculate your premium. The formula is set by iCare (nominal insurer) and accepted by the State Insurance Regulatory Authority, known as SIRA (regulator) and forms part of the state legislation for Workers’ Compensation. 

While NSW has alternative models of insurance for large employers, the conventional model has two key calculation methods depending on your size of business. 

Small Employers

If you are a small employer with an annualised Base Premium (wages x industry rate) of less than $30,000, your premium will be calculated based on the following:

• Wages
• Industry / Scheme Rates

Medium/Large Employers

For medium to large employers with an annualised Base Premium (wages x industry rate) of greater than $30,000, under the conventional model your premium is impacted by additional factors including: 

• 3 years of claims history (Paid Weekly Compensation, Paid Lump Sum, Paid Common Law / Settlement, Paid Legal, Fatality claims)
• 3 years of Base Premium history
• Scheme rates

It is important to note individual claims are capped at $150,000 for the purposes of premium calculation. 

In most cases your policy period will run for 12 months. The renewal date is usually determined by the date you commenced the policy.

There are alternative models of insurance for large employers (Base Premium greater than $500k). Should your business meet this initial criteria we would encourage you to get in touch with Mercer Marsh Benefits to discuss discovery of this option and any potential premium savings.

What influences my premium calculation?

There are three key drivers that influence your premium:

• The wage roll of your business
• Industry Rates (these are aligned to the type of work your employees undertake and/or your business activity)
• Your claims experience (Claims History)

Capping provisions are in place in NSW, meaning your risk premium rate will not increase or decrease greater than 30% when compared to the prior year.

When and how do I pay my premium?

Your premium payment options will be agreed at the renewal of your policy. The options include upfront, quarterly or monthly payments.

Instructions on how to pay your premium are detailed on your premium invoice.

You can take advantage of a 3% discount by paying the conventional premium in full within 28 days of the premium invoice date.

Additionally Mercer Marsh Benefits can help arrange a premium funding option so you can obtain the discount for upfront payment and you will then pay the funder monthly including interest.

What happens if I can’t pay my premium in full?

If you are unable to pay your premium in full Mercer Marsh Benefits can assist you with obtaining a competitive premium funding quote.

The premium funding option allows you to take advantage of any discounts available, as the funder will pay your premium in full. You will then pay the funder in agreed monthly or quarterly instalments including interest.

What happens if I don't pay my premium?

If you don't pay your premium you could be fined and penalties may be applied to the amount in arrears. Your policy may also be cancelled leaving your employees without appropriate cover.

If you don't pay your premium on time a late payment penalty will be applied. Further, you will be deemed uninsured and will be liable for any claims costs that arise until all outstanding premium charges are paid in full.

What payments do you include in your wage declaration? Discover what components of employee’s remuneration is included in the wage declaration.

Click here to download the wage declaration matrix.

What are wage declarations?

Wage declarations provide the regulator/insurer with the required information to calculate Workers’ Compensation premiums.

Employers are required to provide estimated wages at the renewal of the policy and actual wages at the expiration of the policy.

A policy period runs for 12 months from the date the policy is first incepted.

Refer to the Wage Matrix to determine what wages to declare when completing your declaration.

When do I submit wage declarations?

iCare automatically renew your premium and estimated wages do not need to be submitted, however, this can lead to inflated premiums if your wages are forecast to be lower than your previous year. Estimated wages should be submitted to iCare 2 months prior to the policy renewal date. 

Actual wages need to be submitted directly to iCare within 2 months of the policy expiration.

How do I submit my wage declarations?

Completed estimated and actual wage declaration forms are to be submitted to underwriting.operations@icare.nsw.gov.au.

What happens if I miss the due date for submitting my wage declarations?

If you don’t submit updated wages iCare may apply a 30% loading to the expiring wages. This may negatively impact your premium as you may be charged a higher premium than necessary.

Who is covered under your policy? Discover the definitions of Workers and Contractors in NSW, and who is covered under your policy or requires their own policy.

Who is a worker?

A worker is generally identified as an individual who is a staff member or employee of a business or entity who receives an income under a 'contract of service'.

Can contractors be considered workers?

If you, as the employer, engage a contractor/s to perform work you may still need to cover the contractor for Workers' Compensation depending on the nature of their engagement.

Contractors may operate as sole proprietors, partnerships, companies or through family trusts.

It is important to consider if any contractor may be deemed as a worker.

The Assessment Tool on the SIRA website will assist you in determining whether your contractor is a worker.

Contractors are most likely considered workers if:

• The employer (you) directs the contractor regarding work to be performed and the time and manner in which it must be performed
• Paid on time basis
• Tools and material supplied by the employer (you)
• Works only for a single employer (you)

Please note: A person may have been hired as a contractor and be a contractor for other purposes such as tax, but still be a worker for the purpose of Workers’ Compensation Insurance. The status of a person for tax purposes bears no direct relationship to that person's status as a worker for Workers’ Compensation Insurance purposes.

If a worker works in multiple states, which state’s policy covers them?

If you have an employee who works in more than one state or territory, they will be covered by only one state’s policy. 

All states and territories use a state of connection to determine which policies will cover the employee for Workers’ Compensation. This applies irrespective of where the injury occurs. 

The state of connection test considers: 

• Test A: The territory or state in which the worker usually works in that employment
• Test B: If not Identified in (A), the territory or state in which the worker is usually based for the purpose of the employment 
• Test C: If can’t be identified through (A) or (B), the territory or state in which the employer’s principal place of business in Australia is located.

If the above tests don’t provide a state of connection, the employee will be covered by the state in which their injury occurred.

If an employee is working temporarily overseas or interstate, they will continue to be covered by the Workers’ Compensation, however, at 6 months an employer needs to reassess this arrangement to ensure ongoing cover or arrange alternative cover if the arrangement will continue at length. You can contact Mercer Marsh Benefits to discuss if additional coverage is required.

Has an employee had a workplace injury? Discover who will manage the claim and how to notify your insurer.

Who manages my policy and claims? 

State Insurance Regulatory Authority (SIRA) is the Workers’ Compensation regulator of the New South Wales scheme and iCare is the nominal insurer.

iCare manages the Workers’ Compensation policy and appoints Claims Agents to administer and manage claims on their behalf. 

Appointed Claims Agents in NSW are:

• GIO (claims with a date of injury prior to Jan-2018) 
• EML (claims with a date of injury from 01/01/2018)

iCare has also appointed Approved Providers to manage the claims of Large Employers who meet the entry criteria. The Approved Providers are: Allianz, GIO and QBE.

If your employee has a workplace injury, you must lodge the claim via the iCare Claims lodgement portal or directly with your Approved Provider.

How and when do I lodge a Workers’ Compensation claim?

If your employee has a workplace injury, you must lodge the claim within 48hrs of notification and within 5 days to avoid an excess. 

You can lodge the claim via the iCare Claims lodgement portal  or directly with your Approved Provider.

Allianz 
GIO
QBE

Do I have to pay an excess on claims?

An employer excess is payable on claims, this is similar to the excess you would pay on any other insurance policy. 

The excess is equal to the first week of weekly compensation payable. If you report the claim within 5 days of notification, the excess is waived and a deduction is applied to the claims costs that impact your premium calculation.

If the model of insurance you have includes medical only claims in the premium calculation (ie. Loss Prevention & Recovery - LPR), a medical excess of $500 is waived if the claim is notified within 5 days and a deduction is applied to your claims costs.

What is covered by the claim and how do the claims costs impact your premium? Discover the claims costs and how these impact your premium.

What expenses are covered under a Workers’ Compensation claim?

In the event a worker has a work place accident, the Workers’ Compensation policy will cover the following costs within the claim:

• Weekly compensation (Wages)
• Medical costs, for example doctor consultations, medication, x-rays
• Hospital costs (public and private)
• Rehabilitation costs, for occupational rehabilitation and return to work services
• Travelling expenses (including Ambulance)
• Investigations costs (medico legal reports and factual investigations)
• Lump sum payment for permanent impairment
• Common Law payments
• Death benefits and funeral expenses
• Legal costs

How do claims costs impact my premium?

If you are a small employer, the claims costs will not impact you premium calculation. A small employer has an annualised Base Premium (wages x industry rate) of less than $30,000. 

For medium to large employers, Base Premium (wages x industry rate) of greater than $30,000, claims costs will impact your premium. 

3 years of claims experience is used to calculate your premium under the conventional model of insurance, and it includes the following claims costs: 

• Paid Weekly Compensation
• Paid Lump Sum
• Paid Common Law / Settlement
• Paid Legal
• Fatality claims

It is important to note individual claims are capped at $150,000 for the purposes of premium calculation.

There are alternative models of insurance for large employers (Base Premium greater than $500k), Should your business meet this initial criteria we would encourage you to get in touch with Mercer Marsh Benefits to discuss this option and any potential premium savings.

Has your employee had a serious injury? Discover the definition of a workplace and serious injury to determine if you need to report an injury/incident to WorkSafe.

What injuries are covered by the Workers’ Compensation policy?

Your policy covers employees who have sustained either a physical or psychological illness/injury whilst in the workplace.

Cover may also extend to a pre-existing condition, if employment has caused the condition to re-aggravate, worsen or deteriorate. 

What do I need to do in the event of a serious injury/incident? 

If there is a serious injury, incident or a death at the workplace, you need to complete two notifications as soon as you can (specifically within 24hrs of the event): 

• SafeWork NSW (the regulator) 
• Notify Claims Agent (EML) or Approved Provider

Each notification is managed separately of each other with the Claims Agent / Approved provider managing the injury and claim and SafeWork NSW assessing the cause of the event and if corrective actions/fines are required.

What is a serious injury / incident?

A serious incident may not result in an injury that requires ongoing treatment.  Below is a summary of what is considered a serious incident or injury: 

• The death of a person
• A person requiring medical treatment within 48hrs of exposure to a substance
• A person requiring immediate treatment as an inpatient in a hospital
• A person requiring immediate medical treatment for:

1. Amputation
2. Head injury
3. Eye injury
4. De-gloving/scalping
5. Electric shock
6. Loss of bodily function
7. Spinal injury

• Occupational infectious diseases contracted in the course of work including handling or contact with animals, or animal by product.
• A dangerous incident - is one that exposes (or imminently exposes) someone to a serious health or safety risk

How do I notify a serious injury or incident?

You need to notify SafeWork NSW, a body of SIRA (the regulator) of a serious injury or incident as soon as you can by calling 13 10 50.

SafeWork NSW may conduct an investigation.

What are the obligations of the injured employee and employer? Discover what you need to do when a worker has an injury.

Return to Work - Employer Obligations

An employer has a responsibility to ensure the health and safety of their employees, including: 

• Take all reasonable care to prevent injuries or illnesses occurring at work
• Attempt to resolve any health and safety issues as soon as possible
• Do everything reasonable to help an injured employee to return to work

If an employee has an injury, you as an employer are required to support the employee’s recovery and return to work, this includes: 

• Providing a safe place of work
• Reporting of an injury to your insurer in a timely manner
• Developing an appropriate return to work plan to support an injured employee’s recovery
• Forward all documentation to the insurer as received
• Ensure ongoing payments are made to the employee, either by you or the insurer, when there is an accepted claim
• Maintain contact with all parties

Providing Suitable Duties 

Suitable duties are provided when an employee is unable to immediately return to their normal pre-injury duties after an injury. Other terms such as suitable employment, suitable work, modified duties, light duties may also be used to describe suitable duties.

Your commitment to provide suitable duties is a fundamental part of any successful recovery at work strategy. When identifying suitable duties consideration needs to be given to:

• The nature of the worker’s incapacity – this is identified in their medical certificate
• The worker’s age, education, skills and work experience
• Any injury management plan in place

Once suitable duties have been identified, a return to work plan / program is created. The return to work plan outlines the duties being completed and the medical restrictions to ensure clarity for all involved. 

Need Support?

If you need assistance with developing a return to work plan for your employee or with a complex claim, please contact Mercer Marsh Benefits – we can support you with either strategic advice or on the ground with our in-house rehabilitation team - Recovre has consultants across Australia (including regionally). We can support you with a single claim or the injury prevention and management across your program.

Return to Work – Employee’s Obligations

Like Employers, Employees also have obligations both prior to and following a workplace injury/illness, this includes: 

• Take all reasonable care to prevent injuries or illnesses occurring at work
• Report any health and safety concerns immediately
• Participate in the return to work process if an injury occurs

Return to work and Recovery

An injured employee’s role is to focus on their recovery and return to work, there are a number of important aspects of this, including: 

• Report any injury as soon as the injury happens
• Provide copies of Medical Certificates (also known as Certificates of Capacity) in a timely fashion
• Attend medical and other appointments arranged by your treating doctor, or where directed by the insurer such as independent medical specialist appointments
• If unable to attend an appointment, take reasonable steps to make an alternative appointment as soon as possible
• Communicate with all parties and reply to reasonable requests
• Carry out agreed actions to the best of their ability, as outlined in the Return to Work Plan/Program
• Immediately inform the Injury Management Coordinator and/or line manager of any difficulties carrying out the Return to Work Plan/Program
• If referred to a workplace rehabilitation provider, actively participate in all aspects of the service and work cooperatively with the service provider
• Advise of any changes in contact details
• Advise treating doctor and other treatment providers of any changes
• Book medical appointments where possible outside of return to work hours
• Failure to meet obligations, can lead to non-compliance and/or penalties.

Rehabilitation Services

Rehabilitation services are engaged to support an injured employee through the lifecycle of the claim and recovery. This includes the return to work with the same employer or if it is identified, an alternative employer. Examples of the services provided include:  

• Return to Work support
• Suitable Duties identification
• Alternative role identification – vocational / functional assessments
• Job Seeking support

You can contact Mercer Marsh Benefits if you believe you need rehabilitation support on your claims.

Can a worker be dismissed while they have a Workers’ Compensation claim?

An employer is required to support an injured employee’s recovery and return to work following a workplace injury.

An employer cannot dismiss an injured employee from employment within 26 weeks months of the injury occurring if the injury is a contributor to the reasons for dismissal.

In some cases, you can dismiss a worker prior to 26 weeks for situations such as serious misconduct or redundancy, however, great care needs to be taken. It should also be noted termination can lead to a financial impact on your premium.

It is important to discuss any dismissal with your legal advisor, the insurer and Mercer Marsh Benefits prior to taking any action as you will need to ensure you have met your obligations and understand any financial impact. Fines/penalties could apply if you do not meet your obligations.

What is an injured employee paid? Discover how to calculate a wage entitlement and when this entitlement will change.

How are wages entitlements calculated?

If there is an accepted claim and an incapacity for work, an injured employee is entitled to receive weekly compensation for lost earnings.

To calculate a worker’s entitlement to weekly compensation, the 12 months of earnings prior to the injury are assessed. Employers need to provide the insurer with the required payroll information to calculate the worker’s entitlement.

If the worker hasn't been employed for 12 months prior to the injury, the historical earnings from the date their employment commenced are assessed. Where a worker has been employed for less than 4 weeks, earnings of a comparable employee and/or role will be assessed.

The following is used in the calculation of an injured employee’s weekly entitlement:

• Overtime and shift allowances
• Piece rates (e.g. paid by amount packed)
• Commissions
• The value of some non-financial benefits (e.g. use of motor vehicle, residential accommodation)
• The value of any part of the salary that is salary sacrificed

There is a maximum weekly entitlement in NSW and this is reviewed bi-annually on 1/04 and 1/10. To confirm the current maximum weekly compensation rate click here.

Does the wage entitlement remain the same during the claim?

The entitlement to an injured employee’s benefit can change during a claim, there are two key factors that can impact how may an employee is paid under Workers’ Compensation: 

• The length of the claim
• A worker increases their hours of working and/or earnings

The amount paid to the injured employee cannot exceed the weekly maximum rate advised by your insurer.

How are entitlements to weekly benefits reviewed?

An insurer regularly reviews a worker’s entitlement to weekly compensation and the following could alter an entitlement:

• Injury or incapacity resolution
• Changes in capacity for work
• Changes in the relationship between the injury and employment
• Duration of the claim
• Compliance with injury management
• The employee moves overseas

The insurer will advise you if the weekly entitlement changes or ceases and the reasoning.

Are employees covered whilst travelling to and from work?

No, there is no cover for injuries sustained while travelling to and from work.

Claims may be covered in situations when travel is required that is outside of their usual role.

If you would like to ensure your employees are covered for travel to and from work, please contact Mercer Marsh Benefits who will be able to assist you with obtaining a separate quote of insurance to cover your employees’ travel to and from work.

If a worker sustains an injury while on a recess/break, is this covered under Workers’ Compensation?

If an injury occurs while an employee is on an authorised recess or break (i.e. lunch breaks), the injury is covered by your Workers’ Compensation insurance policy.

This includes if the injury occurs either onsite or offsite.

If a worker injures themselves whilst travelling for work, is this covered under Workers’ Compensation?

An employee is covered under the policy for temporary interstate and overseas travel; claims are assessed on individual circumstances to ensure employment is a contributing factor.

If an employee is traveling for greater than 6 months, insurance arrangements may need to be reviewed to ensure continued adequacy of cover.

Also refer to the state of connection information in worker definitions for more information click here.

What happens if an employee has an injury and/or claim and is approaching or has reached retirement age?

If your employee is approaching or has reached retirement age, and sustains an injury, there is no change in their weekly compensation entitlement.

• Once a worker reaches retirement age and is on benefits, they will continue to have an entitlement to weekly compensation payments for up to 1 year. 
• Where an employee sustains an injury after retirement age, there entitlements cease 1 year after their first date of incapacity.

Entitlement to medical benefits will continue for a further two years.

The retirement age (Pension Age) is defined by the Social Security Act 1991 (Cth)

Can an employee be dismissed while they have a workers’ compensation claim?

An employer is required to support an injured employee’s recovery and return to work following a workplace injury.

An employer cannot dismiss an injured employee from employment within 26 weeks months of the injury occurring if the injury is a contributor to the reasons for dismissal.

In some cases, you can dismiss a worker prior to 26 weeks for situations such as serious misconduct or redundancy, however, great care needs to be taken. It should also be noted termination can lead to a financial impact on your premium.

It is important to discuss any dismissal with your legal advisor, the insurer and Mercer Marsh Benefits prior to taking any action as you will need to ensure you have met your obligations and understand any financial impact. Fines/penalties could apply if you do not meet your obligations.