The State Insurance Regulatory Authority (SIRA) is the NSW government organisation responsible for regulating and administering the NSW workers’ compensation system. On 10 July 2016, SIRA undertook several information sessions to introduce the SIRA “Guidelines for Claiming Worker’s Compensation”. These new SIRA guidelines will come into effect from 1 August 2016 and include such items as removing the need for the injured worker’s DOB, changes to claim decisions, removal of pre-approval for certain items and more.
Guidelines For Claiming Workers’ Compensation. The new SIRA guidelines come into effect from 1 August 2016, and a summary of the changes includes:
1) Removal of an injured worker’s DOB and some employer details
2) An initial decision must be made on all notifications of injury
Decisions include:
- Accept Liability
- Provisional Liability
- Declinature
- Reasonable Excuse
- The Notification only coding will be phased out
icare has identified that this may be a significant change for some insurers and employers and are seeking information from stakeholders to implement the change.
For all claims under this code, the insurer must contact the employer and worker via phone or letter and must send a letter to the worker which includes a claim form.
This will not impact the case management of the notification. It just requires a different coding in our system. Once we have confirmed there is no action or payment after notification, we can send the required letters and close the claim.
A Reasonable Excuse Status only applies to weekly payments – as per the legislation.
Note: This is not an admission of liability.
3) Pre-Approval is no longer required for the following:
- Nominated Treating Specialist (within 3 months of DOI)
- Diagnostic Investigations (within 3 months of DOI)
- Pharmacy (prescribed by NTD or NTS within 1 month of DOI)
- Physical treatment – physio, chiro, ex phys (8 sessions within 3 months of DOI)
- Psychological treatment (same as above)
- Hearing Needs Assessment
Encourages early intervention and promotes early recovery and return to work.
4) Reasonably necessary treatment
Case by case analysis and consideration. Reasonably necessary does not mean absolutely necessary
Reduces unnecessary disputes
5) Quicker review, determination and application of treatment
6) Work Capacity Assessment appointments
- Quicker Work Capacity Assessment
- Shorter delay in appointments
- Reduces unnecessary disputes
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