{"id":"return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025","name":"Return to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2025","slug":"return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025","collection":"regulation","jurisdiction":"sa","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":237033,"registerId":"sa-return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025-current","compilationNumber":null,"startDate":"2026-04-06","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Return to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2025","content":"South Australia\nReturn to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2025\nunder the Return to Work Corporation of South Australia Act 1994\n\nContents\n1\tShort title\n2\tCommencement\n3\tInterpretation\n4\tAuthorisation of contracts\nSchedule 1—Repeal of Return to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2015\nLegislative history\n\n1—Short title\nThese regulations may be cited as the Return to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2025.\n2—Commencement\nThese regulations come into operation on 4 December 2025.\n3—Interpretation\nIn these regulations—\nClaims Agent's services means the services to be provided for the Corporation by a claims agent pursuant to the terms of a contract authorised under these regulations.\n4—Authorisation of contracts\n\t(1)\tFor the purposes of section 14(4)(d) of the Return to Work Corporation of South Australia Act 1994, a contract entered into by the Corporation with a private sector body (the Claims Agent) that involves the conferral of powers referred to in section 14(3) of that Act (other than the power to collect premiums, payments and fees) and includes (but is not necessarily limited to) the following terms, or terms that have the effect of providing for the following, is, subject to subregulation (2), an authorised contract:\n\t(a)\tan initial contractual term of not more than 5 years;\n\t(b)\ta right to extend, and further extend, for a period of (in each case) not more than 5 years (an extension period), with this right being subject to—\n\t(i)\tthe Claims Agent achieving a satisfactory level of performance, in the opinion of the Corporation, under the preceding term of the contract; and\n\t(ii)\tthe parties reaching agreement as to the financial terms to apply during the extension period;\n\t(c)\tthe Claims Agent is to—\n\t(i)\tmanage and determine claims under the Return to Work Act 2014; and\n\t(ii)\timplement or manage programs to assist or encourage the recovery and return to work of injured workers,\nas agent for the Corporation, with the scope of these functions to be specified in the contract;\n\t(d)\tthe Claims Agent may exercise such of the Corporation's statutory functions, powers and discretions as may be necessary for the performance of its functions under the contract;\n\t(e)\tfor the purpose of providing the Claims Agent's services, the Claims Agent is to be a delegate of the Corporation under section 17 of the Return to Work Corporation of South Australia Act 1994;\n\t(f)\tthe Corporation's liability to pay compensation under the Return to Work Act 2014 is not underwritten by the Claims Agent;\n\t(g)\tthe Claims Agent is not entitled to receive or invest premiums, payments or fees paid by employers under the Return to Work Act 2014;\n\t(h)\tthe number of claims to be managed or determined by the Claims Agent, and the identity of those claims, is to be determined in a manner specified by the Corporation from time to time;\n\t(i)\ta fee is to be paid by the Corporation to the Claims Agent in consideration of provision by the Claims Agent of the Claims Agent's services, and such fee—\n\t(i)\tmay be adjusted from time to time, having regard to the quality of the service provided by the Claims Agent, the degree to which the Claims Agent performs its functions successfully and other performance measures, including in relation to outcomes in respect of claims (or other outcomes relevant to the operation of the scheme established by the Return to Work Act 2014); and\n\t(ii)\tmay be adjusted by the Corporation for any other reason;\n\t(j)\tin determining whether the fee payable to the Claims Agent is to be adjusted under paragraph (i) (whether by increasing or decreasing the fee), regard may be had to any evaluation undertaken in accordance with the method referred to in subregulation (2)(b)(i);\n\t(k)\tthe Corporation may at any time, for such reason or reasons as may be specified in the contract, step in and take over from the Claims Agent the management or determination of a specific claim or claims of a particular class or classes;\n\t(l)\tin the event of a breach of the terms of the contract by the Claims Agent, the Corporation may—\n\t(i)\tterminate the contract; or\n\t(ii)\texercise such other remedies or sanctions as may be appropriate in the circumstances;\n\t(m)\tthe Corporation may, having regard to the performance by the Claims Agent of its services, or on any other basis agreed between the parties, terminate the Claims Agent's services, or a part of those services;\n\t(n)\tthe Claims Agent must not, without the approval of the Corporation (which may be withheld at the discretion of the Corporation), assign the contract (or the performance of any part of the contract) or make use of subcontractors;\n\t(o)\tthe Claims Agent, or a person employed or engaged by the Claims Agent, must act in accordance with section 185 of the Return to Work Act 2014, as it applies to the Corporation;\n\t(p)\tthe Claims Agent must, in carrying out the Claims Agent's services, use information technology systems of a kind specified by the Corporation on terms and conditions determined by the Corporation;\n\t(q)\tthe Claims Agent must prepare, maintain and implement an employee training program in accordance with any requirements of the Corporation and the program, or such part of the program as is specified by the Corporation, must be submitted to the Corporation for approval;\n\t(r)\tthe Claims Agent is not to provide the service of managing and determining claims under the contract until the Corporation has issued a certificate (a certificate of readiness) certifying that the Claims Agent is ready to provide that service.\n\t(2)\tA contract referred to in subregulation (1) must also—\n\t(a)\tregulate the use of external service providers by the Claims Agent; and\n\t(b)\tinclude the following:\n\t(i)\ta method for monitoring and evaluating the performance by the Claims Agent of the Claims Agent's services;\n\t(ii)\ta method, agreed between the parties, to be used by the Claims Agent for improving the Claims Agent's performance in delivery of the Claims Agent's services;\n\t(iii)\ta code of conduct (consistent with section 3 of the Return to Work Act 2014 and section 12 of the Return to Work Corporation of South Australia Act 1994) to be observed by the Claims Agent in respect of the performance of its obligations and functions under the contract.\n\t(3)\tA contract—\n\t(a)\textended pursuant to a term complying with subregulation (1)(b); or\n\t(b)\tassigned in accordance with subregulation (1)(n),\ncontinues as an authorised contract.\nSchedule 1—Repeal of Return to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2015\nThe Return to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2015 are repealed.\nLegislative history\nNotes\n\t•\tFor further information relating to the Act and subordinate legislation made under the Act see the Index of South Australian Statutes or www.legislation.sa.gov.au.\nPrincipal regulations\nYear\nNo\nReference\nCommencement\n2025\n15\nGazette 1.5.2025 p824 \n4.12.2025: r 2\n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"These regulations repeal the 2015 regulations (Schedule 1) and replace them with a new, prescriptive authorisation framework (s4) that specifies permissible contract terms: maximum initial and extension periods, performance‑linked renewals, delegation and step‑in powers, fee‑adjustment mechanisms, operational requirements (IT, training, monitoring) and limits on assignment and premium handling. The repeal plus explicit new terms substantively re‑specify how the Corporation may outsource claims management."},"complexity_factors":["Interplay with multiple Act provisions (authorisation under s14(4)(d); delegation under s17; obligations under s185) increases legal cross‑referencing.","Discretionary performance assessments and subjective 'satisfactory' performance standard used for extensions (s4(1)(b)(i)) create assessment and governance complexity.","Fee adjustment powers are broad and may be linked to evaluations and other reasons (s4(1)(i)–(j)), introducing financial‑incentive design issues.","Contract duration plus multiple extension rights (initial up to 5 years; extensions each up to 5 years) requires staged procurement and renewal planning (s4(1)(a)–(b)).","Corporation retains operational control: step‑in, takeover, termination and other sanctions (s4(1)(k)–(m)), producing variable operational risk for providers.","Controls on assignment and subcontracting with approval powers concentrate decision‑making with the Corporation (s4(1)(n)), affecting supplier arrangements.","Detailed operational requirements (use of specified IT systems, employee training programs, certificate of readiness) add compliance and implementation burden (s4(1)(p)–(q),(r); s4(2)).","Prohibitions on agent underwriting liability or handling premiums clarify financial boundaries but require contract drafting and oversight (s4(1)(f)–(g)).","Repeal of the 2015 regulations (Schedule 1) signals implementation and transitional work for existing arrangements."],"plain_english_summary":"These regulations authorise the Return to Work Corporation to contract private \"Claims Agents\" to manage and determine workers‑compensation claims and run return‑to‑work programs, setting contract mechanics such as initial terms (≤5 years), extensions (≤5 years subject to performance and agreed fees), delegation of statutory powers, and the Corporation's continuing liability for compensation (s4(1)). Contracts must include performance monitoring, training and IT requirements, limits on receiving premiums or assigning work, and give the Corporation discretion to adjust fees, step in, or terminate services."},"issue_detection":{"absurdities":[],"contradictions":[]},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"Scope cannot be assessed as the legislative text was not retrievable. No determination can be made about whether the regulations' scope diverged from their original intent."},"complexity_factors":["Complexity cannot be fully assessed due to unavailable legislative text","Workers' compensation regulatory frameworks are inherently multi-layered, typically referencing a parent Act and multiple interacting instruments","Contractual arrangements between government corporations and private claims managers can involve complex procurement, liability, and performance obligations","Score reflects a conservative baseline estimate given the regulatory subject matter and title alone"],"plain_english_summary":"These regulations set rules under South Australia’s Return to Work scheme for how ReturnToWorkSA contracts with external providers to manage injured workers’ claims. They affect injured workers, claims agents, employers and service providers because they shape contractual responsibilities, claim handling and parties’ rights and obligations."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original scope as a procedural framework for authorising outsourcing contracts. It replaces the 2015 regulations with substantively similar provisions governing the same subject matter (claims management contractual arrangements). The detailed prescription of contract terms reflects the same regulatory intent: enabling privatisation of claims management while retaining government control and accountability."},"complexity_factors":["Single defined term ('Claims Agent's services') in interpretation section, but heavy reliance on external statutory references","18 specific contractual requirements in subregulation (1) (paragraphs a-r), creating a detailed checklist format","Cross-references to three separate Acts: Return to Work Corporation of South Australia Act 1994, Return to Work Act 2014, and implied references to general contract law","Nested conditional logic in extension provisions: extensions depend on both performance satisfaction AND financial agreement (subregulation (1)(b))","Performance-based fee adjustment mechanism with multiple discretionary factors (subregulation (1)(i)-(j))","Multiple termination triggers: breach (l), general performance (m), and step-in powers (k)","Delegation framework requiring the Claims Agent to be a 'delegate' under section 17 of the parent Act","Prohibition on assignment/subcontracting subject to Corporation discretion (subregulation (1)(n))","Schedule 1 contains a simple repeal of predecessor regulations without transitional provisions"],"plain_english_summary":"**What this legislation does:**\n\nThese regulations set the rules for how South Australia's Return to Work Corporation (the government body that handles workers' compensation) can hire private companies to manage injury claims on its behalf.\n\n**Who it affects:**\n\n- **The Return to Work Corporation** – the state government agency that must follow these rules when outsourcing claims management\n- **Private claims management companies** (called \"Claims Agents\") – businesses that want to win contracts to process workers' compensation claims\n- **Injured workers** – whose claims may be handled by these private agents rather than government staff\n- **Employers** – who pay premiums into the workers' compensation scheme\n\n**Key requirements:**\n\n- Contracts with private agents can last up to **5 years initially**, with possible extensions of up to 5 years each\n- Extensions only happen if the agent performs well and both sides agree on money terms\n- Agents must manage claims under the *Return to Work Act 2014* and run programs to help injured workers recover and get back to work\n- Agents can exercise some government powers but **cannot** underwrite compensation payments or handle employer premiums\n- The Corporation decides which specific claims each agent handles\n- Fees paid to agents can go up or down based on **performance** – including how well they help workers recover\n- The Corporation can **step in and take over** any claim at any time\n- Agents must use government-approved computer systems and training programs\n- Agents cannot hand work to subcontractors without permission\n- Agents must follow a code of conduct and cannot start work until the Corporation issues a \"certificate of readiness\"\n\n**Why it matters:**\n\nThese regulations protect injured workers by ensuring private companies handling their claims meet strict standards. The performance-linked fees and \"step-in\" powers give the government strong oversight. The rules also ensure that even when claims are privatised, the government remains ultimately responsible for compensation payments – private agents don't take on that financial risk."}},"importantCases":[],"_links":{"self":"/api/acts/return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025","history":"/api/acts/return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025/history","analysis":"/api/acts/return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025/analysis","conflicts":"/api/acts/return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025/conflicts","importantCases":"/api/acts/return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025/important-cases","documents":"/api/acts/return-to-work-corporation-claims-management-contractual-arrangements-regulations-2025/documents"}}