Search our site

• Chapter 1: About the manual [58.02 KB]
  Contents: Purpose; Operational authorities; Early return to work; Guiding principles for service; Disclaimer; Conditions of use.
  
  
  
• Chapter 2: The WorkCover Scheme [304.23 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 3: Entitlement to compensation [570.55 KB]
  Contents: Entitlement to compensation; Exceptions to coverage; Definition of worker; Disability; Employment; Employment inside and outside South Australia (territorial); Transitional provisions of the territorial amendments; ‘Retrospective’ elements of the territorial amendments; Ex-gratia payments; Evidentiary requirements; Review rights.
  
  
  
• Chapter 4: Make a claim for compensation [82.16 KB]
  Contents: An overview of the process; Give notice of a disability; Make a claim for compensation.
  
  
  
• Chapter 5: Determine the claim [239.81 KB]
  Contents: Summary of claim determination process; Time limits to determine the claim; Authority to conduct an investigation; Determine the claim.
  
  
  
• Chapter 6: Injury and case management [329.03 KB]
  Contents: Injury and case management; Claim lodgement; Claim registration; Allocating claims to segments; Three-point-contact; Claim management segments; Claims escalation/reallocation; Management of claims management segments; Case management plans; Case conferences; Service providers; Independent medical examinations; Working with health care providers; Problems in health and rehabilitation management; 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; Health care providers’ treatment guides; Treatment phases for workers compensation cases; Rehabilitation and return to work service providers; Sound decision-making/dispute minimisation; Communication; Instructing surveillance.
  
  
  
• Chapter 7: Rehabilitation and return to work [470.66 KB]
  Contents: Definition of rehabilitation; Legislation and objectives; Aims of rehabilitation; Service Delivery Model; Role of the claims agent in the rehabilitation process; Role and responsibilities of vocational rehabilitation consultant; Rehabilitation prior to claim acceptance; Assessing the need for rehabilitation; Determining rehabilitation and return to work objectives for the injured worker; Return to work with pre-injury employer objective services; Intensive Job Seeking Program (IJSP); Job Placement Only; Referral for evaluation and intervention services; Other rehabilitation support services required; Rehabilitation and return to work plans; Reasonableness of rehabilitation and return to work plans and rehabilitation programs; Commencement and completion dates of rehabilitation and return to work plans; Rehabilitation program or rehabilitation and return to work plan amendments; Signing of rehabilitation programs and rehabilitation and return to work plans; Reviewing progress towards the rehabilitation and return to work (RRTW) outcome; 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 for injured workers; Breach of mutuality; Cessation of active rehabilitation; Case closure; Payment of rehabilitation costs; Transferring vocational rehabilitation cases; Re-employment Incentive Scheme for Employers (RISE); Sections 58B and 58C; Interaction of various provisions of the Act and industrial relations legislation; Transmission (this may include succession or assignment) of a business or undertaking.
  
  
  
• Chapter 8: Average weekly earnings for claims made before 1 July 2008 [236.50 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 8A: Average weekly earnings for claims made on or after 1 July 2008 [179.54 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 9: Payment - entitlements [670.67 KB]
  Contents: Payments – entitlements; Centrelink, other Commonwealth benefits and private garnishees; Lump sums; Lump sum compensation for non-economic loss (section 43); Deductions to Centrelink, Medicare Australia and representatives; Redemption of weekly payments and medical expenses (section 42); Loss of earning capacity assessment (LOEC); Compensation for property damage; Weekly payment entitlements; Leave entitlements and effect of an allowance or benefit on weekly payments; Taxation on direct weekly payments; Reasonable costs reasonably incurred.
  
  
  
• Chapter 10: Review of weekly payments [321.70 KB]
  Contents: Review of weekly payments; Discontinuance of weekly payments; Reduction of weekly payments; Suspension of weekly payments; Annual reviews; Retirement of the worker.
  
  
  
• Chapter 11: Payments - medical and other expenses [214.85 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 11A: Social rehabilitation entitlements [94.77 KB]
  Contents: Social rehabilitation and ancillary entitlements; Introduction; Serious injury; Serious injury classification scales; Reasonable costs, reasonably incurred; Travel; Private vehicle; Parking; Public transport; Long distance travel by bus or train; Taxis; Ambulance travel; Airline travel; Accommodation and associated costs; Other travel costs not in association with medical and like services; Family and personal attendant’s entitlements to travel cost reimbursements.
  
  
  
• Chapter 12: Death claims [115.57 KB]
  Contents: Death claims; Entitlements; Funeral expenses; Lump sum payments; Spouse; Domestic partner – commencement date; Orphaned children; Dependent relative; Weekly payments; Review of weekly payments; IDEAS processing of death claims.
  
  
  
• Chapter 13: Potential suicide [74.99 KB]
  Contents: Potential suicide; General indicators of increased risk for suicide; Risk factors; Identifying the problem; Contact with worker; Emergency admission policy; Payments; Resources.
  
  
  
• Chapter 14: Claims administration [319.91 KB]
  Contents: Claims administration; Estimating a claim; File administration; Payment of accounts; File cost; Release of information (confidentiality); Requests for confidential information; Disclosure of section 35(6a) amount to employers; Exceptions to the duty of confidentiality; Confidentiality and rehabilitation; Release of information to the Department of Primary Industries and Resources and Department of Industry and Trade; Disclosure authorised by the Minister for Industrial Affairs; Release of information to Commonwealth government authorities; Freedom of information; Request for previous lump sum payments and/or Industrial Court checks; Physical transfer of files between claims agent and WorkCover; Access to Information; Complaint resolution; Ministerials.
  
  
  
• Chapter 15: Fraud [112.53 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 16: Dispute resolution [235.34 KB]
  Contents: Dispute resolution; The dispute resolution process; Proceedings before the Tribunal; Responsibility of the claims agent to notify WorkCover of an appeal; Notice of dispute; Conciliation; Arbitration; Judicial determination; Full Bench referrals; Costs; Special jurisdiction to expedite decisions; Ministerial intervention; The claims agent’s role in dispute management; Workers under 18 years of age; Dispute management conferences and conciliation conferences; Assessment of dispute matters for referral to external specialist; Arbitration and judicial determination; Orders and decisions; Significant cases; Disputes of interest.
  
  
  
• Chapter 17: Claim recoveries [193.00 KB]
  Contents: Claim recoveries; The importance of claim recoveries; Types of recoveries; Early identification of recoveries; Early notification of recoveries; Third party recoveries; Recoveries from workers; Recoveries from employers; Recoveries from providers; Settlement and write-off approval levels.
  
  
  
• Chapter 18: Health care operational instructions [352.06 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.
  
  
  
•     Glossary of terms [281.38 KB]
  
  

Recent updates

To ensure its accuracy, WorkCover SA's injury and case management manual is regularly updated. Read a summary of recent updates.