You are using a version of the website built for webcrawlers and people whose devices cannot use javascript. Some functionality may not be available.
Contents (2011 - 37)
Skip contents
Workers Compensation Regulation 2010
Repealed version for 30 June 2016 to 31 August 2016 (accessed 21 September 2017 at 00:33)
Part 18 Division 4
Division 4 Certification of cost of claims
152   Definitions
(1)  In this Division, cost of claims means:
(a)  in relation to an injury year related to, or a period of insurance for, a policy issued or renewed so as to take effect before 4 pm on 30 June 2015 (other than a retro-paid loss premium policy)—the total of the following costs:
(i)  the total of the costs of each individual claim of which the insurer has notice at the time of expiry or renewal (as appropriate) of the policy concerned, being a claim made against a particular employer with respect to an injury received (or that is deemed by the 1987 Act or the former Act to have been received) during the injury year or the period of insurance, whichever is relevant, but not including any claim under section 10 (Journey claims) or section 11 (Recess claims) of the 1987 Act,
(ii)  the total of the costs of payment of provisional weekly payments of compensation and provisional payment of medical expenses compensation, if any, under Part 3 of Chapter 7 of the 1998 Act by the insurer, being payments of compensation on the basis of provisional acceptance of liability to a worker employed by a particular employer with respect to an injury received (or that is deemed by the 1987 Act to have been received) during the injury year or the period of insurance, and
(a1)  in relation to an injury year related to, or a period of insurance for, a policy issued or renewed so as to take effect on or after 4 pm on 30 June 2015 but before 4 pm on 30 June 2016 (other than a retro-paid loss premium policy)—the amount calculated in accordance with the relevant insurance premiums order that applies to the policy concerned, and
(a2)  in relation to an injury year related to, or a period of insurance for, a policy issued or renewed so as to take effect on or after 4 pm on 30 June 2016—the amount calculated in accordance with the Workers Compensation Market Practice and Premiums Guidelines, and
(b)  in relation to an injury year related to, or a period of insurance for, a retro-paid loss premium policy—the total of the following costs:
(i)  the total of the costs of each individual claim of which the insurer has notice at the time of each adjustment date concerned, being a claim made against a particular employer with respect to an injury received (or that is deemed by the 1987 Act or the former Act to have been received) during the period of insurance, but not including any claim under section 10 (Journey claims) or section 11 (Recess claims) of the 1987 Act,
(ii)  the total of the costs of payment of provisional weekly payments of compensation and provisional payment of medical expenses compensation, if any, under Part 3 of Chapter 7 of the 1998 Act by the insurer, being payments of compensation on the basis of provisional acceptance of liability to a worker employed by a particular employer with respect to an injury received (or that is deemed by the 1987 Act to have been received) during the period of insurance,
but, in any case where a single event leads to 3 or more individual claims, the total costs of all those claims in relation to that event are not to exceed the amount that is twice the relevant large claim limit for the policy (as determined in accordance with clause 154 (5)–(7) or the relevant insurance premiums order (as appropriate)).
(2)  Despite subclause (1), cost of claims, in relation to a policy issued or renewed so as to take effect before 4 pm on 30 June 1995, has the meaning given to it by clause 135 of the Workers Compensation Regulation 2003 before its substitution by the Workers Compensation Amendment (Retro-Paid Loss Premium Method) Regulation 2009.
153   Prevention of double allowance for provisional compensation payments
(1)  In this clause:
provisional compensation payment means provisional weekly payment of compensation or provisional payment of medical expenses compensation, under Part 3 of Chapter 7 of the 1998 Act, on the basis of provisional acceptance of liability to a worker.
(2)  For the purposes of paragraphs (a) and (b) of the definition of cost of claims in clause 152 (1), if payments are made in respect of a claim pursuant to the 1987 Act and provisional compensation payments have been made in respect of the injury concerned:
(a)  the provisional compensation payments are, for the purposes of determining the cost of the claim, taken to be payments made by the insurer in respect of the claim pursuant to the 1987 Act and are to be included as such under clause 154, and
(b)  clause 155 does not apply to those provisional compensation payments, and
(c)  the cost of those provisional compensation payments is not to be included in the total of the costs of provisional compensation payments under paragraphs (a) (ii) and (b) (ii) of the definition of cost of claims in clause 152 (1).
154   Cost of an individual claim
(1)  For the purposes of paragraphs (a) and (b) of the definition of cost of claims in clause 152 (1), the cost of an individual claim is (except as provided by subclause (2)) the sum of the following:
(a)  the payments, if any, made by the insurer in respect of the claim pursuant to the 1987 Act or the former Act,
(b)  the payments, if any, of damages at common law and under the Compensation to Relatives Act 1897 made by the insurer either in satisfaction of judgments relating to the claim or in settlement of the claim,
(c)  fees and expenses, if any, paid by the insurer to medical practitioners, investigators or assessors in respect of the investigation of the claim,
(d)  legal costs, if any, paid by the insurer in relation to the settlement or investigation of the claim or as a consequence of proceedings at law, including any such costs that were paid to the claimant or incurred by the insurer on the insurer’s own account,
(e)  the most accurate estimation for the time being of the insurer’s outstanding liability reasonably likely to arise out of the claim,
whether the payments were made or the fees, expenses or costs were paid (or the estimation relates to liability that will arise) during or after the injury year or period of insurance in which the injury to which the claim relates was received (or is deemed by the 1987 Act or the former Act to have been received).
(2)  However, the cost of an individual claim:
(a)  does not include any amount calculated by reference to the insurer’s costs of administration or profit, and
(b)  in relation to a policy (other than a retro-paid loss premium policy)—is to be reduced by the amounts, if any, that have been recovered or are recoverable by the insurer from any source, other than an amount recovered or recoverable under section 160 of the 1987 Act, from the Insurers’ Contribution Fund or pursuant to a policy of reinsurance, and
(c)  in relation to a retro-paid loss premium policy—is to be reduced by the amounts, if any, that have been recovered or that, in the opinion of the Nominal Insurer, are recoverable by the insurer from any source, other than an amount recovered or recoverable under section 160 of the 1987 Act, from the Insurers’ Contribution Fund or pursuant to a policy of reinsurance, and
(d)  is to be reduced by:
(i)  in the case where the injured worker’s weekly payment of compensation is less than $500 or is not known (for example, the claim is for payment of medical expenses compensation only)—$500 or, if the cost of the claim is less than $500, that lesser cost, or
(ii)  in any other case—an amount that is the lesser of the following:
(A)  the amount that the injured worker is entitled to receive as one week’s weekly payment of compensation,
(B)  if the claim is covered by a policy of insurance that was issued or renewed so as to take effect before 4pm on 30 June 2006—$1,449.50,
(C)  if the claim is covered by a policy of insurance that was issued or renewed so as to take effect on or after 4pm on 30 June 2006, the amount specified by the relevant insurance premiums order that applies to that policy, and
(e)  does not include any amount paid or payable under section 64A of the 1987 Act (Compensation for cost of interpreter services), and
(f)  does not include any amount which section 54 (4) (b) of the 1998 Act (Second-injury scheme) requires to be excluded from the claims experience of the employer, and
(g)  is to be reduced by an amount that is the most accurate estimation for the time being by the insurer of the amount of any input tax credit or decreasing adjustment that may be claimed or has been claimed by the insurer in respect of the payments, fees, expenses or costs included in the cost of the individual claim under subclause (1), pursuant to the A New Tax System (Goods and Services Tax) Act 1999 of the Commonwealth.
(3)  In this clause, references to the insurer’s outstanding liability reasonably likely to arise out of the claim are references to the amount calculated to be sufficient to meet all reasonably likely future payments in respect of the claim, including adjustments (at such rates, if any, as the Authority from time to time determines) to take account of expected future earnings on investments and expected future inflation or deflation on that amount.
(4)  For the purpose of this clause, in the case of a claim in respect of the death of or injury to a person caused by or arising out of a motor accident as defined in the Motor Accidents Act 1988:
(a)  the insurer’s liability to indemnify an employer in respect of the employer’s liability to the claimant independently of the 1987 Act is taken to be limited to the amount of damages (if any) that would be payable if Division 3 of Part 5 of the Workers Compensation Act 1987 applied to the award of damages concerned, and
(b)  the insurer is taken not to be liable for legal costs connected with proceedings under the Motor Accidents Compensation Act 1999 if damages would not have been payable if that Division applied to that award.
(5)  If the cost of an individual claim exceeds the large claim limit that applied when the injury to which the claim relates was received (or is deemed by the 1987 Act or the former Act to have been received), the cost of the individual claim is the amount of that large claim limit.
(6)  For the purposes of subclause (5) in relation to a policy (other than a retro-paid loss premium policy), the large claim limit specified in Column 2 of the Table to this clause applies to an injury that was received or is deemed to have been received during a year specified in Column 1 of that Table in relation to that limit.
(7)  For the purposes of subclause (5), in relation to a retro-paid loss premium policy, an employer is, before the commencement of the policy, to elect a large claim limit of one of the following amounts to apply to injuries received or deemed to have been received during the period of insurance:
(a)  $350,000,
(b)  $500,000.
Large claim limits
Column 1
Column 2
Period of 12 months commencing with:
Large claim limit
30 June 1985
$100,000
30 June 1986
$200,000
30 June 1987 or 30 June of the years 1988 to 1994
$100,000
30 June 1995 or 30 June of the years 1996 to 2014
$150,000
30 June 2015
The amount specified in the relevant insurance premiums order that applies to the policy concerned
30 June 2016 or 30 June of any subsequent year
The amount specified in the Workers Compensation Market Practice and Premiums Guidelines that applies to the policy concerned
155   Cost of provisional payments of compensation
(1)  For the purposes of paragraphs (a) and (b) of the definition of cost of claims in clause 152 (1), the cost of payment of provisional weekly payments of compensation and provisional payment of medical expenses compensation, if any, with respect to a particular injury is (except as provided by subclause (2)) the sum of the following:
(a)  the sum of the payments of provisional weekly payments of compensation and provisional medical expenses compensation, if any, made by the insurer in respect of the injury pursuant to the 1998 Act,
(b)  fees and expenses, if any, paid by the insurer to medical practitioners, investigators or assessors in respect of the investigation of the injury,
(c)  legal costs, if any, paid by the insurer in relation to the investigation of the injury, the determination of liability to make provisional weekly payments of compensation or provisional payment of medical expenses compensation and otherwise in complying with Divisions 1 and 3 of Part 3 of Chapter 7 of the 1998 Act,
(d)  the most accurate estimation for the time being of the insurer’s outstanding liability to make provisional weekly payments of compensation and provisional payment of medical expenses compensation, if any, with respect to the injury,
whether the payments were made or the fees, expenses or costs were paid (or the estimation relates to liability that will arise) during or after the injury year or period of insurance in which the injury was received (or is deemed by the 1987 Act to have been received).
(2)  However, the cost of provisional weekly payments of compensation and provisional payment of medical expenses compensation with respect to a particular injury:
(a)  does not include any amount calculated by reference to the insurer’s costs of administration or profit, and
(b)  in relation to a policy (other than a retro-paid loss premium policy)—is to be reduced by the amounts, if any, that have been recovered or are recoverable by the insurer from any source, other than an amount recovered or recoverable under section 160 of the 1987 Act, from the Insurers’ Contribution Fund or pursuant to a policy of reinsurance, and
(c)  in relation to a retro-paid loss premium policy—is to be reduced by the amounts, if any, that have been recovered or that, in the opinion of the Nominal Insurer, are recoverable by the insurer from any source, other than an amount recovered or recoverable under section 160 of the 1987 Act, from the Insurers’ Contribution Fund or pursuant to a policy of reinsurance, and
(d)  is to be reduced by:
(i)  in the case where the injured worker’s provisional weekly payment of compensation is less than $500 or is not known (for example, the claim is for provisional payment of medical expenses compensation only)—$500 or, if the cost of the payments is less than $500, that lesser cost, or
(ii)  in any other case—an amount that is the lesser of the following:
(A)  the amount that the injured worker is entitled to receive as one week’s provisional weekly payment of compensation,
(B)  if the payment is under a policy of insurance that was issued or renewed so as to take effect before 4pm on 30 June 2006—$1,449.50,
(C)  if the payment is under a policy of insurance that was issued or renewed so as to take effect on or after 4pm on 30 June 2006, the amount specified by the relevant insurance premiums order that applies to that policy, and
(e)  does not include any amount paid or payable under section 64A (Compensation for cost of interpreter services) of the 1987 Act, and
(f)  does not include any amount that section 54 (4) (b) of the 1998 Act (Second-injury scheme) requires to be excluded from the claims experience of the employer, and
(g)  is to be reduced by an amount that is the most accurate estimation for the time being by the insurer of the amount of any input tax credit or decreasing adjustment that may be claimed or has been claimed by the insurer in respect of the payments, fees, expenses or costs included in the cost of provisional weekly payments of compensation or provisional payment of medical expenses compensation under subclause (1), pursuant to the A New Tax System (Goods and Services Tax) Act 1999 of the Commonwealth.
(3)  In this clause, references to the insurer’s outstanding liability to make provisional weekly payments of compensation or provisional payment of medical expenses compensation with respect to an injury are references to the amount calculated to be sufficient to meet all reasonably likely future provisional payments of weekly compensation or medical expenses compensation in respect of the injury.
156   Certificates relating to cost of claims
(1)  For the purpose of ascertaining the premium payable by an employer in respect of a period of insurance:
(a)  an employer to whom a policy has been issued by an insurer, or
(b)  another insurer,
may, by notice in writing served on the insurer who issued the policy not later than 1 month after the commencement of the period of insurance, require the insurer who issued the policy to furnish the employer or other insurer, within 21 days of service of the notice, with a certificate in the approved form, specifying (with respect to the whole or any part of the last 3 injury years which occurred or will have occurred before the commencement of the period of insurance) the particulars relating to costs of claims required by the form to be inserted in it.
(2)  An insurer who, without reasonable excuse:
(a)  fails to comply with a requirement made in accordance with subclause (1), or
(b)  in purported compliance with any such requirement, furnishes a certificate knowing that the certificate contains particulars that are false or misleading in a material particular or knowing that the certificate is incomplete in a material particular,
is guilty of an offence.
Maximum penalty: 20 penalty units.
157   Effect of certificate
(1)  Where an insurer has, in accordance with clause 156, furnished a certificate to an employer or another insurer for the purpose of ascertainment of the premium payable in respect of a period of insurance, the particulars relating to costs of claims specified in the last or only certificate so furnished are binding on the employer and any insurer for the purpose of calculation at any time of those costs of claims as at the commencement of that period of insurance, except as provided by subclause (3).
(2)    (Repealed)
(3)  If an insurer (other than the insurer who furnished the certificate) does not agree with any of those particulars and applies to the Authority for a variation of those particulars (and the application is not withdrawn or, in the opinion of the Authority, abandoned), the particulars relating to costs of claims specified in the certificate as confirmed or varied by the Authority are binding on any insurer for the purpose of calculation at any time of those costs of claims as at the commencement of that period of insurance.
158   Certificates by scheme agents relating to cost of claims— retro-paid loss premium policy
(1)  For the purpose of ascertaining the premium payable by an employer in respect of a period of insurance in relation to a retro-paid loss premium policy, the Nominal Insurer may, by notice in writing, require the scheme agent through whom the policy was issued, to furnish the Nominal Insurer, within 21 days of service of the notice, with a certificate in the approved form, specifying the particulars relating to costs of claims requested in the notice.
(2)  A scheme agent must not, without reasonable excuse:
(a)  fail to comply with a requirement made in accordance with subclause (1), or
(b)  in purported compliance with any such requirement, furnish a certificate knowing that the certificate contains particulars that are false or misleading in a material particular or knowing that the certificate is incomplete in a material particular.
Maximum penalty: 20 penalty units.
159   Employers who were previously self-insurers
(1)  If an employer:
(a)  makes an application to an insurer for the issue or renewal of a policy, and
(b)  was a self-insurer during any part of the last 3 injury years occurring before the proposed period of insurance,
the cost of claims in relation to the period as a self-insurer is to be calculated (subject to any relevant determination of the Authority) as if the employer had been insured under a policy in respect of that period.
(2)  The provisions of this Division relating to insurers apply (subject to such modifications and exceptions as the Authority may determine) to such an employer in respect of the period as a self-insurer.