Summary of services for Small Business Employers

What you can expect from icare and our Claims Service Providers

We are committed to continuing our focus to provide high-quality standards of service and value for all policy holders. As a small business 1 employer insured under the Nominal Insurer Workers Compensation Scheme in NSW there are services included in the cost of your premium that are available to you.

Injury prevention and trainingServices that focus on providing you with preventative tools, education and advice to develop a sustainable culture of workplace safety and awareness.

The safety and wellbeing of you and your people are

paramount and so we have developed a range of

preventative programs and training to assist you and

your employees to better understand how to maximise

workplace health and safety outcomes.

Þ Improved safety outcomes through our scalable and bespoke prevention programs: As a policy holder

you have exclusive access to scalable and bespoke

prevention programs that improve workplace health

and safety and help to reduce injury rates through our

prevention team: prevent@icare.nsw.gov.au

Þ Training to support you with managing workers insurance: Access a range of training to make

managing workers insurance easy. Developed with

your needs in mind, you can access: Mental Health

First Aid, PIAWE training, Return to Work Programs

& Injury Management Planning and Policy, premium

and underwriting training.

Þ Access to our latest education and training programs: We’re optimising our education and training programs

to help you improve workplace safety culture. This

includes continually expanding our online knowledge

base with industry-leading information, insights and

tools, so you feel empowered to maximise workplace

health and safety outcomes.

Policy, underwriting and performanceServices to ensure your policy works for you and your business.

When it comes to workers insurance for small business

employers, we understand that every business is different,

and some employers may make more claims than others.

So, as part of our standard services, we give you access

to our policy and underwriting teams to provide you with

the best-fit policy solution to better support you and

your specific business needs.

Þ Get covered quicker: If you’re new to icare, you can

get a quick quote on your workers insurance premium

on the icare website (48 hours if requested in writing)

and receive a Certificate of Currency within 48

business hours of request.

Þ Support when you need it: Our customer support

team is focused on resolving your policy and claims

queries in a timely manner whether you email or call

icare’s Customer Support Centre from 7am – 7pm (Mon – Fri).

Þ Support to improve your premium and performance: When you first apply for cover, the cost of your

premium is based on the industry you work in and how

much your business pays in wages. To help you better

understand and manage your premium, you will have

access to icare’s Underwriting team who will review

opportunities to factor in any incentives, discounts or

premium adjustments, to ensure you’re getting the

best-fit workers insurance solution for your business.

Þ Peace of mind knowing you’re always covered: You will automatically have your policy renewed

within six (6) weeks of renewal date and receive

a Certificate of Currency at the time of your renewal,

or you can confirm your cover at any time via

the ‘Employer Lookup function’ on our website

employerlookup.icare.nsw.gov.au

1. You are considered a small employer if your average performance premium is $30,000 or less. This means that your premium will not be impacted by your claims cost.

This document outlines a summary of the services included in your premium, which you can expect from icare and our Claims Service Providers. To see the full list of the services available, please read the Service catalogue for small business employers document.

Resources and industry insightsServices that deliver insights and resources that speak to you and your industry.

As a small business employer, you need easy access

to workers insurance information that supports your

industry and business needs. So, we are continuing

our commitment to deliver a range of industry-specific

resources to help you make better informed decisions

about workers insurance and to help keep your

workplace safer.

Þ Benchmark your performance using the latest insurance data anytime, anywhere: Use the

Industry Insights tool to access the latest insurance

data including volume of claims, cost of injury

and frequency by industry for NSW to be better

informed for better outcomes: www.icare.nsw.gov.au/employers/industry-insights/interactive-tools/

Þ Tailored industry resources and insights: Access

a wide range of knowledge articles and tools on

our ihub (industry hub): your one-stop-shop, full

of workers-insurance information to help you and

your industry make better informed decisions about

workers insurance and to help keep your workplace

safer. www.icare.nsw.gov.au/ihub

Claims management, support and return to workServices that support you and your worker during the full lifecycle of a claim.

We want to be with you every step of the claims journey,

which is why you have full support with managing

claims: from lodgement and contact, to return-to-work

intervention and payment. To make the process simpler

and faster, we’ve developed a segmented approach to

claims management that ensures appropriate levels of

care and management are matched to the circumstances

and complexities of the claim.

Þ Greater control over the management of your claims: Access claim information anytime, anywhere with

our Claims Portal. Through this online tool, you, your

workers and any third-party representatives can easily

manage claims from one central location.

Þ Take the guess work out of knowing the cost of your claim: We provide you with ongoing claims estimates

throughout the duration of your claim, from the first

week of lodging a claim through to 104 weeks after

the date of injury, so you have complete transparency

of the potential costs.

Þ Timely dedicated support during the claim: We will

contact injured workers and treatment professionals

within three (3) days of reporting an injury and keep

you updated through the life of the claim, delivering

an initial liability decision within seven (7) days of

reporting a claim.

Claims management, support and return to work (continued)

Þ Strategic Case Management to deliver best outcomes for you and your worker: Your Claims Service Provider

will work with you to develop a tailored claims strategy

to help you manage all aspects of a claim, including:

• Return to Work (RTW) & Recovery Goals

• Capacity for work

• Medical Treatment

• Liability and benefits

• Identification of barriers affecting RTW and recovery

• Identification of actions or strategies to overcome

barriers and progress the claim

Þ Tailored claim management to maximise recovery and return-to-work: Your claim will be triaged based on

a variety of factors including the injury type, industry

and worker age to ensure the appropriate team or

Case Manager is applied to maximise opportunities

for recovery and return to work. As more information

is gathered during the claim lifecycle, we will

continuously triage your claim to ensure you receive

the right level of support every step of the way.

Þ Specialised support to meet complex claims: Receive tailored case management support to meet

the needs of: primary psychological injury claims,

medically complex claims and fatality claims, through

a dedicated and experienced Case Manager who will

remain involved throughout the claims journey, and

who has lower caseloads to dedicate more time to

each claim.

Þ Transparent and timey medical treatment decision-making: Receive medical treatment decisions

within 21 days from the submission of a request. You

also have access to support with complex treatment

requests through our Medical support panel (MSP)

who offer medical advice and expertise to fast-track

decision-making for both the injured worker and

their employer.

Þ Control over the management of weekly payments: You can choose to have your Claims Service

Provider calculate and pay the appropriate amount

of weekly payments (within 5 days of receiving

the appropriate documentation) or you can enter

a Wage Reimbursement Agreement 2 (pay weekly

entitlements up front and claim reimbursement from

the insurer). This means you have the option to choose

the method that best supports your business and the

injured worker.

Þ Comprehensive workplace rehabilitation support: You have access to icare’s panel of 22 appointed

providers located throughout Metropolitan Sydney

and NSW that are available to support injured

workers in, or returning them to, pre-injury or suitable

employment. icare monitors the service of the

provider panel to continuously improve stakeholder

relationships and achieve consistent best practice in

rehabilitation services.

Þ Timely complaint resolutions: Complaints provide

valuable feedback to enable us to improve our

service, to improve customer experience, clarify any

misunderstanding or rectify a mistake we may have

made. If, in the first instance, the Claims Service

Provider is unable to resolve your complaint within

two (2) days, the complaint is escalated to icare for

management and resolution. Workers or employers

can also dispute a decision on a claim through an

optional internal review, which is conducted by icare.

2. The employer must guarantee financial and administrative resources available to make payments of weekly compensation in a timely manner and consistent with the legislative requirements.

Supporting you with managing workers insurance icare website: Get the latest workers insurance news,

helpful tools and more: https://www.icare.nsw.gov.au

Premium calculation: Find out how your premium is

calculated https://www.icare.nsw.gov.au/employers/premiums/calculating-the-cost-of-your-premium/premium-calculation-small-employer/

Get a policy quote: Take out a policy or get an estimate

of your premium online: https://portal.icare.nsw.gov.au/policy/quote/apply/

Employer look up: Search for employers registered with

icare: https://employerlookup.icare.nsw.gov.au/

Industry hub (ihub): A one-stop-shop hub full of

information to help you and your industry manage

workers insurance: https://www.icare.nsw.gov.au/ihub

Contact us: Þ Policy enquiries Call: 13 44 22 (M-F, 7am-7pm)

Þ New claim notification Call: 13 77 22 (M-F, 7am-7pm)

Þ Website: www.icare.nsw.gov.au

Icare offices:Sydney

Þ 321 Kent St

Sydney NSW 2000

Parramatta

Þ 56 Station Street East

Parramatta NSW 2150

Newcastle

Þ Level 6, 18 Honeysuckle Drive

Newcastle NSW 2300

DefinitionsClaim Estimation: A Claims estimate is the process

of applying a monetary value to a claim based on

the anticipated future cost of that claim (also known

as a Reserve).

Claims Investigations: Investigations including Factual

Investigations and Desktop investigations. Factual

Investigation are independent investigations to determine

the facts surrounding the injury or incident.

Claims portal: The Claims Portal is an online tool

developed by icare that allows workers, employers and

third-party representatives to lodge a claim and complete

tasks related to the management of claims.

Claim strategy: A claims strategy is a plan for managing

all aspects of a claim.

Commutation: A commutation is a settlement of a

worker’s remaining entitlement to weekly benefits and

medical expenses by way of sump sum payment.

Complaints: A complaint is any expression of

dissatisfaction made to an organisation related

to its products, service or the complaints handling

process where a response or resolution is explicitly

or implicitly implied.

Determined weekly benefit amount: The determined

weekly benefit amount is the amount payable for

a full week of weekly payments not including earnings

or deductions.

Disputes / Internal Review: A dispute arises when there

is a disagreement with a Service Provider's decision on

a claim.

Fatality Claims: Fatality claims include claims where

the worker has passed away prior to claim lodgement

and circumstances where the worker dies because of

their injury during the course of the claim. Services for

fatality claims are designed to support the employer

and the worker’s family following the death of a worker.

Services include:

Þ Grief Support and Information Pack

Þ Assistance in guiding the family through

the claim process

Þ Assistance in guiding the employer through

the claim process

Injury Management Plans: An Injury Management Plan

is a written plan for coordinating and managing the

treatment, rehabilitation and retraining of an injured

worker, for the purpose of achieving a timely, safe and

sustainable return to work for the worker.

Liability determination: A liability determination is the

process of assessing whether an injured person is eligible

for workers’ compensation benefits for their injury.

Litigation: Litigated matters are disputes which have

been escalated to involve legal action.

Medically Complex Claim: Medically complex claims refer

to claims which require significant medical management.

Generally, workers with this type of injury may need

significant periods of hospitalisation and prolonged

assistance with daily living activities.

Primary Psychological Injury Claims: Psychological

injuries include post-traumatic stress disorder, anxiety/

stress disorder, depression, short term shock from

exposure to disturbing circumstances, reasons to

stressors, and other mental diseases.

Triaging and Segmentation: The claim is triaged to

determine the risk profile based on psychosocial risk

factors. Segmentation refers to allocation of the claim to

an appropriate team or Case Manager to ensure suitable

resources and intervention measures are applied to

maximise opportunities for recovery and return to work.

Wage Reimbursement Agreement: The wage payment

agreement is where an employer opts to pay weekly

entitlements up front and claim reimbursement from

the insurer.