Contents: Purpose; Operational authorities; Early return to work; Guiding principles for service; Disclaimer; Conditions of use.
Chapter 1: About the manual [58.02 KB]

Contents: The rehabilitation, return to work and compensation system; Employer levy; Injury prevention; Benefits to injured workers; Objectives of the WorkCover Scheme; WorkCover mission and values; Role of Scheme participants; Employer roles and responsibilities; Employer rights; Worker roles and responsibilities; Worker rights; Treating medical practitioner responsibilities; Claims agent responsibilities.
Chapter 2: The WorkCover Scheme [304.23 KB]

Contents: Entitlement to compensation; Exceptions to coverage; Definition of worker; Disability; Employment inside and outside South Australia (territorial); Compensability of disabilites; Multiple disabilities and claims.
Chapter 3: Entitlement to compensation [442 KB]

Contents: An overview of the process; Give notice of a disability; Make a claim for compensation AND provisional liability.
Chapter 4: Make a claim for compensation AND provisional liability [177 KB]

Contents: Summary of claim determination process; Time limits to determine the claim; Authority to conduct an investigation; Determine the claim.
Chapter 5: Determine the claim [151 KB]

Contents: Injury and case management; Claim lodgement; Claim registration; Three-point-contact; Case management planning; Case conferences; Working with health care providers; Problems in health and rehabilitation management; The role of the health care provider in the workers compensation environment; Strategies for effectively working with medical practitioners and other health care providers; Tips for communicating with health care providers; Rehabilitation and return to work service providers; Sound decision-making/dispute minimisation; Communication; Instructing surveillance.
Chapter 6: Injury and case management [153 KB]

Contents: Independent medical examinations and Medical Panels SA; Independent medical examinations; Medical Panels SA.
Chapter 6A: Independent medical examinations and Medical Panels SA [93 KB]

Contents: Rehabilitation and return to work; Rehabilitation and return to work coordinators; Return to Work Inspectorate and Support Unit; Aim of rehabilitation; Workplace rehabilitation service delivery model; Role of the claims agent in the rehabilitation process; Referral for workplace rehabilitation services – flow chart; Role and responsibilities of a workplace rehabilitation consultant; Rehabilitation prior to claim acceptance; Assessing the need for rehabilitation; Workplace rehabilitation services not required, Determining rehabilitation and return to work objectives for the worker; Assessment and referral to a contracted workplace rehabilitation service provider to achieve objectives, Referral for medical expert services to enable a worker's return to work, Other rehabilitation support services required; The use of rehabilitation programs and rehabilitation and return to work plans; Rehabilitation programs; Rehabilitation and return to work plans; Rehabilitation program and rehabilitation and return to work plan reviews; Co-existence of rehabilitation program and rehabilitation and return to work plan; Case conferences; Retraining; Breach of mutuality; Cessation of active rehabilitation where return to work is the goal; Case closure; Payment of rehabilitation costs; Transferring workplace rehabilitation cases; Transfer decision complaints; Process for transferring workplace rehabilitation cases; Re-employment Incentive Scheme for Employers (RISE); RISE post 1 September 2010 (current scheme); RISE pre 1 September 2010 (previous scheme); Sections 58C - proposed termination; Interaction of various provisions of the Act and industrial relations legislation; Transmission of a business or undertaking - element B3; Factors to consider where redundancy occurs; Section 58B – Redundancy flowchart.
Chapter 7: Rehabilitation and return to work [609 KB]

Contents: Average weekly earnings (AWE); Average weekly earnings (AWE) defined; Summary of considerations when calculating average weekly earnings; Procedure for calculating average weekly earnings (AWE); Calculate the AWE; Average weekly earnings checklist.
Chapter 8: Average weekly earnings for claims made before 1 July 2008 [236.50 KB]

Contents: Average weekly earnings; Average weekly earnings (AWE) defined; Inclusions and exclusions when calculating average weekly earnings; Calculate the average weekly earnings; Other considerations that may impact on the calculation of average weekly earnings; Average weekly earnings checklist;
Chapter 8A: Average weekly earnings for claims made on or after 1 July 2008 [179.54 KB]

Contents: Payments - entitlements; Weekly payment entitlements; Weekly payments over designated periods; Entitlement periods; Work capacity assessments � section 35B; Application for continuation of payments after expiry of the third entitlement period � section 35C; Leave entitlements and effect of an allowance or benefit on weekly payments; Taxation on direct weekly payments (including top-up payments); Deduction authorities applied to income maintenance in C�ram; Lump sum compensation for non-economic loss (sections 43, 43A and 43B); Redemptions; Loss of earning capacity assessment (LOEC); Deductions to Centrelink, Department of Education, Employment and Workplace Relations and Medicare Australia for section 42 and/or 43 lump sum payments; Payment of settlement monies and Tribunal costs; Compensation for property damage; Statutory first charges and garnishee orders.
Chapter 9: Payment - entitlements [435 KB]

Contents: Review of weekly payments; Discontinuance of weekly payments; Effect of notice of dispute on discontinuance of weekly payments; Reduction of weekly payments; Effect of a notice of dispute on reduction of weekly payments; Suspension of weekly payments; Annual reviews; Economic adjustments under section 38; Review of weekly payments under section 38; Retirement of the worker; Adjustments of average weekly payments - section 37.
Chapter 10: Review of weekly payments [211 KB]

Contents: Payments - medical and other expenses; Reasonable costs, reasonably incurred; Fees; Types of services; Payment for services; Non-approved services; Payment for appointment cancellation or non-attendance; ‘Stand-alone’ mediation services; Accounts; Disallowance or reduction of charges; Approved services/ therapeutic appliances; Non-endorsed services/fees.
Chapter 11: Payments - medical and other expenses [214.85 KB]

Contents: Social rehabilitation and ancillary entitlements; What we mean by social entitlements; Social rehabilitation and ancillary entitlements available to an injured worker; Reasonable costs; Serious injury; Commonly recommended aids, equipment, appliances and modifications for serious injuries: Home help guidelines; Housing modifications; Travel; Childcare guidelines.
Chapter 11A: Social rehabilitation entitlements [260 KB]

Contents: Death claims; Entitlements; Funeral expenses; Councelling services; Lump sum payments; Definitions relevant to lump sum payments; Determining dependency; Amount of lump sum entitlements; Interest payable on lump sum payments; Change of circumstances; Case law; Guidelines for negotiated settlements; Transitional provisions - lump sum; Weekly payments; Weekly payment entitlement; Taxation on weekly payments for minors; Commutation.
Chapter 12: Death claims [173 KB]

Contents: why people self-harm; warning signs; general approach and philosophy; support; threatening behaviour; contacts.
Chapter 13: Managing critical incidents [54 KB]

Contents: Claims administration; Estimating a claim; File administration; Payment of accounts; File cost; Release of information (confidentiality); Confidentiality provisions of the Workers Rehabilitation and Compensation Act 1986; Employers’ obligation to maintain workers’ confidentiality; Requests for confidential information; Disclosure of section 35(5) amount to employers; Disclosure to other workers compensation authorities; Exceptions to the duty of confidentiality; Confidentiality and rehabilitation; Release of information to other parties; Release of information to Commonwealth government authorities; Freedom of information; Request for previous lump sum payments; Physical transfer of files between claims agent and WorkCover; Access to Information; Complaint resolution; WorkCover Ombudsman; Ministerials.
Chapter 14: Claims administration [221.68 KB]

Contents: Fraud; Definition of fraud; Worker fraud; Employer fraud; Provider fraud; Investigation unit; Detecting and reporting suspected fraud; Non-compliance; Indicators of possible fraud; Claim investigation authorities.
Chapter 15: Fraud [112.53 KB]

Contents: Dispute resolution; Flow chart outlining the basic stages of the dispute resolution process; Proceedings before the Tribunal; Principles of the Workers Compensation Tribunal (the Tribunal); Evidence; Powers of the Tribunal; Contempts; Territorial issues – choice of law; Tribunal may refer a medical question or require a worker to be examined by a medical panel; Responsibilities of the claims agent to notify WorkCover of an appeal; Notice of dispute; Reviewable decisions; Lodging a notice of dispute; Initial reconsideration; Who can reconsider the decision; Time frames; Conciliation; Disclosure of information; Dispute management conference; Conciliation conference; Unresolved matters; Judicial determination; Constitution of the Tribunal; Pre-hearing conference; Hearing the dispute; Full Bench referrals’ Appeals to the Full Bench; Case stated to Supreme Court and final appeals to the Supreme Court; Costs; Costs in section 43 matters; Liability of representatives; Representation costs; Advocacy services – payment of uncured claim costs; Procedures for payment of settlement monies and Tribunal costs; Payment of settlement monies to solicitor’s trust account; Tribunal – payment of costs and disbursements; Special jurisdiction to expedite decisions; The claims agent’s role in dispute management; Impact on case management; Reconsideration; Workers under 18 years of age; Dispute management conferences and conciliation conferences; Assessment of dispute matters for referral to external specialist; Referrals to external providers; Pending disputes pre-dating an employer’s self-insured registration status; Judicial determination; Orders and decisions; Significant cases; Disputes of interest.
Chapter 16: Dispute resolution [160 KB]

Contents: Claim recoveries; The importance of claim recoveries; Types of recoveries; Early identification of recoveries; Time limits to commence recovery action and early notification of recoveries; Third party recoveries; Recoveries from workers; Overpayments of weekly payments recovered from workers and taxation implications; Recoveries from employers; Recoveries from providers; Recovering debts; Writing off and writing down recoverable amounts.
Chapter 17: Claim recoveries [110.00 KB]

Contents: Health care operational instructions; Operational Instruction - Health care 01/2005 - Vertebral Axial Decompression (VAX-D); Operational Instruction – Health care 05/2005 - Neuroskeletal Dynamics (also known as neurokinetics); Operational Instruction – Health care 38/2005 - Procedure for medial or lateral epicondylitis; Operational Instruction – Health care 43/2005 - Computerised trans formal prosthesis (C-leg); Operational Instruction – Health care 44/2005 - Wallis operative technique; Operational Instruction – Health care 46/2005 - Disc replacement surgery; Operational Instruction – Health care 47/2005 - Fitness balls; Operational Instruction – Health care 48/2005 – Prolotherapy; Operational Instruction – Health care 51/2005 - Treating doctor medical reports; Operational Instruction – Health care 52/2005 – Autologous Chondrocyte Implantation; Operational Instruction – Health care 53/2005 - Blinded Opioid Infusion, Morphine pharmacokinetic investigation; Operational Instruction – Health care 54/2005 - Real Time Ultrasound Imaging (RTUI) also known as diagnostic ultrasound; Operational Instruction – Health care 55/2005 - Dietician services/Dietary supplements; Operational Instruction – Health care 56/2005 - erectile Dysfunction medication for males - Viagra (Sildenafil Citrate), CialisTM (Tadalafil) and Levitra (Vardenafil HCI; Operational Instruction – Health care 57/2006 - Recommendations for functional capacity evaluations (FCE); Operational Instruction – Health care 58/2006 - Medical expert rehabilitation services; Operational Instruction – Health care 59/2006 - Driver assessment and driver rehabilitation; Operational Instruction – Health care 02/2007 – Synvisc or Rylan (also know as Viscosupplementation; Operational Instruction – Health care 06/2007 – Multi-Cervical Unit (also known as the ‘neck machine’); Operational Instruction – Health care 45/2007 – Botulinum Toxin (Botox) for chronic pain; Operational Instruction – Health care 60/2007 Non-medical expert services/ non-scheduled medical services; Operational Instruction – Health care 61/2007 - New medical services and technologies; Operational Instruction – Health care 62/2007 – Payment framework for health and rehabilitation services.
Chapter 18: Health care operational instructions [245 KB]