SRC Act Self-Insurance Claims Management System Transition ... · business operations of the claims management system under self-insurance. Manager Injury Prevention and Rehabilitation

Revision: Version 7.0 Date to be Reviewed: 31/01/2018 Page 1

Once printed, this is an uncontrolled document. Latest version Refer to: U:\WEG\REGULATORS\COMCARE\Audits\ Claims Management System \Corrective Action Plan

SRC Act Self-Insurance Claims Management System Transition Plan



OVERVIEW This SRC Act Self-Insurance transition plan provides a program of works required to transition the existing Rehabilitation Management System from the current arrangement as a premium paying organisation, to a self-insurance licence arrangement. As part of Workers Compensation Self-Insurance arrangements, the University proposes to use a third party arrangement with Comcare, for the provision of claim management services. This arrangement will occur on commencement of a self-insurance licence arrangement, with a proposed start date of the 1 July, 2018. The actions required to ensure this will occur seamlessly while maintaining the system requirements for claims management, are detailed within this plan, and include the following sections: 1. Key overview areas for consideration with schedule 2. Claims Management System transition activities against audit criterion 3. Rehabilitation Management System transition activities again audit criterion



Claims Management System Criterion Corrective Action Item Action Officer Action

Date Status

1. Commitment and Corporate Governance

1.1 The applicant will set the direction for its claims management system through a documented commitment by senior executive.

Vary existing policies to include specific reference to claims management or creating a new policy or other strategic management document that captures management intent.

‘Rehabilitation and Claims Management’ Policy

- Existing rehabilitation policy to be amended to include commitment to claims management system requirements.

Manager Injury Prevention and Rehabilitation 1 Feb 17 Completed

- Draft revised ‘Rehabilitation and Claims Management‘ policy to be provided to Director Human Resources (DHR) for review and approval.

Manager Injury Prevention and Rehabilitation 1-Jan-17 In progress

- Final approved document provided to Policy Manager for publication. Manager Injury Prevention and Rehabilitation 1-Feb-18 Not yet

commenced - Rehabilitation and Claims Management Policy must be signed on or after

the date of commencement of licence by the present principal officer or other senior executive.

Manager Injury Prevention and Rehabilitation 1-Apr-18 Not yet

commenced

- Final approved ‘Rehabilitation and Claims Management’ policy published. Manager Injury Prevention and Rehabilitation 1-Jul-18 Not yet

commenced - Document control to be confirmed on corrective action schedule for

‘Rehabilitation and Claims Management Policy’. Document control information unable to be provided on printed document.

Manager Injury Prevention and Rehabilitation 1-Jul-18 Not yet

commenced



1.1 The applicant will set the direction for its claims management system through a documented commitment by senior executive.

‘Injury Management, Rehabilitation and Compensation’ Procedure - Existing ‘Injury Management, Rehabilitation and Compensation’ procedure

to be amended to include additional information on ‘surveillance’ arrangements.

Manager Injury Prevention and Rehabilitation 1-Feb-17 Completed

- Draft revised ‘Injury Management, Rehabilitation and Compensation’ procedure to be provided to DHR for review.


- Final draft provided to Policy Manager for publication. Manager Injury Prevention and Rehabilitation 1-Feb-18 Not yet

commenced - Develop WEG local protocol document detailing process for surveillance,

including: decision points, advisory committee arrangements for funding, delegations, actions to be taken from surveillance conducted, responsible stakeholders, senior authority arrangements, forms of investigation to be implemented.


commenced

- Final revised ‘Injury Management, Rehabilitation and Compensation’ procedure published.


commenced

- Document control to be confirmed on corrective action schedule for ‘Injury Management, Rehabilitation and Compensation’ procedure once published. Document control information unable to be provided on printed document.


commenced

Governance reporting Vary existing ANU documents from templates to include reference to claims management system information and data - including ANU Annual Report, WHS Annual Performance Management Report, and WHS Performance Management Report for University Council, WHS Committee reporting requirements.


commenced

Commence revised reporting format with CMS data included. Manager Injury Prevention and Rehabilitation 1-Jul-18 Not yet

commenced



Criterion Corrective Action Item Action Officer Action Date Status

1.2 The claims management system will provide for internal and external accountability.

ANU Managed Services Agreement (MSA) and Service Level Agreement (SLA) for claims management services with Comcare must be signed prior to licence commencement.

Project Manager WCSI Project 1-Jul-18 In progress

Governance framework (ANU Claims Management System Manual) for monitoring and reporting CMS performance must be in place prior to licence commencement.

Manager Injury Prevention and Rehabilitation 1-Apr-18 In progress

Governance framework (ANU Claims Management System Manual) to be developed to reflect process for monitoring accountability and escalation of issues for all claims management activity.


CMS standard reporting and exception reporting requirements to be developed – including Licensee Key Performance Indicators, quantitative data and qualitative analysis of customer service standards. To be included in ANU Claims Management System Manual.


Final governance framework document (ANU Claims Management System Manual) to be completed and approved by the delegate – DHR.


commenced Document ANU claims management staffing levels, issues, and capability development.

Manager Injury Prevention and Rehabilitation 1-Sep-17 Completed

- Conduct analysis of current Comcare claims to establish nature of claims and resourcing required for management.


- Establish capability for ANU in-house staff to manage new claims as well as claims management of Comcare long tail claims.


Document a claims management risk register. Manager Injury Prevention and Rehabilitation 1-Feb-17 Completed




1.2 The claims management system will provide for internal and external accountability.

Establish process of actuary analysis, business requirements, budget and reporting to be conducted bi-annually. To be documented in CMS Manual.

Project Manager WCSI Project 1-Apr-18 In progress

Document continuity plan in case of IT System failure or other associated with Figtree. To be documented in CMS manual.


Establish if claims management data is to be included in data warehouse for Insight dashboard reporting.

Project Manager WCSI Project 1-Jun-18 Not yet

commenced Provide claims management data for dashboard reporting in Figtree, post commencement of the self-insurance licence.


commenced Update relevant service level agreements (SLAs) to reflect changes in contacts, billing and other administrative requirements as part of the transition to in-house claims management: - Include claims management system audit details in the existing

arrangement with BRM Risk Management. Manager Injury Prevention

and Rehabilitation 1-Jun-18 In progress

- Workplace rehabilitation providers. Manager Injury Prevention and Rehabilitation 1-Jun-18 Not yet

commenced

- Health care providers. Manager Injury Prevention and Rehabilitation 1-Jun-18 Not yet

commenced Establish internal claims management system process and format to be conducted on a bi-annual basis.

Manager Injury Prevention and Rehabilitation 1-Jun-18 Not yet

commenced

Update position descriptions for ANU roles with direct accountability for the business operations of the claims management system under self-insurance.


commenced Update performance development review objectives for ANU roles with direct accountability for the business operations of the claims management system under self-insurance.


commenced

Establish credentialing requirements / training and performance development review objectives for ANU roles with direct accountability for the business operations of the claims management system under self-insurance.


commenced




1.3 The applicant will identify, assess and control risks to the claims management system.

Review existing RMS risk register and include additional claims management issues to be noted.

Manager Injury Prevention and Rehabilitation

18-Aug-17 Completed

Review risk management plan following the grant of WCSI licence to consider the impact of the Commission reporting requirements.


commenced

Document a process to review workload levels and workforce profiling on a regular basis to ensure correct staffing levels are in place for claims management and rehabilitation management systems.

Manager Injury Prevention and Rehabilitation 1-Jun-18 In progress

Develop claims review templates and process for quarterly detailed claims performance monitoring.


commenced The level of independent review is to be determined having regard to the new regulatory model.


commenced Process for the timely reporting of trends and outcomes to be established to manage emerging risk.


commenced The ANU will be reliant on Comcare to ensure the requirements of this criterion are met so should ensure the final Services Level Agreement (SLA) with Comcare covers the requirements.


commenced



2. Planning


2.1 The applicant will identify the administrative and financial limitations for each level of claims manager, including arrangements for the management of reconsiderations.

Claims Management System documentation to be updated to reflect the delegation provisions.

Manager Injury Prevention and Rehabilitation 1-Apr-18 In Progress

Delegation authority letter to be drafted for the Vice Chancellor approval – for implementation on provision of self- insurance licence – advising revised delegations for ANU and Comcare third party claims management.

Manager Injury Prevention and Rehabilitation 1-Feb-17 Completed

Document control to be added to the delegation schedule. Manager Injury Prevention and Rehabilitation 14-Feb-17 Completed

ANU to develop two separate instruments of delegation schedules under Section 41A (Rehabilitation Management System) and Section 108H (Claims Management System).


ANU to identify the administrative and financial limitations for each level of claims manager – specific to the administrative level.


Revised draft delegation schedules to be sent to ANU legal office. Manager Injury Prevention and Rehabilitation 1-Sep-17 Completed

Final delegation scheduled to be completed. Manager Injury Prevention and Rehabilitation 1-Feb-18 In Progress

Final delegation authority letter to be provided to the Vice Chancellor for signature – for commencement on provision of WCSI licence approval.


commenced The University’s delegation schedules must be signed by the principal officer on the date of commencement of licence.


commenced Arrangements to be put in place for reconsideration process to be delegated to an internal staff representative as per a Committee Review process. Policy and procedural documents to be updated.


commenced




2.2 The applicant will have documented procedures for paying compensation to injured employees, dependants of deceased employees, providers of medical treatment and other recipients.

Figtree integration requirements to be identified. Manager Injury Prevention and Rehabilitation 1-Jan-17 Completed

Conduct initial integration discussions with finance, Remuneration and Conditions, and HR Systems.

Manager Injury Prevention and Rehabilitation 1-Jan-17 Completed

Follow up discussions re one off payments, payments for dependents, trust fund arrangements to be conducted.

Manager Injury Prevention and Rehabilitation 15-Jan-17 Completed

Figtree user acceptance testing to be made available to ANU injury management and claims management teams.


Claims management procedures tailored to the University’s claims management arrangements and systems of licence, to be fully developed prior to licence commencement. To be contained in the ANU Claims Management Manual.


Documented procedures (with time frames specific to the University’s pay cycle) to be finalised prior to licence commencement for:


- Provision of updates on payroll information to the Comcare claims team such as normal weekly earnings, actual earnings, hours worked and other leave taken, with adequate time for determinations to be made.


The interface between decisions made by a 3rd party claims manager, Comcare, and the payment process performed by ANU to be established as part of work flow arrangement within Figtree.






Data transfer preparation – claims data from PRACSYS to Figtree (as per Figtree ANU implementation schedule project plan)

Map current department codes in the Comcare Customer Information Service (CIS) database with ANU HR department codes.


14-Dec-17 In progress

Update current department codes in the Comcare CIS database to correspond with ANU HR department codes.


Update all active claims, and all claims with a date of injury 1 July 2012 onwards, in CIS to be remapped to correct Department codes.


Map CIS data fields to Figtree data fields. Manager Injury Prevention and Rehabilitation 26-Jan-18 In progress

Conduct test data transfer between CIS and Figtree for data field matching – small sample.

Manager Injury Prevention and Rehabilitation 9-Feb-18 In progress

Conduct test data transfer all active claims, and all claims with a date of injury 1 July 2012 onwards, in CIS to be remapped to correct Department codes.

Manager Injury Prevention and Rehabilitation 23-Feb-18 In progress

UAT testing for Figtree Claims Management Modules. ANU/ Comcare 23-Mar-18 In progress

Complete updates to workflow and templates for Figtree Claims Management Modules.

Manager Injury Prevention and Rehabilitation 1-May-18 In progress

Establish documented process for the transfer of claims to Figtree when they change from inactive to active status.


Establish documented process and file naming conventions for Claims Management documents to be transferred and stored in Figtree or ERMS.






Establish process for Claim Documentation to be securely transferred from PRACSYS to Figtree (external hard drive, Cloudstor).


Finalise Go Live modules for Figtree Claims Management Systems. Manager Injury Prevention and Rehabilitation 1-Jun-18 In progress

Incapacity payments to claimants.

Establish list of all claimants receiving incapacity payment. Manager Injury Prevention and Rehabilitation 1-Feb-18 In progress

Map process for ‘employment type’ workers compensation only for claimants no longer employed by the University to be re-established in the payroll system.


Complete the payroll set up for all employees no longer employed by the University requiring incapacity payments.


Process to be established for the provision of trust fund set. Manager Injury Prevention and Rehabilitation 1-Jun-18 In progress

- Draft ‘Trust Fund” procedure to be developed. Manager Injury Prevention and Rehabilitation 14-Feb-17 Completed

- Version control to be added to document. Manager Injury Prevention and Rehabilitation 14-Feb-17 Completed

- Draft ‘Trust Fund’ procedure provided to DHR for review. Manager Injury Prevention and Rehabilitation 1-Mar-17 Completed

- Draft ‘Trust Fund’ arrangements and procedure to be discussed with ANU Legal Office.

Manager Injury Prevention and Rehabilitation 1-Aug-17 Completed

- Draft ‘Trust Fund’ arrangements and procedure to be discussed with ANU Finance and Business Services Office.


commenced




- Tailored claims management procedures and beneficiary account/s and procedures must be in place prior to licence commencement.


commenced

- Beneficiary trust account for the payment of dependents of deceased employees to be in place prior to licence commencement.


commenced

2.3 The applicant recognises legislative obligations and plans for legislative and regulatory compliance, having regard to any policy advice that Comcare or the Commission may issue.

Documents, forms, templates and intranet site information to be reviewed and updated to ensure legislative compliance. Essential documents to be completed before licence commencement. - Draft documents and intranet text to be prioritised for review and

revision. Manager Injury Prevention

and Rehabilitation 1-May-18 In progress

- Draft documents and intranet text to be drafted and ready for use. Manager Injury Prevention and Rehabilitation 1-Jun-18 In progress

- Key documents to be prioritised for use post self-insurance licence commencement:

o Claim form o Claim for time off work form o Medical claim form o Claim pack information o Website information regarding claim submission under the new

arrangements o Notice of rights form o Incapacity and benefits payment determination


- Documents and intranet pages to be made live. Manager Injury Prevention and Rehabilitation 1-Jul-18 Not yet

commenced



Criterion 2.3. Transition documents for review / completion

Time Estimate Document Name Action Officer Action Date Status

16 hours Claims management system documents for review and update.


1-Jul-18 In progress

No Title 1 ANU Rehabilitation Manual 2 ANU Claims Information Pack 3 ANU/Comcare – Worktrial Agreement (SRC 64) 4 ANU - Authority to Collect, Use and Disclose Personal Information 5 ANU Notice of Rights 6 ANU – Failure to comply s.36 7 ANU – Failure to comply s.37 8 ANU – Notice of determination; Suspension 9 ANU/Comcare – Suitable duties plan (SRC 109) 10 ANU – Initial letters to stakeholders 11 ANU – letter to IW; s.36 referral for IME 12 ANU – letter to IW; s.36 referral for rehabilitation 13 ANU – letter to treating provider 14 Comcare – Rehabilitation assessment/examination (SRC116) 15 Comcare – Rehabilitation Program 16 Comcare – Rehabilitation Program Alteration 17 Comcare – Medical Services Claims form 18 Comcare – CTOW 19 Comcare – Claim for Aids and Appliances 20 Comcare - Household and attendant care and/or child services (SRC 19)



21 Comcare – Claim for Compensation for a work-related death (SRC 184) 22 Comcare - Claim for alterations to a place of residence/work or modifications to a vehicle/article 23 Comcare - Compensation claim for permanent impairment and non-economic loss—form and

checklist (SRC 026) 24 Comcare - Hearing Aid Request Form 25 Comcare – Periodic review form 26 Comcare – Rehabilitation Program Closure Record 27 Comcare – Physiotherapy Treatment Notification Plan (TNP) 28 Comcare – Claim for Exercise as medical treatment 29 Comcare – All about workers compensation 30 Comcare – Claim Determination letter 31 Comcare – Direct payment update form 32 Comcare – Section 45 election form 33 Comcare – Reconsideration Request 34 Comcare - Statement of financial circumstances 35 Comcare - Request to change bank account and/or personal details (SRC 170) 36 Comcare – Cessation of Employment (SRC 266) 37 Comcare – Medical Certificate for Compensation (SRC 132) 38 Comcare – Psychology treatment notification plan (TNP) 39 Comcare - Psychology/counselling extended consultation request (SRC110) 40 Comcare – Workers Compensation Claim Form (SRC 016)



No Title Hyperlink Injury management 1 Injury management https://services.anu.edu.au/human-resources/health-safety/injury-management 2 Injury reporting https://services.anu.edu.au/human-resources/health-wellbeing/injury-management/injury-reporting

3 Staff member has been injured or become ill outside of work

https://services.anu.edu.au/human-resources/health-wellbeing/injury-management/staff-member-has-been-injured-or-become-ill

4 Forms explained https://services.anu.edu.au/human-resources/health-safety/injury-management/forms-explained

5 Guidelines for leave while on workers compensation

https://services.anu.edu.au/human-resources/health-safety/injury-management/guidelines-for-leave-while-on-workers-compensation

6 Making a workers compensation claim

https://services.anu.edu.au/human-resources/health-safety/injury-management/making-a-workers-compensation-claim

7 Roles and responsibilities while on workers compensation

https://services.anu.edu.au/human-resources/health-safety/injury-management/roles-and-responsibilities-while-on-workers

8 Supervisor & manager roles & responsibilities for workers compensation

https://services.anu.edu.au/human-resources/respect-inclusion/roles-and-responsibilities-for-workers-compensation

9 Minor work-related injury guideline https://policies.anu.edu.au/ppl/document/ANUP_000760

10 Injury management, rehabilitation and compensation procedure

https://policies.anu.edu.au/ppl/document/ANUP_000667

11 Home based work procedure https://policies.anu.edu.au/ppl/document/ANUP_000598 Employee Assistance Program 12 Employee Assistance Program https://services.anu.edu.au/human-resources/wellbeing/employee-assistance-program

13 Responding to a suicidal person at work

https://services.anu.edu.au/files/guidance/responding-to-suicidal-person-at-work.pdf

14 Disruptive Behaviour https://services.anu.edu.au/files/guidance/Disruptive%20Behaviour.pdf

https://services.anu.edu.au/human-resources/health-safety/injury-management

https://services.anu.edu.au/human-resources/health-wellbeing/injury-management/injury-reporting



https://services.anu.edu.au/human-resources/health-safety/injury-management/forms-explained












https://services.anu.edu.au/human-resources/wellbeing/employee-assistance-program

https://services.anu.edu.au/files/guidance/responding-to-suicidal-person-at-work.pdf

https://services.anu.edu.au/files/guidance/Disruptive%20Behaviour.pdf



15 Following a Crisis – What to Say or Do

https://services.anu.edu.au/files/guidance/Following%20A%20Crisis%20-%20What%20to%20Say%20or%20Do.pdf

16 Tips for Parents on Coping with Trauma

https://services.anu.edu.au/files/guidance/Tips%20for%20Parents%20on%20Coping%20with%20Trauma.pdf

17 Disability resource guide https://services.anu.edu.au/human-resources/respect-inclusion/disability-resource-guide 18 Staff disability support https://services.anu.edu.au/human-resources/respect-inclusion/staff-disability-support 19 Your responsibilities https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/your-responsibilities 20 Disclosure https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/disclosure 21 Reasonable adjustments https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/reasonable-adjustments

22 Managing your mental health in the workplace

https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/managing-your-mental-health-in-the

23 Mental health contacts https://services.anu.edu.au/human-resources/respect-inclusion/staff-disability-support/mental-health-contacts

24 Maintaining psychological wellbeing

https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/maintaining-psychological-wellbeing

25 Managing workplace pressures https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/managing-work-pressures 26 Students in distress https://services.anu.edu.au/education-support/supporting-students/students-in-distress

27 Disturbing Content in Students Work

https://services.anu.edu.au/education-support/supporting-students/disturbing-content-in-students-work

28 Managing mental illness in the workplace – Manager checklist https://services.anu.edu.au/files/guidance/managing-mental-illness-in-the-workplace_managers-checklist.pdf

https://services.anu.edu.au/files/guidance/Following%20A%20Crisis%20-%20What%20to%20Say%20or%20Do.pdf

https://services.anu.edu.au/files/guidance/Tips%20for%20Parents%20on%20Coping%20with%20Trauma.pdf

https://services.anu.edu.au/human-resources/respect-inclusion/disability-resource-guide

https://services.anu.edu.au/human-resources/respect-inclusion/staff-disability-support

https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/your-responsibilities

https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/disclosure

https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/reasonable-adjustments



https://services.anu.edu.au/human-resources/respect-inclusion/staff-disability-support/mental-health-contacts



https://services.anu.edu.au/human-resources/health-wellbeing/staff-disability-support/managing-work-pressures

https://services.anu.edu.au/education-support/supporting-students/students-in-distress

https://services.anu.edu.au/education-support/supporting-students/disturbing-content-in-students-work

https://services.anu.edu.au/files/guidance/managing-mental-illness-in-the-workplace_managers-checklist.pdf



Injury prevention advice 29 Injury prevention advice https://services.anu.edu.au/human-resources/health-safety/injury-prevention-advice

30 Working safely with your computer

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/working-safely-with-your-computer

31 Workstation assessments https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/workstation-assessments 32 Safe use of laptops https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/safe-use-of-laptops 33 Office chairs https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/office-chairs 34 Lab ergonomics https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/lab-ergonomics 35 Lifting, pushing & pulling https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/lifting-pushing-pulling 36 Safe storage principles https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/safe-storage-principles

37 Manual tasks risk management https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/manual-tasks-risk-management

38 New furniture, fit-outs and refurbishments

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/new-furniture-fit-outs-and-refurbishments

Occupational Strains Liaison Officer Network

39 Occupational Strains Liaison Officer Network https://services.anu.edu.au/human-resources/health-safety/occupational-strains-liaison-officer-network

40 Guidelines for setting up a workstation assessment

https://services.anu.edu.au/human-resources/health-wellbeing/occupational-strains-liaison-officer-network/guidelines-for-setting

41 Preventing computer-related injuries

https://services.anu.edu.au/human-resources/health-wellbeing/occupational-strains-liaison-officer-network/preventing-computer

42 OSLO workstation assessment guide https://services.anu.edu.au/files/guidance/oslo-workstation-assessment-2014-feb.pdf

43 OSLO contact list https://services.anu.edu.au/files/guidance/oslo-list-6-december-2013.pdf Injury Management and Prevention

44 Injury Management and Prevention https://services.anu.edu.au/business-units/injury-management-and-prevention

https://services.anu.edu.au/human-resources/health-safety/injury-prevention-advice



https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/workstation-assessments

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/safe-use-of-laptops

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/office-chairs

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/lab-ergonomics

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/lifting-pushing-pulling

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/safe-storage-principles

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/manual-tasks-risk-management

https://services.anu.edu.au/human-resources/health-wellbeing/injury-prevention-advice/manual-tasks-risk-management



https://services.anu.edu.au/human-resources/health-safety/occupational-strains-liaison-officer-network





https://services.anu.edu.au/files/guidance/oslo-workstation-assessment-2014-feb.pdf

https://services.anu.edu.au/files/guidance/oslo-list-6-december-2013.pdf

https://services.anu.edu.au/business-units/injury-management-and-prevention



45 Training https://services.anu.edu.au/training?combine&field_development_opp_type_tid=All&field_business_unit_target_id[0]=4948#views-exposed-form-services-development-opportunity-all

46 Manual Task Risk Assessment https://services.anu.edu.au/training/manual-task-risk-assessment-imhr01

47 Office Ergonomic Essentials https://services.anu.edu.au/training/office-ergonomic-essentials-imhr03

48 OSLO Training Module https://services.anu.edu.au/training/oslo-training-module-imhr02

Criterion Corrective Active Item Action Officer Action Date Status

2.4 The applicant sets objectives and targets and identifies key performance measures for its claims management system.

ANU to develop and formalise the objectives, targets and key performance measures for its Claims Management System, specific to the University. Objectives and targets must be established before the Managed Services Agreement (MSA) and the Service Level Agreement (SLA) with Comcare are signed.


Service Level Agreement (SLA) with Comcare to document performance measures for the following areas: - Claims Management - Appeals - Payments and benefits - Return to work

- Claims reviews - Quality assurance - Reporting - Credentialing and training


Update the Human Resources Division (HRD) Business Plan 2018 to include objectives, targets and performance measures.


commenced Update the Work Environment Group (WEG) Operational Plan 2018 to include objectives, targets and performance measures

- Draft targets and metrics for claims management. Manager Injury Prevention and Rehabilitation 1-Jun-18 Not yet

commenced

- Provide claims management metrics to ley stakeholders for review. Manager Injury Prevention and Rehabilitation 1-Jun-18 Not yet

commenced - Update WEG Operational Plan 2018 once WCSI licence arrangements are

granted. Manager Injury Prevention

and Rehabilitation 1-Jul-18 Not yet commenced

https://services.anu.edu.au/training?combine&field_development_opp_type_tid=All&field_business_unit_target_id%5b0%5d=4948#views-exposed-form-services-development-opportunity-all

https://services.anu.edu.au/training?combine&field_development_opp_type_tid=All&field_business_unit_target_id%5b0%5d=4948#views-exposed-form-services-development-opportunity-all

https://services.anu.edu.au/training/manual-task-risk-assessment-imhr01

https://services.anu.edu.au/training/office-ergonomic-essentials-imhr03

https://services.anu.edu.au/training/oslo-training-module-imhr02



Criterion Corrective Active Item Action Officer Action Date Status

2.5 The applicant establishes plans to: (i) achieve its objectives and targets (ii) promote continuous improvement (iii) provide for effective claims management arrangements.

Update the Human Resources Division (HRD) Business Plan 2018 to include objectives, targets and performance measures.


commenced Update the Work Environment Group (WEG) Operational Plan 2018 to include objectives, targets and performance measures, plans to achieve these for the claims management system, promote continuous improvement and provide for effective claims management arrangements.

Draft revised targets and metrics for claims management. Manager Injury Prevention and Rehabilitation 1-Jun-18 Not yet

commenced

Provide claims management metrics to ley stakeholders for review. Manager Injury Prevention and Rehabilitation 1-Jun-18 Not yet

commenced Update WEG Operational Plan 2018 once WCSI licence arrangements are granted.


commenced

3. Implementation


3.1. The applicant will allocate adequate resources to support its claims management system.

Workforce profiling report for ANU Claims and Rehabilitation Management staff to be prepared on an annual basis to analyse workload levels, complexity of cases and staffing recommendations. This will be a requirement of the Governance framework (Claims Management System Manual).


commenced

Process for actuary analysis of business requirements, budget and reporting based on claims numbers, to be conducted bi-annually. This will be a requirement of the Governance framework (Claims Management System Manual).


commenced




3.2. The applicant will define and communicate responsibilities to relevant stakeholders.

As part of the development of the governance framework (ANU Claims Management System Manual) for the Claims Management System, all documents and intranet sites will be reviewed and updated to include the revised responsibilities as part of the CMS.


ANU Welcome to New Staff, WHS & IM Supervisor Programs to be updated to include CMS revisions.


commenced

ANU ‘Notice of Rights’ documentation to be updated to include CMS requirements.


ANU Workers Compensation Claim Pack for staff to be updated to include CMS revisions.


ANU Rehabilitation Manual to be updated to include CMS revisions. Manager Injury Prevention and Rehabilitation 1-Jun-18 In progress

Documents, forms, templates and intranet site information (refer criteria 2.3) to be reviewed and updated to ensure legislative compliance. Essential documents to be completed before licence commencement.



commenced



Criterion - Corrective Action Item Action Officer Action Date Status

3.3 The applicant will communicate relevant information regarding the claims management process including: (i) ensuring that employees are aware of their legislative rights and obligations in relation to workers’ compensation (ii) ensuring that employees are informed of the status of their claims (iii) ensuring consultation occurs between all parties in regards to the claims management process.

Documents, forms, templates and intranet site information (as detailed in Criteria 2.3) to be reviewed and updated to ensure legislative compliance. Essential documents to be completed before licence commencement.



commenced

ANU ‘Notice of Rights’ documentation to be updated to include CMS requirements.


ANU Workers Compensation Claim Pack for staff to be updated to include CMS revisions.


ANU Rehabilitation Manual to be updated to include CMS revisions. Manager Injury Prevention and Rehabilitation 1-Jun-18 In progress

CMS governance framework (ANU Claims Management System Manual) to include a number of communication key milestones to ensure the claimant is kept informed of the progress of their claim.


commenced

The ANU will be reliant on the Comcare to ensure that employees are kept informed of the status of their claims and ensuring consultation occurs between all parties regarding the claims management process. Therefore the Service Level Agreement (SLA) with Comcare should ensure that all parties are aware of their rights and responsibilities.





3.4 The applicant has identified training requirements and will develop and implement training plans to ensure personnel are competent.

ANU corporate profile pack to be finalised for training purposes ANU in-house claims management staff and claims management consultancy services.


Establish governance process for recruitment, credentialing, core competencies, and training information for claims management staff providing services to the ANU in-house and as part of a consultancy arrangement. To be detailed in the ANU Claims Management System Manual.


Service Level Agreement (SLA) to document standards required for so that Comcare staff have the necessary skills, competency and experience to manage compensation claims effectively.


ANU Welcome to New Staff, WHS & IM Supervisor Programs to be updated to include CMS revisions.


Conduct joint training sessions ANU claims management staff to review legislative compliance requirements, key stakeholder liaison and Figtree implementation, including consistent file records management and naming conventions.


commenced

Figtree training requirements for ANU and Comcare claims management staff to be completed.


commenced ANU to identify training needs for ANU and Comcare staff with claims management system responsibilities.


commenced Training and communication plan to be developed for Figtree training requirements for ANU and Comcare staff with claims management system responsibilities.

Project Manager WCSI Project 1-Apr-18 Not yet

commenced

Figtree training requirements for ANU and Comcare claims management staff to be completed.


commenced




3.13 The applicant will provide employees with a reasonable opportunity to provide information or comment when claims for ongoing liability are being assessed or reviewed.

Comcare’s ‘Initial Determinations SRC Act’ guidelines provides for claims reviews to meet these requirements within its claims management system. ANU Claims Management Manual to be developed with reference to this document.


commenced

The ANU will be reliant on Comcare to ensure the requirements of this criterion are met. Service Level Agreement (SLA) to document standards required.

Manager Injury Prevention and Rehabilitation 1-Jan-18 Not yet

commenced

3.14 The applicant will ensure that claim reviews are timely, made accurately and guided by equity, good conscience and the substantial merits of each case without regard to technicalities.

As part of the governance arrangements to be established, ANU will document arrangements for claims review meetings and quality assurance requirements as part of a governance structure. To be documented in ANU Claims Management System Manual.


ANU to ensure that the Service Level Agreement (SLA) with Comcare covers the requirements of this criterion.





3.15 The applicant will have a policy on the use of covert surveillance and will comply with its requirements. The policy must include: (i) on whose authority approval may be granted (ii) detailed instruction on the manner in which covert surveillance is to be conducted (iii) a requirement that any operative undertaking covert surveillance on behalf of the applicant has been issued with, and has agreed to, written instructions on the policy.

Existing ANU privacy arrangements will be reviewed to ensure the requirements of this criterion are met.

Manager Injury Prevention and Rehabilitation 1-Jun-17 Completed

Develop stand-alone ‘Surveillance; procedure as required – on advice from DHR and ANU Legal Office.

Manager Injury Prevention and Rehabilitation 1-Sep-17

Completed

Ensure procedure contains detail in which covert surveillance is to be conducted, with the authority for approval to be the ANU.

Manager Injury Prevention and Rehabilitation 1 Sep-17

Completed

Draft version to be provided to ANU Legal Office for review. Manager Injury Prevention and Rehabilitation 1-Feb-18

Not yet commenced

Draft version distributed for consultation. Manager Injury Prevention and Rehabilitation 1-Mar-18 Not yet

commenced Final draft provided to executive for endorsement / Responsible Officer for approval.

Manager Injury Prevention and Rehabilitation 1-Apr-18

Not yet commenced

Final draft provided to Policy Manager for publication. Manager Injury Prevention and Rehabilitation 1-May-18 Not yet

commenced Document detailed standard operating procedures for the request and approval of covert surveillance activities. To be included in the (ANU Claims Management System Manual).

Manager Injury Prevention and Rehabilitation 1-Jun-18

Not yet commenced




3.16 The applicant will maintain the confidentiality of information and apply legislative requirements.

Role responsibilities and access, specifications and functionality of the Figtree claims management system to undergo consideration testing prior to full implementation from the 1 July 2018.


Testing of the Figtree system to occur to ensure that it complies with privacy requirements.


Existing ANU documents will continue to be relevant, but will need to be reviewed and updated once it has been finalised how information will be stored and transferred within the Figtree system.


Documents to be developed as per detailed in 2.3. are to contain a reference to the employee’s privacy rights under the Australian Privacy Principles.


3.17 The applicant will maintain the relevant level of reporting, records and/or documentation to support its claims management system and legislative compliance.

Documents to be updated are: • System storage of determination, standard letters • Claim File Management and s59 of SRC Act • Retention of Archived Workers' Compensation Files & Material • Rehabilitation Management System Overview • WEG local protocol - Rehabilitation Manual


Figtree system to be tested to ensure that it meets with reporting and record management requirements.

- User acceptance testing (UAT) to commence. Manager Injury Prevention and Rehabilitation 1-Feb-18 In progress

- Feedback collated and revisions to system made. Manager Injury Prevention and Rehabilitation 1-Apr-18 In progress

- Figtree training plan activities to be conducted with Comcare and ANU staff.


- Full Figtree system implementation: claims management system. Manager Injury Prevention and Rehabilitation 1-Jul-18 In progress




4. Measurement and Evaluation

4.1 The applicant will monitor planned objectives and performance measures for core claims management activities.

As part of the WCSI transition, claims management measures will be integrated into existing reporting measures as per WHS and Rehabilitation reporting at the ANU.

- Establish revised reporting requirements. Manager Injury Prevention

and Rehabilitation 1-Jan-18 In progress

- Draft revised reporting requirements. Manager Injury Prevention

and Rehabilitation 1-Feb-18 Not yet commenced

- Obtain approval from Chief Operating Officer for revised reporting. Manager Injury Prevention

and Rehabilitation 1-Apr-18 Not yet commenced

- Commence revised reporting requirements. Manager Injury Prevention

and Rehabilitation 1-Jul-18 Not yet commenced

ANU to ensure that the dashboard reports provided by Figtree align with the objectives, targets and performance measures being developed.


- Dashboard reporting to be reviewed during UAT, and feedback provided re any revisions required.


commenced 4.2 The applicant will conduct an audit program—performed by competent personnel and in accordance with the requirements of the Commission and Comcare—to measure the performance of its claims management system.

Annual external audit schedule and SLA with BRM Risk Management Group, to be updated to include CMS audit - following transition to WCSI.


- Revise existing contract arrangement with BRM Risk Management to include claims management system audit schedule.


- Provide revised contract arrangement to ANU Legal Office for review. Manager Injury Prevention and Rehabilitation 1-May-18 Not yet

commenced - Provide final contract to Director Human resources for approval and

signing. Manager Injury Prevention and Rehabilitation 1-Jul-18

Not yet commenced




4.2 The applicant will conduct an audit program—performed by competent personnel and in accordance with the requirements of the Commission and Comcare—to measure the performance of its claims management system.

ANU audit procedure to be updated to reflect the requirements for claims management system audits, once the licence application decision is made.


commenced

The procedure ‘Work health and safety audit’ does mention the SRC Act and states that that the procedure describes how the University establishes, implements and maintains audits for its claims management systems it actually only contains a procedure for WHS audits. Audit to be updated to detail requirements.


commenced

ANU audit schedule 2016 – 2021 to be updated to reflect the requirements for claims management system audits, once the licence application decision is made.


commenced

4.3 Audit outcomes will be appropriately documented and actioned. The applicant will report to senior executive on its claims management system performance, including audit outcomes.

Following all external audits conducted, a corrective action plan will be developed and communicated to senior executive. Regular reporting of these improvement actions and progress is reported to senior management.


commenced

The Figtree system will be used, once implemented, to allocate actions and due dates for completion, for audit corrective actions established.


commenced

4.4 The applicant will communicate the outcomes and results of claims management system audits to its employees.

Results of CMS audit results to be communicated to staff as per current arrangements for rehabilitation and safety management system audits, including publication on the intranet site.





4.5 The applicant will provide the Commission or Comcare with reports as requested. This includes informing Comcare as soon as practicable of any proceedings brought by them, or against them, in relation to a matter arising in respect of a claim managed by them under the SRC Act.

ANU will inform Comcare of any proceeding brought by them, or against them, in relation to a matter arising in respect of a claim managed by ANU under the SRC Act.


commenced

ANU will provide requested reports. Manager Injury Prevention and Rehabilitation 1-Jul-18 Not yet

commenced It has been established that the Figtree System has a notification system built in to advise the SRCC of matters proceeding to the AAT – including a ‘flag’ for ‘scheme significant matters’. This information will be submitted to Comcare / the Commission through the Comcare data Warehouse monthly reporting.


commenced

The University’s Service Level Agreement (SLA) with Comcare will specify roles and responsibilities for the ANU Claims Management, including the collection and supply of data for the Commission Data Warehouse Specifications.


commenced

5. Review and Improvement 5.1 The applicant will analyse claims management system performance outcomes against documented objectives to determine areas requiring improvement and promote and implement continuous improvement strategies.

Governance framework (ANU Claims Management System Manual) to be developed to determine claims management system implementation, performance tracking and reviews will be conducted as per safety and rehabilitation management systems.
