icare coronavirus information for employers

Updated 8 October 2021

Select from the topics below:

Policy and premiums

Claims related to COVID-19

Claims related to adverse reactions to the COVID-19 vaccine

Working from home claims

Treatment

Investigations and Independent Consultations

Other questions

 


 

Policy and premiums

I have had to reduce staff or shut down due to COVID-19. How does this affect my policy and my premium?

In the first instance, we encourage you to reach out to us on 13 44 22 to discuss how we can best support you and your policy needs.

Depending on your individual circumstances, we may be able to assist you in the following ways:

  • Reducing your wages and premium to reflect your new circumstances.
  • Refunding you the unused portion of your premium while keeping your policy active in readiness for when you return to business. Note: If you are eligible for a refund on your premium as a result, we will issue you your refund within one week of adjusting your wages, provided you have no other premium amounts outstanding.
  • Deferring your premium payments for up to six months if you’re experiencing financial hardship.

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I have applied to receive a government-funded support payment due to the impact of COVID-19. Will this be counted as wages and therefore impact my premium?

The information below applies to government-funded support payments claimed by an employer due to the impact of COVID-19, including but not limited to JobKeeper and JobSaver.

The State Insurance Regulatory Authority (SIRA) has determined that for government-funded programs only payments made for work undertaken or hours worked are to be included as wages to calculate premiums. This includes those payments funded under a government program, such as JobKeeper, JobSaver, established to support the retention of staff during the COVID-19 pandemic. There is no change to the definition of wages other than for government-funded programs.

Therefore, if your business is receiving a government allowance/payment/grant to support the retention of staff during the COVID-19 pandemic, you only need to include in your actual wages declaration the portion paid to your worker for the hours they worked during the period in which the government allowance was paid. 

This applies to all policies in force for any period during which relevant government programs were being administered, regardless of when your policy was issued. It ensures employers are not paying premium on payments made to their staff for hours in which work was not performed or undertaken.  

Refer to the scenarios below to guide you.

Scenario Worker "in hibernation" and receiving JobKeeper Allowance only  Worker working and earning more than just the JobKeeper Allowance
Worker working and earning only the JobKeeper Allowance  Worker at work and earning less than the JobKeeper Allowance (but their pay is increased under JobKeeper) 
Example  Worker earns no wages Worker earns $2,000 per fortnight (including JobKeeper subsidy) Worker only earns JobKeeper Allowance Worker earns $500 per fortnight but receives payment in line with the JobKeeper Allowance
What do you declare? Nil declarable as wages $2,000 declarable as wages JobKeeper Allowance declarable as wages $500 declarable as wages

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My business is experiencing financial difficulty or has had to shut down due to COVID-19 but I'm still receiving overdue payment notices from icare. What do I do?

If you have contacted icare to discuss your circumstances and we’ve deferred payment of your premium, please disregard any overdue payment notices you receive from icare in the meantime. These are automated notices that require no action from you at this stage. If you require assistance and have not yet contacted us to discuss your circumstances, please get in touch on 13 44 22 as soon as possible.

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My business is experiencing financial difficulties or has had to shut down due to COVID-19 but I’ve received an overdue premium payment notice from a legal firm. What do I do?

icare works with third party legal firms to assist with premium collections.

If you have already been granted a payment deferral by icare and you happen to receive an overdue payment notice from one of these firms, please contact the legal firm you’ve received the notice from to re-confirm your payment deferral. You should have received an email from icare confirming your deferral which you can provide to the legal firm if necessary.

If you have not yet discussed your circumstances with us and you think you may need to defer payment of your premium, the legal firm you received the overdue notice from can arrange this for you on our behalf. Please get in touch with them as soon as possible if you require assistance.

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What will happen to my premium if a worker submits a claim for COVID-19 or a COVID-19 vaccine-related illness or injury?

icare will exclude any claims attributed to a positive COVID-19 test or as a result of receiving a COVID-19 vaccination from the individual claims experience of Nominal Insurer policy holders to protect any individual employer from disproportionately being impacted by COVID-19.

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Can I continue under the Loss Prevention and Recovery (LPR) program if my Average Performance Premium (APP) reduces below the minimum threshold of $500,000 due to COVID-19?

Yes, continuing LPR customers (individual or grouped) can remain under LPR premium arrangements if their wages decrease below the premium entry point due to COVID-19. This will be reviewed and discussed with our customers on a year-by-year basis.

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Claims related to COVID-19

What should I do if I am aware of a worker receiving a COVID-19 diagnosis?

If you are made aware of a worker receiving a COVID-19 diagnosis, you have an obligation under Section 44 of the Workplace Injury Management and Workers Compensation Act 1998 to notify your insurer within 48 hours.

You must notify your insurer of the diagnosis whether or not the diagnosis will lead to a workers compensation claim, and you must notify your claims manager even if you are unsure whether the worker contracted COVID-19 in the workplace.

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Am I liable if my worker contracts COVID-19?

In some circumstances coronavirus (COVID-19) may be a compensable workplace injury as a disease is included in the definition of injury under the Workers Compensation Act (1987). To be compensable, a worker must have contracted the virus in the course of their employment and their work activities must be proven to be the main contributing factor to contracting the virus unless they are workers in prescribed employment. Due to the nature of viruses, identifying how and when you contracted the virus can be difficult.  Each claim will be assessed on its individual merits.

What is prescribed employment?

On 14 May 2020, the NSW Parliament passed an amendment to the Workers Compensation Act making it easier for certain types of employment to establish the link between work and contracting COVID-19. Section 19B of the 1987 Act states that workers with COVID-19 who work in certain types of employment will be presumed to have contracted the virus at work or while working.

This applies to the following areas of employment:

  • the retail industry (excluding purely online businesses)
  • the health care sector, including public health employees
  • police and emergency services
  • firefighters (including rural fire services)
  • ambulance officers 
  • educational institutions, including pre-schools, schools and tertiary institutions (other than establishments providing only online teaching)
  • the cleaning industry
  • the construction industry
  • restaurants, clubs and hotels
  • disability and aged care facilities
  • refuges, halfway houses and shelters
  • passenger transport services
  • courts and tribunals
  • correctional and detention centres
  • places of public entertainment or instruction (including cinemas, museums, galleries, cultural institutions, libraries and casinos)
  • cafes
  • supermarkets
  • funeral homes
  • childcare facilities.

Section 19B in the 1987 Act also allows for other types of employment to be prescribed by Regulations, and these Regulations will be developed by the State Insurance Regulatory Authority (SIRA).

The presumption applies to casual workers in the above areas of employment if they have worked on one or more of the 21 days before their date of injury. They also apply to workers who contracted COVID-19 before 14 May 2020 when the amendments were passed.

The presumption will not apply if there is evidence that proves a worker in the above areas of employment contracted the COVID-19 virus outside of work. As such when lodging a claim, employers and workers are still required to provide information on the link between work and contracting the virus.

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What evidence or investigations are required when assessing a claim for COVID-19?

When a claim for alleged work related COVID-19 is received, your insurer will ask for evidence to confirm both the diagnosis and information to support how the diagnosis is related to work.

Evidence confirming a diagnosis of COVID-19 will be required as well as information from the employer, worker and nominated treating doctor in relation to how COVID-19 was contracted. If the worker is not covered by section 19B of the 1987 Act, this information will need to demonstrate that employment was the main contributing factor to the worker contracting the virus.

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I have received a claim where the worker has been asked to self-isolate due to work related exposure to COVID-19, but has not been diagnosed with COVID-19, what should I do?

If the worker has been sent home because of potential exposure to coronavirus, does not show symptoms while in isolation or test positive for COVID-19 then workers compensation will not be payable. If they do show symptoms and test positive for COVID-19 then you will need to notify this through injury notification channels to your insurer within 48 hours of becoming aware. The insurer will then determine liability for the claim according to the legislation, including the presumptive liability provisions which apply to COVID-19 diagnoses in some industries. Generally, the insurer will need to establish that exposure to COVID-19 occurred in the workplace or was work related in order for liability to be accepted.

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I have received a claim where the worker has been asked to self-isolate due to exposure to COVID-19 in the community (not related to work) but has not been diagnosed with COVID-19, what should I do? 

This circumstance does not meet the definition of an injury under workers compensation. 

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I have received a claim for psychological injury as a result of mental health issues arising from the worker being stood down due to business changes as a result of COVID-19. Would this type of claim be accepted?

The claim is not likely to be covered. Compensation is not payable as a result of psychological injury that arises from reasonable actions taken by the employer in relation to promotion, demotion, transfer, dismissal or the 'provision of employment benefits' to the worker (Section 11A). Each claim would be assessed on a case-by-case basis.

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We have an existing workers compensation claim where the worker has now been diagnosed with a mental health condition as a result of stress related to COVID-19. Would this new claim be accepted as part of the existing claim?

A secondary psychological injury can only be accepted as part of an existing workers compensation claim if the development of the psychological condition is related to the initial injury. A psychological injury that developed as a result of factors that are unrelated to an existing workers compensation claim should not be accepted as part of the initial claim. If a new claim was lodged for the psychological condition, it would be assessed on its own merits.

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For workers with an existing injury, and current capacity to work with available suitable duties, could a refusal to follow a direction to be vaccinated constitute towards refusal to participate in suitable duties, leading to suspension of weekly benefits to an injured worker?

A worker’s refusal to follow a lawful direction to vaccinate would only be one factor in determining whether the worker has made reasonable efforts to return to work. In isolation it would be unlikely to constitute a valid reason to suspend, terminate or cease weekly benefits.

Suspension, termination or ceasing of weekly benefits under section 48A of the 1998 Act should be limited to circumstances where the worker has not made genuine attempts to return to work and there are no alternative options for suitable employment. 

In determining whether the circumstances in which a failure to comply with a direction to vaccinate is unreasonable under Chapter 3 of the 1998 Act, your claims managers will be considering the following:

  • The nature of the suitable duties being offered and the reasons why vaccination is considered essential to perform these duties
  • Any public health order or industry wide advice relating to the need for vaccination provided by the Australian Health Protection Principal Committee (AHPPC)
  • The worker’s reasons for not wanting to get vaccinated (i.e. medical)
  • If the worker has a valid reason for refusal, whether the employer can make reasonable adjustments for the worker or if there is other suitable employment that does not require the worker to get vaccinated, having regard to the factors listed under section 32A(a) of the 1987 Act
  • If the worker does not have a valid reason for refusal, advising the worker of the relevant public health orders that apply to the workplace and their obligations under section 48 of the 1998 Act to make reasonable efforts to return to suitable or pre-injury employment.

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Claims related to adverse reactions to the COVID-19 vaccine

Am I liable if I encourage, or require my worker to get the COVID-19 vaccine, and they experience an adverse reaction?

In some circumstances an adverse reaction to the COVID-19 vaccine may be covered under workers compensation. Each claim will be assessed on its own merits.

To be covered, the insurer will need to be satisfied that:

  • the vaccine injury arose out of, or in the course of, the worker's employment; and
  • the worker's employment was a substantial contributing factor to the vaccine injury or was the main contributing factor for a disease injury; or
  • in the case of heart attack or stroke injury, the nature of the employment was a relevant factor in increasing the risk of the injury (see below).

While each claim needs to be assessed on its own facts and evidence, several factors may increase the likelihood that a vaccine injury is found to be covered under workers compensation, including whether an employer:

  • took steps to arrange for its employees to be administered a COVID-19 vaccine
  • encouraged or induced its employees to get vaccinated in order to obtain benefits for its business
  • permitted or directed employees to have a COVID-19 vaccination during ordinary working hours; or
  • provided instructions to employees relating to the administration of the vaccine.

The link between the vaccine injury and the worker's employment is easier to establish where a worker is influenced by their employer's requirement to get vaccinated or is subject to a NSW Government Public Health Order. In these circumstances there is an increased likelihood of the vaccine injury being covered under workers compensation.

When lodging a claim, employers and workers will be required to provide information on the link between work and the adverse reaction to the vaccine.

If a vaccine injury is a "heart attack injury" or "stroke injury" under section 9B of the 1987 Act, the worker is required to also establish that the nature of their employment significantly contributed to the injury. In practice, this may mean that the worker will have to satisfy additional requirements. For example, the worker may need to show that they only opted for a particular vaccine brand due to their employment.

Special conditions for first responders (exempt workers)

Police officers, fire fighters and paramedics are known as 'exempt workers'. For exempt workers, employment must have been a substantial contributing factor to the injury. An exempt worker will still need to prove that:

  • an injury was sustained in the course of employment
  • there was a causal link between the COVID-19 vaccine and the adverse reaction.

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Are health workers subject to the Public Health Order requiring mandatory vaccination?

Subject to all other criteria required for a valid workers compensation claim, the new Public Health Order requirement would increase the likelihood of establishing the causal link between the vaccine injury and the worker’s employment.

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Can a vaccinated worker claim benefits under the No-fault COVID-19 indemnity scheme and workers compensation for an adverse reaction?

If a worker is able to establish a compensable COVID-19 vaccine-related injury under workers compensation then the Commonwealth Vaccine Scheme would not prevent them from making a claim under workers compensation legislation.

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What will happen to my premium if a worker submits a claim for COVID-19 or a COVID-19 vaccine-related injury?

icare will exclude any claims attributed to a positive COVID-19 test or as a result of receiving a COVID-19 vaccination from the individual claims experience of Nominal Insurer policy holders to protect any individual employer from disproportionately being impacted by COVID-19.

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My worker has lodged a claim for psychological injury due to being encouraged, or required to receive the COVID-19 vaccine for work, would this claim be accepted?

While the individual circumstances of each case would need to be considered, a worker may make a claim for psychological injury.  For example, a psychological injury may be obtained by a worker being stood down because they refused to be vaccinated.

Whether the claim is accepted by your insurer will depend on the usual requirements being satisfied which include: the definition of an injury, whether the injury arose out of, or in the course of, employment, that employment was the main contributing factor to the development of the psychological injury in the case of a disease, or work was a main or substantial contributing factor to the injury.

An employer may be able to rely upon 11A of the 1987 Act to defend a claim for being stood down because of a refusal to vaccinate, if the following is met:

  • The requirement to vaccinate is covered by the category of the 'provision of employment benefits' to the worker, and
  • The injury was wholly or predominantly caused by the reasonable action taken or proposed to be taken by or on behalf of the employer with respect to 'provision of employment benefits' to the worker. 

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Can my worker ask for confirmation that an Independent Medical Examiner, Factual Investigator, or Rehabilitation Provider has been vaccinated before they attend the appointment?

At this stage, there is no requirement for businesses to disclose whether their staff members have received the COVID-19 vaccine to visitors to the business.

A worker may ask a service provider whether their staff have been vaccinated, however, a service provider is unlikely to provide this information given the privacy obligations it has towards their employees. With employee consent, a service provider may give this information to visitors.

Your insurer should take steps to ensure that the worker’s preferences are taken into account when making appointments with service providers.  

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Working from home claims

Is a worker able to claim workers compensation if they are injured whilst working at home?

A worker may be able to claim for injuries sustained whilst working from home or another remote location, and compensation may be payable. In order for the claim to be accepted, your insurer will need evidence that the worker has sustained an injury arising out of, or in the course of employment and that their work was a substantial contributing factor to the injury.

Employers continue to have a responsibility to ensure workers have a safe environment to work, even when at home and in other locations away from the normal workplace. Employers should encourage workers to create a safe work environment whilst working remotely - this includes making sure that the work location is appropriate ergonomically and in an area free of trip hazards with adequate lighting. Employers also need to encourage workers to take extra care for their personal safety whilst at home, just as they would in their normal workplace.

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If a worker is working from home and decides to work at an alternate address, such as a friend or colleague’s house, would they still be covered for workers compensation?

Yes they would. The same principles would apply as if they were working at their own home. In order for the claim to be accepted, the insurer will need evidence that the worker has sustained an injury arising out of, or in the course of employment and that employment is a main or substantial contributing factor to the injury. Where a worker can show that the nature or requirements of their work played a substantial role in an injury that occurred whilst they were either at home or at any other location where they worked remotely, then their injury will be covered under workers compensation.

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If a worker comes into contact with a person with COVID-19 whilst working from home, can they make a claim?

Contracting COVID-19 can constitute an injury under workers compensation because a disease is included in the definition of injury under the Workers Compensation Act 1987. However, work must be proven to be the main or substantial contributing factor to contracting the virus. The test is the same whether working from an office or from home. For a claim to be accepted, the worker would still need to establish they had contracted COVID-19 because of their employment, and work activities must be proven to be the main or substantial contributing factor to contracting the virus. Each claim will be assessed on its individual merits.

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Treatment

If an injured worker cannot see their treating doctor, can they be asked to see another doctor who can consult via telehealth? If they refuse to see another doctor, what can be done?

It's the worker's right and responsibility to nominate a doctor who is prepared to help them, their employer and their claims service provider achieve a safe recovery and return to work. If there is evidence that the doctor is unavailable to assist them and the employer with these goals, your insurer can ask them to consider nominating another treating doctor who is able to consult and support them with a potential option for telehealth.

If a worker unreasonably refuses to access such support and services made available to help them, and this constitutes a failure to comply with their return to work obligations, their weekly payments may be suspended. What constitutes a failure to comply with return to work obligations will depend on the circumstances.

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Are allied health practitioners allowed to provide Certificates of Capacity?

Yes, amendments to the regulations have been made to allow SIRA-approved physiotherapists and psychologists to issue Certificates of Capacity. The initial Certificate of Capacity must still be issued by a medical practitioner (the Nominated Treating Doctor).

These changes are designed to relieve pressure on general practitioners and the overall health system during the COVID-19 pandemic; they are also time limited and will be in place for a further 12 months (from April 2021) unless repealed earlier.

SIRA has produced a Certificate of capacity/Certificate of fitness (PDF, 0.2 MB) for treating physiotherapists or psychologists and has released a training package for treating physiotherapists and psychologists on how to complete the Certificate.

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Investigations and Independent Consultations

Can investigators conduct interviews via teleconference or video conference rather than face-to-face?

Yes, provided the normal protocols are adhered to in terms of security, privacy, consent and customer experience, it is acceptable to conduct interviews remotely.

For interviews conducted face-to-face, the parties involved should comply with any current Public Health (COVID-19 Mandatory Face Coverings) Orders which can be found on the NSW Heath website.

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Is it acceptable for Independent Medical Examinations and other Independent Consultations to occur via teleconference or video conference rather than face-to-face?

It may be acceptable for an Independent Medical Examination or other Independent Consultation to occur via teleconference or video conference. These types of appointments must be pre-approved by your insurer and should be undertaken with the consent of the worker and the Independent Consultant. Practitioners must consider the appropriateness of this mode of service delivery for each worker on a case-by-case basis. Practitioners are responsible for delivering telehealth services in accordance with the principles of professional conduct and the relevant professional and practice guidelines to ensure that all care is taken to ensure the safety, appropriateness and effectiveness of the service.

It is likely that assessments reliant on interviews with the worker are able to proceed via telehealth. This includes interviews related to psychological injuries. Independent Medical Examinations that require physical assessment are unlikely to be able to proceed in a telehealth format.

For Independent Medical Examinations and other Independent Consultations being conducted face-to-face, any current Public Health (COVID-19 Mandatory Face Coverings) Orders should be adhered to. This may mean that the assessor, worker and any other parties may be required to wear a face mask during the in-person assessment. The face mask may be removed if necessary for components of the assessment, but wearing of the face mask should be resumed as soon as possible.

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What should I do if a worker refuses to attend an Independent Medical Examination or other Independent Consultant appointment due to concerns in relation to exposure to COVID-19?

The legislation allows employers to ask injured workers to attend Independent Medical Examinations and this request must be made in accordance with the applicable guidelines. If an injured worker unreasonably refuses to attend this examination, their weekly payments may be suspended by the insurer.

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What constitutes an unreasonable refusal of an examination?

Workers are still expected to attend Independent Medical Examinations and other appointments unless there are specific reasons why this is not possible. In most circumstances, current social distancing requirements that are recommended for the general population still allow medical appointments to take place. This includes Independent Medical Examinations.

If, however, the worker is required to self-isolate, then the Independent Medical Examination should be postponed until the self-isolation period has been completed. A worker is required to self-isolate if they:

  • have COVID-19 (required to self-isolate until recovery from COVID-19 is confirmed)
  • have been in close contact with a confirmed case of COVID-19 (14-day self-isolation period required)
  • arrived in Australia after midnight on 15 March 2020 (14-day self-isolation period required).
  • A worker needs to provide evidence of the requirement to self-isolate such as a letter from a doctor, travel documents or self-isolation order. For further information on social distancing and self-isolation requirements.

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    Is it acceptable for an Independent Medical Examiner or other Independent Consultant to refuse to examine a worker?

    Independent Medical Examiners and other Independent Consultants may decide to stop providing face to face consultations, or stop travelling to certain areas. This will make confirming appointments more difficult in some circumstances and possible delays should be taken into account.

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    Other questions

    The Federal Government has introduced disaster payments for businesses and individuals who have lost working hours/income as a result of a lockdown. What impact do these payments have on weekly entitlements?

    Disaster payments are different from JobKeeper as they are paid directly to individuals by Centrelink rather than through the employer's payroll system. 

    The disaster payment is not considered earnings for the purposes of calculating PIAWE or weekly payments.

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    What if a worker does not want to go to work because they are worried about contracting COVID-19?

    You should speak to your employee about any concerns they have about attending work in the first instance. You should advise what plans are in place to reduce risk in your workplace or advise of any special arrangements that are also in place.

    The legislation requires injured workers make reasonable efforts to return to work. If an insurer does not believe a worker is making reasonable efforts, it may take steps to suspend a worker’s weekly payments. What constitutes an unreasonable refusal to return to work will depend on the circumstances.

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    If workers are stood down or have reduced shifts due to the business impacts of COVID-19, is this covered by workers compensation?

    No, business disruption is not covered under workers compensation.

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    What happens if an employer needs to withdraw suitable duties because of COVID-19?

    Some workers who return to work after an injury are placed on ‘suitable duties’ if they are unable to return to the job they had before their injury. If a worker is undertaking suitable duties and those duties are removed by the employer due to the impact of COVID-19, then the worker may be entitled to weekly benefits. Weekly benefits will be paid in accordance with the legislation. If a worker who has returned to work after an injury has full capacity for work (i.e. they are ‘fit for pre-injury duties’) then there is no ongoing entitlement to weekly benefits.

    If an employer chooses to pay a worker some form of leave entitlement while they are stood down, this may be considered ‘current weekly earnings.’ Insurers will consider this on a case-by-case basis and consider whether the leave payment meets the definition of ‘current weekly earnings.’

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    Do employers need to advise icare if our employees are working from home?

    Employers do not need to advise icare if they are implementing work from home arrangements across the board. However, employers should advise their Case Manager if a worker on a Return to Work plan moves to a work from home arrangement to ensure the arrangement is appropriate for the worker’s capacity for work, and to ensure any injury related equipment or modifications can be arranged.

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    If a worker is on a Return to Work plan and is asked to work at home, can an employer request assistance to ensure their injury is accommodated at home?

    Yes, in these circumstances it may be appropriate to organise a workplace assessment of the work environment. SIRA-funded aides and equipment may also be requested to ensure that the injury is accommodated in the home environment.

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    Can we assist workers by paying for food delivery or other services during the COVID-19 Pandemic?

    No, food delivery and other related services are not considered a claims cost. The worker should investigate delivery options available within the community such as priority delivery services for vulnerable members of the community. This type of service would need to be organised outside of the workers compensation claim.

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    Can we assist workers by paying for delivery of pharmaceutical items related to their injury?

    Yes, the delivery of pharmaceutical items may be appropriate in some circumstances to ensure injured workers have access to the medication and other items, but only if they specifically relate to their workers compensation injury.

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    What should I do if my employee turns up for work unwell?

    Follow any guidance from NSW Health

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    How can I protect my employees?

    Follow good hygiene practices and follow the latest advice from NSW Health. Ensure you have business continuity plans in place to help ensure normal business operation.

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    Are there opportunities to redeploy injured workers into other roles if they are unable to return to work with their pre-injury employer or where suitable duties have been withdrawn?

    Where it is not feasible for a worker to return to their pre-injury workplace or suitable duties, as part of proactive claims management your insurer should work with you to investigate alternatives to help you return to work. Several industries such as medical supply manufacturing, pharmacies, supermarkets and delivery services are experiencing an increase in demand and roles are available. SIRA vocational programs can also be utilised to support workers looking to return to work with new employers.

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    Employers have an obligation to support injured workers in returning to work following an injury. If an employer’s workforce is being stood down, does this obligation still apply?

    Employers are required to give their workers the opportunity to recover at work after a work-related injury by providing suitable work. However, employers don’t need to provide suitable work to a worker with current work capacity when:

    • it is not reasonably practicable to do so
    • the worker voluntarily left employment, either before or after the start of the incapacity for work
    • the employer terminated the worker’s employment for a reason not related to the injury.

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