If you have, or someone you employ has, a workers compensation claim there are many different people or organisations that may be involved in helping you return safely to work or the community.
Here we explain who they are and what they do:
Who does what in the workers rehabilitation and compensation system [589KB]
Claims agent (Employers Mutual)
Unless your employer is self-insured, WorkCover has contracted a private company as its claims agent – Employers Mutual – that is responsible for most of the day-to-day decisions relating to your claim.
An agent's responsibilities and powers are described in the Workers Rehabilitation and Compensation Act 1986 and Employers Mutual’s case managers use the Injury and Case Management Manual produced by WorkCover as the major reference point for day-to-day claims management services.
Contact Employers Mutual on (08) 8127 1100.
Case manager (or claims manager)
A case manager is employed by a claims agent or your self-insured employer to manage workers compensation matters including:
- determining if a claim is eligible for compensation
- managing an injured worker's claim for compensation
- managing and coordinating rehabilitation and return to work plans for the injured worker
- providing advice to workers and employers on rehabilitation and compensation
- providing advice to employers on health and safety in the workplace.
Your case manager will work with you, your employer, doctor and rehabilitation provider to coordinate your return to work process. In all situations, you should remain in contact with your case manager.
Employers
If you are injured or become sick because of your work, your employer has an important role to play to help you recover and return safely to work. Your employer needs to provide alternative duties (where possible) and work cooperatively with the case manager, rehabilitation providers and doctors to ease you back into work when you are medically assessed as ready. It is important that you keep in touch with your manager if you are away from work.
Freedom of Information (FOI)
Under Freedom of Information a person can request a copy of their records from WorkCover. If you need to know more, or want to make a request, view our Freedom of Information page or contact WorkCover's FOI/Section 107B officer to make an enquiry.
Government Minister
The Minister for Industrial Relations is ultimately responsible both for workers rehabilitation and compensation and occupational health and safety in South Australia.
Health care providers
A health care provider helps with medical or health care so you can return to work or independence. Your doctor, physiotherapist or specialist are all health care providers and they should all work together to help you recover. View a list of approved WorkCover providers.
Legal representatives
You have a right to legal representation at any time, and will probably need representation if you have a case before the Workers Compensation Tribunal. For a free service, contact SA Unions or visit the SA Unions website (you do not have to be a union member).
Privacy
The Workers Rehabilitation and Compensation Act 1986 is very specific about disclosure of information. WorkCover and our claims agent have strict policies about who is entitled to see claimant information. Other providers are also bound by the Workers Rehabilitation and Compensation Act 1986 and the Federal Privacy Act that protect workers rights to privacy. For more information on confidentiality see worker rights and responsibilities.
Rehabilitation providers
There are two kinds of rehabilitation providers that might help you return to safe work or the community. There are health care professionals who may also with rehabilitation, such as occupational therapists, physiotherapists and psychologists. The other kind are vocational rehabilitation providers who coordinate return to work services, including liaising with doctors and employers.
Self-insured employers
Employers that fund and manage their own workers rehabilitation and compensation claims are known as self-insured employers. Generally self-insured employers are large companies (or government) that employ more than 200 workers.
WorkCover Ombudsman
If you have a problem relating to the operation of the WorkCover Scheme, you can contact the WorkCover Ombudsman, who runs an independent office set up to investigate complaints. The Ombudsman can implement the 'safety net' for injured workers, testing the reasonableness of decisions to stop or reduce weekly payments. To contact the Office of the WorkCover Ombudsman please phone (08) 8463 6593, email owo@saugov.sa.gov.au or www.wcombudsmansa.com.au.
WorkCover's Service Improvement Unit
WorkCover is funded by employers to manage a balanced and financially-sound system that rehabilitates, compensates and returns injured workers to safe workplaces and the community. If you have a complaint about WorkCover or our claims agent you can lodge a formal complaint through the Service Improvement Unit.
Worker
An injured worker who has a claim accepted may receive medical, rehabilitation, return to work and financial support. Under the Act the worker needs to cooperate with the case manager and be actively supporting their return to work.
Worker associations and support groups
There are a number of independent organisations that can discuss workers rehabilitation and compensation issues with you. While we recognise the role these groups play in providing advice, WorkCover cannot endorse the specific advice they may give to injured workers. Contact details are available on our advice and support page.
Workers Compensation Tribunal
The Workers Compensation Tribunal can help workers with undetermined claims or review decisions made about a claim by the claims agent. Workers have several conciliation and arbitration options once a Notice of Dispute is lodged with the Tribunal. More information is available on our workers compensation dispute page, in our fact sheet Help when you’re not satisfied - A guide to workers compensation disputes, or visit the South Australian Industrial Relations Tribunal website.