{"id":"qld:sl-2025-0116","name":"Workers’ Compensation and Rehabilitation Regulation 2025","slug":"workers-compensation-and-rehabilitation-regulation-2025","collection":"regulation","jurisdiction":"qld","status":"in_force","isInForce":true,"actNumber":"116 of 2025","makingDate":null,"administeringDepartment":null,"currentVersion":{"id":173680,"registerId":"qld-sl-2025-0116-current","compilationNumber":null,"startDate":"2026-04-05","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"pt.1","sectionType":"part","heading":"Preliminary","content":"# Preliminary","sortOrder":0},{"sectionNumber":"sec.1","sectionType":"section","heading":"Short title","content":"### sec.1 Short title\n\nThis regulation may be cited as the Workers’ Compensation and Rehabilitation Regulation 2025 .","sortOrder":1},{"sectionNumber":"sec.2","sectionType":"section","heading":"Commencement","content":"### sec.2 Commencement\n\nThis regulation commences on 1 September 2025.","sortOrder":2},{"sectionNumber":"sec.3","sectionType":"section","heading":"Definitions","content":"### sec.3 Definitions\n\nSchedule 18 defines particular words used in this regulation.","sortOrder":3},{"sectionNumber":"sec.4","sectionType":"section","heading":"WorkCover’s capital adequacy— Act , s 453","content":"### sec.4 WorkCover’s capital adequacy— Act , s 453\n\nFor section 453 (b) of the Act , WorkCover maintains capital adequacy if WorkCover’s total assets are at least equal to its total liabilities.","sortOrder":4},{"sectionNumber":"pt.2","sectionType":"part","heading":"Employer insurance","content":"# Employer insurance","sortOrder":5},{"sectionNumber":"pt.2-div.1","sectionType":"division","heading":"Policies and premium assessments","content":"## Policies and premium assessments","sortOrder":6},{"sectionNumber":"sec.5","sectionType":"section","heading":"Application for policy","content":"### sec.5 Application for policy\n\nAn application for a WorkCover policy must be made to WorkCover in the approved form.","sortOrder":7},{"sectionNumber":"sec.6","sectionType":"section","heading":"Policies and renewals","content":"### sec.6 Policies and renewals\n\nOn payment of the premium shown as payable in a premium notice issued by WorkCover to an employer, WorkCover must issue to the employer a policy, in the approved form, for the period of insurance stated in the notice.\nA policy has no effect until—\nWorkCover receives the premium payable to WorkCover for the policy or the policy’s renewal; or\nWorkCover approves an instalment plan under section 10 .\n(sec.6-ssec.1) On payment of the premium shown as payable in a premium notice issued by WorkCover to an employer, WorkCover must issue to the employer a policy, in the approved form, for the period of insurance stated in the notice.\n(sec.6-ssec.2) A policy has no effect until— WorkCover receives the premium payable to WorkCover for the policy or the policy’s renewal; or WorkCover approves an instalment plan under section 10 .\n- (a) WorkCover receives the premium payable to WorkCover for the policy or the policy’s renewal; or\n- (b) WorkCover approves an instalment plan under section 10 .","sortOrder":8},{"sectionNumber":"sec.7","sectionType":"section","heading":"Assessment of premium","content":"### sec.7 Assessment of premium\n\nWorkCover must assess the premium payable under a policy for each period of insurance shown in a premium notice.\nThis section does not apply to a policy for household workers.\n(sec.7-ssec.1) WorkCover must assess the premium payable under a policy for each period of insurance shown in a premium notice.\n(sec.7-ssec.2) This section does not apply to a policy for household workers.","sortOrder":9},{"sectionNumber":"sec.8","sectionType":"section","heading":"Declaration of wages","content":"### sec.8 Declaration of wages\n\nEach employer, other than a self-insurer, must, on or before 31 August in each year, give WorkCover a declaration of wages so WorkCover can assess the employer’s premium.\nThe declaration must be in—\nthe approved form; or\nwith WorkCover’s approval—another form acceptable to WorkCover.\nIf the employer gives WorkCover a declaration of wages after 31 August in a year, the employer must pay the additional premium stated in schedule 1 opposite the day when the employer gives WorkCover the declaration.\nThis section does not apply if the employer employs only household workers.\n(sec.8-ssec.1) Each employer, other than a self-insurer, must, on or before 31 August in each year, give WorkCover a declaration of wages so WorkCover can assess the employer’s premium.\n(sec.8-ssec.2) The declaration must be in— the approved form; or with WorkCover’s approval—another form acceptable to WorkCover.\n(sec.8-ssec.3) If the employer gives WorkCover a declaration of wages after 31 August in a year, the employer must pay the additional premium stated in schedule 1 opposite the day when the employer gives WorkCover the declaration.\n(sec.8-ssec.4) This section does not apply if the employer employs only household workers.\n- (a) the approved form; or\n- (b) with WorkCover’s approval—another form acceptable to WorkCover.","sortOrder":10},{"sectionNumber":"sec.9","sectionType":"section","heading":"Value of board and lodging","content":"### sec.9 Value of board and lodging\n\nThis section applies if a worker’s entitlements during a period of insurance include board provided by the employer.\nThe board is taken to be wages paid, or provided, by the employer to the worker.\nFor each week of board provided by the employer, the amount of wages under subsection (2) is the higher of the following—\nthe value of the board;\neither—\nif an industrial instrument that provides for a weekly allowance for board applies to the employment of the worker—the amount of the weekly allowance stated in the industrial instrument; or\nif subparagraph (i) does not apply—6% of QOTE.\nIn this section—\nboard means accommodation, meals, laundry services or any other entitlement having a monetary value provided when lodging.\n(sec.9-ssec.1) This section applies if a worker’s entitlements during a period of insurance include board provided by the employer.\n(sec.9-ssec.2) The board is taken to be wages paid, or provided, by the employer to the worker.\n(sec.9-ssec.3) For each week of board provided by the employer, the amount of wages under subsection (2) is the higher of the following— the value of the board; either— if an industrial instrument that provides for a weekly allowance for board applies to the employment of the worker—the amount of the weekly allowance stated in the industrial instrument; or if subparagraph (i) does not apply—6% of QOTE.\n(sec.9-ssec.4) In this section— board means accommodation, meals, laundry services or any other entitlement having a monetary value provided when lodging.\n- (a) the value of the board;\n- (b) either— (i) if an industrial instrument that provides for a weekly allowance for board applies to the employment of the worker—the amount of the weekly allowance stated in the industrial instrument; or (ii) if subparagraph (i) does not apply—6% of QOTE.\n- (i) if an industrial instrument that provides for a weekly allowance for board applies to the employment of the worker—the amount of the weekly allowance stated in the industrial instrument; or\n- (ii) if subparagraph (i) does not apply—6% of QOTE.\n- (i) if an industrial instrument that provides for a weekly allowance for board applies to the employment of the worker—the amount of the weekly allowance stated in the industrial instrument; or\n- (ii) if subparagraph (i) does not apply—6% of QOTE.","sortOrder":11},{"sectionNumber":"sec.10","sectionType":"section","heading":"Payment of premium by instalments","content":"### sec.10 Payment of premium by instalments\n\nWorkCover may accept payment of a premium by instalments under an instalment plan approved by WorkCover if WorkCover is satisfied that payment of the premium by the due date would impose financial hardship on the employer.\nThe instalment plan is subject to the following conditions—\ninterest at an annual rate specified by WorkCover’s board by gazette notice must be added to the amount of each instalment;\ninterest must be calculated from the due date;\nthe interest rate that applies at the start of the instalment plan remains constant until the plan ends;\non approval of the instalment plan, the employer must, if required by WorkCover, enter into a payment arrangement acceptable to WorkCover;\nif an instalment of premium is not paid on or before the due date for payment of the instalment—\nthe total amount of unpaid instalments and interest on unpaid instalments to that day immediately becomes payable to WorkCover; and\nan additional premium under section 11 applies to the unpaid instalments and interest mentioned in subparagraph (i) ; and\nthe policy for which the premium is payable stops having effect.\nSee also section 48 of the Act for breach of the employer’s obligation to insure.\n(sec.10-ssec.1) WorkCover may accept payment of a premium by instalments under an instalment plan approved by WorkCover if WorkCover is satisfied that payment of the premium by the due date would impose financial hardship on the employer.\n(sec.10-ssec.2) The instalment plan is subject to the following conditions— interest at an annual rate specified by WorkCover’s board by gazette notice must be added to the amount of each instalment; interest must be calculated from the due date; the interest rate that applies at the start of the instalment plan remains constant until the plan ends; on approval of the instalment plan, the employer must, if required by WorkCover, enter into a payment arrangement acceptable to WorkCover; if an instalment of premium is not paid on or before the due date for payment of the instalment— the total amount of unpaid instalments and interest on unpaid instalments to that day immediately becomes payable to WorkCover; and an additional premium under section 11 applies to the unpaid instalments and interest mentioned in subparagraph (i) ; and the policy for which the premium is payable stops having effect. See also section 48 of the Act for breach of the employer’s obligation to insure.\n- (a) interest at an annual rate specified by WorkCover’s board by gazette notice must be added to the amount of each instalment;\n- (b) interest must be calculated from the due date;\n- (c) the interest rate that applies at the start of the instalment plan remains constant until the plan ends;\n- (d) on approval of the instalment plan, the employer must, if required by WorkCover, enter into a payment arrangement acceptable to WorkCover;\n- (e) if an instalment of premium is not paid on or before the due date for payment of the instalment— (i) the total amount of unpaid instalments and interest on unpaid instalments to that day immediately becomes payable to WorkCover; and (ii) an additional premium under section 11 applies to the unpaid instalments and interest mentioned in subparagraph (i) ; and (iii) the policy for which the premium is payable stops having effect. Note— See also section 48 of the Act for breach of the employer’s obligation to insure.\n- (i) the total amount of unpaid instalments and interest on unpaid instalments to that day immediately becomes payable to WorkCover; and\n- (ii) an additional premium under section 11 applies to the unpaid instalments and interest mentioned in subparagraph (i) ; and\n- (iii) the policy for which the premium is payable stops having effect.\n- (i) the total amount of unpaid instalments and interest on unpaid instalments to that day immediately becomes payable to WorkCover; and\n- (ii) an additional premium under section 11 applies to the unpaid instalments and interest mentioned in subparagraph (i) ; and\n- (iii) the policy for which the premium is payable stops having effect.","sortOrder":12},{"sectionNumber":"sec.11","sectionType":"section","heading":"Additional premium for late payment of premium— Act , ss 61 and 62","content":"### sec.11 Additional premium for late payment of premium— Act , ss 61 and 62\n\nThis section applies if an employer does not pay WorkCover, on or before the due date—\nthe amount stated in a premium notice; or\nthe amount by which a final assessment of an amount of premium by an industrial magistrate or the industrial court is more than the amount of premium paid under section 551 (4) of the Act .\nFor sections 61 and 62 of the Act , the additional premium payable is—\nif the amount mentioned in subsection (1) is paid to WorkCover within 30 days after the due date—5% of the amount; or\nif the amount mentioned in subsection (1) is paid to WorkCover after 30 days but within 60 days after the due date—10% of the amount; or\nif the amount mentioned in subsection (1) is paid to WorkCover after 60 days after the due date or if the amount is not paid—10% of the amount plus interest at the annual rate mentioned in section 10 (2) (a) for the period that—\nstarts on the due date, or a later date decided by WorkCover; and\nends on the day the amount mentioned in subsection (1) and the additional premium under paragraph (a) or (b) is paid to WorkCover.\nThis section does not apply if—\nthe employer employs only household workers; or\nWorkCover has approved an instalment plan under section 10 and the employer complies with the plan.\nIn this section—\ndue date means—\nfor an amount mentioned in subsection (1) (a) —the due date stated in the premium notice; or\nfor an amount mentioned in subsection (1) (b) —the last day of the period mentioned in section 62 (1) (b) of the Act .\n(sec.11-ssec.1) This section applies if an employer does not pay WorkCover, on or before the due date— the amount stated in a premium notice; or the amount by which a final assessment of an amount of premium by an industrial magistrate or the industrial court is more than the amount of premium paid under section 551 (4) of the Act .\n(sec.11-ssec.2) For sections 61 and 62 of the Act , the additional premium payable is— if the amount mentioned in subsection (1) is paid to WorkCover within 30 days after the due date—5% of the amount; or if the amount mentioned in subsection (1) is paid to WorkCover after 30 days but within 60 days after the due date—10% of the amount; or if the amount mentioned in subsection (1) is paid to WorkCover after 60 days after the due date or if the amount is not paid—10% of the amount plus interest at the annual rate mentioned in section 10 (2) (a) for the period that— starts on the due date, or a later date decided by WorkCover; and ends on the day the amount mentioned in subsection (1) and the additional premium under paragraph (a) or (b) is paid to WorkCover.\n(sec.11-ssec.3) This section does not apply if— the employer employs only household workers; or WorkCover has approved an instalment plan under section 10 and the employer complies with the plan.\n(sec.11-ssec.4) In this section— due date means— for an amount mentioned in subsection (1) (a) —the due date stated in the premium notice; or for an amount mentioned in subsection (1) (b) —the last day of the period mentioned in section 62 (1) (b) of the Act .\n- (a) the amount stated in a premium notice; or\n- (b) the amount by which a final assessment of an amount of premium by an industrial magistrate or the industrial court is more than the amount of premium paid under section 551 (4) of the Act .\n- (a) if the amount mentioned in subsection (1) is paid to WorkCover within 30 days after the due date—5% of the amount; or\n- (b) if the amount mentioned in subsection (1) is paid to WorkCover after 30 days but within 60 days after the due date—10% of the amount; or\n- (c) if the amount mentioned in subsection (1) is paid to WorkCover after 60 days after the due date or if the amount is not paid—10% of the amount plus interest at the annual rate mentioned in section 10 (2) (a) for the period that— (i) starts on the due date, or a later date decided by WorkCover; and (ii) ends on the day the amount mentioned in subsection (1) and the additional premium under paragraph (a) or (b) is paid to WorkCover.\n- (i) starts on the due date, or a later date decided by WorkCover; and\n- (ii) ends on the day the amount mentioned in subsection (1) and the additional premium under paragraph (a) or (b) is paid to WorkCover.\n- (i) starts on the due date, or a later date decided by WorkCover; and\n- (ii) ends on the day the amount mentioned in subsection (1) and the additional premium under paragraph (a) or (b) is paid to WorkCover.\n- (a) the employer employs only household workers; or\n- (b) WorkCover has approved an instalment plan under section 10 and the employer complies with the plan.\n- (a) for an amount mentioned in subsection (1) (a) —the due date stated in the premium notice; or\n- (b) for an amount mentioned in subsection (1) (b) —the last day of the period mentioned in section 62 (1) (b) of the Act .","sortOrder":13},{"sectionNumber":"sec.12","sectionType":"section","heading":"Premium for ascertaining appeal court— Act , s 569","content":"### sec.12 Premium for ascertaining appeal court— Act , s 569\n\nFor section 569 (2) (a) of the Act , the employer’s premium, for a financial year, is the amount calculated using the formula—\nwhere—\nrate means the rate for the employer’s industry or business specified by WorkCover by gazette notice under section 54 (2) of the Act , or decided by WorkCover under section 54 (3) of the Act , that applies to the financial year.\nwages means—\nthe wages paid, or provided, by the employer for the preceding financial year; or\nif the employer has been insured for only part of a financial year—a reasonable estimate of the wages that would have been paid, or provided, by the employer for the financial year.\n- (a) the wages paid, or provided, by the employer for the preceding financial year; or\n- (b) if the employer has been insured for only part of a financial year—a reasonable estimate of the wages that would have been paid, or provided, by the employer for the financial year.","sortOrder":14},{"sectionNumber":"sec.13","sectionType":"section","heading":"Former employer may apply to cancel policy","content":"### sec.13 Former employer may apply to cancel policy\n\nThis section applies if a person (the former employer ) wants to cancel a policy because the former employer has stopped employing workers.\nThe former employer must give WorkCover a written notice stating—\nthat the former employer wants to cancel the policy because the former employer has stopped employing workers; and\nthe day the former employer stopped employing workers (the end day ); and\nthe wages paid, or provided, by the former employer during the period that—\nstarts on 1 July last preceding the end day; and\nends on the end day; and\nthe address to which any document addressed to the former employer may be sent.\nThis section does not apply if the person employed only household workers.\n(sec.13-ssec.1) This section applies if a person (the former employer ) wants to cancel a policy because the former employer has stopped employing workers.\n(sec.13-ssec.2) The former employer must give WorkCover a written notice stating— that the former employer wants to cancel the policy because the former employer has stopped employing workers; and the day the former employer stopped employing workers (the end day ); and the wages paid, or provided, by the former employer during the period that— starts on 1 July last preceding the end day; and ends on the end day; and the address to which any document addressed to the former employer may be sent.\n(sec.13-ssec.3) This section does not apply if the person employed only household workers.\n- (a) that the former employer wants to cancel the policy because the former employer has stopped employing workers; and\n- (b) the day the former employer stopped employing workers (the end day ); and\n- (c) the wages paid, or provided, by the former employer during the period that— (i) starts on 1 July last preceding the end day; and (ii) ends on the end day; and\n- (i) starts on 1 July last preceding the end day; and\n- (ii) ends on the end day; and\n- (d) the address to which any document addressed to the former employer may be sent.\n- (i) starts on 1 July last preceding the end day; and\n- (ii) ends on the end day; and","sortOrder":15},{"sectionNumber":"sec.14","sectionType":"section","heading":"Cancellation of policy if workers no longer employed","content":"### sec.14 Cancellation of policy if workers no longer employed\n\nThis section applies if—\na person (the former employer ) has given WorkCover a written notice under section 13 (2) ; or\nWorkCover is satisfied, after making reasonable enquiries, that a person (also the former employer ) has stopped employing workers.\nWorkCover may cancel the former employer’s policy.\nWorkCover must assess the amount of premium payable by the former employer for the period during which the Act required the former employer to hold a policy.\nIf the premium paid by the former employer for the last employment period was more than the amount of premium assessed under subsection (3) , WorkCover must refund the amount overpaid to the former employer.\nIf the premium paid by the former employer for the last employment period was less than the amount of premium assessed under subsection (3) , the former employer must pay WorkCover the amount of the deficit on or before the due date under a premium notice issued for the amount of the deficit.\nSee also chapter 2 , part 3 , division 3 of the Act for circumstances in which additional premiums may be payable by employers or former employers.\nIn this section—\nlast employment period means—\nfor a former employer mentioned in subsection (1) (a) —the period mentioned in section 13 (2) (c) ; or\nfor a former employer mentioned in subsection (1) (b) —the period that—\nstarts on 1 July last preceding the day WorkCover is satisfied the former employer stopped employing workers (the end day ); and\nends on the end day.\n(sec.14-ssec.1) This section applies if— a person (the former employer ) has given WorkCover a written notice under section 13 (2) ; or WorkCover is satisfied, after making reasonable enquiries, that a person (also the former employer ) has stopped employing workers.\n(sec.14-ssec.2) WorkCover may cancel the former employer’s policy.\n(sec.14-ssec.3) WorkCover must assess the amount of premium payable by the former employer for the period during which the Act required the former employer to hold a policy.\n(sec.14-ssec.4) If the premium paid by the former employer for the last employment period was more than the amount of premium assessed under subsection (3) , WorkCover must refund the amount overpaid to the former employer.\n(sec.14-ssec.5) If the premium paid by the former employer for the last employment period was less than the amount of premium assessed under subsection (3) , the former employer must pay WorkCover the amount of the deficit on or before the due date under a premium notice issued for the amount of the deficit. See also chapter 2 , part 3 , division 3 of the Act for circumstances in which additional premiums may be payable by employers or former employers.\n(sec.14-ssec.6) In this section— last employment period means— for a former employer mentioned in subsection (1) (a) —the period mentioned in section 13 (2) (c) ; or for a former employer mentioned in subsection (1) (b) —the period that— starts on 1 July last preceding the day WorkCover is satisfied the former employer stopped employing workers (the end day ); and ends on the end day.\n- (a) a person (the former employer ) has given WorkCover a written notice under section 13 (2) ; or\n- (b) WorkCover is satisfied, after making reasonable enquiries, that a person (also the former employer ) has stopped employing workers.\n- (a) for a former employer mentioned in subsection (1) (a) —the period mentioned in section 13 (2) (c) ; or\n- (b) for a former employer mentioned in subsection (1) (b) —the period that— (i) starts on 1 July last preceding the day WorkCover is satisfied the former employer stopped employing workers (the end day ); and (ii) ends on the end day.\n- (i) starts on 1 July last preceding the day WorkCover is satisfied the former employer stopped employing workers (the end day ); and\n- (ii) ends on the end day.\n- (i) starts on 1 July last preceding the day WorkCover is satisfied the former employer stopped employing workers (the end day ); and\n- (ii) ends on the end day.","sortOrder":16},{"sectionNumber":"pt.2-div.2","sectionType":"division","heading":"Employer excess","content":"## Employer excess","sortOrder":17},{"sectionNumber":"sec.15","sectionType":"section","heading":"Excess period— Act , s 65","content":"### sec.15 Excess period— Act , s 65\n\nFor section 65 (2) of the Act , the amount prescribed in relation to a worker who sustains an injury for which compensation is payable is the lesser of the following—\nQOTE;\nthe amount of the weekly payment of compensation payable to the worker under chapter 3 , part 9 of the Act .\n- (a) QOTE;\n- (b) the amount of the weekly payment of compensation payable to the worker under chapter 3 , part 9 of the Act .","sortOrder":18},{"sectionNumber":"pt.2-div.3","sectionType":"division","heading":"Self-insurance","content":"## Self-insurance","sortOrder":19},{"sectionNumber":"sec.16","sectionType":"section","heading":"Definitions for division","content":"### sec.16 Definitions for division\n\nIn this division—\nannual levy means the amount payable under section 81 of the Act .\nprovisional annual levy see section 19 (2) (a) .\nspecified date see section 18 (2) .","sortOrder":20},{"sectionNumber":"sec.17","sectionType":"section","heading":"Application fee— Act , s 70","content":"### sec.17 Application fee— Act , s 70\n\nFor section 70 (c) of the Act , the fee prescribed is—\nfor a single employer—15,000 fee units; or\nfor a group employer—20,000 fee units.\n- (a) for a single employer—15,000 fee units; or\n- (b) for a group employer—20,000 fee units.","sortOrder":21},{"sectionNumber":"sec.18","sectionType":"section","heading":"Annual levy— Act , s 81","content":"### sec.18 Annual levy— Act , s 81\n\nFor section 81 (2) of the Act , this section prescribes the way to calculate a self-insurer’s levy for each financial year or part of a financial year of a licence.\nThe Regulator must specify a date (the specified date ) for a financial year and publish the date in the gazette.\nThe self-insurer’s levy for each financial year or part of a financial year of a licence must be calculated using the formula—\nwhere—\nestimated claims liability means the self-insurer’s estimated claims liability most recently agreed by the Regulator and the self-insurer under section 67 , or most recently decided by the arbiter under section 102 , before the specified date for the financial year.\nrate means the rate published by the Regulator under section 81(6) of the Act for the particular financial year.\n(sec.18-ssec.1) For section 81 (2) of the Act , this section prescribes the way to calculate a self-insurer’s levy for each financial year or part of a financial year of a licence.\n(sec.18-ssec.2) The Regulator must specify a date (the specified date ) for a financial year and publish the date in the gazette.\n(sec.18-ssec.3) The self-insurer’s levy for each financial year or part of a financial year of a licence must be calculated using the formula— where— estimated claims liability means the self-insurer’s estimated claims liability most recently agreed by the Regulator and the self-insurer under section 67 , or most recently decided by the arbiter under section 102 , before the specified date for the financial year. rate means the rate published by the Regulator under section 81(6) of the Act for the particular financial year.","sortOrder":22},{"sectionNumber":"sec.19","sectionType":"section","heading":"Provisional annual levy—not agreed or decided","content":"### sec.19 Provisional annual levy—not agreed or decided\n\nThis section applies in relation to a self-insurer if, on the specified date—\nthe self-insurer’s estimated claims liability for a year has been calculated by the appointed actuary under section 62 ; but\nthe Regulator and the self-insurer have not agreed on the amount of the self-insurer’s estimated claims liability under section 67 and the arbiter has not decided the amount of the self-insurer’s estimated claims liability under section 102 .\nThe Regulator may use the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 to—\ncalculate the self-insurer’s annual levy under section 18 (the provisional annual levy ); and\ngive the self-insurer written notice of the amount of the provisional annual levy under section 81 (7) of the Act .\n(sec.19-ssec.1) This section applies in relation to a self-insurer if, on the specified date— the self-insurer’s estimated claims liability for a year has been calculated by the appointed actuary under section 62 ; but the Regulator and the self-insurer have not agreed on the amount of the self-insurer’s estimated claims liability under section 67 and the arbiter has not decided the amount of the self-insurer’s estimated claims liability under section 102 .\n(sec.19-ssec.2) The Regulator may use the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 to— calculate the self-insurer’s annual levy under section 18 (the provisional annual levy ); and give the self-insurer written notice of the amount of the provisional annual levy under section 81 (7) of the Act .\n- (a) the self-insurer’s estimated claims liability for a year has been calculated by the appointed actuary under section 62 ; but\n- (b) the Regulator and the self-insurer have not agreed on the amount of the self-insurer’s estimated claims liability under section 67 and the arbiter has not decided the amount of the self-insurer’s estimated claims liability under section 102 .\n- (a) calculate the self-insurer’s annual levy under section 18 (the provisional annual levy ); and\n- (b) give the self-insurer written notice of the amount of the provisional annual levy under section 81 (7) of the Act .","sortOrder":23},{"sectionNumber":"sec.20","sectionType":"section","heading":"Actual annual levy—agreed","content":"### sec.20 Actual annual levy—agreed\n\nThis section applies if—\nthe Regulator gave a self-insurer a written notice under section 19 (2) (b) stating the amount of the provisional annual levy based on the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 ; and\nthe Regulator and the self-insurer have agreed under section 67 on the amount of the self-insurer’s estimated claims liability.\nThe Regulator must give the self-insurer written notice of the amount of the annual levy (the actual annual levy ) under section 81 (7) of the Act based on the agreed amount within 14 days after the Regulator and the self-insurer agree to the amount.\nIf the actual annual levy is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the actual annual levy and the amount paid as the provisional annual levy.\nIf the actual annual levy is less than the provisional annual levy, the Regulator must pay the self-insurer the difference between the actual annual levy and the amount paid as the provisional annual levy.\n(sec.20-ssec.1) This section applies if— the Regulator gave a self-insurer a written notice under section 19 (2) (b) stating the amount of the provisional annual levy based on the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 ; and the Regulator and the self-insurer have agreed under section 67 on the amount of the self-insurer’s estimated claims liability.\n(sec.20-ssec.2) The Regulator must give the self-insurer written notice of the amount of the annual levy (the actual annual levy ) under section 81 (7) of the Act based on the agreed amount within 14 days after the Regulator and the self-insurer agree to the amount.\n(sec.20-ssec.3) If the actual annual levy is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the actual annual levy and the amount paid as the provisional annual levy.\n(sec.20-ssec.4) If the actual annual levy is less than the provisional annual levy, the Regulator must pay the self-insurer the difference between the actual annual levy and the amount paid as the provisional annual levy.\n- (a) the Regulator gave a self-insurer a written notice under section 19 (2) (b) stating the amount of the provisional annual levy based on the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 ; and\n- (b) the Regulator and the self-insurer have agreed under section 67 on the amount of the self-insurer’s estimated claims liability.","sortOrder":24},{"sectionNumber":"sec.21","sectionType":"section","heading":"Actual annual levy—not agreed but decided","content":"### sec.21 Actual annual levy—not agreed but decided\n\nThis section applies if—\nthe Regulator gave a self-insurer a written notice under section 19 (2) (b) stating the amount of the provisional annual levy based on the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 ; and\nthe Regulator and the self-insurer have not agreed under section 67 on the amount of the self-insurer’s estimated claims liability; and\nthe arbiter has decided the amount of the self-insurer’s estimated claims liability under section 102 and the amount (the decided adjusted amount ) is not the same as the amount of the self-insurer’s estimated claims liability used to calculate the provisional annual levy.\nThe Regulator must give the self-insurer written notice of the amount of the annual levy (the actual annual levy ) under section 81 (7) of the Act based on the decided adjusted amount within 14 days after the Regulator receives notice of the amount under section 102 (4) .\nIf the actual annual levy is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the actual annual levy and the amount paid as the provisional annual levy.\nIf the actual annual levy is less than the provisional annual levy, the Regulator must pay the self-insurer the difference between the actual annual levy and the amount paid as the provisional annual levy.\n(sec.21-ssec.1) This section applies if— the Regulator gave a self-insurer a written notice under section 19 (2) (b) stating the amount of the provisional annual levy based on the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 ; and the Regulator and the self-insurer have not agreed under section 67 on the amount of the self-insurer’s estimated claims liability; and the arbiter has decided the amount of the self-insurer’s estimated claims liability under section 102 and the amount (the decided adjusted amount ) is not the same as the amount of the self-insurer’s estimated claims liability used to calculate the provisional annual levy.\n(sec.21-ssec.2) The Regulator must give the self-insurer written notice of the amount of the annual levy (the actual annual levy ) under section 81 (7) of the Act based on the decided adjusted amount within 14 days after the Regulator receives notice of the amount under section 102 (4) .\n(sec.21-ssec.3) If the actual annual levy is more than the provisional annual levy, the self-insurer must pay the Regulator the difference between the actual annual levy and the amount paid as the provisional annual levy.\n(sec.21-ssec.4) If the actual annual levy is less than the provisional annual levy, the Regulator must pay the self-insurer the difference between the actual annual levy and the amount paid as the provisional annual levy.\n- (a) the Regulator gave a self-insurer a written notice under section 19 (2) (b) stating the amount of the provisional annual levy based on the amount of the self-insurer’s estimated claims liability as calculated by the appointed actuary under section 62 ; and\n- (b) the Regulator and the self-insurer have not agreed under section 67 on the amount of the self-insurer’s estimated claims liability; and\n- (c) the arbiter has decided the amount of the self-insurer’s estimated claims liability under section 102 and the amount (the decided adjusted amount ) is not the same as the amount of the self-insurer’s estimated claims liability used to calculate the provisional annual levy.","sortOrder":25},{"sectionNumber":"sec.22","sectionType":"section","heading":"Additional amount if levy not paid before due date— Act , s 82","content":"### sec.22 Additional amount if levy not paid before due date— Act , s 82\n\nFor section 82 (1) of the Act , the additional amount payable by a self-insurer in relation to the late payment of an amount of annual levy is—\nif the amount is paid to the Regulator within 30 days after the due date—5% of the amount; or\nif the amount is paid to the Regulator after 30 days but within 60 days after the due date—10% of the amount; or\nif the amount is paid to the Regulator after 60 days after the due date or if the amount is not paid—10% of the amount plus interest at a rate specified by the Regulator by gazette notice for the period that—\nstarts on the due date, or a later date decided by the Regulator; and\nends on the day the amount of the annual levy and the additional amount under paragraph (a) or (b) is paid to the Regulator.\n- (a) if the amount is paid to the Regulator within 30 days after the due date—5% of the amount; or\n- (b) if the amount is paid to the Regulator after 30 days but within 60 days after the due date—10% of the amount; or\n- (c) if the amount is paid to the Regulator after 60 days after the due date or if the amount is not paid—10% of the amount plus interest at a rate specified by the Regulator by gazette notice for the period that— (i) starts on the due date, or a later date decided by the Regulator; and (ii) ends on the day the amount of the annual levy and the additional amount under paragraph (a) or (b) is paid to the Regulator.\n- (i) starts on the due date, or a later date decided by the Regulator; and\n- (ii) ends on the day the amount of the annual levy and the additional amount under paragraph (a) or (b) is paid to the Regulator.\n- (i) starts on the due date, or a later date decided by the Regulator; and\n- (ii) ends on the day the amount of the annual levy and the additional amount under paragraph (a) or (b) is paid to the Regulator.","sortOrder":26},{"sectionNumber":"sec.23","sectionType":"section","heading":"Condition of licence— Act , s 83","content":"### sec.23 Condition of licence— Act , s 83\n\nFor section 83 (1) (a) of the Act , a self-insurer’s licence is subject to the condition that the self-insurer must give the Regulator, for each year or part of a year of the licence, a declaration in the approved form of the wages paid, or provided by, the self-insurer.","sortOrder":27},{"sectionNumber":"sec.24","sectionType":"section","heading":"Premium payable after cancellation of self-insurer’s licence— Act , s 98","content":"### sec.24 Premium payable after cancellation of self-insurer’s licence— Act , s 98\n\nFor section 98 of the Act , the way prescribed for the calculation of the premium payable by a self-insurer whose licence is cancelled (the former self-insurer ) for the first 2 periods of insurance after cancellation is according to the method and at the rate specified by WorkCover, by gazette notice under section 54 of the Act , as if the former self-insurer were insuring with WorkCover for the first time.\nHowever, the rate specified under subsection (1) must not be less than the rate calculated using the formula—\nwhere—\nadministrative costs means the administrative costs associated with claims incurred by the former self-insurer during the final period of licence, calculated by multiplying payments + liability by 0.095.\nfinal period of licence means—\nfor a former self-insurer licensed as a self-insurer for 3 or more years immediately before cancellation of the former self-insurer’s licence—3 years; or\nfor a former self-insurer licensed as a self-insurer for less than 3 years immediately before cancellation of the former self-insurer’s licence—the period of the licence.\nliability means an actuarial estimate of the former self-insurer’s outstanding liability at the end of the former self-insurer’s licence for claims incurred by the former self-insurer during the final period of licence, excluding liability for the excess period.\npayments means the actual payments made by the former self-insurer for claims incurred during the final period of licence, less recoveries received and payments made that are the equivalent of amounts payable for the excess period.\nwages means the wages paid, or provided, by the self-insurer during the final period of licence.\n(sec.24-ssec.1) For section 98 of the Act , the way prescribed for the calculation of the premium payable by a self-insurer whose licence is cancelled (the former self-insurer ) for the first 2 periods of insurance after cancellation is according to the method and at the rate specified by WorkCover, by gazette notice under section 54 of the Act , as if the former self-insurer were insuring with WorkCover for the first time.\n(sec.24-ssec.2) However, the rate specified under subsection (1) must not be less than the rate calculated using the formula— where— administrative costs means the administrative costs associated with claims incurred by the former self-insurer during the final period of licence, calculated by multiplying payments + liability by 0.095. final period of licence means— for a former self-insurer licensed as a self-insurer for 3 or more years immediately before cancellation of the former self-insurer’s licence—3 years; or for a former self-insurer licensed as a self-insurer for less than 3 years immediately before cancellation of the former self-insurer’s licence—the period of the licence. liability means an actuarial estimate of the former self-insurer’s outstanding liability at the end of the former self-insurer’s licence for claims incurred by the former self-insurer during the final period of licence, excluding liability for the excess period. payments means the actual payments made by the former self-insurer for claims incurred during the final period of licence, less recoveries received and payments made that are the equivalent of amounts payable for the excess period. wages means the wages paid, or provided, by the self-insurer during the final period of licence.\n- (a) for a former self-insurer licensed as a self-insurer for 3 or more years immediately before cancellation of the former self-insurer’s licence—3 years; or\n- (b) for a former self-insurer licensed as a self-insurer for less than 3 years immediately before cancellation of the former self-insurer’s licence—the period of the licence.","sortOrder":28},{"sectionNumber":"sec.25","sectionType":"section","heading":"Deemed levy for ascertaining appeal court— Act , s 569","content":"### sec.25 Deemed levy for ascertaining appeal court— Act , s 569\n\nFor section 569 (2) (a) of the Act , the deemed levy, for a self-insurer for a financial year of the self-insurer’s licence, is the amount calculated using the formula—\nwhere—\nestimated claims liability means the self-insurer’s estimated claims liability mentioned in section 18 (3) .\nrate means the rate published by the Regulator under section 81(6) of the Act for the particular financial year.","sortOrder":29},{"sectionNumber":"pt.3","sectionType":"part","heading":"Calculation of self-insurer’s liability","content":"# Calculation of self-insurer’s liability","sortOrder":30},{"sectionNumber":"pt.3-div.1","sectionType":"division","heading":"Outstanding liability","content":"## Outstanding liability","sortOrder":31},{"sectionNumber":"sec.26","sectionType":"section","heading":"Definitions for division","content":"### sec.26 Definitions for division\n\nIn this division—\napplication day , in relation to a self-insurer, means the day the self-insurer applied to be licensed as a self-insurer under section 70 of the Act .\nappointed actuary see section 28 .\nassessment day , in relation to a self-insurer, means the last day of the financial quarter immediately before the application day.\noutstanding liability see section 87 (1) (b) of the Act .\nsummary report see section 32 (1) .","sortOrder":32},{"sectionNumber":"sec.27","sectionType":"section","heading":"Calculation of outstanding liability— Act , s 87","content":"### sec.27 Calculation of outstanding liability— Act , s 87\n\nFor section 87 (2) of the Act , the amount of a self-insurer’s outstanding liability must be calculated under this division.","sortOrder":33},{"sectionNumber":"sec.28","sectionType":"section","heading":"Appointment of actuaries","content":"### sec.28 Appointment of actuaries\n\nWorkCover and the self-insurer must each appoint an actuary (each an appointed actuary ) to calculate the amount of the self-insurer’s outstanding liability.","sortOrder":34},{"sectionNumber":"sec.29","sectionType":"section","heading":"Regulator to give appointed actuaries information","content":"### sec.29 Regulator to give appointed actuaries information\n\nThe Regulator must give each appointed actuary the information necessary to enable the appointed actuary to calculate the amount of the self-insurer’s outstanding liability within the period mentioned in section 31 (3) .","sortOrder":35},{"sectionNumber":"sec.30","sectionType":"section","heading":"Actuarial calculation","content":"### sec.30 Actuarial calculation\n\nEach appointed actuary’s calculation of the amount of the self-insurer’s outstanding liability must—\nbe prepared under the actuarial standard; and\napply a central estimate of the liability; and\napply the risk free rate of return; and\ninclude claims administration expenses of 7% of the self-insurer’s outstanding liability; and\nnot include a prudential margin; and\nbe based, to the extent practicable, on claims for compensation and damages made against the self-insurer before the self-insurer was granted a licence to become a self-insurer; and\nbe based on data that is up-to-date on the assessment day.\n- (a) be prepared under the actuarial standard; and\n- (b) apply a central estimate of the liability; and\n- (c) apply the risk free rate of return; and\n- (d) include claims administration expenses of 7% of the self-insurer’s outstanding liability; and\n- (e) not include a prudential margin; and\n- (f) be based, to the extent practicable, on claims for compensation and damages made against the self-insurer before the self-insurer was granted a licence to become a self-insurer; and\n- (g) be based on data that is up-to-date on the assessment day.","sortOrder":36},{"sectionNumber":"sec.31","sectionType":"section","heading":"Actuarial report","content":"### sec.31 Actuarial report\n\nEach appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the self-insurer’s outstanding liability.\nThe actuarial report must state the following—\nthe amount of the self-insurer’s outstanding liability;\nthe key assumptions made by the appointed actuary for the calculation;\nhow the key assumptions made by the appointed actuary have been derived, including—\nthe average amount of a claim for compensation against the self-insurer; and\nthe average amount of a claim for damages against the self-insurer; and\nthe amount anticipated to have been incurred by the self-insurer in potential claims for compensation or damages for which no claim has yet been made; and\nthe frequency of claims for compensation against the self-insurer; and\nthe frequency of claims for damages against the self-insurer; and\nthe net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and\nthe net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and\nthe rate of inflation used;\nthe nature of the data used in the calculation;\nthe appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\nhow the appointed actuary interpreted the data;\nthe actuarial model used in the calculation;\nthe results of the calculation;\nthe appointed actuary’s confidence in the results of the calculation.\nEach appointed actuary must prepare the actuarial report within 35 days after the application day.\n(sec.31-ssec.1) Each appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the self-insurer’s outstanding liability.\n(sec.31-ssec.2) The actuarial report must state the following— the amount of the self-insurer’s outstanding liability; the key assumptions made by the appointed actuary for the calculation; how the key assumptions made by the appointed actuary have been derived, including— the average amount of a claim for compensation against the self-insurer; and the average amount of a claim for damages against the self-insurer; and the amount anticipated to have been incurred by the self-insurer in potential claims for compensation or damages for which no claim has yet been made; and the frequency of claims for compensation against the self-insurer; and the frequency of claims for damages against the self-insurer; and the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and the rate of inflation used; the nature of the data used in the calculation; the appointed actuary’s assessment of the data, including, for example, the accuracy of the data; how the appointed actuary interpreted the data; the actuarial model used in the calculation; the results of the calculation; the appointed actuary’s confidence in the results of the calculation.\n(sec.31-ssec.3) Each appointed actuary must prepare the actuarial report within 35 days after the application day.\n- (a) the amount of the self-insurer’s outstanding liability;\n- (b) the key assumptions made by the appointed actuary for the calculation;\n- (c) how the key assumptions made by the appointed actuary have been derived, including— (i) the average amount of a claim for compensation against the self-insurer; and (ii) the average amount of a claim for damages against the self-insurer; and (iii) the amount anticipated to have been incurred by the self-insurer in potential claims for compensation or damages for which no claim has yet been made; and (iv) the frequency of claims for compensation against the self-insurer; and (v) the frequency of claims for damages against the self-insurer; and (vi) the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and (viii) the rate of inflation used;\n- (i) the average amount of a claim for compensation against the self-insurer; and\n- (ii) the average amount of a claim for damages against the self-insurer; and\n- (iii) the amount anticipated to have been incurred by the self-insurer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the self-insurer; and\n- (v) the frequency of claims for damages against the self-insurer; and\n- (vi) the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;\n- (d) the nature of the data used in the calculation;\n- (e) the appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\n- (f) how the appointed actuary interpreted the data;\n- (g) the actuarial model used in the calculation;\n- (h) the results of the calculation;\n- (i) the appointed actuary’s confidence in the results of the calculation.\n- (i) the average amount of a claim for compensation against the self-insurer; and\n- (ii) the average amount of a claim for damages against the self-insurer; and\n- (iii) the amount anticipated to have been incurred by the self-insurer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the self-insurer; and\n- (v) the frequency of claims for damages against the self-insurer; and\n- (vi) the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;","sortOrder":37},{"sectionNumber":"sec.32","sectionType":"section","heading":"Summary report","content":"### sec.32 Summary report\n\nThe appointed actuaries must also jointly prepare a report (the summary report ) that—\nincludes each appointed actuary’s individual actuarial report; and\nstates how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\nThe appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the self-insurer within 2 months after the application day.\n(sec.32-ssec.1) The appointed actuaries must also jointly prepare a report (the summary report ) that— includes each appointed actuary’s individual actuarial report; and states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\n(sec.32-ssec.2) The appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the self-insurer within 2 months after the application day.\n- (a) includes each appointed actuary’s individual actuarial report; and\n- (b) states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.","sortOrder":38},{"sectionNumber":"sec.33","sectionType":"section","heading":"Agreement on amount","content":"### sec.33 Agreement on amount\n\nWorkCover and the self-insurer may agree on the amount of the self-insurer’s outstanding liability having regard to the summary report.","sortOrder":39},{"sectionNumber":"sec.34","sectionType":"section","heading":"Referral to arbiter if no agreement on amount","content":"### sec.34 Referral to arbiter if no agreement on amount\n\nThis section applies if WorkCover and the self-insurer do not agree on the amount of the self-insurer’s outstanding liability.\nWorkCover and the self-insurer must, by written notice, tell the Regulator that WorkCover and the self-insurer do not agree on the amount of the self-insurer’s outstanding liability.\nIf the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the self-insurer’s outstanding liability.\nSee sections 102 to 104 in relation to the arbiter’s decision.\n(sec.34-ssec.1) This section applies if WorkCover and the self-insurer do not agree on the amount of the self-insurer’s outstanding liability.\n(sec.34-ssec.2) WorkCover and the self-insurer must, by written notice, tell the Regulator that WorkCover and the self-insurer do not agree on the amount of the self-insurer’s outstanding liability.\n(sec.34-ssec.3) If the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the self-insurer’s outstanding liability. See sections 102 to 104 in relation to the arbiter’s decision.","sortOrder":40},{"sectionNumber":"sec.35","sectionType":"section","heading":"Payment of amount","content":"### sec.35 Payment of amount\n\nWorkCover must pay to the self-insurer the amount of the self-insurer’s outstanding liability (the final amount )—\nagreed to by WorkCover and the self-insurer; or\nif there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\nWorkCover must pay the self-insurer—\n75% of the final amount on the day the self-insurer’s licence starts; and\nthe balance of the final amount within 1 month after the day the self-insurer’s licence starts.\nHowever, the final amount paid by WorkCover must be adjusted by WorkCover’s appointed actuary to take into account—\nthe amount of compensation and damages, if any, paid by the self-insurer during the final period; and\nclaims for compensation and damages, if any, lodged against the self-insurer during the final period.\nIn this section—\nfinal period , in relation to a self-insurer, means the period that—\nstarts on the assessment day; and\nends on the day the self-insurer becomes liable for the self-insurer’s outstanding liability.\n(sec.35-ssec.1) WorkCover must pay to the self-insurer the amount of the self-insurer’s outstanding liability (the final amount )— agreed to by WorkCover and the self-insurer; or if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n(sec.35-ssec.2) WorkCover must pay the self-insurer— 75% of the final amount on the day the self-insurer’s licence starts; and the balance of the final amount within 1 month after the day the self-insurer’s licence starts.\n(sec.35-ssec.3) However, the final amount paid by WorkCover must be adjusted by WorkCover’s appointed actuary to take into account— the amount of compensation and damages, if any, paid by the self-insurer during the final period; and claims for compensation and damages, if any, lodged against the self-insurer during the final period.\n(sec.35-ssec.4) In this section— final period , in relation to a self-insurer, means the period that— starts on the assessment day; and ends on the day the self-insurer becomes liable for the self-insurer’s outstanding liability.\n- (a) agreed to by WorkCover and the self-insurer; or\n- (b) if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n- (a) 75% of the final amount on the day the self-insurer’s licence starts; and\n- (b) the balance of the final amount within 1 month after the day the self-insurer’s licence starts.\n- (a) the amount of compensation and damages, if any, paid by the self-insurer during the final period; and\n- (b) claims for compensation and damages, if any, lodged against the self-insurer during the final period.\n- (a) starts on the assessment day; and\n- (b) ends on the day the self-insurer becomes liable for the self-insurer’s outstanding liability.","sortOrder":41},{"sectionNumber":"sec.36","sectionType":"section","heading":"Transfer of claims information","content":"### sec.36 Transfer of claims information\n\nWorkCover must, before the day the self-insurer’s licence starts, give the self-insurer all the information in WorkCover’s possession about the claims for compensation and damages that relate to the self-insurer’s outstanding liability.","sortOrder":42},{"sectionNumber":"pt.3-div.2","sectionType":"division","heading":"Total liability","content":"## Total liability","sortOrder":43},{"sectionNumber":"sec.37","sectionType":"section","heading":"Definitions for division","content":"### sec.37 Definitions for division\n\nIn this division—\nappointed actuary see section 39 .\nassessment day , in relation to a member, means the last day of the financial quarter immediately before the day the old insurer applied to the Regulator under section 89 of the Act for a change in the group membership on the old insurer’s licence.\nconsent day , in relation to a member, means the day the Regulator approved the old insurer’s application under section 89 of the Act for a change in the group membership on the old insurer’s licence.\nmember means a member to whom section 90 of the Act applies.\nnew insurer see section 38 .\nold insurer see section 38 .\nsummary report see section 43 (1) .","sortOrder":44},{"sectionNumber":"sec.38","sectionType":"section","heading":"Calculation of total liability after change in self-insurer’s membership— Act , s 90","content":"### sec.38 Calculation of total liability after change in self-insurer’s membership— Act , s 90\n\nFor section 90 (9) (a) of the Act , when a member leaves a self-insurer that is a group employer (the old insurer ) and becomes part of another self-insurer (the new insurer ) the amount of the member’s total liability must be calculated under this division.","sortOrder":45},{"sectionNumber":"sec.39","sectionType":"section","heading":"Appointment of actuaries","content":"### sec.39 Appointment of actuaries\n\nThe old insurer and the new insurer must each appoint an actuary (each an appointed actuary ) to calculate the amount of the member’s total liability.","sortOrder":46},{"sectionNumber":"sec.40","sectionType":"section","heading":"Insurers to give appointed actuaries information","content":"### sec.40 Insurers to give appointed actuaries information\n\nThe old insurer and the new insurer must give each appointed actuary, in the approved form, the information necessary to enable the appointed actuary to calculate the amount of the member’s total liability within the period mentioned in section 42 (3) .","sortOrder":47},{"sectionNumber":"sec.41","sectionType":"section","heading":"Actuarial calculation","content":"### sec.41 Actuarial calculation\n\nEach appointed actuary’s calculation of the amount of the member’s total liability must—\nbe prepared under the actuarial standard; and\napply a central estimate of the liability; and\napply the risk free rate of return; and\ninclude claims administration expenses of 7% of the member’s total liability; and\nnot include a prudential margin; and\nbe based, to the extent practicable, on claims for compensation and damages made against the member; and\nbe based on data that is up-to-date on the assessment day.\n- (a) be prepared under the actuarial standard; and\n- (b) apply a central estimate of the liability; and\n- (c) apply the risk free rate of return; and\n- (d) include claims administration expenses of 7% of the member’s total liability; and\n- (e) not include a prudential margin; and\n- (f) be based, to the extent practicable, on claims for compensation and damages made against the member; and\n- (g) be based on data that is up-to-date on the assessment day.","sortOrder":48},{"sectionNumber":"sec.42","sectionType":"section","heading":"Actuarial report","content":"### sec.42 Actuarial report\n\nEach appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the member’s total liability.\nThe actuarial report must state the following—\nthe amount of the member’s total liability;\nthe key assumptions made by the appointed actuary for the calculation;\nhow the key assumptions by the appointed actuary have been derived, including—\nthe average amount of a claim for compensation against the member; and\nthe average amount of a claim for damages against the member; and\nthe amount anticipated to have been incurred by the member in potential claims for compensation or damages for which no claim has yet been made; and\nthe frequency of claims for compensation against the member; and\nthe frequency of claims for damages against the member; and\nthe net amount of claims for compensation and damages against the member after allowing for future inflation ( inflated value ); and\nthe net present value of the inflated value after allowing for income from assets set aside by the member to pay the amount mentioned in paragraph (a) ; and\nthe rate of inflation used;\nthe nature of the data used in the calculation;\nthe appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\nhow the appointed actuary interpreted the data;\nthe actuarial model used in the calculation;\nthe results of the calculation;\nthe appointed actuary’s confidence in the results of the calculation.\nEach appointed actuary must prepare the actuarial report within 35 days after the consent day.\n(sec.42-ssec.1) Each appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the member’s total liability.\n(sec.42-ssec.2) The actuarial report must state the following— the amount of the member’s total liability; the key assumptions made by the appointed actuary for the calculation; how the key assumptions by the appointed actuary have been derived, including— the average amount of a claim for compensation against the member; and the average amount of a claim for damages against the member; and the amount anticipated to have been incurred by the member in potential claims for compensation or damages for which no claim has yet been made; and the frequency of claims for compensation against the member; and the frequency of claims for damages against the member; and the net amount of claims for compensation and damages against the member after allowing for future inflation ( inflated value ); and the net present value of the inflated value after allowing for income from assets set aside by the member to pay the amount mentioned in paragraph (a) ; and the rate of inflation used; the nature of the data used in the calculation; the appointed actuary’s assessment of the data, including, for example, the accuracy of the data; how the appointed actuary interpreted the data; the actuarial model used in the calculation; the results of the calculation; the appointed actuary’s confidence in the results of the calculation.\n(sec.42-ssec.3) Each appointed actuary must prepare the actuarial report within 35 days after the consent day.\n- (a) the amount of the member’s total liability;\n- (b) the key assumptions made by the appointed actuary for the calculation;\n- (c) how the key assumptions by the appointed actuary have been derived, including— (i) the average amount of a claim for compensation against the member; and (ii) the average amount of a claim for damages against the member; and (iii) the amount anticipated to have been incurred by the member in potential claims for compensation or damages for which no claim has yet been made; and (iv) the frequency of claims for compensation against the member; and (v) the frequency of claims for damages against the member; and (vi) the net amount of claims for compensation and damages against the member after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the member to pay the amount mentioned in paragraph (a) ; and (viii) the rate of inflation used;\n- (i) the average amount of a claim for compensation against the member; and\n- (ii) the average amount of a claim for damages against the member; and\n- (iii) the amount anticipated to have been incurred by the member in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the member; and\n- (v) the frequency of claims for damages against the member; and\n- (vi) the net amount of claims for compensation and damages against the member after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the member to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;\n- (d) the nature of the data used in the calculation;\n- (e) the appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\n- (f) how the appointed actuary interpreted the data;\n- (g) the actuarial model used in the calculation;\n- (h) the results of the calculation;\n- (i) the appointed actuary’s confidence in the results of the calculation.\n- (i) the average amount of a claim for compensation against the member; and\n- (ii) the average amount of a claim for damages against the member; and\n- (iii) the amount anticipated to have been incurred by the member in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the member; and\n- (v) the frequency of claims for damages against the member; and\n- (vi) the net amount of claims for compensation and damages against the member after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the member to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;","sortOrder":49},{"sectionNumber":"sec.43","sectionType":"section","heading":"Summary report","content":"### sec.43 Summary report\n\nThe appointed actuaries must also jointly prepare a report (the summary report ) that—\nincludes each appointed actuary’s individual actuarial report; and\nstates how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\nThe appointed actuaries must give a copy of the summary report to the Regulator, the old insurer and the new insurer within 2 months after the consent day.\n(sec.43-ssec.1) The appointed actuaries must also jointly prepare a report (the summary report ) that— includes each appointed actuary’s individual actuarial report; and states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\n(sec.43-ssec.2) The appointed actuaries must give a copy of the summary report to the Regulator, the old insurer and the new insurer within 2 months after the consent day.\n- (a) includes each appointed actuary’s individual actuarial report; and\n- (b) states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.","sortOrder":50},{"sectionNumber":"sec.44","sectionType":"section","heading":"Agreement on amount","content":"### sec.44 Agreement on amount\n\nThe old insurer and the new insurer may agree on the amount of the member’s total liability having regard to the summary report.","sortOrder":51},{"sectionNumber":"sec.45","sectionType":"section","heading":"Referral to arbiter if no agreement on amount","content":"### sec.45 Referral to arbiter if no agreement on amount\n\nThis section applies if the old insurer or the new insurer do not agree on the amount of the member’s total liability.\nThe old insurer and the new insurer must, by written notice, tell the Regulator that the old insurer and the new insurer do not agree on the amount of the member’s total liability.\nIf the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the member’s total liability.\nSee sections 102 to 104 in relation to the arbiter’s decision.\n(sec.45-ssec.1) This section applies if the old insurer or the new insurer do not agree on the amount of the member’s total liability.\n(sec.45-ssec.2) The old insurer and the new insurer must, by written notice, tell the Regulator that the old insurer and the new insurer do not agree on the amount of the member’s total liability.\n(sec.45-ssec.3) If the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the member’s total liability. See sections 102 to 104 in relation to the arbiter’s decision.","sortOrder":52},{"sectionNumber":"sec.46","sectionType":"section","heading":"Payment of amount","content":"### sec.46 Payment of amount\n\nThe old insurer must pay to the new insurer the amount of the member’s total liability (the final amount )—\nagreed to by the old insurer and the new insurer; or\nif there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\nThe old insurer must pay the final amount—\nwithin 3 months after the consent day; or\non or before a later day agreed to by the old insurer and the new insurer.\nHowever, the final amount paid by the old insurer must be adjusted by the old insurer’s appointed actuary to take into account—\nthe amount of compensation and damages, if any, paid by the member during the final period; and\nclaims for compensation and damages, if any, lodged against the member during the final period.\nThe old insurer must, by written notice, tell the Regulator the following information not later than the day the final amount is paid to the new insurer—\nthe final amount paid, as adjusted under subsection (3) ;\nthe day the new insurer assumes liability for compensation and damages claimed against the member;\nthe name and contact details of the old insurer, the new insurer and the member.\nIn this section—\nfinal period , in relation to a member, means the period that—\nstarts on the assessment day; and\nends on the day the new insurer assumes liability for the member’s total liability.\n(sec.46-ssec.1) The old insurer must pay to the new insurer the amount of the member’s total liability (the final amount )— agreed to by the old insurer and the new insurer; or if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n(sec.46-ssec.2) The old insurer must pay the final amount— within 3 months after the consent day; or on or before a later day agreed to by the old insurer and the new insurer.\n(sec.46-ssec.3) However, the final amount paid by the old insurer must be adjusted by the old insurer’s appointed actuary to take into account— the amount of compensation and damages, if any, paid by the member during the final period; and claims for compensation and damages, if any, lodged against the member during the final period.\n(sec.46-ssec.4) The old insurer must, by written notice, tell the Regulator the following information not later than the day the final amount is paid to the new insurer— the final amount paid, as adjusted under subsection (3) ; the day the new insurer assumes liability for compensation and damages claimed against the member; the name and contact details of the old insurer, the new insurer and the member.\n(sec.46-ssec.5) In this section— final period , in relation to a member, means the period that— starts on the assessment day; and ends on the day the new insurer assumes liability for the member’s total liability.\n- (a) agreed to by the old insurer and the new insurer; or\n- (b) if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n- (a) within 3 months after the consent day; or\n- (b) on or before a later day agreed to by the old insurer and the new insurer.\n- (a) the amount of compensation and damages, if any, paid by the member during the final period; and\n- (b) claims for compensation and damages, if any, lodged against the member during the final period.\n- (a) the final amount paid, as adjusted under subsection (3) ;\n- (b) the day the new insurer assumes liability for compensation and damages claimed against the member;\n- (c) the name and contact details of the old insurer, the new insurer and the member.\n- (a) starts on the assessment day; and\n- (b) ends on the day the new insurer assumes liability for the member’s total liability.","sortOrder":53},{"sectionNumber":"sec.47","sectionType":"section","heading":"Transfer of claims information","content":"### sec.47 Transfer of claims information\n\nThe old insurer must, not later than the day the final amount is paid to the new insurer under section 46 , give the new insurer all the information in the old insurer’s possession about the claims for compensation and damages that relate to the member’s total liability.","sortOrder":54},{"sectionNumber":"pt.3-div.3","sectionType":"division","heading":"Liability after cancellation of self-insurer’s licence","content":"## Liability after cancellation of self-insurer’s licence","sortOrder":55},{"sectionNumber":"sec.48","sectionType":"section","heading":"Definitions for division","content":"### sec.48 Definitions for division\n\nIn this division—\nappointed actuary see section 50 .\nassessment day , in relation to a former self-insurer, means the last day of the financial quarter immediately before the cancellation day.\ncancellation day , in relation to a former self-insurer, means the day the former self-insurer’s licence was cancelled.\nformer self-insurer means a self-insurer whose licence has been cancelled.\nsummary report see section 54 (1) .","sortOrder":56},{"sectionNumber":"sec.49","sectionType":"section","heading":"Calculation of liability after cancellation— Act , s 102","content":"### sec.49 Calculation of liability after cancellation— Act , s 102\n\nFor section 102 (3) of the Act , the amount of a former self-insurer’s liability under sections 68C and 87 (1) of the Act must be calculated under this division.","sortOrder":57},{"sectionNumber":"sec.50","sectionType":"section","heading":"Appointment of actuaries","content":"### sec.50 Appointment of actuaries\n\nWorkCover and the former self-insurer must each appoint an actuary (each an appointed actuary ) to calculate the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .","sortOrder":58},{"sectionNumber":"sec.51","sectionType":"section","heading":"Former self-insurer to give appointed actuaries information","content":"### sec.51 Former self-insurer to give appointed actuaries information\n\nThe former self-insurer must give each appointed actuary, in the approved form, the information necessary to enable the appointed actuary to calculate the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act within the period mentioned in section 53 (3) .","sortOrder":59},{"sectionNumber":"sec.52","sectionType":"section","heading":"Actuarial calculation","content":"### sec.52 Actuarial calculation\n\nEach appointed actuary’s calculation of the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act must—\nbe prepared under the actuarial standard; and\napply a central estimate of the liability; and\napply the risk free rate of return; and\ninclude claims administration expenses of 7% of the former self-insurer’s liability under sections 68C and 87 (1) of the Act ; and\nnot include a prudential margin; and\nbe based, to the extent practicable, on claims for compensation and damages made against the former self-insurer before the self-insurer was granted a licence to become a self-insurer; and\nbe based on data that is up-to-date on the assessment day.\n- (a) be prepared under the actuarial standard; and\n- (b) apply a central estimate of the liability; and\n- (c) apply the risk free rate of return; and\n- (d) include claims administration expenses of 7% of the former self-insurer’s liability under sections 68C and 87 (1) of the Act ; and\n- (e) not include a prudential margin; and\n- (f) be based, to the extent practicable, on claims for compensation and damages made against the former self-insurer before the self-insurer was granted a licence to become a self-insurer; and\n- (g) be based on data that is up-to-date on the assessment day.","sortOrder":60},{"sectionNumber":"sec.53","sectionType":"section","heading":"Actuarial report","content":"### sec.53 Actuarial report\n\nEach appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .\nThe actuarial report must state the following—\nthe amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act ;\nthe key assumptions made by the appointed actuary for the calculation;\nhow the key assumptions made by the appointed actuary have been derived, including—\nthe average amount of a claim for compensation against the former self-insurer; and\nthe average amount of a claim for damages against the former self-insurer; and\nthe amount anticipated to have been incurred by the former self-insurer in potential claims for compensation or damages for which no claim has yet been made; and\nthe frequency of claims for compensation against the former self-insurer; and\nthe frequency of claims for damages against the former self-insurer; and\nthe net amount of claims for compensation and damages against the former self-insurer after allowing for future inflation ( inflated value ); and\nthe net present value of the inflated value after allowing for income from assets set aside by the former self-insurer to pay the amount mentioned in paragraph (a) ; and\nthe rate of inflation used;\nthe nature of the data used in the calculation;\nthe appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\nhow the appointed actuary interpreted the data;\nthe actuarial model used in the calculation;\nthe results of the calculation;\nthe appointed actuary’s confidence in the results of the calculation.\nEach appointed actuary must prepare the actuarial report within 35 days after the cancellation day.\n(sec.53-ssec.1) Each appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .\n(sec.53-ssec.2) The actuarial report must state the following— the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act ; the key assumptions made by the appointed actuary for the calculation; how the key assumptions made by the appointed actuary have been derived, including— the average amount of a claim for compensation against the former self-insurer; and the average amount of a claim for damages against the former self-insurer; and the amount anticipated to have been incurred by the former self-insurer in potential claims for compensation or damages for which no claim has yet been made; and the frequency of claims for compensation against the former self-insurer; and the frequency of claims for damages against the former self-insurer; and the net amount of claims for compensation and damages against the former self-insurer after allowing for future inflation ( inflated value ); and the net present value of the inflated value after allowing for income from assets set aside by the former self-insurer to pay the amount mentioned in paragraph (a) ; and the rate of inflation used; the nature of the data used in the calculation; the appointed actuary’s assessment of the data, including, for example, the accuracy of the data; how the appointed actuary interpreted the data; the actuarial model used in the calculation; the results of the calculation; the appointed actuary’s confidence in the results of the calculation.\n(sec.53-ssec.3) Each appointed actuary must prepare the actuarial report within 35 days after the cancellation day.\n- (a) the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act ;\n- (b) the key assumptions made by the appointed actuary for the calculation;\n- (c) how the key assumptions made by the appointed actuary have been derived, including— (i) the average amount of a claim for compensation against the former self-insurer; and (ii) the average amount of a claim for damages against the former self-insurer; and (iii) the amount anticipated to have been incurred by the former self-insurer in potential claims for compensation or damages for which no claim has yet been made; and (iv) the frequency of claims for compensation against the former self-insurer; and (v) the frequency of claims for damages against the former self-insurer; and (vi) the net amount of claims for compensation and damages against the former self-insurer after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the former self-insurer to pay the amount mentioned in paragraph (a) ; and (viii) the rate of inflation used;\n- (i) the average amount of a claim for compensation against the former self-insurer; and\n- (ii) the average amount of a claim for damages against the former self-insurer; and\n- (iii) the amount anticipated to have been incurred by the former self-insurer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the former self-insurer; and\n- (v) the frequency of claims for damages against the former self-insurer; and\n- (vi) the net amount of claims for compensation and damages against the former self-insurer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the former self-insurer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;\n- (d) the nature of the data used in the calculation;\n- (e) the appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\n- (f) how the appointed actuary interpreted the data;\n- (g) the actuarial model used in the calculation;\n- (h) the results of the calculation;\n- (i) the appointed actuary’s confidence in the results of the calculation.\n- (i) the average amount of a claim for compensation against the former self-insurer; and\n- (ii) the average amount of a claim for damages against the former self-insurer; and\n- (iii) the amount anticipated to have been incurred by the former self-insurer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the former self-insurer; and\n- (v) the frequency of claims for damages against the former self-insurer; and\n- (vi) the net amount of claims for compensation and damages against the former self-insurer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the former self-insurer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;","sortOrder":61},{"sectionNumber":"sec.54","sectionType":"section","heading":"Summary report","content":"### sec.54 Summary report\n\nThe appointed actuaries must also jointly prepare a report (the summary report ) that—\nincludes each appointed actuary’s individual actuarial report; and\nstates how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\nThe appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the former self-insurer within 2 months after the cancellation day.\n(sec.54-ssec.1) The appointed actuaries must also jointly prepare a report (the summary report ) that— includes each appointed actuary’s individual actuarial report; and states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\n(sec.54-ssec.2) The appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the former self-insurer within 2 months after the cancellation day.\n- (a) includes each appointed actuary’s individual actuarial report; and\n- (b) states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.","sortOrder":62},{"sectionNumber":"sec.55","sectionType":"section","heading":"Agreement on amount","content":"### sec.55 Agreement on amount\n\nWorkCover and the former self-insurer may agree on the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act having regard to the summary report.","sortOrder":63},{"sectionNumber":"sec.56","sectionType":"section","heading":"Referral to arbiter if no agreement on amount","content":"### sec.56 Referral to arbiter if no agreement on amount\n\nThis section applies if WorkCover and the former self-insurer do not agree on the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .\nWorkCover and the former self-insurer must, by written notice, tell the Regulator that WorkCover and the former self-insurer do not agree on the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .\nIf the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .\nSee sections 102 to 104 in relation to the arbiter’s decision.\n(sec.56-ssec.1) This section applies if WorkCover and the former self-insurer do not agree on the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .\n(sec.56-ssec.2) WorkCover and the former self-insurer must, by written notice, tell the Regulator that WorkCover and the former self-insurer do not agree on the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act .\n(sec.56-ssec.3) If the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act . See sections 102 to 104 in relation to the arbiter’s decision.","sortOrder":64},{"sectionNumber":"sec.57","sectionType":"section","heading":"Payment of amount","content":"### sec.57 Payment of amount\n\nThe former self-insurer must pay to WorkCover the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act (the final amount )—\nagreed to by WorkCover and the former self-insurer; or\nif there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\nHowever, the final amount paid by the former self-insurer must be adjusted by the former self-insurer’s appointed actuary to take into account—\nthe amount of compensation and damages, if any, paid by the former self-insurer during the final period; and\nclaims for compensation and damages, if any, lodged against the former self-insurer during the final period.\nIn this section—\nfinal period , in relation to a former self-insurer, means the period that—\nstarts on the assessment day; and\nends on the cancellation day.\n(sec.57-ssec.1) The former self-insurer must pay to WorkCover the amount of the former self-insurer’s liability under sections 68C and 87 (1) of the Act (the final amount )— agreed to by WorkCover and the former self-insurer; or if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n(sec.57-ssec.2) However, the final amount paid by the former self-insurer must be adjusted by the former self-insurer’s appointed actuary to take into account— the amount of compensation and damages, if any, paid by the former self-insurer during the final period; and claims for compensation and damages, if any, lodged against the former self-insurer during the final period.\n(sec.57-ssec.3) In this section— final period , in relation to a former self-insurer, means the period that— starts on the assessment day; and ends on the cancellation day.\n- (a) agreed to by WorkCover and the former self-insurer; or\n- (b) if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n- (a) the amount of compensation and damages, if any, paid by the former self-insurer during the final period; and\n- (b) claims for compensation and damages, if any, lodged against the former self-insurer during the final period.\n- (a) starts on the assessment day; and\n- (b) ends on the cancellation day.","sortOrder":65},{"sectionNumber":"pt.3-div.4","sectionType":"division","heading":"Estimated claims liability for lodgement of security","content":"## Estimated claims liability for lodgement of security","sortOrder":66},{"sectionNumber":"sec.58","sectionType":"section","heading":"Definitions for division","content":"### sec.58 Definitions for division\n\nIn this division—\nappointed actuary see section 60 .\nsecond appointed actuary see section 66 (1) .\nself-insurer’s data means data that will enable the calculation of the amount of the self-insurer’s estimated claims liability.","sortOrder":67},{"sectionNumber":"sec.59","sectionType":"section","heading":"Calculation of estimated claims liability— Act , s 84","content":"### sec.59 Calculation of estimated claims liability— Act , s 84\n\nFor section 84 (4) (b) of the Act , the amount of a self-insurer’s estimated claims liability must be calculated under this division.","sortOrder":68},{"sectionNumber":"sec.60","sectionType":"section","heading":"Appointment of actuary","content":"### sec.60 Appointment of actuary\n\nThe Regulator must appoint an actuary (the appointed actuary ) to calculate the amount of the self-insurer’s estimated claims liability.","sortOrder":69},{"sectionNumber":"sec.61","sectionType":"section","heading":"Self-insurer to give Regulator and appointed actuary information","content":"### sec.61 Self-insurer to give Regulator and appointed actuary information\n\nThe self-insurer must give the Regulator and the appointed actuary, in the approved form, the information necessary to enable the appointed actuary to calculate the amount of the self-insurer’s estimated claims liability.","sortOrder":70},{"sectionNumber":"sec.62","sectionType":"section","heading":"Actuarial calculation","content":"### sec.62 Actuarial calculation\n\nThe appointed actuary’s calculation of the amount of the self-insurer’s estimated claims liability must—\nbe prepared under the actuarial standard; and\napply a central estimate of the liability; and\napply the risk free rate of return; and\ninclude claims administration expenses of 7% of the self-insurer’s estimated claims liability; and\nnot include a prudential margin; and\nbe based, to the extent practicable, on claims for compensation and damages made against the self-insurer; and\nbe based on data that is up-to-date on—\nfor a calculation in relation to the renewal of the self-insurer’s licence—the last day of the financial quarter immediately before the day the renewed licence starts; or\notherwise—the day immediately before the amount is calculated.\n- (a) be prepared under the actuarial standard; and\n- (b) apply a central estimate of the liability; and\n- (c) apply the risk free rate of return; and\n- (d) include claims administration expenses of 7% of the self-insurer’s estimated claims liability; and\n- (e) not include a prudential margin; and\n- (f) be based, to the extent practicable, on claims for compensation and damages made against the self-insurer; and\n- (g) be based on data that is up-to-date on— (i) for a calculation in relation to the renewal of the self-insurer’s licence—the last day of the financial quarter immediately before the day the renewed licence starts; or (ii) otherwise—the day immediately before the amount is calculated.\n- (i) for a calculation in relation to the renewal of the self-insurer’s licence—the last day of the financial quarter immediately before the day the renewed licence starts; or\n- (ii) otherwise—the day immediately before the amount is calculated.\n- (i) for a calculation in relation to the renewal of the self-insurer’s licence—the last day of the financial quarter immediately before the day the renewed licence starts; or\n- (ii) otherwise—the day immediately before the amount is calculated.","sortOrder":71},{"sectionNumber":"sec.63","sectionType":"section","heading":"Actuarial report","content":"### sec.63 Actuarial report\n\nThe appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the self-insurer’s estimated claims liability.\nThe actuarial report must state the following—\nthe amount of the self-insurer’s estimated claims liability;\nthe key assumptions made by the appointed actuary for the calculation;\nhow the key assumptions made by the appointed actuary have been derived, including—\nthe average amount of a claim for compensation against the self-insurer; and\nthe average amount of a claim for damages against the self-insurer; and\nthe amount anticipated to have been incurred by the self-insurer in potential claims for compensation and damages for which no claim has yet been made; and\nthe frequency of claims for compensation against the self-insurer; and\nthe frequency of claims for damages against the self-insurer; and\nthe net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and\nthe net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and\nthe rate of inflation used;\nthe nature of the data used in the calculation;\nthe appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\nhow the appointed actuary interpreted the data;\nthe actuarial model used in the calculation;\nthe results of the calculation;\nthe appointed actuary’s confidence in the results of the calculation.\n(sec.63-ssec.1) The appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the self-insurer’s estimated claims liability.\n(sec.63-ssec.2) The actuarial report must state the following— the amount of the self-insurer’s estimated claims liability; the key assumptions made by the appointed actuary for the calculation; how the key assumptions made by the appointed actuary have been derived, including— the average amount of a claim for compensation against the self-insurer; and the average amount of a claim for damages against the self-insurer; and the amount anticipated to have been incurred by the self-insurer in potential claims for compensation and damages for which no claim has yet been made; and the frequency of claims for compensation against the self-insurer; and the frequency of claims for damages against the self-insurer; and the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and the rate of inflation used; the nature of the data used in the calculation; the appointed actuary’s assessment of the data, including, for example, the accuracy of the data; how the appointed actuary interpreted the data; the actuarial model used in the calculation; the results of the calculation; the appointed actuary’s confidence in the results of the calculation.\n- (a) the amount of the self-insurer’s estimated claims liability;\n- (b) the key assumptions made by the appointed actuary for the calculation;\n- (c) how the key assumptions made by the appointed actuary have been derived, including— (i) the average amount of a claim for compensation against the self-insurer; and (ii) the average amount of a claim for damages against the self-insurer; and (iii) the amount anticipated to have been incurred by the self-insurer in potential claims for compensation and damages for which no claim has yet been made; and (iv) the frequency of claims for compensation against the self-insurer; and (v) the frequency of claims for damages against the self-insurer; and (vi) the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and (viii) the rate of inflation used;\n- (i) the average amount of a claim for compensation against the self-insurer; and\n- (ii) the average amount of a claim for damages against the self-insurer; and\n- (iii) the amount anticipated to have been incurred by the self-insurer in potential claims for compensation and damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the self-insurer; and\n- (v) the frequency of claims for damages against the self-insurer; and\n- (vi) the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;\n- (d) the nature of the data used in the calculation;\n- (e) the appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\n- (f) how the appointed actuary interpreted the data;\n- (g) the actuarial model used in the calculation;\n- (h) the results of the calculation;\n- (i) the appointed actuary’s confidence in the results of the calculation.\n- (i) the average amount of a claim for compensation against the self-insurer; and\n- (ii) the average amount of a claim for damages against the self-insurer; and\n- (iii) the amount anticipated to have been incurred by the self-insurer in potential claims for compensation and damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the self-insurer; and\n- (v) the frequency of claims for damages against the self-insurer; and\n- (vi) the net amount of claims for compensation and damages against the self-insurer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the self-insurer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;","sortOrder":72},{"sectionNumber":"sec.64","sectionType":"section","heading":"Appointed actuary must give copy of report to Regulator and self-insurer","content":"### sec.64 Appointed actuary must give copy of report to Regulator and self-insurer\n\nThe appointed actuary must give a copy of the actuarial report to the Regulator and the self-insurer before—\nthe day stated by the Regulator; or\na later day agreed to by the Regulator and the appointed actuary.\n- (a) the day stated by the Regulator; or\n- (b) a later day agreed to by the Regulator and the appointed actuary.","sortOrder":73},{"sectionNumber":"sec.65","sectionType":"section","heading":"Regulator to tell self-insurer whether agreement on amount","content":"### sec.65 Regulator to tell self-insurer whether agreement on amount\n\nWithin 35 days after the appointed actuary gives the Regulator a copy of the actuarial report, the Regulator must give the self-insurer a written notice stating whether the Regulator agrees or does not agree with the appointed actuary’s assessment of the self-insurer’s estimated claims liability.","sortOrder":74},{"sectionNumber":"sec.66","sectionType":"section","heading":"Referral to second appointed actuary if no agreement on amount","content":"### sec.66 Referral to second appointed actuary if no agreement on amount\n\nAfter receiving a copy of the appointed actuary’s report, the Regulator may ask another actuary appointed by the Regulator (the second appointed actuary ) to—\ncalculate the amount of the self-insurer’s estimated claims liability under section 62 ; and\ngive the Regulator an actuarial report under section 63 (2) .\nThe Regulator must give the second appointed actuary the appointed actuary’s report and the self-insurer’s data.\n(sec.66-ssec.1) After receiving a copy of the appointed actuary’s report, the Regulator may ask another actuary appointed by the Regulator (the second appointed actuary ) to— calculate the amount of the self-insurer’s estimated claims liability under section 62 ; and give the Regulator an actuarial report under section 63 (2) .\n(sec.66-ssec.2) The Regulator must give the second appointed actuary the appointed actuary’s report and the self-insurer’s data.\n- (a) calculate the amount of the self-insurer’s estimated claims liability under section 62 ; and\n- (b) give the Regulator an actuarial report under section 63 (2) .","sortOrder":75},{"sectionNumber":"sec.67","sectionType":"section","heading":"Agreement on amount","content":"### sec.67 Agreement on amount\n\nIf, at any time, the Regulator and the self-insurer agree on the self-insurer’s estimated claims liability, having regard to the appointed actuary’s actuarial report or the second appointed actuary’s actuarial report, the self-insurer’s estimated claims liability is the amount agreed to by the Regulator and the self-insurer.","sortOrder":76},{"sectionNumber":"sec.68","sectionType":"section","heading":"Referral to arbiter if no agreement on amount","content":"### sec.68 Referral to arbiter if no agreement on amount\n\nThis section applies if the Regulator and the self-insurer do not agree under section 67 on the amount of the self-insurer’s estimated claims liability.\nThe Regulator must refer the appointed actuary’s actuarial report, the self-insurer’s data and any second appointed actuary’s actuarial report to the arbiter to decide the amount of the self-insurer’s estimated claims liability.\nSee sections 102 to 104 in relation to the arbiter’s decision.\nThe Regulator must make the referral within 14 days after the day the Regulator gives the self-insurer a written notice under section 65 stating that the Regulator does not agree with the appointed actuary’s assessment of the self-insurer’s estimated claims liability.\n(sec.68-ssec.1) This section applies if the Regulator and the self-insurer do not agree under section 67 on the amount of the self-insurer’s estimated claims liability.\n(sec.68-ssec.2) The Regulator must refer the appointed actuary’s actuarial report, the self-insurer’s data and any second appointed actuary’s actuarial report to the arbiter to decide the amount of the self-insurer’s estimated claims liability. See sections 102 to 104 in relation to the arbiter’s decision.\n(sec.68-ssec.3) The Regulator must make the referral within 14 days after the day the Regulator gives the self-insurer a written notice under section 65 stating that the Regulator does not agree with the appointed actuary’s assessment of the self-insurer’s estimated claims liability.","sortOrder":77},{"sectionNumber":"pt.3-div.5","sectionType":"division","heading":"Self-insurers who become non-scheme employers","content":"## Self-insurers who become non-scheme employers","sortOrder":78},{"sectionNumber":"sec.69","sectionType":"section","heading":"Definition for division","content":"### sec.69 Definition for division\n\nIn this division—\ncancellation day , in relation to a non-scheme employer, means the day the non-scheme employer’s continued licence is cancelled under section 105E of the Act .\nUnder section 105F (d) of the Act , on cancellation of the continued licence, WorkCover replaces the non-scheme employer, for any proceeding taken by a claimant or worker against the non-scheme employer, as insurer.","sortOrder":79},{"sectionNumber":"sec.70","sectionType":"section","heading":"Calculation of non-scheme employer’s liability— Act , s 105I","content":"### sec.70 Calculation of non-scheme employer’s liability— Act , s 105I\n\nFor section 105I (2) of the Act , the amount of a non-scheme employer’s liability under section 105B (3) of the Act must be calculated by—\nestimating the amount under subdivision 2 ; and\nfinalising the amount under subdivision 3 .\nThe amount of the non-scheme employer’s liability under section 105B (3) of the Act is the finalised amount calculated under subdivision 3 .\nThe non-scheme employer’s liability under section 105B (3) of the Act is finalised for section 105I (5) of the Act when—\nthe finalised amount is calculated under subdivision 3 ; or\nif the finalised amount is different to the final amount paid under section 79 —the amount payable by the non-scheme employer under section 88 (2) or by WorkCover under section 88 (3) is paid.\n(sec.70-ssec.1) For section 105I (2) of the Act , the amount of a non-scheme employer’s liability under section 105B (3) of the Act must be calculated by— estimating the amount under subdivision 2 ; and finalising the amount under subdivision 3 .\n(sec.70-ssec.2) The amount of the non-scheme employer’s liability under section 105B (3) of the Act is the finalised amount calculated under subdivision 3 .\n(sec.70-ssec.3) The non-scheme employer’s liability under section 105B (3) of the Act is finalised for section 105I (5) of the Act when— the finalised amount is calculated under subdivision 3 ; or if the finalised amount is different to the final amount paid under section 79 —the amount payable by the non-scheme employer under section 88 (2) or by WorkCover under section 88 (3) is paid.\n- (a) estimating the amount under subdivision 2 ; and\n- (b) finalising the amount under subdivision 3 .\n- (a) the finalised amount is calculated under subdivision 3 ; or\n- (b) if the finalised amount is different to the final amount paid under section 79 —the amount payable by the non-scheme employer under section 88 (2) or by WorkCover under section 88 (3) is paid.","sortOrder":80},{"sectionNumber":"sec.71","sectionType":"section","heading":"Definitions for subdivision","content":"### sec.71 Definitions for subdivision\n\nIn this subdivision—\nappointed actuary see section 72 .\nsummary report see section 76 (1) .","sortOrder":81},{"sectionNumber":"sec.72","sectionType":"section","heading":"Appointment of actuaries","content":"### sec.72 Appointment of actuaries\n\nWorkCover and the non-scheme employer must each appoint an actuary (each an appointed actuary ) to estimate the amount of the non-scheme employer’s liability under section 105B (3) of the Act .","sortOrder":82},{"sectionNumber":"sec.73","sectionType":"section","heading":"Non-scheme employer to give appointed actuaries information","content":"### sec.73 Non-scheme employer to give appointed actuaries information\n\nThe non-scheme employer must give each appointed actuary, in the approved form, the information necessary to enable the appointed actuary to estimate the amount of the non-scheme employer’s liability under section 105B (3) of the Act within the period mentioned in section 75 (3) .","sortOrder":83},{"sectionNumber":"sec.74","sectionType":"section","heading":"Actuarial calculation","content":"### sec.74 Actuarial calculation\n\nEach appointed actuary’s calculation of the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act must—\nbe prepared under the actuarial standard; and\napply a central estimate of the liability; and\napply the risk free rate of return; and\ninclude claims administration expenses of 7% of the non-scheme employer’s liability under section 105B (3) of the Act ; and\nnot include a prudential margin; and\nbe based, to the extent practicable, on claims for compensation and damages made against the non-scheme employer; and\nbe based on data that only relates to the period before the non-scheme employer’s exit date.\n- (a) be prepared under the actuarial standard; and\n- (b) apply a central estimate of the liability; and\n- (c) apply the risk free rate of return; and\n- (d) include claims administration expenses of 7% of the non-scheme employer’s liability under section 105B (3) of the Act ; and\n- (e) not include a prudential margin; and\n- (f) be based, to the extent practicable, on claims for compensation and damages made against the non-scheme employer; and\n- (g) be based on data that only relates to the period before the non-scheme employer’s exit date.","sortOrder":84},{"sectionNumber":"sec.75","sectionType":"section","heading":"Actuarial report","content":"### sec.75 Actuarial report\n\nEach appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nThe actuarial report must state the following—\nthe estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act ;\nthe key assumptions made by the appointed actuary for the calculation;\nhow the key assumptions made by the appointed actuary have been derived, including—\nthe average amount of a claim for compensation against the non-scheme employer; and\nthe average amount of a claim for damages against the non-scheme employer; and\nthe amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and\nthe frequency of claims for compensation against the non-scheme employer; and\nthe frequency of claims for damages against the non-scheme employer; and\nthe net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and\nthe net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and\nthe rate of inflation used;\nthe nature of the data used in the calculation;\nthe appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\nhow the appointed actuary interpreted the data;\nthe actuarial model used in the calculation;\nthe results of the calculation;\nthe appointed actuary’s confidence in the results of the calculation.\nEach appointed actuary must prepare the actuarial report within 35 days after the cancellation day.\n(sec.75-ssec.1) Each appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act .\n(sec.75-ssec.2) The actuarial report must state the following— the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act ; the key assumptions made by the appointed actuary for the calculation; how the key assumptions made by the appointed actuary have been derived, including— the average amount of a claim for compensation against the non-scheme employer; and the average amount of a claim for damages against the non-scheme employer; and the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and the frequency of claims for compensation against the non-scheme employer; and the frequency of claims for damages against the non-scheme employer; and the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and the rate of inflation used; the nature of the data used in the calculation; the appointed actuary’s assessment of the data, including, for example, the accuracy of the data; how the appointed actuary interpreted the data; the actuarial model used in the calculation; the results of the calculation; the appointed actuary’s confidence in the results of the calculation.\n(sec.75-ssec.3) Each appointed actuary must prepare the actuarial report within 35 days after the cancellation day.\n- (a) the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act ;\n- (b) the key assumptions made by the appointed actuary for the calculation;\n- (c) how the key assumptions made by the appointed actuary have been derived, including— (i) the average amount of a claim for compensation against the non-scheme employer; and (ii) the average amount of a claim for damages against the non-scheme employer; and (iii) the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and (iv) the frequency of claims for compensation against the non-scheme employer; and (v) the frequency of claims for damages against the non-scheme employer; and (vi) the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and (viii) the rate of inflation used;\n- (i) the average amount of a claim for compensation against the non-scheme employer; and\n- (ii) the average amount of a claim for damages against the non-scheme employer; and\n- (iii) the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the non-scheme employer; and\n- (v) the frequency of claims for damages against the non-scheme employer; and\n- (vi) the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;\n- (d) the nature of the data used in the calculation;\n- (e) the appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\n- (f) how the appointed actuary interpreted the data;\n- (g) the actuarial model used in the calculation;\n- (h) the results of the calculation;\n- (i) the appointed actuary’s confidence in the results of the calculation.\n- (i) the average amount of a claim for compensation against the non-scheme employer; and\n- (ii) the average amount of a claim for damages against the non-scheme employer; and\n- (iii) the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the non-scheme employer; and\n- (v) the frequency of claims for damages against the non-scheme employer; and\n- (vi) the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;","sortOrder":85},{"sectionNumber":"sec.76","sectionType":"section","heading":"Summary report","content":"### sec.76 Summary report\n\nThe appointed actuaries must also jointly prepare a report (the summary report ) that—\nincludes each appointed actuary’s individual actuarial report; and\nstates how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\nThe appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the cancellation day.\n(sec.76-ssec.1) The appointed actuaries must also jointly prepare a report (the summary report ) that— includes each appointed actuary’s individual actuarial report; and states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\n(sec.76-ssec.2) The appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the cancellation day.\n- (a) includes each appointed actuary’s individual actuarial report; and\n- (b) states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.","sortOrder":86},{"sectionNumber":"sec.77","sectionType":"section","heading":"Agreement on amount","content":"### sec.77 Agreement on amount\n\nWorkCover and the non-scheme employer may agree on the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act having regard to the summary report.","sortOrder":87},{"sectionNumber":"sec.78","sectionType":"section","heading":"Referral to arbiter if no agreement on amount","content":"### sec.78 Referral to arbiter if no agreement on amount\n\nThis section applies if WorkCover and the non-scheme employer do not agree on the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nWorkCover and the non-scheme employer must, by written notice, tell the Regulator that WorkCover and the non-scheme employer do not agree on the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nIf the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nSee sections 102 to 104 in relation to the arbiter’s decision.\n(sec.78-ssec.1) This section applies if WorkCover and the non-scheme employer do not agree on the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act .\n(sec.78-ssec.2) WorkCover and the non-scheme employer must, by written notice, tell the Regulator that WorkCover and the non-scheme employer do not agree on the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act .\n(sec.78-ssec.3) If the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act . See sections 102 to 104 in relation to the arbiter’s decision.","sortOrder":88},{"sectionNumber":"sec.79","sectionType":"section","heading":"Payment of amount","content":"### sec.79 Payment of amount\n\nThe non-scheme employer must pay to WorkCover the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act (the final amount )—\nagreed to by WorkCover and the non-scheme employer; or\nif there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\nHowever, the final amount paid by the non-scheme employer must be adjusted by the non-scheme employer’s appointed actuary to take into account—\nthe amount of compensation and damages, if any, paid by the non-scheme employer during the final period; and\nclaims for compensation and damages, if any, lodged against the non-scheme employer during the final period.\nSee section 105I (3) (b) of the Act for when the final amount must be paid.\nIn this section—\nassessment day means the last day of the financial quarter immediately before the cancellation day.\nfinal period , in relation to a non-scheme employer, means the period that—\nstarts on the assessment day; and\nends on the cancellation day.\n(sec.79-ssec.1) The non-scheme employer must pay to WorkCover the estimated amount of the non-scheme employer’s liability under section 105B (3) of the Act (the final amount )— agreed to by WorkCover and the non-scheme employer; or if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n(sec.79-ssec.2) However, the final amount paid by the non-scheme employer must be adjusted by the non-scheme employer’s appointed actuary to take into account— the amount of compensation and damages, if any, paid by the non-scheme employer during the final period; and claims for compensation and damages, if any, lodged against the non-scheme employer during the final period. See section 105I (3) (b) of the Act for when the final amount must be paid.\n(sec.79-ssec.3) In this section— assessment day means the last day of the financial quarter immediately before the cancellation day. final period , in relation to a non-scheme employer, means the period that— starts on the assessment day; and ends on the cancellation day.\n- (a) agreed to by WorkCover and the non-scheme employer; or\n- (b) if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n- (a) the amount of compensation and damages, if any, paid by the non-scheme employer during the final period; and\n- (b) claims for compensation and damages, if any, lodged against the non-scheme employer during the final period.\n- (a) starts on the assessment day; and\n- (b) ends on the cancellation day.","sortOrder":89},{"sectionNumber":"sec.80","sectionType":"section","heading":"Definitions for subdivision","content":"### sec.80 Definitions for subdivision\n\nIn this subdivision—\nappointed actuary see section 81 (1) .\nsummary report see section 85 (1) .","sortOrder":90},{"sectionNumber":"sec.81","sectionType":"section","heading":"Appointment of actuaries","content":"### sec.81 Appointment of actuaries\n\nWorkCover and the non-scheme employer must each appoint an actuary (each an appointed actuary ) to finalise the amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nThe appointment must be made within 20 business days after the day that is 4 years after the cancellation day.\n(sec.81-ssec.1) WorkCover and the non-scheme employer must each appoint an actuary (each an appointed actuary ) to finalise the amount of the non-scheme employer’s liability under section 105B (3) of the Act .\n(sec.81-ssec.2) The appointment must be made within 20 business days after the day that is 4 years after the cancellation day.","sortOrder":91},{"sectionNumber":"sec.82","sectionType":"section","heading":"WorkCover to give appointed actuaries information","content":"### sec.82 WorkCover to give appointed actuaries information\n\nWorkCover must give each appointed actuary the information necessary to enable the appointed actuary to finalise the amount of the non-scheme employer’s liability under section 105B (3) of the Act within the period mentioned in section 84 (3) .","sortOrder":92},{"sectionNumber":"sec.83","sectionType":"section","heading":"Actuarial calculation","content":"### sec.83 Actuarial calculation\n\nEach appointed actuary’s calculation of the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act must—\nbe prepared under the actuarial standard; and\napply a central estimate of the liability; and\napply the same risk free rate of return that was used in estimating under subdivision 2 the non-scheme employer’s liability under section 105B (3) of the Act ; and\ninclude claims administration expenses of 7% of the non-scheme employer’s liability under section 105B (3) of the Act ; and\nnot include a prudential margin; and\nbe based, to the extent practicable, on claims for compensation and damages made against the non-scheme employer; and\nhave regard to payments for compensation and damages made in relation to the non-scheme employer’s liability under section 105B (3) of the Act during the period (the 4 year period ) that—\nstarts on the cancellation day; and\nends 4 years after the cancellation day; and\nbe based on data that—\nis up-to-date on the last day of the last financial quarter of the 4 year period for which data is available; and\nonly relates to the period before the non-scheme employer’s exit date.\n- (a) be prepared under the actuarial standard; and\n- (b) apply a central estimate of the liability; and\n- (c) apply the same risk free rate of return that was used in estimating under subdivision 2 the non-scheme employer’s liability under section 105B (3) of the Act ; and\n- (d) include claims administration expenses of 7% of the non-scheme employer’s liability under section 105B (3) of the Act ; and\n- (e) not include a prudential margin; and\n- (f) be based, to the extent practicable, on claims for compensation and damages made against the non-scheme employer; and\n- (h) have regard to payments for compensation and damages made in relation to the non-scheme employer’s liability under section 105B (3) of the Act during the period (the 4 year period ) that— (i) starts on the cancellation day; and (ii) ends 4 years after the cancellation day; and\n- (i) starts on the cancellation day; and\n- (ii) ends 4 years after the cancellation day; and\n- (i) be based on data that— (i) is up-to-date on the last day of the last financial quarter of the 4 year period for which data is available; and (ii) only relates to the period before the non-scheme employer’s exit date.\n- (i) is up-to-date on the last day of the last financial quarter of the 4 year period for which data is available; and\n- (ii) only relates to the period before the non-scheme employer’s exit date.\n- (i) starts on the cancellation day; and\n- (ii) ends 4 years after the cancellation day; and\n- (i) is up-to-date on the last day of the last financial quarter of the 4 year period for which data is available; and\n- (ii) only relates to the period before the non-scheme employer’s exit date.","sortOrder":93},{"sectionNumber":"sec.84","sectionType":"section","heading":"Actuarial report","content":"### sec.84 Actuarial report\n\nEach appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nThe actuarial report must state the following—\nthe finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act ;\nthe key assumptions made by the appointed actuary for the calculation;\nhow the key assumptions made by the appointed actuary have been derived, including—\nthe average amount of a claim for compensation against the non-scheme employer; and\nthe average amount of a claim for damages against the non-scheme employer; and\nthe amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and\nthe frequency of claims for compensation against the non-scheme employer; and\nthe frequency of claims for damages against the non-scheme employer; and\nthe net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and\nthe net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and\nthe rate of inflation used;\nthe nature of the data used in the calculation;\nthe appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\nhow the appointed actuary interpreted the data;\nthe actuarial model used in the calculation;\nthe results of the calculation;\nthe appointed actuary’s confidence in the results of the calculation.\nEach appointed actuary must prepare the actuarial report within 35 days after the day that is 4 years after the cancellation day.\n(sec.84-ssec.1) Each appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act .\n(sec.84-ssec.2) The actuarial report must state the following— the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act ; the key assumptions made by the appointed actuary for the calculation; how the key assumptions made by the appointed actuary have been derived, including— the average amount of a claim for compensation against the non-scheme employer; and the average amount of a claim for damages against the non-scheme employer; and the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and the frequency of claims for compensation against the non-scheme employer; and the frequency of claims for damages against the non-scheme employer; and the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and the rate of inflation used; the nature of the data used in the calculation; the appointed actuary’s assessment of the data, including, for example, the accuracy of the data; how the appointed actuary interpreted the data; the actuarial model used in the calculation; the results of the calculation; the appointed actuary’s confidence in the results of the calculation.\n(sec.84-ssec.3) Each appointed actuary must prepare the actuarial report within 35 days after the day that is 4 years after the cancellation day.\n- (a) the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act ;\n- (b) the key assumptions made by the appointed actuary for the calculation;\n- (c) how the key assumptions made by the appointed actuary have been derived, including— (i) the average amount of a claim for compensation against the non-scheme employer; and (ii) the average amount of a claim for damages against the non-scheme employer; and (iii) the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and (iv) the frequency of claims for compensation against the non-scheme employer; and (v) the frequency of claims for damages against the non-scheme employer; and (vi) the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and (viii) the rate of inflation used;\n- (i) the average amount of a claim for compensation against the non-scheme employer; and\n- (ii) the average amount of a claim for damages against the non-scheme employer; and\n- (iii) the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the non-scheme employer; and\n- (v) the frequency of claims for damages against the non-scheme employer; and\n- (vi) the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;\n- (d) the nature of the data used in the calculation;\n- (e) the appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\n- (f) how the appointed actuary interpreted the data;\n- (g) the actuarial model used in the calculation;\n- (h) the results of the calculation;\n- (i) the appointed actuary’s confidence in the results of the calculation.\n- (i) the average amount of a claim for compensation against the non-scheme employer; and\n- (ii) the average amount of a claim for damages against the non-scheme employer; and\n- (iii) the amount anticipated to have been incurred by the non-scheme employer in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the non-scheme employer; and\n- (v) the frequency of claims for damages against the non-scheme employer; and\n- (vi) the net amount of claims for compensation and damages against the non-scheme employer after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme employer to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;","sortOrder":94},{"sectionNumber":"sec.85","sectionType":"section","heading":"Summary report","content":"### sec.85 Summary report\n\nThe appointed actuaries must also jointly prepare a report (the summary report ) that—\nincludes each appointed actuary’s individual actuarial report; and\nstates how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\nThe appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the day that is 4 years after the cancellation day.\n(sec.85-ssec.1) The appointed actuaries must also jointly prepare a report (the summary report ) that— includes each appointed actuary’s individual actuarial report; and states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\n(sec.85-ssec.2) The appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the non-scheme employer within 2 months after the day that is 4 years after the cancellation day.\n- (a) includes each appointed actuary’s individual actuarial report; and\n- (b) states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.","sortOrder":95},{"sectionNumber":"sec.86","sectionType":"section","heading":"Agreement on amount","content":"### sec.86 Agreement on amount\n\nWorkCover and the non-scheme employer may agree on the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act having regard to the summary report.","sortOrder":96},{"sectionNumber":"sec.87","sectionType":"section","heading":"Referral to arbiter if no agreement on amount","content":"### sec.87 Referral to arbiter if no agreement on amount\n\nThis section applies if WorkCover and the non-scheme employer do not agree on the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nWorkCover and the non-scheme employer must, by written notice, tell the Regulator that WorkCover and the non-scheme employer do not agree on the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nIf the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act .\nSee sections 102 to 104 in relation to the arbiter’s decision.\n(sec.87-ssec.1) This section applies if WorkCover and the non-scheme employer do not agree on the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act .\n(sec.87-ssec.2) WorkCover and the non-scheme employer must, by written notice, tell the Regulator that WorkCover and the non-scheme employer do not agree on the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act .\n(sec.87-ssec.3) If the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act . See sections 102 to 104 in relation to the arbiter’s decision.","sortOrder":97},{"sectionNumber":"sec.88","sectionType":"section","heading":"Payment of amount","content":"### sec.88 Payment of amount\n\nThis section applies if the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act is—\nagreed to by WorkCover and the non-scheme employer under section 86 ; or\nif there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\nIf the finalised amount is more than the final amount paid under section 79 (the interim payment ), the non-scheme employer must, within 20 business days after the agreement or decision mentioned in subsection (1) , pay WorkCover—\nthe difference between the finalised amount and the interim payment; and\ninterest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return mentioned in section 83 (c) .\nIf the finalised amount is less than the final amount paid under section 79 (the interim payment ), WorkCover must, within 20 business days after the agreement or decision mentioned in subsection (1) , pay the non-scheme employer—\nthe difference between the interim payment and the finalised amount; and\ninterest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return mentioned in section 83 (c) .\n(sec.88-ssec.1) This section applies if the finalised amount of the non-scheme employer’s liability under section 105B (3) of the Act is— agreed to by WorkCover and the non-scheme employer under section 86 ; or if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n(sec.88-ssec.2) If the finalised amount is more than the final amount paid under section 79 (the interim payment ), the non-scheme employer must, within 20 business days after the agreement or decision mentioned in subsection (1) , pay WorkCover— the difference between the finalised amount and the interim payment; and interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return mentioned in section 83 (c) .\n(sec.88-ssec.3) If the finalised amount is less than the final amount paid under section 79 (the interim payment ), WorkCover must, within 20 business days after the agreement or decision mentioned in subsection (1) , pay the non-scheme employer— the difference between the interim payment and the finalised amount; and interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return mentioned in section 83 (c) .\n- (a) agreed to by WorkCover and the non-scheme employer under section 86 ; or\n- (b) if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n- (a) the difference between the finalised amount and the interim payment; and\n- (b) interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return mentioned in section 83 (c) .\n- (a) the difference between the interim payment and the finalised amount; and\n- (b) interest on the difference, from the day the whole of the interim payment was paid, at the same risk free rate of return mentioned in section 83 (c) .","sortOrder":98},{"sectionNumber":"pt.3-div.6","sectionType":"division","heading":"Total liability—member of group employer who becomes non-scheme employer","content":"## Total liability—member of group employer who becomes non-scheme employer","sortOrder":99},{"sectionNumber":"sec.89","sectionType":"section","heading":"Definitions for division","content":"### sec.89 Definitions for division\n\nIn this division—\nappointed actuary see section 91 (1) .\nassessment day , in relation to a non-scheme member, means the last day of the financial quarter immediately before the final day.\nfinal day , in relation to a non-scheme member, means the day the non-scheme member stopped being a member of the old self-insurer under section 105M of the Act .\nold self-insurer , in relation to a non-scheme member, means the self-insurer of which the non-scheme member was a member immediately before becoming a non-scheme employer.\nsummary report see section 95 (1) .","sortOrder":100},{"sectionNumber":"sec.90","sectionType":"section","heading":"Calculation of non-scheme member’s total liability— Act , s 105O","content":"### sec.90 Calculation of non-scheme member’s total liability— Act , s 105O\n\nFor section 105O (3) (a) of the Act , the amount of a non-scheme member’s total liability must be calculated under this division.","sortOrder":101},{"sectionNumber":"sec.91","sectionType":"section","heading":"Appointment of actuaries","content":"### sec.91 Appointment of actuaries\n\nWorkCover and the old self-insurer must each appoint an actuary (each an appointed actuary ) to calculate the amount of the non-scheme member’s total liability.\nThe actuary appointed by the old self-insurer must be approved by the non-scheme member.\n(sec.91-ssec.1) WorkCover and the old self-insurer must each appoint an actuary (each an appointed actuary ) to calculate the amount of the non-scheme member’s total liability.\n(sec.91-ssec.2) The actuary appointed by the old self-insurer must be approved by the non-scheme member.","sortOrder":102},{"sectionNumber":"sec.92","sectionType":"section","heading":"WorkCover and old self-insurer to give appointed actuaries information","content":"### sec.92 WorkCover and old self-insurer to give appointed actuaries information\n\nWorkCover and the old self-insurer must give each appointed actuary, in the approved form, the information necessary to enable the appointed actuary to calculate the amount of the non-scheme member’s total liability within the period mentioned in section 94 (3) .","sortOrder":103},{"sectionNumber":"sec.93","sectionType":"section","heading":"Actuarial calculation","content":"### sec.93 Actuarial calculation\n\nEach appointed actuary’s calculation of the amount of the non-scheme member’s total liability must—\nbe prepared under the actuarial standard; and\napply a central estimate of the relevant liability; and\napply the risk free rate of return; and\ninclude claims administration expenses of 7% of the non-scheme member’s total liability; and\nnot include a prudential margin; and\nbe based, to the extent practicable, on claims for compensation and damages made against the non-scheme member; and\nbe based on data that is up-to-date on the assessment day.\n- (a) be prepared under the actuarial standard; and\n- (b) apply a central estimate of the relevant liability; and\n- (c) apply the risk free rate of return; and\n- (d) include claims administration expenses of 7% of the non-scheme member’s total liability; and\n- (e) not include a prudential margin; and\n- (f) be based, to the extent practicable, on claims for compensation and damages made against the non-scheme member; and\n- (g) be based on data that is up-to-date on the assessment day.","sortOrder":104},{"sectionNumber":"sec.94","sectionType":"section","heading":"Actuarial report","content":"### sec.94 Actuarial report\n\nEach appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the non-scheme member’s total liability.\nThe actuarial report must state the following—\nthe amount of the non-scheme member’s total liability;\nthe key assumptions made by the appointed actuary for the calculation;\nhow the key assumptions made by the appointed actuary have been derived, including—\nthe average amount of a claim for compensation against the non-scheme member; and\nthe average amount of a claim for damages against the non-scheme member; and\nthe amount anticipated to have been incurred by the non-scheme member in potential claims for compensation or damages for which no claim has yet been made; and\nthe frequency of claims for compensation against the non-scheme member; and\nthe frequency of claims for damages against the non-scheme member; and\nthe net amount of claims for compensation and damages against the non-scheme member after allowing for future inflation ( inflated value ); and\nthe net present value of the inflated value after allowing for income from assets set aside by the non-scheme member to pay the amount mentioned in paragraph (a) ; and\nthe rate of inflation used;\nthe nature of the data used in the calculation;\nthe appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\nhow the appointed actuary interpreted the data;\nthe actuarial model used in the calculation;\nthe results of the calculation;\nthe appointed actuary’s confidence in the results of the calculation.\nEach appointed actuary must prepare the actuarial report within 35 days after the final day.\n(sec.94-ssec.1) Each appointed actuary must prepare an actuarial report under the actuarial standard of the appointed actuary’s calculation of the amount of the non-scheme member’s total liability.\n(sec.94-ssec.2) The actuarial report must state the following— the amount of the non-scheme member’s total liability; the key assumptions made by the appointed actuary for the calculation; how the key assumptions made by the appointed actuary have been derived, including— the average amount of a claim for compensation against the non-scheme member; and the average amount of a claim for damages against the non-scheme member; and the amount anticipated to have been incurred by the non-scheme member in potential claims for compensation or damages for which no claim has yet been made; and the frequency of claims for compensation against the non-scheme member; and the frequency of claims for damages against the non-scheme member; and the net amount of claims for compensation and damages against the non-scheme member after allowing for future inflation ( inflated value ); and the net present value of the inflated value after allowing for income from assets set aside by the non-scheme member to pay the amount mentioned in paragraph (a) ; and the rate of inflation used; the nature of the data used in the calculation; the appointed actuary’s assessment of the data, including, for example, the accuracy of the data; how the appointed actuary interpreted the data; the actuarial model used in the calculation; the results of the calculation; the appointed actuary’s confidence in the results of the calculation.\n(sec.94-ssec.3) Each appointed actuary must prepare the actuarial report within 35 days after the final day.\n- (a) the amount of the non-scheme member’s total liability;\n- (b) the key assumptions made by the appointed actuary for the calculation;\n- (c) how the key assumptions made by the appointed actuary have been derived, including— (i) the average amount of a claim for compensation against the non-scheme member; and (ii) the average amount of a claim for damages against the non-scheme member; and (iii) the amount anticipated to have been incurred by the non-scheme member in potential claims for compensation or damages for which no claim has yet been made; and (iv) the frequency of claims for compensation against the non-scheme member; and (v) the frequency of claims for damages against the non-scheme member; and (vi) the net amount of claims for compensation and damages against the non-scheme member after allowing for future inflation ( inflated value ); and (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme member to pay the amount mentioned in paragraph (a) ; and (viii) the rate of inflation used;\n- (i) the average amount of a claim for compensation against the non-scheme member; and\n- (ii) the average amount of a claim for damages against the non-scheme member; and\n- (iii) the amount anticipated to have been incurred by the non-scheme member in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the non-scheme member; and\n- (v) the frequency of claims for damages against the non-scheme member; and\n- (vi) the net amount of claims for compensation and damages against the non-scheme member after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme member to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;\n- (d) the nature of the data used in the calculation;\n- (e) the appointed actuary’s assessment of the data, including, for example, the accuracy of the data;\n- (f) how the appointed actuary interpreted the data;\n- (g) the actuarial model used in the calculation;\n- (h) the results of the calculation;\n- (i) the appointed actuary’s confidence in the results of the calculation.\n- (i) the average amount of a claim for compensation against the non-scheme member; and\n- (ii) the average amount of a claim for damages against the non-scheme member; and\n- (iii) the amount anticipated to have been incurred by the non-scheme member in potential claims for compensation or damages for which no claim has yet been made; and\n- (iv) the frequency of claims for compensation against the non-scheme member; and\n- (v) the frequency of claims for damages against the non-scheme member; and\n- (vi) the net amount of claims for compensation and damages against the non-scheme member after allowing for future inflation ( inflated value ); and\n- (vii) the net present value of the inflated value after allowing for income from assets set aside by the non-scheme member to pay the amount mentioned in paragraph (a) ; and\n- (viii) the rate of inflation used;","sortOrder":105},{"sectionNumber":"sec.95","sectionType":"section","heading":"Summary report","content":"### sec.95 Summary report\n\nThe appointed actuaries must also jointly prepare a report (the summary report ) that—\nincludes each appointed actuary’s individual actuarial report; and\nstates how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\nThe appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the old self-insurer within 2 months after the final day.\n(sec.95-ssec.1) The appointed actuaries must also jointly prepare a report (the summary report ) that— includes each appointed actuary’s individual actuarial report; and states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.\n(sec.95-ssec.2) The appointed actuaries must give a copy of the summary report to the Regulator, WorkCover and the old self-insurer within 2 months after the final day.\n- (a) includes each appointed actuary’s individual actuarial report; and\n- (b) states how the reports mentioned in paragraph (a) agree or differ and the reasons for any difference.","sortOrder":106},{"sectionNumber":"sec.96","sectionType":"section","heading":"Agreement on amount","content":"### sec.96 Agreement on amount\n\nWorkCover and the old self-insurer may agree on the amount of the non-scheme member’s total liability having regard to the summary report.","sortOrder":107},{"sectionNumber":"sec.97","sectionType":"section","heading":"Referral to arbiter if no agreement on amount","content":"### sec.97 Referral to arbiter if no agreement on amount\n\nThis section applies if WorkCover and the old self-insurer do not agree on the amount of the non-scheme member’s total liability.\nWorkCover and the old self-insurer must, by written notice, tell the Regulator that WorkCover and the old self-insurer do not agree on the amount of the non-scheme member’s total liability.\nIf the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the non-scheme member’s total liability.\nSee sections 102 to 104 in relation to the arbiter’s decision.\n(sec.97-ssec.1) This section applies if WorkCover and the old self-insurer do not agree on the amount of the non-scheme member’s total liability.\n(sec.97-ssec.2) WorkCover and the old self-insurer must, by written notice, tell the Regulator that WorkCover and the old self-insurer do not agree on the amount of the non-scheme member’s total liability.\n(sec.97-ssec.3) If the Regulator receives a written notice under subsection (2) , the Regulator must refer the summary report to the arbiter to decide the amount of the non-scheme member’s total liability. See sections 102 to 104 in relation to the arbiter’s decision.","sortOrder":108},{"sectionNumber":"sec.98","sectionType":"section","heading":"Payment of amount","content":"### sec.98 Payment of amount\n\nThe old self-insurer must pay to WorkCover the amount of the non-scheme member’s total liability (the final amount )—\nagreed to by the old self-insurer and WorkCover; or\nif there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\nThe old self-insurer must pay the final amount—\nwithin 3 months after the final day; or\non or before a later day agreed to by the old self-insurer and WorkCover.\nHowever, the final amount paid by the old self-insurer must be adjusted by the old self-insurer’s appointed actuary to take into account—\nthe amount of compensation and damages, if any, paid by the non-scheme member during the final period; and\nclaims for compensation and damages, if any, lodged against the non-scheme member during the final period.\nThe old self-insurer must, by written notice, tell the Regulator the following information not later than the day the final amount is paid to WorkCover—\nthe final amount paid, as adjusted under subsection (3) ;\nthe name and contact details of the old self-insurer and the non-scheme member.\nIn this section—\nfinal period , in relation to a non-scheme member, means the period that—\nstarts on the assessment day; and\nends on the final day.\n(sec.98-ssec.1) The old self-insurer must pay to WorkCover the amount of the non-scheme member’s total liability (the final amount )— agreed to by the old self-insurer and WorkCover; or if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n(sec.98-ssec.2) The old self-insurer must pay the final amount— within 3 months after the final day; or on or before a later day agreed to by the old self-insurer and WorkCover.\n(sec.98-ssec.3) However, the final amount paid by the old self-insurer must be adjusted by the old self-insurer’s appointed actuary to take into account— the amount of compensation and damages, if any, paid by the non-scheme member during the final period; and claims for compensation and damages, if any, lodged against the non-scheme member during the final period.\n(sec.98-ssec.4) The old self-insurer must, by written notice, tell the Regulator the following information not later than the day the final amount is paid to WorkCover— the final amount paid, as adjusted under subsection (3) ; the name and contact details of the old self-insurer and the non-scheme member.\n(sec.98-ssec.5) In this section— final period , in relation to a non-scheme member, means the period that— starts on the assessment day; and ends on the final day.\n- (a) agreed to by the old self-insurer and WorkCover; or\n- (b) if there is no agreement—decided by the arbiter under section 102 (2) (b) (ii) .\n- (a) within 3 months after the final day; or\n- (b) on or before a later day agreed to by the old self-insurer and WorkCover.\n- (a) the amount of compensation and damages, if any, paid by the non-scheme member during the final period; and\n- (b) claims for compensation and damages, if any, lodged against the non-scheme member during the final period.\n- (a) the final amount paid, as adjusted under subsection (3) ;\n- (b) the name and contact details of the old self-insurer and the non-scheme member.\n- (a) starts on the assessment day; and\n- (b) ends on the final day.","sortOrder":109},{"sectionNumber":"sec.99","sectionType":"section","heading":"Transfer of claims information","content":"### sec.99 Transfer of claims information\n\nThe old self-insurer must, not later than the day the final amount is paid to WorkCover under section 98 , give WorkCover all the information in the old self-insurer’s possession about the claims for compensation and damages that relate to the non-scheme member’s total liability.","sortOrder":110},{"sectionNumber":"pt.3-div.7","sectionType":"division","heading":"Actuarial arbiter","content":"## Actuarial arbiter","sortOrder":111},{"sectionNumber":"sec.100","sectionType":"section","heading":"Appointment of arbiter","content":"### sec.100 Appointment of arbiter\n\nThe Regulator must appoint an actuarial arbiter (the arbiter ).\nThe person appointed under subsection (1) must—\nbe a Fellow or Accredited Member of the Actuaries Institute; and\nbe selected by a selection panel consisting of—\n2 individuals nominated by the Regulator; and\n2 individuals nominated by WorkCover; and\n2 individuals nominated by the Association of Self Insured Employers of Queensland.\nThe arbiter is appointed on the terms and conditions, not provided for by this regulation, decided by the Regulator.\n(sec.100-ssec.1) The Regulator must appoint an actuarial arbiter (the arbiter ).\n(sec.100-ssec.2) The person appointed under subsection (1) must— be a Fellow or Accredited Member of the Actuaries Institute; and be selected by a selection panel consisting of— 2 individuals nominated by the Regulator; and 2 individuals nominated by WorkCover; and 2 individuals nominated by the Association of Self Insured Employers of Queensland.\n(sec.100-ssec.3) The arbiter is appointed on the terms and conditions, not provided for by this regulation, decided by the Regulator.\n- (a) be a Fellow or Accredited Member of the Actuaries Institute; and\n- (b) be selected by a selection panel consisting of— (i) 2 individuals nominated by the Regulator; and (ii) 2 individuals nominated by WorkCover; and (iii) 2 individuals nominated by the Association of Self Insured Employers of Queensland.\n- (i) 2 individuals nominated by the Regulator; and\n- (ii) 2 individuals nominated by WorkCover; and\n- (iii) 2 individuals nominated by the Association of Self Insured Employers of Queensland.\n- (i) 2 individuals nominated by the Regulator; and\n- (ii) 2 individuals nominated by WorkCover; and\n- (iii) 2 individuals nominated by the Association of Self Insured Employers of Queensland.","sortOrder":112},{"sectionNumber":"sec.101","sectionType":"section","heading":"Functions of arbiter","content":"### sec.101 Functions of arbiter\n\nThe functions of the arbiter are—\nto consider reports referred to the arbiter under this part; and\nto decide on amounts of liability mentioned in this part.\n- (a) to consider reports referred to the arbiter under this part; and\n- (b) to decide on amounts of liability mentioned in this part.","sortOrder":113},{"sectionNumber":"sec.102","sectionType":"section","heading":"Arbiter must decide amount of liability","content":"### sec.102 Arbiter must decide amount of liability\n\nThis section applies if—\nunder section 34 (3) , 45 (3) , 56 (3) , 78 (3) , 87 (3) or 97 (3) , the Regulator refers a summary report about an amount of liability to the arbiter; or\nunder section 68 (2) , the Regulator refers an appointed actuary’s actuarial report, the self-insurer’s data and a second appointed actuary’s actuarial report, if any, about an amount of liability to the arbiter.\nThe arbiter must—\nfor a referral mentioned in subsection (1) (a) —\nconsider the individual reports included in the summary report; and\ndecide—\nthe central estimate for the liability; and\nthe amount of the liability; or\nfor a referral mentioned in subsection (1) (b) —\nconsider the documents mentioned in subsection (1) (b) ; and\ndecide—\nif an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and\nthe amount of the liability.\nThe amount of the liability decided under subsection (2) (a) (ii) (B) must not be—\nmore than the higher of the amounts of liability stated in the individual reports; or\nless than the lower of the amounts of liability stated in the individual reports.\nThe arbiter must give a written statement of the arbiter’s decision, and the reasons for the decision, to the Regulator within 21 days after the referral to the arbiter is made.\n(sec.102-ssec.1) This section applies if— under section 34 (3) , 45 (3) , 56 (3) , 78 (3) , 87 (3) or 97 (3) , the Regulator refers a summary report about an amount of liability to the arbiter; or under section 68 (2) , the Regulator refers an appointed actuary’s actuarial report, the self-insurer’s data and a second appointed actuary’s actuarial report, if any, about an amount of liability to the arbiter.\n(sec.102-ssec.2) The arbiter must— for a referral mentioned in subsection (1) (a) — consider the individual reports included in the summary report; and decide— the central estimate for the liability; and the amount of the liability; or for a referral mentioned in subsection (1) (b) — consider the documents mentioned in subsection (1) (b) ; and decide— if an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and the amount of the liability.\n(sec.102-ssec.3) The amount of the liability decided under subsection (2) (a) (ii) (B) must not be— more than the higher of the amounts of liability stated in the individual reports; or less than the lower of the amounts of liability stated in the individual reports.\n(sec.102-ssec.4) The arbiter must give a written statement of the arbiter’s decision, and the reasons for the decision, to the Regulator within 21 days after the referral to the arbiter is made.\n- (a) under section 34 (3) , 45 (3) , 56 (3) , 78 (3) , 87 (3) or 97 (3) , the Regulator refers a summary report about an amount of liability to the arbiter; or\n- (b) under section 68 (2) , the Regulator refers an appointed actuary’s actuarial report, the self-insurer’s data and a second appointed actuary’s actuarial report, if any, about an amount of liability to the arbiter.\n- (a) for a referral mentioned in subsection (1) (a) — (i) consider the individual reports included in the summary report; and (ii) decide— (A) the central estimate for the liability; and (B) the amount of the liability; or\n- (i) consider the individual reports included in the summary report; and\n- (ii) decide— (A) the central estimate for the liability; and (B) the amount of the liability; or\n- (A) the central estimate for the liability; and\n- (B) the amount of the liability; or\n- (b) for a referral mentioned in subsection (1) (b) — (i) consider the documents mentioned in subsection (1) (b) ; and (ii) decide— (A) if an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and (B) the amount of the liability.\n- (i) consider the documents mentioned in subsection (1) (b) ; and\n- (ii) decide— (A) if an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and (B) the amount of the liability.\n- (A) if an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and\n- (B) the amount of the liability.\n- (i) consider the individual reports included in the summary report; and\n- (ii) decide— (A) the central estimate for the liability; and (B) the amount of the liability; or\n- (A) the central estimate for the liability; and\n- (B) the amount of the liability; or\n- (A) the central estimate for the liability; and\n- (B) the amount of the liability; or\n- (i) consider the documents mentioned in subsection (1) (b) ; and\n- (ii) decide— (A) if an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and (B) the amount of the liability.\n- (A) if an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and\n- (B) the amount of the liability.\n- (A) if an appointed actuary’s actuarial report and a second appointed actuary’s report is referred—the central estimate for the liability; and\n- (B) the amount of the liability.\n- (a) more than the higher of the amounts of liability stated in the individual reports; or\n- (b) less than the lower of the amounts of liability stated in the individual reports.","sortOrder":114},{"sectionNumber":"sec.103","sectionType":"section","heading":"Arbiter’s decision is final","content":"### sec.103 Arbiter’s decision is final\n\nUnless the Supreme Court decides a decision of the arbiter under section 102 is affected by jurisdictional error, the decision—\nis final and conclusive; and\ncan not be challenged, appealed against, reviewed, quashed, set aside or called in question in any other way under the Judicial Review Act 1991 or otherwise (whether by the Supreme Court, another court, a tribunal or another entity); and\nis not subject to any declaratory, injunctive or other order of the Supreme Court, another court, a tribunal or another entity on any ground.\n- (a) is final and conclusive; and\n- (b) can not be challenged, appealed against, reviewed, quashed, set aside or called in question in any other way under the Judicial Review Act 1991 or otherwise (whether by the Supreme Court, another court, a tribunal or another entity); and\n- (c) is not subject to any declaratory, injunctive or other order of the Supreme Court, another court, a tribunal or another entity on any ground.","sortOrder":115},{"sectionNumber":"sec.104","sectionType":"section","heading":"Arbiter’s costs","content":"### sec.104 Arbiter’s costs\n\nThe costs of an arbiter incurred in deciding an amount of liability under section 102 are to be paid in equal amounts by the following entities—\nfor a decision about an amount of liability under division 1 —WorkCover and the self-insurer;\nfor a decision about an amount of liability under division 2 —the old insurer and the new insurer;\nfor a decision about an amount of liability under division 3 —WorkCover and the former self-insurer;\nfor a decision about an amount of liability under division 4 —the Regulator and the self-insurer;\nfor a decision about an amount of liability under division 5 , subdivision 2 or 3 —WorkCover and the non-scheme employer;\nfor a decision about an amount of liability under division 6 —WorkCover and the old self-insurer.\n- (a) for a decision about an amount of liability under division 1 —WorkCover and the self-insurer;\n- (b) for a decision about an amount of liability under division 2 —the old insurer and the new insurer;\n- (c) for a decision about an amount of liability under division 3 —WorkCover and the former self-insurer;\n- (d) for a decision about an amount of liability under division 4 —the Regulator and the self-insurer;\n- (e) for a decision about an amount of liability under division 5 , subdivision 2 or 3 —WorkCover and the non-scheme employer;\n- (f) for a decision about an amount of liability under division 6 —WorkCover and the old self-insurer.","sortOrder":116},{"sectionNumber":"pt.4","sectionType":"part","heading":"Compensation","content":"# Compensation","sortOrder":117},{"sectionNumber":"pt.4-div.1","sectionType":"division","heading":"Calculation of normal weekly earnings","content":"## Calculation of normal weekly earnings","sortOrder":118},{"sectionNumber":"sec.105","sectionType":"section","heading":"Calculation of NWE— Act , s 106","content":"### sec.105 Calculation of NWE— Act , s 106\n\nThis division prescribes, for section 106 (3) of the Act , the way in which to calculate a worker’s NWE in the 12 months immediately before the day the worker sustained an injury.","sortOrder":119},{"sectionNumber":"sec.106","sectionType":"section","heading":"What amounts may be taken into account","content":"### sec.106 What amounts may be taken into account\n\nIn calculating the worker’s NWE, amounts paid to the worker by way of overtime, higher duties, penalties and allowances, in relation to work required by the worker’s employer, may be taken into account but only if the amounts—\nare of a regular nature; and\nwould have continued if not for the worker’s injury.\nHowever, amounts mentioned in the Act , schedule 6 , definition wages , paragraphs (a) to (d) must not be taken into account in calculating the worker’s NWE.\n(sec.106-ssec.1) In calculating the worker’s NWE, amounts paid to the worker by way of overtime, higher duties, penalties and allowances, in relation to work required by the worker’s employer, may be taken into account but only if the amounts— are of a regular nature; and would have continued if not for the worker’s injury.\n(sec.106-ssec.2) However, amounts mentioned in the Act , schedule 6 , definition wages , paragraphs (a) to (d) must not be taken into account in calculating the worker’s NWE.\n- (a) are of a regular nature; and\n- (b) would have continued if not for the worker’s injury.","sortOrder":120},{"sectionNumber":"sec.107","sectionType":"section","heading":"NWE if impracticable to calculate worker’s earnings","content":"### sec.107 NWE if impracticable to calculate worker’s earnings\n\nThis section applies if it is impracticable to calculate the worker’s earnings in the 12 months immediately before the day the worker sustained the injury because of—\nthe period for which the worker has been employed; or\nthe terms of the worker’s employment.\nIn calculating the worker’s NWE, regard must be had to—\nthe NWE, in the 12 months immediately before the day the worker sustained the injury, of a person employed by the same employer who—\nis employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; and\nperforms the same or comparable work as the worker; or\nif paragraph (a) does not apply—the NWE, in the 12 months immediately before the day the worker sustained the injury, of a person employed by another employer who—\nis employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; or\nperforms the same or comparable work as the worker and receives the same or comparable earnings as the worker.\n(sec.107-ssec.1) This section applies if it is impracticable to calculate the worker’s earnings in the 12 months immediately before the day the worker sustained the injury because of— the period for which the worker has been employed; or the terms of the worker’s employment.\n(sec.107-ssec.2) In calculating the worker’s NWE, regard must be had to— the NWE, in the 12 months immediately before the day the worker sustained the injury, of a person employed by the same employer who— is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; and performs the same or comparable work as the worker; or if paragraph (a) does not apply—the NWE, in the 12 months immediately before the day the worker sustained the injury, of a person employed by another employer who— is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; or performs the same or comparable work as the worker and receives the same or comparable earnings as the worker.\n- (a) the period for which the worker has been employed; or\n- (b) the terms of the worker’s employment.\n- (a) the NWE, in the 12 months immediately before the day the worker sustained the injury, of a person employed by the same employer who— (i) is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; and (ii) performs the same or comparable work as the worker; or\n- (i) is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; and\n- (ii) performs the same or comparable work as the worker; or\n- (b) if paragraph (a) does not apply—the NWE, in the 12 months immediately before the day the worker sustained the injury, of a person employed by another employer who— (i) is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; or (ii) performs the same or comparable work as the worker and receives the same or comparable earnings as the worker.\n- (i) is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; or\n- (ii) performs the same or comparable work as the worker and receives the same or comparable earnings as the worker.\n- (i) is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; and\n- (ii) performs the same or comparable work as the worker; or\n- (i) is employed under the same or a comparable industrial agreement or the same or comparable terms and conditions as the worker; or\n- (ii) performs the same or comparable work as the worker and receives the same or comparable earnings as the worker.","sortOrder":121},{"sectionNumber":"sec.108","sectionType":"section","heading":"NWE if worker employed by 2 or more employers","content":"### sec.108 NWE if worker employed by 2 or more employers\n\nThis section applies if, at the time the worker’s injury was sustained, the worker was employed under concurrent contracts of service with 2 or more employers.\nThe worker’s NWE is to be calculated as if earnings under all the contracts were earnings in the employment of the employer for whom the worker was working when the injury was sustained.\n(sec.108-ssec.1) This section applies if, at the time the worker’s injury was sustained, the worker was employed under concurrent contracts of service with 2 or more employers.\n(sec.108-ssec.2) The worker’s NWE is to be calculated as if earnings under all the contracts were earnings in the employment of the employer for whom the worker was working when the injury was sustained.","sortOrder":122},{"sectionNumber":"sec.109","sectionType":"section","heading":"NWE if insurer considers calculation unfair","content":"### sec.109 NWE if insurer considers calculation unfair\n\nThis section applies if an insurer considers that the calculation of a worker’s NWE under this division would be unfair.\nThe worker’s NWE may be calculated in a way the insurer considers to be fair, and the calculation under this subsection is taken to be the worker’s NWE.\n(sec.109-ssec.1) This section applies if an insurer considers that the calculation of a worker’s NWE under this division would be unfair.\n(sec.109-ssec.2) The worker’s NWE may be calculated in a way the insurer considers to be fair, and the calculation under this subsection is taken to be the worker’s NWE.","sortOrder":123},{"sectionNumber":"pt.4-div.2","sectionType":"division","heading":"Application for compensation","content":"## Application for compensation","sortOrder":124},{"sectionNumber":"sec.110","sectionType":"section","heading":"Evidence and particulars for application for compensation— Act , s 132","content":"### sec.110 Evidence and particulars for application for compensation— Act , s 132\n\nFor section 132 (3) (b) of the Act , an application for compensation for a worker’s injury must be accompanied by evidence and particulars of—\nthe injury and its cause; and\nthe nature, extent and duration of incapacity resulting from the injury; and\nif the injury is, or results in, the death of the worker—\nthe identity of the worker; and\nthe worker’s death; and\nthe relationship to the worker, and dependency, of persons claiming to be the worker’s dependants; and\nif the injury is a latent onset injury that is a terminal condition and the worker has dependants—the relationship to the worker of persons claiming to be the worker’s dependants.\n- (a) the injury and its cause; and\n- (b) the nature, extent and duration of incapacity resulting from the injury; and\n- (c) if the injury is, or results in, the death of the worker— (i) the identity of the worker; and (ii) the worker’s death; and (iii) the relationship to the worker, and dependency, of persons claiming to be the worker’s dependants; and\n- (i) the identity of the worker; and\n- (ii) the worker’s death; and\n- (iii) the relationship to the worker, and dependency, of persons claiming to be the worker’s dependants; and\n- (d) if the injury is a latent onset injury that is a terminal condition and the worker has dependants—the relationship to the worker of persons claiming to be the worker’s dependants.\n- (i) the identity of the worker; and\n- (ii) the worker’s death; and\n- (iii) the relationship to the worker, and dependency, of persons claiming to be the worker’s dependants; and","sortOrder":125},{"sectionNumber":"sec.111","sectionType":"section","heading":"Evidence and particulars for assessment of DPI— Act , s 132A","content":"### sec.111 Evidence and particulars for assessment of DPI— Act , s 132A\n\nFor section 132A (3) (c) (ii) of the Act , an application to have a worker’s injury assessed under section 179 of the Act must be accompanied by evidence and particulars of—\nthe injury and its cause; and\nthe nature, extent and duration of incapacity resulting from the injury.\n- (a) the injury and its cause; and\n- (b) the nature, extent and duration of incapacity resulting from the injury.","sortOrder":126},{"sectionNumber":"sec.112","sectionType":"section","heading":"Evidence and particulars for certificate of dependency— Act , s 132B","content":"### sec.112 Evidence and particulars for certificate of dependency— Act , s 132B\n\nFor section 132B (3) (c) (ii) of the Act , an application for the issue of a certificate stating a person is a dependant of a deceased worker must be accompanied by evidence and particulars of—\nthe injury and its cause; and\nthe identity of the worker; and\nthe worker’s death; and\nthe relationship to the worker, and dependency, of the person claiming to be the worker’s dependant.\n- (a) the injury and its cause; and\n- (b) the identity of the worker; and\n- (c) the worker’s death; and\n- (d) the relationship to the worker, and dependency, of the person claiming to be the worker’s dependant.","sortOrder":127},{"sectionNumber":"sec.113","sectionType":"section","heading":"Doctor, nurse practitioner or registered dentist required to give medical certificate not available","content":"### sec.113 Doctor, nurse practitioner or registered dentist required to give medical certificate not available\n\nThis section applies if—\na person (the applicant ) makes an application to an insurer under section 132 , 132A or 132B of the Act ; and\nthe application is not accompanied by a medical certificate; and\na doctor, nurse practitioner or registered dentist required or permitted to give the medical certificate was not available to attend the worker for the purpose of giving the certificate.\nThe applicant must give the insurer a declaration in the approved form stating—\nthat a doctor, nurse practitioner or registered dentist was not available to attend the worker for the purpose of giving the medical certificate; and\nthe details of the worker’s injury.\nFor a non-fatal injury, the declaration—\nmay be accepted by the insurer as proof of incapacity of the worker only once for injury to the worker in any 1 event; and\nis acceptable proof of incapacity of the worker for not more than 3 days.\nThe declaration is taken to be a certificate in the approved form for section 132 (3) (a) , 132A (3) (c) (i) or 132B (3) (c) (i) of the Act .\n(sec.113-ssec.1) This section applies if— a person (the applicant ) makes an application to an insurer under section 132 , 132A or 132B of the Act ; and the application is not accompanied by a medical certificate; and a doctor, nurse practitioner or registered dentist required or permitted to give the medical certificate was not available to attend the worker for the purpose of giving the certificate.\n(sec.113-ssec.2) The applicant must give the insurer a declaration in the approved form stating— that a doctor, nurse practitioner or registered dentist was not available to attend the worker for the purpose of giving the medical certificate; and the details of the worker’s injury.\n(sec.113-ssec.3) For a non-fatal injury, the declaration— may be accepted by the insurer as proof of incapacity of the worker only once for injury to the worker in any 1 event; and is acceptable proof of incapacity of the worker for not more than 3 days.\n(sec.113-ssec.4) The declaration is taken to be a certificate in the approved form for section 132 (3) (a) , 132A (3) (c) (i) or 132B (3) (c) (i) of the Act .\n- (a) a person (the applicant ) makes an application to an insurer under section 132 , 132A or 132B of the Act ; and\n- (b) the application is not accompanied by a medical certificate; and\n- (c) a doctor, nurse practitioner or registered dentist required or permitted to give the medical certificate was not available to attend the worker for the purpose of giving the certificate.\n- (a) that a doctor, nurse practitioner or registered dentist was not available to attend the worker for the purpose of giving the medical certificate; and\n- (b) the details of the worker’s injury.\n- (a) may be accepted by the insurer as proof of incapacity of the worker only once for injury to the worker in any 1 event; and\n- (b) is acceptable proof of incapacity of the worker for not more than 3 days.","sortOrder":128},{"sectionNumber":"sec.114","sectionType":"section","heading":"Doctor, nurse practitioner or registered dentist required to give medical certificate outside Queensland","content":"### sec.114 Doctor, nurse practitioner or registered dentist required to give medical certificate outside Queensland\n\nThis section applies if—\na person (the applicant ) makes an application to an insurer under section 132 , 132A or 132B of the Act ; and\nthe application is not accompanied by a medical certificate; and\nthe worker sustained the injury outside Queensland.\nThe applicant may give the insurer a document, that is substantially to the same effect as the medical certificate, prepared by a person who holds a qualification corresponding to a doctor, nurse practitioner or registered dentist who attends the worker for the purpose of giving the document.\nThe document is taken to be a certificate in the approved form for section 132 (3) (a) , 132A (3) (c) (i) or 132B (3) (c) (i) of the Act .\nAlso, the insurer may—\nask the person who gave the document to give a detailed report on the worker’s condition to the insurer within 10 days after receiving the request; and\npay an amount to the person who gave the document for the report that the insurer considers reasonable having regard to the table of costs.\n(sec.114-ssec.1) This section applies if— a person (the applicant ) makes an application to an insurer under section 132 , 132A or 132B of the Act ; and the application is not accompanied by a medical certificate; and the worker sustained the injury outside Queensland.\n(sec.114-ssec.2) The applicant may give the insurer a document, that is substantially to the same effect as the medical certificate, prepared by a person who holds a qualification corresponding to a doctor, nurse practitioner or registered dentist who attends the worker for the purpose of giving the document.\n(sec.114-ssec.3) The document is taken to be a certificate in the approved form for section 132 (3) (a) , 132A (3) (c) (i) or 132B (3) (c) (i) of the Act .\n(sec.114-ssec.4) Also, the insurer may— ask the person who gave the document to give a detailed report on the worker’s condition to the insurer within 10 days after receiving the request; and pay an amount to the person who gave the document for the report that the insurer considers reasonable having regard to the table of costs.\n- (a) a person (the applicant ) makes an application to an insurer under section 132 , 132A or 132B of the Act ; and\n- (b) the application is not accompanied by a medical certificate; and\n- (c) the worker sustained the injury outside Queensland.\n- (a) ask the person who gave the document to give a detailed report on the worker’s condition to the insurer within 10 days after receiving the request; and\n- (b) pay an amount to the person who gave the document for the report that the insurer considers reasonable having regard to the table of costs.","sortOrder":129},{"sectionNumber":"sec.115","sectionType":"section","heading":"Requirement to submit to personal examination by registered person— Act , ss 135 and 510","content":"### sec.115 Requirement to submit to personal examination by registered person— Act , ss 135 and 510\n\nA requirement by an insurer under section 135 or 510 of the Act for a claimant or worker to submit to a personal examination by a registered person must be made by written notice.\nThe notice must state—\nthe name of the registered person engaged to make the examination; and\nif the registered person is a specialist—the field of specialty; and\nthe day, time and place of the examination.\nThe registered person stated under subsection (2) (a) must not be employed by the insurer giving the notice.\nA registered person who examines a claimant or worker under subsection (2) must, within 10 days after the examination, give the insurer—\na written report of the examination; and\nan itemised account for the examination.\nThe insurer must pay the registered person the costs of performing the examination, and giving the report, that the insurer considers reasonable having regard to the table of costs.\n(sec.115-ssec.1) A requirement by an insurer under section 135 or 510 of the Act for a claimant or worker to submit to a personal examination by a registered person must be made by written notice.\n(sec.115-ssec.2) The notice must state— the name of the registered person engaged to make the examination; and if the registered person is a specialist—the field of specialty; and the day, time and place of the examination.\n(sec.115-ssec.3) The registered person stated under subsection (2) (a) must not be employed by the insurer giving the notice.\n(sec.115-ssec.4) A registered person who examines a claimant or worker under subsection (2) must, within 10 days after the examination, give the insurer— a written report of the examination; and an itemised account for the examination.\n(sec.115-ssec.5) The insurer must pay the registered person the costs of performing the examination, and giving the report, that the insurer considers reasonable having regard to the table of costs.\n- (a) the name of the registered person engaged to make the examination; and\n- (b) if the registered person is a specialist—the field of specialty; and\n- (c) the day, time and place of the examination.\n- (a) a written report of the examination; and\n- (b) an itemised account for the examination.","sortOrder":130},{"sectionNumber":"pt.4-div.3","sectionType":"division","heading":"Entitlement to compensation for permanent impairment—generally","content":"## Entitlement to compensation for permanent impairment—generally","sortOrder":131},{"sectionNumber":"sec.116","sectionType":"section","heading":"Additional lump sum compensation for workers with terminal latent onset injuries— Act , s 128B","content":"### sec.116 Additional lump sum compensation for workers with terminal latent onset injuries— Act , s 128B\n\nFor section 128B (2) (c) of the Act , the additional lump sum compensation, and graduated scale, stated in schedule 2 are prescribed.","sortOrder":132},{"sectionNumber":"sec.117","sectionType":"section","heading":"Calculation of lump sum compensation— Act , s 180","content":"### sec.117 Calculation of lump sum compensation— Act , s 180\n\nFor section 180 (1) of the Act , the lump sum compensation for a worker’s DPI is calculated by multiplying the maximum statutory compensation by the worker’s DPI.\nA worker’s DPI is assessed as 10%. The maximum statutory compensation is $422,295. The lump sum compensation is $42,229.50.","sortOrder":133},{"sectionNumber":"sec.118","sectionType":"section","heading":"Additional lump sum compensation for workers with DPI of 30% or more— Act , s 192","content":"### sec.118 Additional lump sum compensation for workers with DPI of 30% or more— Act , s 192\n\nFor section 192 (2) of the Act , the additional lump sum compensation, and graduated scale, stated in schedule 3 are prescribed.","sortOrder":134},{"sectionNumber":"sec.119","sectionType":"section","heading":"Occupational therapist’s assessment of level of dependency and day to day care requirements— Act , ss 193 and 224","content":"### sec.119 Occupational therapist’s assessment of level of dependency and day to day care requirements— Act , ss 193 and 224\n\nThis section prescribes—\nthe way for assessing a worker’s level of dependency for section 193 (4) of the Act ; and\nthe way for assessing a worker’s level of dependency and day to day care requirements for section 224 (3) of the Act .\nThe way is the way stated in the modified barthel index.\n(sec.119-ssec.1) This section prescribes— the way for assessing a worker’s level of dependency for section 193 (4) of the Act ; and the way for assessing a worker’s level of dependency and day to day care requirements for section 224 (3) of the Act .\n(sec.119-ssec.2) The way is the way stated in the modified barthel index.\n- (a) the way for assessing a worker’s level of dependency for section 193 (4) of the Act ; and\n- (b) the way for assessing a worker’s level of dependency and day to day care requirements for section 224 (3) of the Act .","sortOrder":135},{"sectionNumber":"sec.120","sectionType":"section","heading":"Occupational therapist’s assessment report— Act , ss 193 and 224","content":"### sec.120 Occupational therapist’s assessment report— Act , ss 193 and 224\n\nThis section prescribes—\ninformation to be included in an assessment report relating to a worker’s level of dependency for section 193 (5) (b) of the Act ; and\ninformation to be included in an assessment report relating to a worker’s level of dependency and day to day care requirements for section 224 (4) (b) of the Act .\nThe information is the following—\nwhether day to day care of the same level was provided to the worker before the worker sustained the injury;\nwhether day to day care of the same level would ordinarily be provided at the worker’s home;\nwhether day to day care of the same level is likely to continue to be provided at the worker’s home;\nthe number of hours of day to day care required by the worker.\n(sec.120-ssec.1) This section prescribes— information to be included in an assessment report relating to a worker’s level of dependency for section 193 (5) (b) of the Act ; and information to be included in an assessment report relating to a worker’s level of dependency and day to day care requirements for section 224 (4) (b) of the Act .\n(sec.120-ssec.2) The information is the following— whether day to day care of the same level was provided to the worker before the worker sustained the injury; whether day to day care of the same level would ordinarily be provided at the worker’s home; whether day to day care of the same level is likely to continue to be provided at the worker’s home; the number of hours of day to day care required by the worker.\n- (a) information to be included in an assessment report relating to a worker’s level of dependency for section 193 (5) (b) of the Act ; and\n- (b) information to be included in an assessment report relating to a worker’s level of dependency and day to day care requirements for section 224 (4) (b) of the Act .\n- (a) whether day to day care of the same level was provided to the worker before the worker sustained the injury;\n- (b) whether day to day care of the same level would ordinarily be provided at the worker’s home;\n- (c) whether day to day care of the same level is likely to continue to be provided at the worker’s home;\n- (d) the number of hours of day to day care required by the worker.","sortOrder":136},{"sectionNumber":"sec.121","sectionType":"section","heading":"Additional lump sum compensation for gratuitous care— Act , s 193 (6)","content":"### sec.121 Additional lump sum compensation for gratuitous care— Act , s 193 (6)\n\nFor section 193 (6) of the Act , the additional lump sum compensation, and graduated scale, stated in schedule 4 are prescribed.\nFor section 193 (6) (c) of the Act , the occupational therapist’s report given under section 193 (5) of the Act is prescribed.\n(sec.121-ssec.1) For section 193 (6) of the Act , the additional lump sum compensation, and graduated scale, stated in schedule 4 are prescribed.\n(sec.121-ssec.2) For section 193 (6) (c) of the Act , the occupational therapist’s report given under section 193 (5) of the Act is prescribed.","sortOrder":137},{"sectionNumber":"pt.4-div.4","sectionType":"division","heading":"Entitlement to additional compensation for permanent impairment— Act , s 193A","content":"## Entitlement to additional compensation for permanent impairment— Act , s 193A","sortOrder":138},{"sectionNumber":"sec.122","sectionType":"section","heading":"Purpose of division","content":"### sec.122 Purpose of division\n\nFor section 193A of the Act , this division prescribes the following—\nthe amount of section 193A compensation for an injury;\nthe condition to which an entitlement to section 193A compensation is subject;\nthe process for deciding whether the condition mentioned in paragraph (b) is satisfied for a worker to whom section 193A of the Act applies;\nthe establishment of a panel to review decisions made by insurers about section 193A compensation.\n- (a) the amount of section 193A compensation for an injury;\n- (b) the condition to which an entitlement to section 193A compensation is subject;\n- (c) the process for deciding whether the condition mentioned in paragraph (b) is satisfied for a worker to whom section 193A of the Act applies;\n- (d) the establishment of a panel to review decisions made by insurers about section 193A compensation.","sortOrder":139},{"sectionNumber":"sec.123","sectionType":"section","heading":"Definitions for division","content":"### sec.123 Definitions for division\n\nIn this division—\ninjury means an injury mentioned in section 193A (1) of the Act .\npanel means the panel established under section 141 .\nqualifying condition means the condition prescribed by section 126 .\nsection 193A compensation , for an injury, means the additional lump sum compensation mentioned in section 193A (2) of the Act for the injury.\nsection 193A notice see section 129 (1) .","sortOrder":140},{"sectionNumber":"sec.124","sectionType":"section","heading":"Application of division","content":"### sec.124 Application of division\n\nThis division applies only to a worker to whom section 193A of the Act applies.","sortOrder":141},{"sectionNumber":"sec.125","sectionType":"section","heading":"Amount of compensation— Act , s 193A","content":"### sec.125 Amount of compensation— Act , s 193A\n\nFor section 193A (2) (a) of the Act , the amount of section 193A compensation for an injury sustained by a worker in relation to whom the qualifying condition is satisfied is the amount under schedule 5 .","sortOrder":142},{"sectionNumber":"sec.126","sectionType":"section","heading":"Qualifying condition— Act , s 193A","content":"### sec.126 Qualifying condition— Act , s 193A\n\nFor section 193A (2) (b) of the Act , this section prescribes the condition applying to an entitlement to section 193A compensation for an injury sustained by a worker.\nThe worker is entitled to section 193A compensation only if—\nthe insurer is satisfied, on the balance of probabilities, that the worker’s employer is, or would have been, liable to pay damages to the worker; but\nthe worker can not seek damages because of the application of former section 237 (1) (a) (i) .\nIn this section—\nformer section 237(1)(a)(i) means section 237 (1) (a) (i) of the Act , as in force from 15 October 2013 until 31 January 2015.\n(sec.126-ssec.1) For section 193A (2) (b) of the Act , this section prescribes the condition applying to an entitlement to section 193A compensation for an injury sustained by a worker.\n(sec.126-ssec.2) The worker is entitled to section 193A compensation only if— the insurer is satisfied, on the balance of probabilities, that the worker’s employer is, or would have been, liable to pay damages to the worker; but the worker can not seek damages because of the application of former section 237 (1) (a) (i) .\n(sec.126-ssec.3) In this section— former section 237(1)(a)(i) means section 237 (1) (a) (i) of the Act , as in force from 15 October 2013 until 31 January 2015.\n- (a) the insurer is satisfied, on the balance of probabilities, that the worker’s employer is, or would have been, liable to pay damages to the worker; but\n- (b) the worker can not seek damages because of the application of former section 237 (1) (a) (i) .","sortOrder":143},{"sectionNumber":"sec.127","sectionType":"section","heading":"Application of subdivision","content":"### sec.127 Application of subdivision\n\nThis subdivision applies if a worker’s DPI has been decided.\nSection 193A of the Act applies only if a worker’s DPI has been decided—see section 191 of the Act .\nAlso, see chapter 3 , part 10 of the Act for provisions about—\nassessing a worker’s injury to decide if the injury has resulted in a DPI; and\ngiving the worker a notice of assessment stating the DPI for the injury; and\nan insurer making an offer of compensation to the worker.\n- 1 Section 193A of the Act applies only if a worker’s DPI has been decided—see section 191 of the Act .\n- 2 Also, see chapter 3 , part 10 of the Act for provisions about— • assessing a worker’s injury to decide if the injury has resulted in a DPI; and • giving the worker a notice of assessment stating the DPI for the injury; and • an insurer making an offer of compensation to the worker.\n- • assessing a worker’s injury to decide if the injury has resulted in a DPI; and\n- • giving the worker a notice of assessment stating the DPI for the injury; and\n- • an insurer making an offer of compensation to the worker.\n- • assessing a worker’s injury to decide if the injury has resulted in a DPI; and\n- • giving the worker a notice of assessment stating the DPI for the injury; and\n- • an insurer making an offer of compensation to the worker.","sortOrder":144},{"sectionNumber":"sec.128","sectionType":"section","heading":"Insurer to consider qualifying condition","content":"### sec.128 Insurer to consider qualifying condition\n\nAn insurer must decide—\nwhether the insurer has enough information to decide whether the qualifying condition is satisfied for the worker; and\nif the insurer decides it has enough information—whether the qualifying condition is satisfied for the worker.\n- (a) whether the insurer has enough information to decide whether the qualifying condition is satisfied for the worker; and\n- (b) if the insurer decides it has enough information—whether the qualifying condition is satisfied for the worker.","sortOrder":145},{"sectionNumber":"sec.129","sectionType":"section","heading":"Notification","content":"### sec.129 Notification\n\nAfter deciding the matters mentioned in section 128 , the insurer must give the worker a notice (a section 193A notice ) in the approved form.\nIf the insurer decides the qualifying condition is satisfied for the worker, the section 193A notice must state the amount of section 193A compensation to which the worker is entitled for the worker’s injury.\nIf the insurer decides the qualifying condition is not satisfied for the worker, the section 193A notice must state—\nthe insurer’s decision; and\nthat the worker may ask the insurer for written reasons for the decision; and\nthat the worker may apply to the panel for a review of the decision only if the worker has asked the insurer for written reasons for the decision.\nIf the insurer decides it does not have enough information to decide whether the qualifying condition is satisfied for the worker, the section 193A notice must state—\nthe insurer’s decision; and\nthat the worker may, within the period mentioned in section 131 (2) (a) , give the insurer information to enable the insurer to decide whether the qualifying condition is satisfied for the worker; and\nthat, if the worker does not give the insurer the information within the period mentioned in paragraph (b) —\nthe qualifying condition will be taken not to be satisfied for the worker; and\nthe worker will not be entitled to section 193A compensation; and\nthe worker will not have a right to apply to the panel for a review of the matters mentioned in subparagraphs (i) and (ii) .\n(sec.129-ssec.1) After deciding the matters mentioned in section 128 , the insurer must give the worker a notice (a section 193A notice ) in the approved form.\n(sec.129-ssec.2) If the insurer decides the qualifying condition is satisfied for the worker, the section 193A notice must state the amount of section 193A compensation to which the worker is entitled for the worker’s injury.\n(sec.129-ssec.3) If the insurer decides the qualifying condition is not satisfied for the worker, the section 193A notice must state— the insurer’s decision; and that the worker may ask the insurer for written reasons for the decision; and that the worker may apply to the panel for a review of the decision only if the worker has asked the insurer for written reasons for the decision.\n(sec.129-ssec.4) If the insurer decides it does not have enough information to decide whether the qualifying condition is satisfied for the worker, the section 193A notice must state— the insurer’s decision; and that the worker may, within the period mentioned in section 131 (2) (a) , give the insurer information to enable the insurer to decide whether the qualifying condition is satisfied for the worker; and that, if the worker does not give the insurer the information within the period mentioned in paragraph (b) — the qualifying condition will be taken not to be satisfied for the worker; and the worker will not be entitled to section 193A compensation; and the worker will not have a right to apply to the panel for a review of the matters mentioned in subparagraphs (i) and (ii) .\n- (a) the insurer’s decision; and\n- (b) that the worker may ask the insurer for written reasons for the decision; and\n- (c) that the worker may apply to the panel for a review of the decision only if the worker has asked the insurer for written reasons for the decision.\n- (a) the insurer’s decision; and\n- (b) that the worker may, within the period mentioned in section 131 (2) (a) , give the insurer information to enable the insurer to decide whether the qualifying condition is satisfied for the worker; and\n- (c) that, if the worker does not give the insurer the information within the period mentioned in paragraph (b) — (i) the qualifying condition will be taken not to be satisfied for the worker; and (ii) the worker will not be entitled to section 193A compensation; and (iii) the worker will not have a right to apply to the panel for a review of the matters mentioned in subparagraphs (i) and (ii) .\n- (i) the qualifying condition will be taken not to be satisfied for the worker; and\n- (ii) the worker will not be entitled to section 193A compensation; and\n- (iii) the worker will not have a right to apply to the panel for a review of the matters mentioned in subparagraphs (i) and (ii) .\n- (i) the qualifying condition will be taken not to be satisfied for the worker; and\n- (ii) the worker will not be entitled to section 193A compensation; and\n- (iii) the worker will not have a right to apply to the panel for a review of the matters mentioned in subparagraphs (i) and (ii) .","sortOrder":146},{"sectionNumber":"sec.130","sectionType":"section","heading":"Worker may request reasons","content":"### sec.130 Worker may request reasons\n\nThis section applies if an insurer has given the worker a section 193A notice stating the insurer has decided the qualifying condition is not satisfied for the worker.\nThe worker may, within 10 business days after receiving the notice, ask the insurer for written reasons for the decision.\nThe insurer must give the worker the reasons for the decision within 10 business days after receiving the worker’s request.\n(sec.130-ssec.1) This section applies if an insurer has given the worker a section 193A notice stating the insurer has decided the qualifying condition is not satisfied for the worker.\n(sec.130-ssec.2) The worker may, within 10 business days after receiving the notice, ask the insurer for written reasons for the decision.\n(sec.130-ssec.3) The insurer must give the worker the reasons for the decision within 10 business days after receiving the worker’s request.","sortOrder":147},{"sectionNumber":"sec.131","sectionType":"section","heading":"Giving information","content":"### sec.131 Giving information\n\nThis section applies if the insurer has given the worker a section 193A notice stating the insurer does not have enough information to decide whether the qualifying condition is satisfied for the worker.\nThe worker—\nmay give the insurer information relevant to the decision—\nwithin 60 business days after receiving the section 193A notice; or\non or before a later day agreed to by the insurer and the worker; and\nif the worker gives information to the insurer under paragraph (a) —must tell the insurer whether the worker has engaged a lawyer and incurred legal costs in giving the information.\nThe qualifying condition is taken not to be satisfied for the worker if the worker does not give the insurer information relevant to the decision within the period mentioned in subsection (2) (a) .\n(sec.131-ssec.1) This section applies if the insurer has given the worker a section 193A notice stating the insurer does not have enough information to decide whether the qualifying condition is satisfied for the worker.\n(sec.131-ssec.2) The worker— may give the insurer information relevant to the decision— within 60 business days after receiving the section 193A notice; or on or before a later day agreed to by the insurer and the worker; and if the worker gives information to the insurer under paragraph (a) —must tell the insurer whether the worker has engaged a lawyer and incurred legal costs in giving the information.\n(sec.131-ssec.3) The qualifying condition is taken not to be satisfied for the worker if the worker does not give the insurer information relevant to the decision within the period mentioned in subsection (2) (a) .\n- (a) may give the insurer information relevant to the decision— (i) within 60 business days after receiving the section 193A notice; or (ii) on or before a later day agreed to by the insurer and the worker; and\n- (i) within 60 business days after receiving the section 193A notice; or\n- (ii) on or before a later day agreed to by the insurer and the worker; and\n- (b) if the worker gives information to the insurer under paragraph (a) —must tell the insurer whether the worker has engaged a lawyer and incurred legal costs in giving the information.\n- (i) within 60 business days after receiving the section 193A notice; or\n- (ii) on or before a later day agreed to by the insurer and the worker; and","sortOrder":148},{"sectionNumber":"sec.132","sectionType":"section","heading":"Decision based on worker’s information","content":"### sec.132 Decision based on worker’s information\n\nThis section applies if the worker has given the insurer information under section 131 .\nThe insurer must consider the information and decide whether the qualifying condition is satisfied for the worker.\nThe insurer must make the decision within the later of the following periods to end—\n60 business days after receiving the information from the worker;\nif the insurer meets with the worker under section 133 within 60 business days after receiving the information from the worker—10 business days after the day of the meeting.\nIf the insurer decides the qualifying condition is satisfied for the worker, the insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.\nIf the insurer decides the qualifying condition is not satisfied for the worker, the insurer must give the worker written reasons for the decision.\nIf the insurer does not make a decision within the period mentioned in subsection (3) , the insurer is taken to have decided the qualifying condition is not satisfied for the worker.\n(sec.132-ssec.1) This section applies if the worker has given the insurer information under section 131 .\n(sec.132-ssec.2) The insurer must consider the information and decide whether the qualifying condition is satisfied for the worker.\n(sec.132-ssec.3) The insurer must make the decision within the later of the following periods to end— 60 business days after receiving the information from the worker; if the insurer meets with the worker under section 133 within 60 business days after receiving the information from the worker—10 business days after the day of the meeting.\n(sec.132-ssec.4) If the insurer decides the qualifying condition is satisfied for the worker, the insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.\n(sec.132-ssec.5) If the insurer decides the qualifying condition is not satisfied for the worker, the insurer must give the worker written reasons for the decision.\n(sec.132-ssec.6) If the insurer does not make a decision within the period mentioned in subsection (3) , the insurer is taken to have decided the qualifying condition is not satisfied for the worker.\n- (a) 60 business days after receiving the information from the worker;\n- (b) if the insurer meets with the worker under section 133 within 60 business days after receiving the information from the worker—10 business days after the day of the meeting.","sortOrder":149},{"sectionNumber":"sec.133","sectionType":"section","heading":"Meeting before decision made","content":"### sec.133 Meeting before decision made\n\nThis section applies if—\nthe worker has given the insurer information under section 131 ; and\nthe insurer proposes to decide the qualifying condition is not satisfied for the worker.\nBefore making the decision, the insurer must—\ngive the worker an opportunity to meet with the insurer to discuss the proposed decision; and\nif the worker agrees to meet with the insurer—give the worker any relevant information in the possession of the insurer at least 10 business days before the meeting.\nThe insurer is not required to give the worker more than 1 opportunity to meet with the insurer.\nIn this section—\nrelevant information , in relation to a worker, means information, other than information given to the insurer by the worker, that the insurer intends to consider for making the proposed decision.\n(sec.133-ssec.1) This section applies if— the worker has given the insurer information under section 131 ; and the insurer proposes to decide the qualifying condition is not satisfied for the worker.\n(sec.133-ssec.2) Before making the decision, the insurer must— give the worker an opportunity to meet with the insurer to discuss the proposed decision; and if the worker agrees to meet with the insurer—give the worker any relevant information in the possession of the insurer at least 10 business days before the meeting.\n(sec.133-ssec.3) The insurer is not required to give the worker more than 1 opportunity to meet with the insurer.\n(sec.133-ssec.4) In this section— relevant information , in relation to a worker, means information, other than information given to the insurer by the worker, that the insurer intends to consider for making the proposed decision.\n- (a) the worker has given the insurer information under section 131 ; and\n- (b) the insurer proposes to decide the qualifying condition is not satisfied for the worker.\n- (a) give the worker an opportunity to meet with the insurer to discuss the proposed decision; and\n- (b) if the worker agrees to meet with the insurer—give the worker any relevant information in the possession of the insurer at least 10 business days before the meeting.","sortOrder":150},{"sectionNumber":"sec.134","sectionType":"section","heading":"Definition for subdivision","content":"### sec.134 Definition for subdivision\n\nIn this subdivision—\ndecision , of an insurer, includes a decision taken to have been made by the insurer under section 132 (6) .","sortOrder":151},{"sectionNumber":"sec.135","sectionType":"section","heading":"Application of subdivision","content":"### sec.135 Application of subdivision\n\nThis subdivision applies to a worker—\nwho, under subdivision 3 , has received written reasons for an insurer’s decision that the qualifying condition is not satisfied for the worker; or\nin relation to whom an insurer is taken to have decided that the qualifying condition is not satisfied under section 132 (6) .\n- (a) who, under subdivision 3 , has received written reasons for an insurer’s decision that the qualifying condition is not satisfied for the worker; or\n- (b) in relation to whom an insurer is taken to have decided that the qualifying condition is not satisfied under section 132 (6) .","sortOrder":152},{"sectionNumber":"sec.136","sectionType":"section","heading":"Application for review","content":"### sec.136 Application for review\n\nThe worker may apply to the panel for a review of the decision within 20 business days after—\nthe worker receives written reasons for the decision; or\nthe day on which the worker becomes aware the insurer has failed to decide whether the qualifying condition is satisfied for the worker within the period mentioned in section 132 (3) .\nThe application must include the following—\nthe worker’s reasons for asking for a review of the decision;\nif the worker has received written reasons for the decision—the reasons;\nif the worker has not already had an opportunity to give the insurer information about whether the qualifying condition is satisfied for the worker—any information the worker wants the panel to consider in support of the worker’s application;\nif the worker has engaged a lawyer and incurred legal costs in relation to the application—a statutory declaration verifying the worker has engaged the lawyer and incurred legal costs.\nThe worker must give the insurer a copy of the application.\n(sec.136-ssec.1) The worker may apply to the panel for a review of the decision within 20 business days after— the worker receives written reasons for the decision; or the day on which the worker becomes aware the insurer has failed to decide whether the qualifying condition is satisfied for the worker within the period mentioned in section 132 (3) .\n(sec.136-ssec.2) The application must include the following— the worker’s reasons for asking for a review of the decision; if the worker has received written reasons for the decision—the reasons; if the worker has not already had an opportunity to give the insurer information about whether the qualifying condition is satisfied for the worker—any information the worker wants the panel to consider in support of the worker’s application; if the worker has engaged a lawyer and incurred legal costs in relation to the application—a statutory declaration verifying the worker has engaged the lawyer and incurred legal costs.\n(sec.136-ssec.3) The worker must give the insurer a copy of the application.\n- (a) the worker receives written reasons for the decision; or\n- (b) the day on which the worker becomes aware the insurer has failed to decide whether the qualifying condition is satisfied for the worker within the period mentioned in section 132 (3) .\n- (a) the worker’s reasons for asking for a review of the decision;\n- (b) if the worker has received written reasons for the decision—the reasons;\n- (c) if the worker has not already had an opportunity to give the insurer information about whether the qualifying condition is satisfied for the worker—any information the worker wants the panel to consider in support of the worker’s application;\n- (d) if the worker has engaged a lawyer and incurred legal costs in relation to the application—a statutory declaration verifying the worker has engaged the lawyer and incurred legal costs.","sortOrder":153},{"sectionNumber":"sec.137","sectionType":"section","heading":"Insurer to give information to panel","content":"### sec.137 Insurer to give information to panel\n\nAs soon as practicable after receiving a copy of the worker’s application under section 136 , the insurer must give the panel and the worker any information the insurer has considered in deciding whether the qualifying condition is satisfied for the worker.","sortOrder":154},{"sectionNumber":"sec.138","sectionType":"section","heading":"Review by panel","content":"### sec.138 Review by panel\n\nAfter considering the application and reviewing the insurer’s decision, the panel must decide to—\nconfirm the decision; or\ncancel the decision and substitute a new decision.\nThe panel must give the worker and the insurer written notice of its decision and the reasons for its decision.\nIf the panel decides to substitute a new decision, the new decision is taken to be the insurer’s decision that the qualifying condition is satisfied for the worker.\nTo remove any doubt, it is declared that the panel may review the insurer’s decision without receiving oral submissions.\n(sec.138-ssec.1) After considering the application and reviewing the insurer’s decision, the panel must decide to— confirm the decision; or cancel the decision and substitute a new decision.\n(sec.138-ssec.2) The panel must give the worker and the insurer written notice of its decision and the reasons for its decision.\n(sec.138-ssec.3) If the panel decides to substitute a new decision, the new decision is taken to be the insurer’s decision that the qualifying condition is satisfied for the worker.\n(sec.138-ssec.4) To remove any doubt, it is declared that the panel may review the insurer’s decision without receiving oral submissions.\n- (a) confirm the decision; or\n- (b) cancel the decision and substitute a new decision.","sortOrder":155},{"sectionNumber":"sec.139","sectionType":"section","heading":"Panel’s decision is final","content":"### sec.139 Panel’s decision is final\n\nUnless the Supreme Court decides a decision of the panel under section 138 is affected by jurisdictional error, the decision—\nis final and conclusive; and\ncan not be challenged, appealed against, reviewed, quashed, set aside or called in question in any other way under the Judicial Review Act 1991 or otherwise (whether by the Supreme Court, another court, a tribunal or another entity); and\nis not subject to any declaratory, injunctive or other order of the Supreme Court, another court, a tribunal or another entity on any ground.\n- (a) is final and conclusive; and\n- (b) can not be challenged, appealed against, reviewed, quashed, set aside or called in question in any other way under the Judicial Review Act 1991 or otherwise (whether by the Supreme Court, another court, a tribunal or another entity); and\n- (c) is not subject to any declaratory, injunctive or other order of the Supreme Court, another court, a tribunal or another entity on any ground.","sortOrder":156},{"sectionNumber":"sec.140","sectionType":"section","heading":"Insurer must notify amount of entitlement","content":"### sec.140 Insurer must notify amount of entitlement\n\nThis section applies if the insurer is notified by the panel that the insurer’s decision is substituted with a new decision that the qualifying condition is satisfied for the worker.\nThe insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.\n(sec.140-ssec.1) This section applies if the insurer is notified by the panel that the insurer’s decision is substituted with a new decision that the qualifying condition is satisfied for the worker.\n(sec.140-ssec.2) The insurer must give the worker a written notice in the approved form stating the amount of section 193A compensation to which the worker is entitled for the worker’s injury.","sortOrder":157},{"sectionNumber":"sec.141","sectionType":"section","heading":"Panel— Act , s 193A (3)","content":"### sec.141 Panel— Act , s 193A (3)\n\nFor section 193A (3) of the Act , there is to be a panel made up of 1 chairperson and 2 other members.\nThe function of the panel is to meet, as required, to review decisions under subdivision 4 .\n(sec.141-ssec.1) For section 193A (3) of the Act , there is to be a panel made up of 1 chairperson and 2 other members.\n(sec.141-ssec.2) The function of the panel is to meet, as required, to review decisions under subdivision 4 .","sortOrder":158},{"sectionNumber":"sec.142","sectionType":"section","heading":"Appointment to panel","content":"### sec.142 Appointment to panel\n\nThe Minister must appoint a chairperson and 2 other members to the panel, on terms decided by the Minister.\nThe Minister must ensure that each person appointed to the panel—\nis qualified, or eligible to qualify, as a lawyer; and\nhas demonstrated significant experience relevant to the laws of personal injury and negligence.\n(sec.142-ssec.1) The Minister must appoint a chairperson and 2 other members to the panel, on terms decided by the Minister.\n(sec.142-ssec.2) The Minister must ensure that each person appointed to the panel— is qualified, or eligible to qualify, as a lawyer; and has demonstrated significant experience relevant to the laws of personal injury and negligence.\n- (a) is qualified, or eligible to qualify, as a lawyer; and\n- (b) has demonstrated significant experience relevant to the laws of personal injury and negligence.","sortOrder":159},{"sectionNumber":"sec.143","sectionType":"section","heading":"Administrative matters","content":"### sec.143 Administrative matters\n\nThe Regulator may decide administrative matters about the panel that are not provided for under this subdivision, including, for example, the way in which the panel must meet.","sortOrder":160},{"sectionNumber":"sec.144","sectionType":"section","heading":"Liability not affected","content":"### sec.144 Liability not affected\n\nTo remove any doubt, it is declared that a decision made by an insurer or the panel under this division does not impose liability on, or otherwise affect the liability of, the insurer or an employer for any other purpose or proceeding.","sortOrder":161},{"sectionNumber":"pt.4-div.5","sectionType":"division","heading":"Entitlement to compensation for pneumoconiosis","content":"## Entitlement to compensation for pneumoconiosis","sortOrder":162},{"sectionNumber":"sec.145","sectionType":"section","heading":"Working out pneumoconiosis score using chest image— Act , s 36F","content":"### sec.145 Working out pneumoconiosis score using chest image— Act , s 36F\n\nFor section 36F (b) of the Act , the way stated in schedule 6 is prescribed.","sortOrder":163},{"sectionNumber":"sec.146","sectionType":"section","heading":"Lump sum compensation for workers with pneumoconiosis— Act , s 128G","content":"### sec.146 Lump sum compensation for workers with pneumoconiosis— Act , s 128G\n\nFor section 128G (2) of the Act , the lump sum compensation, and graduated scale, stated in schedule 7 are prescribed.\nFor section 128G (3) of the Act , the pneumoconiosis bands stated in schedule 7 are prescribed.\n(sec.146-ssec.1) For section 128G (2) of the Act , the lump sum compensation, and graduated scale, stated in schedule 7 are prescribed.\n(sec.146-ssec.2) For section 128G (3) of the Act , the pneumoconiosis bands stated in schedule 7 are prescribed.","sortOrder":164},{"sectionNumber":"pt.4-div.6","sectionType":"division","heading":"Liability for caring allowance","content":"## Liability for caring allowance","sortOrder":165},{"sectionNumber":"sec.147","sectionType":"section","heading":"Payment of caring allowance— Act , s 225","content":"### sec.147 Payment of caring allowance— Act , s 225\n\nFor section 225 (a) of the Act , if an insurer pays a caring allowance, the prescribed way of payment is for the insurer to—\ndecide the number of hours of the day to day care required by the worker having regard to the occupational therapist’s assessment report under section 224 (4) of the Act , and the graduated scale stated in schedule 8 ; and\ndecide the allowance having regard to the information in the occupational therapist’s report; and\npay the allowance at an hourly rate equal to the carer pension rate divided by 35.\nIn this section—\ncarer pension rate means the weekly amount of the maximum carer payment payable from time to time under a Commonwealth law, but does not include an amount for allowances such as rent assistance or family payment.\n(sec.147-ssec.1) For section 225 (a) of the Act , if an insurer pays a caring allowance, the prescribed way of payment is for the insurer to— decide the number of hours of the day to day care required by the worker having regard to the occupational therapist’s assessment report under section 224 (4) of the Act , and the graduated scale stated in schedule 8 ; and decide the allowance having regard to the information in the occupational therapist’s report; and pay the allowance at an hourly rate equal to the carer pension rate divided by 35.\n(sec.147-ssec.2) In this section— carer pension rate means the weekly amount of the maximum carer payment payable from time to time under a Commonwealth law, but does not include an amount for allowances such as rent assistance or family payment.\n- (a) decide the number of hours of the day to day care required by the worker having regard to the occupational therapist’s assessment report under section 224 (4) of the Act , and the graduated scale stated in schedule 8 ; and\n- (b) decide the allowance having regard to the information in the occupational therapist’s report; and\n- (c) pay the allowance at an hourly rate equal to the carer pension rate divided by 35.","sortOrder":166},{"sectionNumber":"pt.5","sectionType":"part","heading":"Rehabilitation","content":"# Rehabilitation","sortOrder":167},{"sectionNumber":"pt.5-div.1","sectionType":"division","heading":"Rehabilitation and return to work coordinators","content":"## Rehabilitation and return to work coordinators","sortOrder":168},{"sectionNumber":"sec.148","sectionType":"section","heading":"Functions— Act , s 41","content":"### sec.148 Functions— Act , s 41\n\nFor section 41 (1)(b) of the Act , the following functions are prescribed for a rehabilitation and return to work coordinator—\ninitiate early communication with an injured worker in order to clarify the nature and severity of the worker’s injury;\nprovide overall coordination of the worker’s return to work;\nif a rehabilitation and return to work plan is developed under section 221 of the Act —\nconsult with the worker and the worker’s employer to develop the suitable duties program component of the plan; and\nensure the program is consistent with the current medical certificate or report for the worker’s injury;\nliaise with—\nany person engaged by the employer to help in the worker’s rehabilitation and return to work; and\nthe insurer for the purpose of providing information about the worker’s progress and indicating, as early as possible, if there is a need for the insurer to assist or intervene.\n- (a) initiate early communication with an injured worker in order to clarify the nature and severity of the worker’s injury;\n- (b) provide overall coordination of the worker’s return to work;\n- (c) if a rehabilitation and return to work plan is developed under section 221 of the Act — (i) consult with the worker and the worker’s employer to develop the suitable duties program component of the plan; and (ii) ensure the program is consistent with the current medical certificate or report for the worker’s injury;\n- (i) consult with the worker and the worker’s employer to develop the suitable duties program component of the plan; and\n- (ii) ensure the program is consistent with the current medical certificate or report for the worker’s injury;\n- (d) liaise with— (i) any person engaged by the employer to help in the worker’s rehabilitation and return to work; and (ii) the insurer for the purpose of providing information about the worker’s progress and indicating, as early as possible, if there is a need for the insurer to assist or intervene.\n- (i) any person engaged by the employer to help in the worker’s rehabilitation and return to work; and\n- (ii) the insurer for the purpose of providing information about the worker’s progress and indicating, as early as possible, if there is a need for the insurer to assist or intervene.\n- (i) consult with the worker and the worker’s employer to develop the suitable duties program component of the plan; and\n- (ii) ensure the program is consistent with the current medical certificate or report for the worker’s injury;\n- (i) any person engaged by the employer to help in the worker’s rehabilitation and return to work; and\n- (ii) the insurer for the purpose of providing information about the worker’s progress and indicating, as early as possible, if there is a need for the insurer to assist or intervene.","sortOrder":169},{"sectionNumber":"sec.149","sectionType":"section","heading":"Criteria for obligation of employer to appoint— Act , s 226","content":"### sec.149 Criteria for obligation of employer to appoint— Act , s 226\n\nFor section 226 (1) of the Act , an employer must appoint a rehabilitation and return to work coordinator if—\nfor an employer who employs workers at a workplace in a high risk industry—the wages of the employer in Queensland for the preceding financial year were more than 2,600 times QOTE; or\notherwise—the wages of the employer in Queensland for the preceding financial year were more than 5,200 times QOTE.\nFor the purpose of section 226 (3) (a) of the Act , an employer is taken to have established a workplace, or started to employ workers at the workplace, only when the employer first meets the criteria prescribed under subsection (1) .\nAn employer may appoint a person as the rehabilitation and return to work coordinator for more than 1 workplace if the person can reasonably perform the person’s functions as a rehabilitation and return to work coordinator for each workplace.\nIn this section—\nhigh risk industry means an industry specified by the Regulator by gazette notice as a high risk industry for the purpose of this section.\n(sec.149-ssec.1) For section 226 (1) of the Act , an employer must appoint a rehabilitation and return to work coordinator if— for an employer who employs workers at a workplace in a high risk industry—the wages of the employer in Queensland for the preceding financial year were more than 2,600 times QOTE; or otherwise—the wages of the employer in Queensland for the preceding financial year were more than 5,200 times QOTE.\n(sec.149-ssec.2) For the purpose of section 226 (3) (a) of the Act , an employer is taken to have established a workplace, or started to employ workers at the workplace, only when the employer first meets the criteria prescribed under subsection (1) .\n(sec.149-ssec.3) An employer may appoint a person as the rehabilitation and return to work coordinator for more than 1 workplace if the person can reasonably perform the person’s functions as a rehabilitation and return to work coordinator for each workplace.\n(sec.149-ssec.4) In this section— high risk industry means an industry specified by the Regulator by gazette notice as a high risk industry for the purpose of this section.\n- (a) for an employer who employs workers at a workplace in a high risk industry—the wages of the employer in Queensland for the preceding financial year were more than 2,600 times QOTE; or\n- (b) otherwise—the wages of the employer in Queensland for the preceding financial year were more than 5,200 times QOTE.","sortOrder":170},{"sectionNumber":"pt.5-div.2","sectionType":"division","heading":"Scheme directions","content":"## Scheme directions","sortOrder":171},{"sectionNumber":"sec.150","sectionType":"section","heading":"Scheme direction providing for standard for rehabilitation— Act , s 329A","content":"### sec.150 Scheme direction providing for standard for rehabilitation— Act , s 329A\n\nFor section 329A (1) (b) of the Act , a scheme direction may provide for the standard for rehabilitation.","sortOrder":172},{"sectionNumber":"pt.6","sectionType":"part","heading":"Treatment, care and support payments","content":"# Treatment, care and support payments","sortOrder":173},{"sectionNumber":"pt.6-div.1","sectionType":"division","heading":"Assessing entitlement","content":"## Assessing entitlement","sortOrder":174},{"sectionNumber":"sec.151","sectionType":"section","heading":"Definitions for division","content":"### sec.151 Definitions for division\n\nIn this division—\nchildren’s functional independence measure means the functional independence measure adapted for paediatrics and described on the department’s website.\nfunctional independence measure means a clinical tool used to assess the functional ability of a person by scoring motor and cognitive items against a scale and described on the department’s website.","sortOrder":175},{"sectionNumber":"sec.152","sectionType":"section","heading":"Purpose of subdivision— Act , s 232M","content":"### sec.152 Purpose of subdivision— Act , s 232M\n\nFor section 232M (2) (a) of the Act , this subdivision prescribes the eligibility criteria for particular serious personal injuries.","sortOrder":176},{"sectionNumber":"sec.153","sectionType":"section","heading":"Eligibility criteria for permanent spinal cord injury","content":"### sec.153 Eligibility criteria for permanent spinal cord injury\n\nThe eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit are—\nthe permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and\nthe injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.\nIn this section—\nASIA impairment scale means the scale, known as the American Spinal Injury Association impairment scale, used for measuring impairment resulting from a spinal cord injury and published by the American Spinal Injury Association.\nISAFSCI means the document called ‘International standards to document autonomic function following spinal cord injury’, published by the American Spinal Injury Association.\nISNCSCI means the document called ‘International standards for neurological classification of spinal cord injury’, published by the American Spinal Injury Association.\n(sec.153-ssec.1) The eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit are— the permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and the injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.\n(sec.153-ssec.2) In this section— ASIA impairment scale means the scale, known as the American Spinal Injury Association impairment scale, used for measuring impairment resulting from a spinal cord injury and published by the American Spinal Injury Association. ISAFSCI means the document called ‘International standards to document autonomic function following spinal cord injury’, published by the American Spinal Injury Association. ISNCSCI means the document called ‘International standards for neurological classification of spinal cord injury’, published by the American Spinal Injury Association.\n- (a) the permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and\n- (b) the injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.","sortOrder":177},{"sectionNumber":"sec.154","sectionType":"section","heading":"Eligibility criteria for traumatic brain injury","content":"### sec.154 Eligibility criteria for traumatic brain injury\n\nThe eligibility criteria for a traumatic brain injury resulting in a permanent impairment are—\nany or all of the following apply—\nthe injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;\nthe worker is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;\nbrain imaging shows a significant brain abnormality as a result of the injury; and\nthe worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—\nfor an adult—the functional independence measure; or\nfor a child—the children’s functional independence measure.\nIn this section—\napproved scale , for assessing post-traumatic amnesia, means—\nthe Westmead PTA scale; or\na clinically accepted scale similar to the Westmead PTA scale approved by the Regulator for this definition.\nWestmead PTA scale means the clinical tool, known as the Westmead Post Traumatic Amnesia Scale, used to assess the period a person suffers post-traumatic amnesia.\n(sec.154-ssec.1) The eligibility criteria for a traumatic brain injury resulting in a permanent impairment are— any or all of the following apply— the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale; the worker is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury; brain imaging shows a significant brain abnormality as a result of the injury; and the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— for an adult—the functional independence measure; or for a child—the children’s functional independence measure.\n(sec.154-ssec.2) In this section— approved scale , for assessing post-traumatic amnesia, means— the Westmead PTA scale; or a clinically accepted scale similar to the Westmead PTA scale approved by the Regulator for this definition. Westmead PTA scale means the clinical tool, known as the Westmead Post Traumatic Amnesia Scale, used to assess the period a person suffers post-traumatic amnesia.\n- (a) any or all of the following apply— (i) the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale; (ii) the worker is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury; (iii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (i) the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;\n- (ii) the worker is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;\n- (iii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (b) the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— (i) for an adult—the functional independence measure; or (ii) for a child—the children’s functional independence measure.\n- (i) for an adult—the functional independence measure; or\n- (ii) for a child—the children’s functional independence measure.\n- (i) the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;\n- (ii) the worker is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;\n- (iii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (i) for an adult—the functional independence measure; or\n- (ii) for a child—the children’s functional independence measure.\n- (a) the Westmead PTA scale; or\n- (b) a clinically accepted scale similar to the Westmead PTA scale approved by the Regulator for this definition.","sortOrder":178},{"sectionNumber":"sec.155","sectionType":"section","heading":"Eligibility criterion for amputation of leg through or above femur","content":"### sec.155 Eligibility criterion for amputation of leg through or above femur\n\nThe eligibility criterion for the amputation of a leg through or above the femur is that the amputation involves the loss of 65% or more of the length of the femur.\nFor subsection (1) , the percentage of the length of the femur lost must be worked out by—\ncomparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or\nif X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.\nTo remove any doubt, it is declared that the eligibility criterion in subsection (1) may be satisfied even if the worker suffers from a personal injury that is the amputation of more than 1 limb or parts of different limbs.\n(sec.155-ssec.1) The eligibility criterion for the amputation of a leg through or above the femur is that the amputation involves the loss of 65% or more of the length of the femur.\n(sec.155-ssec.2) For subsection (1) , the percentage of the length of the femur lost must be worked out by— comparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or if X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.\n(sec.155-ssec.3) To remove any doubt, it is declared that the eligibility criterion in subsection (1) may be satisfied even if the worker suffers from a personal injury that is the amputation of more than 1 limb or parts of different limbs.\n- (a) comparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or\n- (b) if X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.","sortOrder":179},{"sectionNumber":"sec.156","sectionType":"section","heading":"Eligibility criteria for amputation of more than 1 limb or parts of different limbs","content":"### sec.156 Eligibility criteria for amputation of more than 1 limb or parts of different limbs\n\nThe eligibility criteria for the amputation of more than 1 limb or parts of different limbs are—\nthe amputations involve the loss of 50% or more of the length of each of the worker’s tibias; or\nboth of the worker’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or\nthe amputations involve—\nthe loss of 50% or more of the length of 1 of the worker’s tibias; and\n1 of the worker’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\nFor subsection (1) , the percentage of the length of the tibia lost must be worked out by—\ncomparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or\nif X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or\nif the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.\n(sec.156-ssec.1) The eligibility criteria for the amputation of more than 1 limb or parts of different limbs are— the amputations involve the loss of 50% or more of the length of each of the worker’s tibias; or both of the worker’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or the amputations involve— the loss of 50% or more of the length of 1 of the worker’s tibias; and 1 of the worker’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n(sec.156-ssec.2) For subsection (1) , the percentage of the length of the tibia lost must be worked out by— comparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or if X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or if the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.\n- (a) the amputations involve the loss of 50% or more of the length of each of the worker’s tibias; or\n- (b) both of the worker’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or\n- (c) the amputations involve— (i) the loss of 50% or more of the length of 1 of the worker’s tibias; and (ii) 1 of the worker’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n- (i) the loss of 50% or more of the length of 1 of the worker’s tibias; and\n- (ii) 1 of the worker’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n- (i) the loss of 50% or more of the length of 1 of the worker’s tibias; and\n- (ii) 1 of the worker’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n- (a) comparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or\n- (b) if X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or\n- (c) if the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.","sortOrder":180},{"sectionNumber":"sec.157","sectionType":"section","heading":"Eligibility criteria for full thickness burn to all or part of body","content":"### sec.157 Eligibility criteria for full thickness burn to all or part of body\n\nThe eligibility criteria for a full thickness burn to all or part of the body are—\nthe full thickness burn is to—\nfor a worker younger than 16 years—more than 30% of the total body surface area; or\nfor a worker 16 years or older—more than 40% of the total body surface area; or\nboth hands; or\nthe face; or\nthe genital area; and\nthe worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—\nfor an adult—the functional independence measure; or\nfor a child—the children’s functional independence measure.\n- (a) the full thickness burn is to— (i) for a worker younger than 16 years—more than 30% of the total body surface area; or (ii) for a worker 16 years or older—more than 40% of the total body surface area; or (iii) both hands; or (iv) the face; or (v) the genital area; and\n- (i) for a worker younger than 16 years—more than 30% of the total body surface area; or\n- (ii) for a worker 16 years or older—more than 40% of the total body surface area; or\n- (iii) both hands; or\n- (iv) the face; or\n- (v) the genital area; and\n- (b) the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— (i) for an adult—the functional independence measure; or (ii) for a child—the children’s functional independence measure.\n- (i) for an adult—the functional independence measure; or\n- (ii) for a child—the children’s functional independence measure.\n- (i) for a worker younger than 16 years—more than 30% of the total body surface area; or\n- (ii) for a worker 16 years or older—more than 40% of the total body surface area; or\n- (iii) both hands; or\n- (iv) the face; or\n- (v) the genital area; and\n- (i) for an adult—the functional independence measure; or\n- (ii) for a child—the children’s functional independence measure.","sortOrder":181},{"sectionNumber":"sec.158","sectionType":"section","heading":"Eligibility criterion for inhalation burn resulting in permanent respiratory impairment","content":"### sec.158 Eligibility criterion for inhalation burn resulting in permanent respiratory impairment\n\nThe eligibility criterion for an inhalation burn resulting in a permanent respiratory impairment is that the worker’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—\nfor an adult—the functional independence measure; or\nfor a child—the children’s functional independence measure.\n- (a) for an adult—the functional independence measure; or\n- (b) for a child—the children’s functional independence measure.","sortOrder":182},{"sectionNumber":"sec.159","sectionType":"section","heading":"Eligibility criterion for permanent blindness caused by trauma","content":"### sec.159 Eligibility criterion for permanent blindness caused by trauma\n\nThe eligibility criterion for permanent blindness caused by trauma is that the injured person has a visual defect, or a combination of visual defects, that result in visual loss that is, or is equivalent to—\nvisual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or\nthe constriction of the worker’s field of vision to 10 degrees or less of the arc around central fixation in the worker’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).\nIn this section—\nSnellen scale means the scale for measuring visual acuity using rows of letters printed in decreasing sizes.\n(sec.159-ssec.1) The eligibility criterion for permanent blindness caused by trauma is that the injured person has a visual defect, or a combination of visual defects, that result in visual loss that is, or is equivalent to— visual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or the constriction of the worker’s field of vision to 10 degrees or less of the arc around central fixation in the worker’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).\n(sec.159-ssec.2) In this section— Snellen scale means the scale for measuring visual acuity using rows of letters printed in decreasing sizes.\n- (a) visual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or\n- (b) the constriction of the worker’s field of vision to 10 degrees or less of the arc around central fixation in the worker’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).","sortOrder":183},{"sectionNumber":"sec.160","sectionType":"section","heading":"Assessments using measures to be carried out by particular persons","content":"### sec.160 Assessments using measures to be carried out by particular persons\n\nAn assessment using the functional independence measure or children’s functional independence measure may be used for deciding whether a serious personal injury meets the eligibility criteria for the injury only if the assessment is carried out by a person who is—\naccredited by the Australasian Rehabilitation Outcomes Centre to carry out the assessment; and\napproved by the insurer to carry out the assessment.\n- (a) accredited by the Australasian Rehabilitation Outcomes Centre to carry out the assessment; and\n- (b) approved by the insurer to carry out the assessment.","sortOrder":184},{"sectionNumber":"pt.6-div.2","sectionType":"division","heading":"Assessing worker’s needs","content":"## Assessing worker’s needs","sortOrder":185},{"sectionNumber":"sec.161","sectionType":"section","heading":"Assessments generally— Act , s 232O","content":"### sec.161 Assessments generally— Act , s 232O\n\nFor section 232O (2) (a) of the Act , this section prescribes requirements for assessing a matter mentioned in section 232O (1) (a) of the Act .\nIn carrying out the assessment, the insurer must, to the extent practicable, consult with the worker who has sustained the serious personal injury about the following matters—\nthe treatment, care and support needs resulting from the serious personal injury the worker considers are necessary and reasonable;\nthe treatment, care and support needed by the worker for any other injury resulting from the same event as the serious personal injury;\nthe worker’s abilities and limitations;\nthe worker’s individual goals.\nThe insurer may also consult with any other person the insurer considers appropriate.\n(sec.161-ssec.1) For section 232O (2) (a) of the Act , this section prescribes requirements for assessing a matter mentioned in section 232O (1) (a) of the Act .\n(sec.161-ssec.2) In carrying out the assessment, the insurer must, to the extent practicable, consult with the worker who has sustained the serious personal injury about the following matters— the treatment, care and support needs resulting from the serious personal injury the worker considers are necessary and reasonable; the treatment, care and support needed by the worker for any other injury resulting from the same event as the serious personal injury; the worker’s abilities and limitations; the worker’s individual goals.\n(sec.161-ssec.3) The insurer may also consult with any other person the insurer considers appropriate.\n- (a) the treatment, care and support needs resulting from the serious personal injury the worker considers are necessary and reasonable;\n- (b) the treatment, care and support needed by the worker for any other injury resulting from the same event as the serious personal injury;\n- (c) the worker’s abilities and limitations;\n- (d) the worker’s individual goals.","sortOrder":186},{"sectionNumber":"sec.162","sectionType":"section","heading":"Intervals for carrying out assessments— Act , s 232O","content":"### sec.162 Intervals for carrying out assessments— Act , s 232O\n\nFor section 232O (2) (a) of the Act , an assessment under section 232O (1) (a) of the Act relating to an eligible worker must be carried out—\nas soon as practicable after the insurer decides the worker is entitled to treatment, care and support payments; and\nif an assessment under section 232O (1) (a) of the Act relating to the worker has previously been carried out—within 1 year after the last assessment was carried out.\n- (a) as soon as practicable after the insurer decides the worker is entitled to treatment, care and support payments; and\n- (b) if an assessment under section 232O (1) (a) of the Act relating to the worker has previously been carried out—within 1 year after the last assessment was carried out.","sortOrder":187},{"sectionNumber":"sec.163","sectionType":"section","heading":"Appropriately qualified person must give advice about particular needs— Act , s 232O","content":"### sec.163 Appropriately qualified person must give advice about particular needs— Act , s 232O\n\nFor section 232O (2) (a) of the Act , this section prescribes requirements about assessing a matter mentioned in 232O(1)(a) of the Act if the insurer is assessing a worker’s needs for, or relating to—\na home modification; or\ntransport modification; or\nworkplace modification; or\nattendant care and support services that are personal assistance services or services to assist a person to participate in the community.\nIn carrying out the assessment, the insurer must obtain and consider information about the needs mentioned in subsection (1) from a person who is appropriately qualified to give advice about the needs.\nan occupational therapist specialising in home or workplace modifications\n(sec.163-ssec.1) For section 232O (2) (a) of the Act , this section prescribes requirements about assessing a matter mentioned in 232O(1)(a) of the Act if the insurer is assessing a worker’s needs for, or relating to— a home modification; or transport modification; or workplace modification; or attendant care and support services that are personal assistance services or services to assist a person to participate in the community.\n(sec.163-ssec.2) In carrying out the assessment, the insurer must obtain and consider information about the needs mentioned in subsection (1) from a person who is appropriately qualified to give advice about the needs. an occupational therapist specialising in home or workplace modifications\n- (a) a home modification; or\n- (b) transport modification; or\n- (c) workplace modification; or\n- (d) attendant care and support services that are personal assistance services or services to assist a person to participate in the community.","sortOrder":188},{"sectionNumber":"sec.164","sectionType":"section","heading":"Purpose of subdivision— Act , s 232N","content":"### sec.164 Purpose of subdivision— Act , s 232N\n\nFor section 232N (b) of the Act , this subdivision prescribes matters the insurer must consider in deciding whether an eligible worker’s treatment, care and support needs resulting from the worker’s serious personal injury are necessary and reasonable in the circumstances.\nThis subdivision does not limit the matters the insurer may consider in making a decision mentioned in subsection (1) .\n(sec.164-ssec.1) For section 232N (b) of the Act , this subdivision prescribes matters the insurer must consider in deciding whether an eligible worker’s treatment, care and support needs resulting from the worker’s serious personal injury are necessary and reasonable in the circumstances.\n(sec.164-ssec.2) This subdivision does not limit the matters the insurer may consider in making a decision mentioned in subsection (1) .","sortOrder":189},{"sectionNumber":"sec.165","sectionType":"section","heading":"Benefit to worker","content":"### sec.165 Benefit to worker\n\nThe insurer must consider whether providing treatment, care or support for, or relating to, the worker’s treatment, care and support needs—\nis likely to maximise the worker’s independence, participation in the community and employment; and\nwill assist the worker in managing the injury.\nIn considering the matters mentioned in subsection (1) , the insurer must also have regard to the following matters—\nwhether the treatment, care or support relates directly to the worker’s individual goals;\nwhether the treatment, care or support will improve or maintain the worker’s ability to conduct daily activities or participate in the community or employment;\nwhether the treatment, care or support has been provided to the worker previously, resulting in an improvement to, or assistance in managing, the worker’s injury;\nwhether the treatment, care or support has a measurable outcome;\nwhether the worker has agreed or is likely to agree that the treatment, care or support will benefit the worker in the ways mentioned in subsection (1) ;\nany associated risks of the treatment, care or support to the worker, weighed against the expected benefit of the treatment, care or support to the worker.\n(sec.165-ssec.1) The insurer must consider whether providing treatment, care or support for, or relating to, the worker’s treatment, care and support needs— is likely to maximise the worker’s independence, participation in the community and employment; and will assist the worker in managing the injury.\n(sec.165-ssec.2) In considering the matters mentioned in subsection (1) , the insurer must also have regard to the following matters— whether the treatment, care or support relates directly to the worker’s individual goals; whether the treatment, care or support will improve or maintain the worker’s ability to conduct daily activities or participate in the community or employment; whether the treatment, care or support has been provided to the worker previously, resulting in an improvement to, or assistance in managing, the worker’s injury; whether the treatment, care or support has a measurable outcome; whether the worker has agreed or is likely to agree that the treatment, care or support will benefit the worker in the ways mentioned in subsection (1) ; any associated risks of the treatment, care or support to the worker, weighed against the expected benefit of the treatment, care or support to the worker.\n- (a) is likely to maximise the worker’s independence, participation in the community and employment; and\n- (b) will assist the worker in managing the injury.\n- (a) whether the treatment, care or support relates directly to the worker’s individual goals;\n- (b) whether the treatment, care or support will improve or maintain the worker’s ability to conduct daily activities or participate in the community or employment;\n- (c) whether the treatment, care or support has been provided to the worker previously, resulting in an improvement to, or assistance in managing, the worker’s injury;\n- (d) whether the treatment, care or support has a measurable outcome;\n- (e) whether the worker has agreed or is likely to agree that the treatment, care or support will benefit the worker in the ways mentioned in subsection (1) ;\n- (f) any associated risks of the treatment, care or support to the worker, weighed against the expected benefit of the treatment, care or support to the worker.","sortOrder":190},{"sectionNumber":"sec.166","sectionType":"section","heading":"Appropriateness of service","content":"### sec.166 Appropriateness of service\n\nThe insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs—\nis consistent with other treatment, care or support being received by the worker; and\nis consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.\nIn considering the matters mentioned in subsection (1) , the insurer must also have regard to the following matters—\nwhether the treatment, care or support will be consistent with the worker’s future treatment, care and support needs;\nwhether the treatment, care or support relates directly to the worker’s individual goals;\nwhether the treatment, care or support could be harmful to the worker;\nwhether similar treatment, care or support is already being, or is to be, provided to the worker for the injury;\nwhether there is evidence that supports the effectiveness of the treatment, care or support.\npeer-reviewed journal articles\ninclusion in clinical guidelines and frameworks\nsuccessful clinical trials\ninclusion in the medical benefits schedule administered by the Commonwealth\n(sec.166-ssec.1) The insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs— is consistent with other treatment, care or support being received by the worker; and is consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.\n(sec.166-ssec.2) In considering the matters mentioned in subsection (1) , the insurer must also have regard to the following matters— whether the treatment, care or support will be consistent with the worker’s future treatment, care and support needs; whether the treatment, care or support relates directly to the worker’s individual goals; whether the treatment, care or support could be harmful to the worker; whether similar treatment, care or support is already being, or is to be, provided to the worker for the injury; whether there is evidence that supports the effectiveness of the treatment, care or support. peer-reviewed journal articles inclusion in clinical guidelines and frameworks successful clinical trials inclusion in the medical benefits schedule administered by the Commonwealth\n- (a) is consistent with other treatment, care or support being received by the worker; and\n- (b) is consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.\n- (a) whether the treatment, care or support will be consistent with the worker’s future treatment, care and support needs;\n- (b) whether the treatment, care or support relates directly to the worker’s individual goals;\n- (c) whether the treatment, care or support could be harmful to the worker;\n- (d) whether similar treatment, care or support is already being, or is to be, provided to the worker for the injury;\n- (e) whether there is evidence that supports the effectiveness of the treatment, care or support. Examples of evidence— • peer-reviewed journal articles • inclusion in clinical guidelines and frameworks • successful clinical trials • inclusion in the medical benefits schedule administered by the Commonwealth\n- • peer-reviewed journal articles\n- • inclusion in clinical guidelines and frameworks\n- • successful clinical trials\n- • inclusion in the medical benefits schedule administered by the Commonwealth\n- • peer-reviewed journal articles\n- • inclusion in clinical guidelines and frameworks\n- • successful clinical trials\n- • inclusion in the medical benefits schedule administered by the Commonwealth","sortOrder":191},{"sectionNumber":"sec.167","sectionType":"section","heading":"Appropriateness of provider","content":"### sec.167 Appropriateness of provider\n\nThe insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs is provided by an appropriate provider.\nIn considering the matter mentioned in subsection (1) , the insurer must also have regard to the following matters—\nwhether the provider, or the provider’s staff, are appropriately qualified to provide the treatment, care or support;\nwhether the provider is appropriate having regard to, for example, the worker’s age, culture, ethnicity and location;\nwhether the provider is acceptable to the worker;\nwhether the provider has or may have a conflict of interest in providing the treatment, care or support to the worker;\nwhether the provider’s fee is reasonable;\nif, under section 232K (2) of the Act , the treatment, care or support must be provided by a registered provider—whether the provider is a registered provider.\n(sec.167-ssec.1) The insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs is provided by an appropriate provider.\n(sec.167-ssec.2) In considering the matter mentioned in subsection (1) , the insurer must also have regard to the following matters— whether the provider, or the provider’s staff, are appropriately qualified to provide the treatment, care or support; whether the provider is appropriate having regard to, for example, the worker’s age, culture, ethnicity and location; whether the provider is acceptable to the worker; whether the provider has or may have a conflict of interest in providing the treatment, care or support to the worker; whether the provider’s fee is reasonable; if, under section 232K (2) of the Act , the treatment, care or support must be provided by a registered provider—whether the provider is a registered provider.\n- (a) whether the provider, or the provider’s staff, are appropriately qualified to provide the treatment, care or support;\n- (b) whether the provider is appropriate having regard to, for example, the worker’s age, culture, ethnicity and location;\n- (c) whether the provider is acceptable to the worker;\n- (d) whether the provider has or may have a conflict of interest in providing the treatment, care or support to the worker;\n- (e) whether the provider’s fee is reasonable;\n- (f) if, under section 232K (2) of the Act , the treatment, care or support must be provided by a registered provider—whether the provider is a registered provider.","sortOrder":192},{"sectionNumber":"sec.168","sectionType":"section","heading":"Cost-effectiveness","content":"### sec.168 Cost-effectiveness\n\nThe insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs is cost-effective.\nIn considering the matter mentioned in subsection (1) , the insurer must also have regard to the following matters—\nthe likely benefit to the worker of receiving the treatment, care or support weighed against the cost of providing the treatment, care or support to the worker;\nthe cost of the treatment, care or support compared with the cost of the same or similar treatment, care or support provided by other suitable providers;\nwhether there is a more cost-effective way to provide the treatment, care or support;\nconsidering whether leasing equipment would be more cost-effective than purchasing new equipment\nconsidering whether the treatment, care or support can be more appropriately funded under another scheme\nwhether the cost of the treatment, care or support is reasonable having regard to the period for which it is required;\nwhether the cost of the treatment, care or support is more than an amount prescribed for the treatment, care or support under section 232R (4) of the Act .\n(sec.168-ssec.1) The insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs is cost-effective.\n(sec.168-ssec.2) In considering the matter mentioned in subsection (1) , the insurer must also have regard to the following matters— the likely benefit to the worker of receiving the treatment, care or support weighed against the cost of providing the treatment, care or support to the worker; the cost of the treatment, care or support compared with the cost of the same or similar treatment, care or support provided by other suitable providers; whether there is a more cost-effective way to provide the treatment, care or support; considering whether leasing equipment would be more cost-effective than purchasing new equipment considering whether the treatment, care or support can be more appropriately funded under another scheme whether the cost of the treatment, care or support is reasonable having regard to the period for which it is required; whether the cost of the treatment, care or support is more than an amount prescribed for the treatment, care or support under section 232R (4) of the Act .\n- (a) the likely benefit to the worker of receiving the treatment, care or support weighed against the cost of providing the treatment, care or support to the worker;\n- (b) the cost of the treatment, care or support compared with the cost of the same or similar treatment, care or support provided by other suitable providers;\n- (c) whether there is a more cost-effective way to provide the treatment, care or support; Examples— • considering whether leasing equipment would be more cost-effective than purchasing new equipment • considering whether the treatment, care or support can be more appropriately funded under another scheme\n- • considering whether leasing equipment would be more cost-effective than purchasing new equipment\n- • considering whether the treatment, care or support can be more appropriately funded under another scheme\n- (d) whether the cost of the treatment, care or support is reasonable having regard to the period for which it is required;\n- (e) whether the cost of the treatment, care or support is more than an amount prescribed for the treatment, care or support under section 232R (4) of the Act .\n- • considering whether leasing equipment would be more cost-effective than purchasing new equipment\n- • considering whether the treatment, care or support can be more appropriately funded under another scheme","sortOrder":193},{"sectionNumber":"sec.169","sectionType":"section","heading":"Registered provider must provide particular needs","content":"### sec.169 Registered provider must provide particular needs\n\nFor section 232K (2) (b) of the Act , the following treatment, care or support is prescribed—\na home modification;\nworkplace modification;\na service for the coordination of treatment, care and support.\na case manager engaged to coordinate a worker’s treatment, care and support\n- (a) a home modification;\n- (b) workplace modification;\n- (c) a service for the coordination of treatment, care and support.","sortOrder":194},{"sectionNumber":"sec.170","sectionType":"section","heading":"Support plans— Act , s 232O","content":"### sec.170 Support plans— Act , s 232O\n\nFor section 232O (3) of the Act , this section prescribes requirements about an eligible worker’s support plan.\nThe support plan must state—\nthe name of the worker; and\nthe outcomes of the assessment under section 232O (1) (a) of the Act ; and\nthe matters mentioned in section 161 (2) , if known by the insurer; and\nany treatment, care and support needs resulting from the worker’s serious personal injury the insurer considers are necessary and reasonable in the circumstances; and\nany treatment, care or support resulting from any other injury resulting from the same event as the serious personal injury that the insurer considers is necessary and reasonable in the circumstances; and\nany other treatment, care or support for the serious personal injury, or any other injury resulting from the same event as the serious personal injury, the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act , having regard to the following matters—\nwhether the treatment, care or support is needed by the worker as a result of the injury;\nwhether it would be fair and reasonable in the circumstances for the insurer to, wholly or partly, pay for the treatment, care or support;\nwhether providing the treatment, care or support will, or is likely to, reduce the worker’s treatment, care and support needs for the injury;\nwhether the insurer considers paying, wholly or partly, for the treatment, care or support is more practical or cost-effective than the insurer paying for the worker’s treatment, care and support needs for the injury, without compromising the level of treatment, care or support received by the worker under chapter 4A of the Act ;\nwhether the treatment, care or support is excluded treatment, care or support;\nwhere the treatment, care or support is to be provided, including, for example, whether the treatment, care or support is to be provided outside Australia; and\nthe intervals at which an assessment under section 232O (1) (a) of the Act will be carried out for the worker.\nThe support plan must be consistent with an existing decision about a service request relating to the worker.\nHowever, subsection (3) applies only to the extent the support plan relates to the period covered by the existing decision.\n(sec.170-ssec.1) For section 232O (3) of the Act , this section prescribes requirements about an eligible worker’s support plan.\n(sec.170-ssec.2) The support plan must state— the name of the worker; and the outcomes of the assessment under section 232O (1) (a) of the Act ; and the matters mentioned in section 161 (2) , if known by the insurer; and any treatment, care and support needs resulting from the worker’s serious personal injury the insurer considers are necessary and reasonable in the circumstances; and any treatment, care or support resulting from any other injury resulting from the same event as the serious personal injury that the insurer considers is necessary and reasonable in the circumstances; and any other treatment, care or support for the serious personal injury, or any other injury resulting from the same event as the serious personal injury, the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act , having regard to the following matters— whether the treatment, care or support is needed by the worker as a result of the injury; whether it would be fair and reasonable in the circumstances for the insurer to, wholly or partly, pay for the treatment, care or support; whether providing the treatment, care or support will, or is likely to, reduce the worker’s treatment, care and support needs for the injury; whether the insurer considers paying, wholly or partly, for the treatment, care or support is more practical or cost-effective than the insurer paying for the worker’s treatment, care and support needs for the injury, without compromising the level of treatment, care or support received by the worker under chapter 4A of the Act ; whether the treatment, care or support is excluded treatment, care or support; where the treatment, care or support is to be provided, including, for example, whether the treatment, care or support is to be provided outside Australia; and the intervals at which an assessment under section 232O (1) (a) of the Act will be carried out for the worker.\n(sec.170-ssec.3) The support plan must be consistent with an existing decision about a service request relating to the worker.\n(sec.170-ssec.4) However, subsection (3) applies only to the extent the support plan relates to the period covered by the existing decision.\n- (a) the name of the worker; and\n- (b) the outcomes of the assessment under section 232O (1) (a) of the Act ; and\n- (c) the matters mentioned in section 161 (2) , if known by the insurer; and\n- (d) any treatment, care and support needs resulting from the worker’s serious personal injury the insurer considers are necessary and reasonable in the circumstances; and\n- (e) any treatment, care or support resulting from any other injury resulting from the same event as the serious personal injury that the insurer considers is necessary and reasonable in the circumstances; and\n- (f) any other treatment, care or support for the serious personal injury, or any other injury resulting from the same event as the serious personal injury, the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act , having regard to the following matters— (i) whether the treatment, care or support is needed by the worker as a result of the injury; (ii) whether it would be fair and reasonable in the circumstances for the insurer to, wholly or partly, pay for the treatment, care or support; (iii) whether providing the treatment, care or support will, or is likely to, reduce the worker’s treatment, care and support needs for the injury; (iv) whether the insurer considers paying, wholly or partly, for the treatment, care or support is more practical or cost-effective than the insurer paying for the worker’s treatment, care and support needs for the injury, without compromising the level of treatment, care or support received by the worker under chapter 4A of the Act ; (v) whether the treatment, care or support is excluded treatment, care or support; (vi) where the treatment, care or support is to be provided, including, for example, whether the treatment, care or support is to be provided outside Australia; and\n- (i) whether the treatment, care or support is needed by the worker as a result of the injury;\n- (ii) whether it would be fair and reasonable in the circumstances for the insurer to, wholly or partly, pay for the treatment, care or support;\n- (iii) whether providing the treatment, care or support will, or is likely to, reduce the worker’s treatment, care and support needs for the injury;\n- (iv) whether the insurer considers paying, wholly or partly, for the treatment, care or support is more practical or cost-effective than the insurer paying for the worker’s treatment, care and support needs for the injury, without compromising the level of treatment, care or support received by the worker under chapter 4A of the Act ;\n- (v) whether the treatment, care or support is excluded treatment, care or support;\n- (vi) where the treatment, care or support is to be provided, including, for example, whether the treatment, care or support is to be provided outside Australia; and\n- (g) the intervals at which an assessment under section 232O (1) (a) of the Act will be carried out for the worker.\n- (i) whether the treatment, care or support is needed by the worker as a result of the injury;\n- (ii) whether it would be fair and reasonable in the circumstances for the insurer to, wholly or partly, pay for the treatment, care or support;\n- (iii) whether providing the treatment, care or support will, or is likely to, reduce the worker’s treatment, care and support needs for the injury;\n- (iv) whether the insurer considers paying, wholly or partly, for the treatment, care or support is more practical or cost-effective than the insurer paying for the worker’s treatment, care and support needs for the injury, without compromising the level of treatment, care or support received by the worker under chapter 4A of the Act ;\n- (v) whether the treatment, care or support is excluded treatment, care or support;\n- (vi) where the treatment, care or support is to be provided, including, for example, whether the treatment, care or support is to be provided outside Australia; and","sortOrder":195},{"sectionNumber":"sec.171","sectionType":"section","heading":"Amending support plans— Act , s 232O","content":"### sec.171 Amending support plans— Act , s 232O\n\nFor section 232O (5) of the Act , this section prescribes requirements for amending an eligible worker’s support plan under section 232O (4) (a) of the Act .\nAn amendment of the support plan must be consistent with an existing decision about a service request relating to the worker.\nHowever, subsection (2) applies only to the extent the support plan relates to the period covered by the existing decision.\n(sec.171-ssec.1) For section 232O (5) of the Act , this section prescribes requirements for amending an eligible worker’s support plan under section 232O (4) (a) of the Act .\n(sec.171-ssec.2) An amendment of the support plan must be consistent with an existing decision about a service request relating to the worker.\n(sec.171-ssec.3) However, subsection (2) applies only to the extent the support plan relates to the period covered by the existing decision.","sortOrder":196},{"sectionNumber":"sec.172","sectionType":"section","heading":"Deciding service request— Act , s 232P","content":"### sec.172 Deciding service request— Act , s 232P\n\nFor section 232P (4) of the Act , this section prescribes the matters an insurer must consider in deciding a service request relating to an eligible worker.\nThe insurer must consider the following matters—\nwhether or not the requested service relates to—\nthe worker’s treatment, care and support needs resulting from the worker’s serious personal injury; or\nthe worker’s need for treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury;\nif the requested service relates to the treatment, care and support needs mentioned in paragraph (a) (i) —whether or not the needs are necessary and reasonable in the circumstances;\nif the requested service relates to the treatment, care or support mentioned in paragraph (a) (ii) —whether or not the treatment, care or support is necessary and reasonable in the circumstances;\nif the requested service does not relate to treatment, care and support needs or treatment, care or support mentioned in paragraph (a) (ii) , or the insurer does not consider the needs or the treatment, care or support mentioned in paragraph (a) (ii) are necessary and reasonable in the circumstances—whether or not the insurer should, wholly or partly, pay for the requested service under chapter 4A of the Act , having regard to the matters mentioned in section 170 (2) (f) .\n(sec.172-ssec.1) For section 232P (4) of the Act , this section prescribes the matters an insurer must consider in deciding a service request relating to an eligible worker.\n(sec.172-ssec.2) The insurer must consider the following matters— whether or not the requested service relates to— the worker’s treatment, care and support needs resulting from the worker’s serious personal injury; or the worker’s need for treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury; if the requested service relates to the treatment, care and support needs mentioned in paragraph (a) (i) —whether or not the needs are necessary and reasonable in the circumstances; if the requested service relates to the treatment, care or support mentioned in paragraph (a) (ii) —whether or not the treatment, care or support is necessary and reasonable in the circumstances; if the requested service does not relate to treatment, care and support needs or treatment, care or support mentioned in paragraph (a) (ii) , or the insurer does not consider the needs or the treatment, care or support mentioned in paragraph (a) (ii) are necessary and reasonable in the circumstances—whether or not the insurer should, wholly or partly, pay for the requested service under chapter 4A of the Act , having regard to the matters mentioned in section 170 (2) (f) .\n- (a) whether or not the requested service relates to— (i) the worker’s treatment, care and support needs resulting from the worker’s serious personal injury; or (ii) the worker’s need for treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury;\n- (i) the worker’s treatment, care and support needs resulting from the worker’s serious personal injury; or\n- (ii) the worker’s need for treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury;\n- (b) if the requested service relates to the treatment, care and support needs mentioned in paragraph (a) (i) —whether or not the needs are necessary and reasonable in the circumstances;\n- (c) if the requested service relates to the treatment, care or support mentioned in paragraph (a) (ii) —whether or not the treatment, care or support is necessary and reasonable in the circumstances;\n- (d) if the requested service does not relate to treatment, care and support needs or treatment, care or support mentioned in paragraph (a) (ii) , or the insurer does not consider the needs or the treatment, care or support mentioned in paragraph (a) (ii) are necessary and reasonable in the circumstances—whether or not the insurer should, wholly or partly, pay for the requested service under chapter 4A of the Act , having regard to the matters mentioned in section 170 (2) (f) .\n- (i) the worker’s treatment, care and support needs resulting from the worker’s serious personal injury; or\n- (ii) the worker’s need for treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury;","sortOrder":197},{"sectionNumber":"pt.6-div.3","sectionType":"division","heading":"Payment options","content":"## Payment options","sortOrder":198},{"sectionNumber":"sec.173","sectionType":"section","heading":"Circumstances in which payment request may be made— Act , s 232Q","content":"### sec.173 Circumstances in which payment request may be made— Act , s 232Q\n\nFor section 232Q (3) (b) of the Act , this section prescribes the circumstances for making a payment request for the payment of all or part of an expense for the treatment, care or support of an eligible worker.\nA payment request may not be made by a person for the expense if—\nthe person has entered into a funding agreement with the insurer for the treatment, care or support; and\nthe expense was incurred in the period covered by the funding agreement.\nA payment request must be made within 6 months after the expense is incurred.\nHowever, the insurer may accept a later payment request if the insurer considers it is fair and reasonable in the circumstances to accept the request.\n(sec.173-ssec.1) For section 232Q (3) (b) of the Act , this section prescribes the circumstances for making a payment request for the payment of all or part of an expense for the treatment, care or support of an eligible worker.\n(sec.173-ssec.2) A payment request may not be made by a person for the expense if— the person has entered into a funding agreement with the insurer for the treatment, care or support; and the expense was incurred in the period covered by the funding agreement.\n(sec.173-ssec.3) A payment request must be made within 6 months after the expense is incurred.\n(sec.173-ssec.4) However, the insurer may accept a later payment request if the insurer considers it is fair and reasonable in the circumstances to accept the request.\n- (a) the person has entered into a funding agreement with the insurer for the treatment, care or support; and\n- (b) the expense was incurred in the period covered by the funding agreement.","sortOrder":199},{"sectionNumber":"sec.174","sectionType":"section","heading":"Deciding payment request— Act , s 232R","content":"### sec.174 Deciding payment request— Act , s 232R\n\nFor section 232R (2) of the Act , this section prescribes matters about an insurer deciding a payment request for the payment of all or part of an expense for the treatment, care or support of an eligible worker.\nIf the insurer makes an information request for the payment request and the person of whom it is made does not provide the information requested by the stated day or a later day agreed to by the insurer and the person—\nthe request lapses; and\nthe insurer is not required to approve or refuse the request.\nThe insurer must approve the payment request if—\nthe expense is incurred in the eligibility period for the eligible worker; and\nthe treatment, care or support to which the request relates is an approved service for the eligible worker.\nFor subsection (3) (b) , excluded treatment, care or support is an approved service only if the treatment, care or support—\nis specifically stated in a support plan for the worker to be—\ntreatment, care or support resulting from the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or\ntreatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or\ntreatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or\nif a support plan has not been made for the worker—is specifically approved under an approval of a service request relating to the worker.\nTo remove any doubt, it is declared that an insurer may approve a payment request even though the treatment, care or support to which the request relates is not an approved service for the eligible worker.\n(sec.174-ssec.1) For section 232R (2) of the Act , this section prescribes matters about an insurer deciding a payment request for the payment of all or part of an expense for the treatment, care or support of an eligible worker.\n(sec.174-ssec.2) If the insurer makes an information request for the payment request and the person of whom it is made does not provide the information requested by the stated day or a later day agreed to by the insurer and the person— the request lapses; and the insurer is not required to approve or refuse the request.\n(sec.174-ssec.3) The insurer must approve the payment request if— the expense is incurred in the eligibility period for the eligible worker; and the treatment, care or support to which the request relates is an approved service for the eligible worker.\n(sec.174-ssec.4) For subsection (3) (b) , excluded treatment, care or support is an approved service only if the treatment, care or support— is specifically stated in a support plan for the worker to be— treatment, care or support resulting from the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or if a support plan has not been made for the worker—is specifically approved under an approval of a service request relating to the worker.\n(sec.174-ssec.5) To remove any doubt, it is declared that an insurer may approve a payment request even though the treatment, care or support to which the request relates is not an approved service for the eligible worker.\n- (a) the request lapses; and\n- (b) the insurer is not required to approve or refuse the request.\n- (a) the expense is incurred in the eligibility period for the eligible worker; and\n- (b) the treatment, care or support to which the request relates is an approved service for the eligible worker.\n- (a) is specifically stated in a support plan for the worker to be— (i) treatment, care or support resulting from the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or (ii) treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or (iii) treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or\n- (i) treatment, care or support resulting from the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or\n- (ii) treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or\n- (iii) treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or\n- (b) if a support plan has not been made for the worker—is specifically approved under an approval of a service request relating to the worker.\n- (i) treatment, care or support resulting from the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or\n- (ii) treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or\n- (iii) treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or","sortOrder":200},{"sectionNumber":"sec.175","sectionType":"section","heading":"Limit on amount payable under payment request— Act , s 232R","content":"### sec.175 Limit on amount payable under payment request— Act , s 232R\n\nFor section 232R (4) of the Act , the amount prescribed is—\nfor medical treatment or rehabilitation—the amount stated in the table of costs; or\nfor hospitalisation of the worker as an in-patient at a private hospital—the amount stated in section 217 (3) of the Act ; or\nfor hospitalisation of the worker as an in-patient at a public hospital—the amount stated in section 218A (3) of the Act .\n- (a) for medical treatment or rehabilitation—the amount stated in the table of costs; or\n- (b) for hospitalisation of the worker as an in-patient at a private hospital—the amount stated in section 217 (3) of the Act ; or\n- (c) for hospitalisation of the worker as an in-patient at a public hospital—the amount stated in section 218A (3) of the Act .","sortOrder":201},{"sectionNumber":"pt.6-div.4","sectionType":"division","heading":"Review of entitlement","content":"## Review of entitlement","sortOrder":202},{"sectionNumber":"sec.176","sectionType":"section","heading":"Review of worker’s entitlement— Act , s 232S","content":"### sec.176 Review of worker’s entitlement— Act , s 232S\n\nFor section 232S (3) of the Act , this section prescribes matters for a review of a worker’s entitlement to treatment, care and support payments under section 232S of the Act .\nThe insurer must give the worker written notice of the review at least 20 business days before carrying out the review.\nIn carrying out the review, the insurer may ask the worker to give the insurer information needed to make a decision about the worker’s entitlement at the end of the review.\n(sec.176-ssec.1) For section 232S (3) of the Act , this section prescribes matters for a review of a worker’s entitlement to treatment, care and support payments under section 232S of the Act .\n(sec.176-ssec.2) The insurer must give the worker written notice of the review at least 20 business days before carrying out the review.\n(sec.176-ssec.3) In carrying out the review, the insurer may ask the worker to give the insurer information needed to make a decision about the worker’s entitlement at the end of the review.","sortOrder":203},{"sectionNumber":"pt.7","sectionType":"part","heading":"Damages","content":"# Damages","sortOrder":204},{"sectionNumber":"pt.7-div.1","sectionType":"division","heading":"Particulars in notice of claim","content":"## Particulars in notice of claim","sortOrder":205},{"sectionNumber":"sec.177","sectionType":"section","heading":"Notice of claim for damages— Act , s 275","content":"### sec.177 Notice of claim for damages— Act , s 275\n\nFor section 275 (3) of the Act , the particulars contained in this division are prescribed.\nSee section 276 of the Act if the claimant alleges an urgent need to start a proceeding for damages despite noncompliance with section 275 of the Act .","sortOrder":206},{"sectionNumber":"sec.178","sectionType":"section","heading":"Particulars of claimant and worker","content":"### sec.178 Particulars of claimant and worker\n\nA notice of claim must include—\nthe worker’s—\nfull name and any other known names; and\nresidential address; and\ndate of birth; and\ngender; and\nusual occupation and, if that differs from the nature of employment at the time the worker was injured, the nature of the employment at that time; and\nthe name and address of every employer of the worker at the time the worker was injured.\nAlso, if the claimant is not the worker, the notice of claim must include the claimant’s—\nfull name and any other known names; and\nresidential address; and\ndate of birth; and\ngender.\n(sec.178-ssec.1) A notice of claim must include— the worker’s— full name and any other known names; and residential address; and date of birth; and gender; and usual occupation and, if that differs from the nature of employment at the time the worker was injured, the nature of the employment at that time; and the name and address of every employer of the worker at the time the worker was injured.\n(sec.178-ssec.2) Also, if the claimant is not the worker, the notice of claim must include the claimant’s— full name and any other known names; and residential address; and date of birth; and gender.\n- (a) the worker’s— (i) full name and any other known names; and (ii) residential address; and (iii) date of birth; and (iv) gender; and (v) usual occupation and, if that differs from the nature of employment at the time the worker was injured, the nature of the employment at that time; and\n- (i) full name and any other known names; and\n- (ii) residential address; and\n- (iii) date of birth; and\n- (iv) gender; and\n- (v) usual occupation and, if that differs from the nature of employment at the time the worker was injured, the nature of the employment at that time; and\n- (b) the name and address of every employer of the worker at the time the worker was injured.\n- (i) full name and any other known names; and\n- (ii) residential address; and\n- (iii) date of birth; and\n- (iv) gender; and\n- (v) usual occupation and, if that differs from the nature of employment at the time the worker was injured, the nature of the employment at that time; and\n- (a) full name and any other known names; and\n- (b) residential address; and\n- (c) date of birth; and\n- (d) gender.","sortOrder":207},{"sectionNumber":"sec.179","sectionType":"section","heading":"Particulars of event","content":"### sec.179 Particulars of event\n\nA notice of claim must include the following—\nthe date, time and place of the event;\nthe claimant’s description of the facts of the circumstances surrounding the worker’s injury;\nthe names and addresses of all witnesses to the injury, and their relationship, if any, to the worker;\nthe name and address of any person on behalf of the claimant’s employer to whom the claimant reported the injury and the details of the person’s employment;\nthe full particulars of the negligence alleged against the claimant’s employer and any other party on which the claim is based;\nif a party other than the claimant’s employer (the other party ) is involved—\nthe liability expressed as a percentage for which the claimant holds the other party responsible; and\ndetails of the notice of claim given to the other party.\n- (a) the date, time and place of the event;\n- (b) the claimant’s description of the facts of the circumstances surrounding the worker’s injury;\n- (c) the names and addresses of all witnesses to the injury, and their relationship, if any, to the worker;\n- (d) the name and address of any person on behalf of the claimant’s employer to whom the claimant reported the injury and the details of the person’s employment;\n- (e) the full particulars of the negligence alleged against the claimant’s employer and any other party on which the claim is based;\n- (f) if a party other than the claimant’s employer (the other party ) is involved— (i) the liability expressed as a percentage for which the claimant holds the other party responsible; and (ii) details of the notice of claim given to the other party.\n- (i) the liability expressed as a percentage for which the claimant holds the other party responsible; and\n- (ii) details of the notice of claim given to the other party.\n- (i) the liability expressed as a percentage for which the claimant holds the other party responsible; and\n- (ii) details of the notice of claim given to the other party.","sortOrder":208},{"sectionNumber":"sec.180","sectionType":"section","heading":"Injury particulars","content":"### sec.180 Injury particulars\n\nA notice of claim must include full particulars of the nature and extent of—\nall injuries alleged to have been sustained by the claimant or worker because of the event; and\nthe degree of permanent impairment that the claimant alleges has resulted from the injuries; and\nthe amount of damages sought under each head of damage claimed by the claimant and the method of calculating each amount; and\nhow the claimant or worker is currently affected by the injuries.\nAlso, the notice of claim must include all personal injuries, illnesses and impairments of a medical, psychiatric or psychological nature sustained by the claimant or worker, either before or after the event that may affect—\nthe extent of the permanent impairment resulting from the injury to which the claim relates; or\nthe amount of damages in another way.\nIn addition, if the claimant has claimed damages, compensation or benefits in relation to a personal injury, illness or impairment mentioned in subsection (2) , the notice of claim must include—\nthe name and address of any person against whom a claim for damages or compensation was made; and\nif an insurer or other insurance provider was involved in a claim mentioned in paragraph (a) —the name and address of that entity.\n(sec.180-ssec.1) A notice of claim must include full particulars of the nature and extent of— all injuries alleged to have been sustained by the claimant or worker because of the event; and the degree of permanent impairment that the claimant alleges has resulted from the injuries; and the amount of damages sought under each head of damage claimed by the claimant and the method of calculating each amount; and how the claimant or worker is currently affected by the injuries.\n(sec.180-ssec.2) Also, the notice of claim must include all personal injuries, illnesses and impairments of a medical, psychiatric or psychological nature sustained by the claimant or worker, either before or after the event that may affect— the extent of the permanent impairment resulting from the injury to which the claim relates; or the amount of damages in another way.\n(sec.180-ssec.3) In addition, if the claimant has claimed damages, compensation or benefits in relation to a personal injury, illness or impairment mentioned in subsection (2) , the notice of claim must include— the name and address of any person against whom a claim for damages or compensation was made; and if an insurer or other insurance provider was involved in a claim mentioned in paragraph (a) —the name and address of that entity.\n- (a) all injuries alleged to have been sustained by the claimant or worker because of the event; and\n- (b) the degree of permanent impairment that the claimant alleges has resulted from the injuries; and\n- (c) the amount of damages sought under each head of damage claimed by the claimant and the method of calculating each amount; and\n- (d) how the claimant or worker is currently affected by the injuries.\n- (a) the extent of the permanent impairment resulting from the injury to which the claim relates; or\n- (b) the amount of damages in another way.\n- (a) the name and address of any person against whom a claim for damages or compensation was made; and\n- (b) if an insurer or other insurance provider was involved in a claim mentioned in paragraph (a) —the name and address of that entity.","sortOrder":209},{"sectionNumber":"sec.181","sectionType":"section","heading":"Particulars of hospital, treatment and rehabilitation","content":"### sec.181 Particulars of hospital, treatment and rehabilitation\n\nA notice of claim must include the name and address of each of the following for each injury alleged to have been sustained by the claimant or worker—\neach hospital at which the claimant or worker has been treated for the injury;\neach doctor who treated the claimant or worker for the injury;\neach provider of treatment or rehabilitation services that assessed, treated, or provided treatment or rehabilitation services in relation to permanent impairment arising from the injury.\nAlso, if section 180 (2) applies, the notice of claim must include the name and address of—\neach hospital at which the claimant or worker has been treated for the personal injury, illness or impairment; and\neach doctor who treated the claimant for the personal injury, illness or impairment.\n(sec.181-ssec.1) A notice of claim must include the name and address of each of the following for each injury alleged to have been sustained by the claimant or worker— each hospital at which the claimant or worker has been treated for the injury; each doctor who treated the claimant or worker for the injury; each provider of treatment or rehabilitation services that assessed, treated, or provided treatment or rehabilitation services in relation to permanent impairment arising from the injury.\n(sec.181-ssec.2) Also, if section 180 (2) applies, the notice of claim must include the name and address of— each hospital at which the claimant or worker has been treated for the personal injury, illness or impairment; and each doctor who treated the claimant for the personal injury, illness or impairment.\n- (a) each hospital at which the claimant or worker has been treated for the injury;\n- (b) each doctor who treated the claimant or worker for the injury;\n- (c) each provider of treatment or rehabilitation services that assessed, treated, or provided treatment or rehabilitation services in relation to permanent impairment arising from the injury.\n- (a) each hospital at which the claimant or worker has been treated for the personal injury, illness or impairment; and\n- (b) each doctor who treated the claimant for the personal injury, illness or impairment.","sortOrder":210},{"sectionNumber":"sec.182","sectionType":"section","heading":"Particulars if claim for diminished income earning capacity","content":"### sec.182 Particulars if claim for diminished income earning capacity\n\nIf a claimant claims damages for diminished income earning capacity, the notice of claim must include the following particulars of the claimant’s employment for the 3 year period immediately before the event, and the period since the event—\nthe name and address of each of the claimant’s employers;\nthe period of employment by each employer;\nthe capacity in which the claimant was employed by each employer;\nthe claimant’s gross and net (after tax) earnings for each period of employment;\nthe periods during which the claimant was receiving payments from Centrelink under the Social Security Act 1991 (Cwlth) ;\nthe periods during which the claimant received no income, and the reasons why the claimant was not receiving any income.\nSee also section 276 of the Act .\n- (a) the name and address of each of the claimant’s employers;\n- (b) the period of employment by each employer;\n- (c) the capacity in which the claimant was employed by each employer;\n- (d) the claimant’s gross and net (after tax) earnings for each period of employment;\n- (e) the periods during which the claimant was receiving payments from Centrelink under the Social Security Act 1991 (Cwlth) ;\n- (f) the periods during which the claimant received no income, and the reasons why the claimant was not receiving any income.","sortOrder":211},{"sectionNumber":"sec.183","sectionType":"section","heading":"Particulars if injury causes death","content":"### sec.183 Particulars if injury causes death\n\nA notice of claim relating to an injury causing death must include the following additional particulars—\nif the claimant is the spouse of the deceased worker—\nthe relevant date; and\nthe relevant place; and\nthe claimant’s net (after tax) weekly income immediately before and after the worker’s death; and\nthe age to which the claimant intended to work and whether the claimant intended the future employment to be full-time or part-time; and\ndetails of any current health problems of the claimant; and\nthe amount of average weekly financial benefit derived by the claimant from the deceased worker before the worker’s death and the method of calculating the amount; and\nthe expected date of birth of a posthumous child of the relationship; and\ndetails of any remarriage or start of a marriage-like relationship; or\nif the claimant is not the spouse of the deceased worker—\nthe claimant’s relationship to the deceased worker; and\nthe claimant’s net (after tax) weekly income; and\nthe age to which the claimant would have been dependent on the deceased worker and the basis of the dependency; and\ndetails of any current health problems of the claimant; and\nthe amount of average weekly financial benefit derived by the claimant from the deceased worker immediately before the worker’s death and the method of calculating the amount.\nIn this section—\nrelevant date means—\nthe date of marriage; or\nthe date the civil partnership had effect; or\nthe date on which the de facto relationship started.\nrelevant place means—\nthe place of the marriage; or\nthe place of registration of the civil partnership; or\nthe residential address where the de facto relationship started.\n(sec.183-ssec.1) A notice of claim relating to an injury causing death must include the following additional particulars— if the claimant is the spouse of the deceased worker— the relevant date; and the relevant place; and the claimant’s net (after tax) weekly income immediately before and after the worker’s death; and the age to which the claimant intended to work and whether the claimant intended the future employment to be full-time or part-time; and details of any current health problems of the claimant; and the amount of average weekly financial benefit derived by the claimant from the deceased worker before the worker’s death and the method of calculating the amount; and the expected date of birth of a posthumous child of the relationship; and details of any remarriage or start of a marriage-like relationship; or if the claimant is not the spouse of the deceased worker— the claimant’s relationship to the deceased worker; and the claimant’s net (after tax) weekly income; and the age to which the claimant would have been dependent on the deceased worker and the basis of the dependency; and details of any current health problems of the claimant; and the amount of average weekly financial benefit derived by the claimant from the deceased worker immediately before the worker’s death and the method of calculating the amount.\n(sec.183-ssec.2) In this section— relevant date means— the date of marriage; or the date the civil partnership had effect; or the date on which the de facto relationship started. relevant place means— the place of the marriage; or the place of registration of the civil partnership; or the residential address where the de facto relationship started.\n- (a) if the claimant is the spouse of the deceased worker— (i) the relevant date; and (ii) the relevant place; and (iii) the claimant’s net (after tax) weekly income immediately before and after the worker’s death; and (iv) the age to which the claimant intended to work and whether the claimant intended the future employment to be full-time or part-time; and (v) details of any current health problems of the claimant; and (vi) the amount of average weekly financial benefit derived by the claimant from the deceased worker before the worker’s death and the method of calculating the amount; and (vii) the expected date of birth of a posthumous child of the relationship; and (viii) details of any remarriage or start of a marriage-like relationship; or\n- (i) the relevant date; and\n- (ii) the relevant place; and\n- (iii) the claimant’s net (after tax) weekly income immediately before and after the worker’s death; and\n- (iv) the age to which the claimant intended to work and whether the claimant intended the future employment to be full-time or part-time; and\n- (v) details of any current health problems of the claimant; and\n- (vi) the amount of average weekly financial benefit derived by the claimant from the deceased worker before the worker’s death and the method of calculating the amount; and\n- (vii) the expected date of birth of a posthumous child of the relationship; and\n- (viii) details of any remarriage or start of a marriage-like relationship; or\n- (b) if the claimant is not the spouse of the deceased worker— (i) the claimant’s relationship to the deceased worker; and (ii) the claimant’s net (after tax) weekly income; and (iii) the age to which the claimant would have been dependent on the deceased worker and the basis of the dependency; and (iv) details of any current health problems of the claimant; and (v) the amount of average weekly financial benefit derived by the claimant from the deceased worker immediately before the worker’s death and the method of calculating the amount.\n- (i) the claimant’s relationship to the deceased worker; and\n- (ii) the claimant’s net (after tax) weekly income; and\n- (iii) the age to which the claimant would have been dependent on the deceased worker and the basis of the dependency; and\n- (iv) details of any current health problems of the claimant; and\n- (v) the amount of average weekly financial benefit derived by the claimant from the deceased worker immediately before the worker’s death and the method of calculating the amount.\n- (i) the relevant date; and\n- (ii) the relevant place; and\n- (iii) the claimant’s net (after tax) weekly income immediately before and after the worker’s death; and\n- (iv) the age to which the claimant intended to work and whether the claimant intended the future employment to be full-time or part-time; and\n- (v) details of any current health problems of the claimant; and\n- (vi) the amount of average weekly financial benefit derived by the claimant from the deceased worker before the worker’s death and the method of calculating the amount; and\n- (vii) the expected date of birth of a posthumous child of the relationship; and\n- (viii) details of any remarriage or start of a marriage-like relationship; or\n- (i) the claimant’s relationship to the deceased worker; and\n- (ii) the claimant’s net (after tax) weekly income; and\n- (iii) the age to which the claimant would have been dependent on the deceased worker and the basis of the dependency; and\n- (iv) details of any current health problems of the claimant; and\n- (v) the amount of average weekly financial benefit derived by the claimant from the deceased worker immediately before the worker’s death and the method of calculating the amount.\n- (a) the date of marriage; or\n- (b) the date the civil partnership had effect; or\n- (c) the date on which the de facto relationship started.\n- (a) the place of the marriage; or\n- (b) the place of registration of the civil partnership; or\n- (c) the residential address where the de facto relationship started.","sortOrder":212},{"sectionNumber":"sec.184","sectionType":"section","heading":"Particulars of mitigation","content":"### sec.184 Particulars of mitigation\n\nA notice of claim must include all steps taken by the worker or claimant to mitigate their loss.","sortOrder":213},{"sectionNumber":"pt.7-div.2","sectionType":"division","heading":"General provisions","content":"## General provisions","sortOrder":214},{"sectionNumber":"sec.185","sectionType":"section","heading":"Time for adding another person as contributor— Act , s 278A","content":"### sec.185 Time for adding another person as contributor— Act , s 278A\n\nFor section 278A (1) of the Act , the time prescribed is the later of the following—\n30 business days after the insurer receives the notice of claim;\n5 business days after the insurer identifies someone else as a contributor.\n- (a) 30 business days after the insurer receives the notice of claim;\n- (b) 5 business days after the insurer identifies someone else as a contributor.","sortOrder":215},{"sectionNumber":"sec.186","sectionType":"section","heading":"Contribution notice to contain particular information— Act , s 278B","content":"### sec.186 Contribution notice to contain particular information— Act , s 278B\n\nFor section 278B (1) (a) of the Act , the following information is prescribed—\nthe contributor’s full name;\nthe contributor’s business address;\nthe contributor’s postal address;\nthe name and contact details of the contributor’s legal representatives, if any;\nthe contributor’s ABN, if any;\nif the contributor is a corporation—\nthe corporation’s ACN; and\nthe corporation’s registered office.\n- (a) the contributor’s full name;\n- (b) the contributor’s business address;\n- (c) the contributor’s postal address;\n- (d) the name and contact details of the contributor’s legal representatives, if any;\n- (e) the contributor’s ABN, if any;\n- (f) if the contributor is a corporation— (i) the corporation’s ACN; and (ii) the corporation’s registered office.\n- (i) the corporation’s ACN; and\n- (ii) the corporation’s registered office.\n- (i) the corporation’s ACN; and\n- (ii) the corporation’s registered office.","sortOrder":216},{"sectionNumber":"pt.8","sectionType":"part","heading":"Assessment of damages","content":"# Assessment of damages","sortOrder":217},{"sectionNumber":"sec.187","sectionType":"section","heading":"Prescribed amount of damages for loss of consortium or loss of servitium— Act , s 306M","content":"### sec.187 Prescribed amount of damages for loss of consortium or loss of servitium— Act , s 306M\n\nFor section 306M (1) (b) of the Act , for an injury sustained during a period stated in an item of the following table, the amount stated in the item is prescribed.\nItem\nPeriod (dates inclusive)\nAmount\n1\n1 July 2010 to 30 June 2011\n$35,340\n2\n1 July 2011 to 30 June 2012\n$36,350\n3\n1 July 2012 to 30 June 2013\n$38,290\n4\n1 July 2013 to 30 June 2014\n$39,430\n5\n1 July 2014 to 30 June 2015\n$40,920\n6\n1 July 2015 to 30 June 2017\n$41,920\n7\n1 July 2017 to 30 June 2018\n$42,650\n8\n1 July 2018 to 30 June 2019\n$43,960\n9\n1 July 2019 to 30 June 2020\n$45,290\n10\n1 July 2020 and after\n28.78 times QOTE","sortOrder":218},{"sectionNumber":"sec.188","sectionType":"section","heading":"Rules for assessing injury scale value— Act , s 306O","content":"### sec.188 Rules for assessing injury scale value— Act , s 306O\n\nFor section 306O (1) (c) (i) of the Act , a court must have regard to the following—\nfor assessment of the ranges of injury scale value—the ranges mentioned in schedule 14 ;\nfor matters to which a court is to have regard in the application of schedule 14 —the rules mentioned in schedule 13 ;\nfor the PIRS that must be used with schedule 14 —the scales mentioned in schedule 16 ;\nfor matters relevant to the application of schedule 16 and requirements with which a medical expert must comply in assessing a PIRS rating—the matters mentioned in schedule 15 .\n- (a) for assessment of the ranges of injury scale value—the ranges mentioned in schedule 14 ;\n- (b) for matters to which a court is to have regard in the application of schedule 14 —the rules mentioned in schedule 13 ;\n- (c) for the PIRS that must be used with schedule 14 —the scales mentioned in schedule 16 ;\n- (d) for matters relevant to the application of schedule 16 and requirements with which a medical expert must comply in assessing a PIRS rating—the matters mentioned in schedule 15 .","sortOrder":219},{"sectionNumber":"sec.189","sectionType":"section","heading":"General damages calculation provisions— Act , s 306P","content":"### sec.189 General damages calculation provisions— Act , s 306P\n\nFor section 306P (2) , definition general damages calculation provisions , for each period stated in a table in schedule 17 , this section and that table are the general damages calculation provisions for the period.\nFor an injury within the injury scale value stated in an item of any of tables 1 to 9, the general damages are the sum of—\nthe base amount for the item (if any); and\nthe variable amount for the item.\nFor an injury within the injury scale value stated in an item of a table other than a table mentioned in subsection (2) , the general damages are the amount worked out in the way stated in the column of the table with the heading ‘general damages’.\nIn this section—\nvariable amount means the amount worked out in the way stated in the column of a table with the heading ‘variable amount’.\n(sec.189-ssec.1) For section 306P (2) , definition general damages calculation provisions , for each period stated in a table in schedule 17 , this section and that table are the general damages calculation provisions for the period.\n(sec.189-ssec.2) For an injury within the injury scale value stated in an item of any of tables 1 to 9, the general damages are the sum of— the base amount for the item (if any); and the variable amount for the item.\n(sec.189-ssec.3) For an injury within the injury scale value stated in an item of a table other than a table mentioned in subsection (2) , the general damages are the amount worked out in the way stated in the column of the table with the heading ‘general damages’.\n(sec.189-ssec.4) In this section— variable amount means the amount worked out in the way stated in the column of a table with the heading ‘variable amount’.\n- (a) the base amount for the item (if any); and\n- (b) the variable amount for the item.","sortOrder":220},{"sectionNumber":"sec.190","sectionType":"section","heading":"Prescribed amount of award for future loss— Act , s 306R","content":"### sec.190 Prescribed amount of award for future loss— Act , s 306R\n\nFor section 306R (2) of the Act , for an injury sustained during a period stated in an item of the following table, the amount stated in the item is prescribed.\nItem\nPeriod (dates inclusive)\nAmount\n1\n1 July 2010 to 30 June 2011\n$117,800\n2\n1 July 2011 to 30 June 2012\n$121,160\n3\n1 July 2012 to 30 June 2013\n$127,620\n4\n1 July 2013 to 30 June 2014\n$131,420\n5\n1 July 2014 to 30 June 2015\n$136,400\n6\n1 July 2015 to 30 June 2017\n$139,740\n7\n1 July 2017 to 30 June 2018\n$142,160\n8\n1 July 2018 to 30 June 2019\n$146,540\n9\n1 July 2019 to 30 June 2020\n$150,970\n10\n1 July 2020 and after\n95.92 times QOTE","sortOrder":221},{"sectionNumber":"pt.9","sectionType":"part","heading":"Costs","content":"# Costs","sortOrder":222},{"sectionNumber":"pt.9-div.1","sectionType":"division","heading":"Hearing before industrial magistrate or industrial commission","content":"## Hearing before industrial magistrate or industrial commission","sortOrder":223},{"sectionNumber":"sec.191","sectionType":"section","heading":"Costs of hearing before industrial magistrate or industrial commission","content":"### sec.191 Costs of hearing before industrial magistrate or industrial commission\n\nA decision to award costs of a hearing before an industrial magistrate or the industrial commission is at the discretion of the magistrate or commission.\nIf the magistrate or commission awards costs—\ncosts in relation to counsel’s or solicitor’s fees are the costs stated in the Uniform Civil Procedure Rules 1999 , schedule 2 , part 2 , scale C; and\ncosts in relation to witnesses are the allowances stated in the Uniform Civil Procedure (Fees) Regulation 2019 , part 3 ; and\ncosts in relation to bailiffs are the fees stated in the Uniform Civil Procedure (Fees) Regulation 2019 , schedule 2A .\nHowever, the magistrate or commission may award costs up to 1.5 times the amounts under subsection (2) (a) , in total or in relation to any item, if the magistrate or commission is satisfied the amounts under subsection (2) (a) are inadequate having regard to—\nthe work involved; or\nthe importance, difficulty or complexity of the matter to which the proceeding relates.\n(sec.191-ssec.1) A decision to award costs of a hearing before an industrial magistrate or the industrial commission is at the discretion of the magistrate or commission.\n(sec.191-ssec.2) If the magistrate or commission awards costs— costs in relation to counsel’s or solicitor’s fees are the costs stated in the Uniform Civil Procedure Rules 1999 , schedule 2 , part 2 , scale C; and costs in relation to witnesses are the allowances stated in the Uniform Civil Procedure (Fees) Regulation 2019 , part 3 ; and costs in relation to bailiffs are the fees stated in the Uniform Civil Procedure (Fees) Regulation 2019 , schedule 2A .\n(sec.191-ssec.3) However, the magistrate or commission may award costs up to 1.5 times the amounts under subsection (2) (a) , in total or in relation to any item, if the magistrate or commission is satisfied the amounts under subsection (2) (a) are inadequate having regard to— the work involved; or the importance, difficulty or complexity of the matter to which the proceeding relates.\n- (a) costs in relation to counsel’s or solicitor’s fees are the costs stated in the Uniform Civil Procedure Rules 1999 , schedule 2 , part 2 , scale C; and\n- (b) costs in relation to witnesses are the allowances stated in the Uniform Civil Procedure (Fees) Regulation 2019 , part 3 ; and\n- (c) costs in relation to bailiffs are the fees stated in the Uniform Civil Procedure (Fees) Regulation 2019 , schedule 2A .\n- (a) the work involved; or\n- (b) the importance, difficulty or complexity of the matter to which the proceeding relates.","sortOrder":224},{"sectionNumber":"sec.192","sectionType":"section","heading":"Payment of additional amount for costs","content":"### sec.192 Payment of additional amount for costs\n\nThis section applies if—\nthe Regulator or an insurer is required to pay costs in a proceeding in relation to a witness who—\nis a medical practitioner; or\ngives evidence of a professional nature; and\nthe amount of fees and expenses payable in relation to the witness by the party that called the witness is more than the amount of costs awarded by the industrial magistrate or the industrial commission.\nThe Regulator or the insurer may, on the application of the party that called the witness, pay an additional amount for costs that the Regulator or the insurer is satisfied are reasonable, having regard to the subject matter of the proceeding.\n(sec.192-ssec.1) This section applies if— the Regulator or an insurer is required to pay costs in a proceeding in relation to a witness who— is a medical practitioner; or gives evidence of a professional nature; and the amount of fees and expenses payable in relation to the witness by the party that called the witness is more than the amount of costs awarded by the industrial magistrate or the industrial commission.\n(sec.192-ssec.2) The Regulator or the insurer may, on the application of the party that called the witness, pay an additional amount for costs that the Regulator or the insurer is satisfied are reasonable, having regard to the subject matter of the proceeding.\n- (a) the Regulator or an insurer is required to pay costs in a proceeding in relation to a witness who— (i) is a medical practitioner; or (ii) gives evidence of a professional nature; and\n- (i) is a medical practitioner; or\n- (ii) gives evidence of a professional nature; and\n- (b) the amount of fees and expenses payable in relation to the witness by the party that called the witness is more than the amount of costs awarded by the industrial magistrate or the industrial commission.\n- (i) is a medical practitioner; or\n- (ii) gives evidence of a professional nature; and","sortOrder":225},{"sectionNumber":"pt.9-div.2","sectionType":"division","heading":"Claim for damages","content":"## Claim for damages","sortOrder":226},{"sectionNumber":"sec.193","sectionType":"section","heading":"Application of division","content":"### sec.193 Application of division\n\nThis division applies to a claimant who is—\na worker whose DPI is 20% or more; or\na worker who has a terminal condition; or\na dependant.\n- (a) a worker whose DPI is 20% or more; or\n- (b) a worker who has a terminal condition; or\n- (c) a dependant.","sortOrder":227},{"sectionNumber":"sec.194","sectionType":"section","heading":"Costs before proceeding started","content":"### sec.194 Costs before proceeding started\n\nThis section prescribes the legal professional costs of a claim incurred before a proceeding in a court is started.\nIf a claimant recovers net damages of $150,000 or more, the costs are—\nfor pre-proceeding notification and negotiation if a compulsory conference was not held—120% of the amount in schedule 9 , column A; and\nfor pre-proceeding notification and negotiation if a compulsory conference was held—the amounts in schedule 9 , columns A and B; and\nfor investigation of liability by an expert—the amount in schedule 9 , column C; and\nfor an application to the court—the amount in schedule 9 , column D.\nIf a claimant recovers net damages of $50,000 or more but less than $150,000, the costs are 85% of the amount calculated under subsection (2) .\nIf a claimant recovers net damages of less than $50,000, the costs are 85% of the amount calculated under subsection (2) multiplied by the proportion that the net damages bear to $50,000.\nIf the net damages recovered are $30,000, the costs are (85% of the amount calculated under subsection (2) ) x 3 / 5 .\nHowever, if the court in which the proceeding is started awards legal costs, the costs recoverable under subsections (2) , (3) and (4) are multiplied by 120%.\nIn this section—\nnet damages means the damages recovered less the compensation paid by an insurer.\n(sec.194-ssec.1) This section prescribes the legal professional costs of a claim incurred before a proceeding in a court is started.\n(sec.194-ssec.2) If a claimant recovers net damages of $150,000 or more, the costs are— for pre-proceeding notification and negotiation if a compulsory conference was not held—120% of the amount in schedule 9 , column A; and for pre-proceeding notification and negotiation if a compulsory conference was held—the amounts in schedule 9 , columns A and B; and for investigation of liability by an expert—the amount in schedule 9 , column C; and for an application to the court—the amount in schedule 9 , column D.\n(sec.194-ssec.3) If a claimant recovers net damages of $50,000 or more but less than $150,000, the costs are 85% of the amount calculated under subsection (2) .\n(sec.194-ssec.4) If a claimant recovers net damages of less than $50,000, the costs are 85% of the amount calculated under subsection (2) multiplied by the proportion that the net damages bear to $50,000. If the net damages recovered are $30,000, the costs are (85% of the amount calculated under subsection (2) ) x 3 / 5 .\n(sec.194-ssec.5) However, if the court in which the proceeding is started awards legal costs, the costs recoverable under subsections (2) , (3) and (4) are multiplied by 120%.\n(sec.194-ssec.6) In this section— net damages means the damages recovered less the compensation paid by an insurer.\n- (a) for pre-proceeding notification and negotiation if a compulsory conference was not held—120% of the amount in schedule 9 , column A; and\n- (b) for pre-proceeding notification and negotiation if a compulsory conference was held—the amounts in schedule 9 , columns A and B; and\n- (c) for investigation of liability by an expert—the amount in schedule 9 , column C; and\n- (d) for an application to the court—the amount in schedule 9 , column D.","sortOrder":228},{"sectionNumber":"sec.195","sectionType":"section","heading":"Costs after proceeding started","content":"### sec.195 Costs after proceeding started\n\nThis section prescribes the legal professional costs of a claim incurred after a proceeding in a court is started.\nThe costs are in accordance with the scale of costs for work done for or in a proceeding in the court.\nSee the Uniform Civil Procedure Rules 1999 , chapter 17A .\nDespite subsection (2) , the costs do not include counsel’s fees.\nAlso, the costs do not include—\nthe cost of work performed before the proceeding was started; or\nthe cost of work performed before the proceeding was started that is performed again after the proceeding was started.\n(sec.195-ssec.1) This section prescribes the legal professional costs of a claim incurred after a proceeding in a court is started.\n(sec.195-ssec.2) The costs are in accordance with the scale of costs for work done for or in a proceeding in the court. See the Uniform Civil Procedure Rules 1999 , chapter 17A .\n(sec.195-ssec.3) Despite subsection (2) , the costs do not include counsel’s fees.\n(sec.195-ssec.4) Also, the costs do not include— the cost of work performed before the proceeding was started; or the cost of work performed before the proceeding was started that is performed again after the proceeding was started.\n- (a) the cost of work performed before the proceeding was started; or\n- (b) the cost of work performed before the proceeding was started that is performed again after the proceeding was started.","sortOrder":229},{"sectionNumber":"sec.196","sectionType":"section","heading":"Outlays","content":"### sec.196 Outlays\n\nIn addition to the costs mentioned in section 194 or 195 , the following outlays incurred by the claimant are allowed—\n1 hospital report fee for each hospital that treated the worker’s injury;\n1 report fee for each doctor in general practice who treated the worker’s injury;\n1 medical specialist’s report fee for each medical discipline reasonably relevant and necessary for understanding the worker’s injury;\n1 report fee of an expert investigating liability, of not more than $1,000, less any proportion of the fee agreed to be paid by the insurer;\nAustralian Taxation Office or tax agents’ fees for supplying copies of income tax returns;\nfees charged by the claimant’s previous employers for giving information necessary for the claimant to complete the notice of claim, but not more than $50 for each employer;\nfees charged by a mediator of an amount previously agreed to by the insurer;\nfiling fees or other necessary charges incurred in relation to an application to the court before the proceeding is started;\nreasonable fees for sundry items properly incurred, other than photocopying costs.\nThe fees mentioned in subsection (1) (a) to (d) are allowable only for reports disclosed before the start of the proceeding.\nThe fees mentioned in subsection (1) (a) to (c) are payable in accordance with the scale of fees recommended by the Australian Medical Association.\nCounsel’s fees are not allowed under this section or under the Uniform Civil Procedure Rules 1999 , chapter 17A .\n(sec.196-ssec.1) In addition to the costs mentioned in section 194 or 195 , the following outlays incurred by the claimant are allowed— 1 hospital report fee for each hospital that treated the worker’s injury; 1 report fee for each doctor in general practice who treated the worker’s injury; 1 medical specialist’s report fee for each medical discipline reasonably relevant and necessary for understanding the worker’s injury; 1 report fee of an expert investigating liability, of not more than $1,000, less any proportion of the fee agreed to be paid by the insurer; Australian Taxation Office or tax agents’ fees for supplying copies of income tax returns; fees charged by the claimant’s previous employers for giving information necessary for the claimant to complete the notice of claim, but not more than $50 for each employer; fees charged by a mediator of an amount previously agreed to by the insurer; filing fees or other necessary charges incurred in relation to an application to the court before the proceeding is started; reasonable fees for sundry items properly incurred, other than photocopying costs.\n(sec.196-ssec.2) The fees mentioned in subsection (1) (a) to (d) are allowable only for reports disclosed before the start of the proceeding.\n(sec.196-ssec.3) The fees mentioned in subsection (1) (a) to (c) are payable in accordance with the scale of fees recommended by the Australian Medical Association.\n(sec.196-ssec.4) Counsel’s fees are not allowed under this section or under the Uniform Civil Procedure Rules 1999 , chapter 17A .\n- (a) 1 hospital report fee for each hospital that treated the worker’s injury;\n- (b) 1 report fee for each doctor in general practice who treated the worker’s injury;\n- (c) 1 medical specialist’s report fee for each medical discipline reasonably relevant and necessary for understanding the worker’s injury;\n- (d) 1 report fee of an expert investigating liability, of not more than $1,000, less any proportion of the fee agreed to be paid by the insurer;\n- (e) Australian Taxation Office or tax agents’ fees for supplying copies of income tax returns;\n- (f) fees charged by the claimant’s previous employers for giving information necessary for the claimant to complete the notice of claim, but not more than $50 for each employer;\n- (g) fees charged by a mediator of an amount previously agreed to by the insurer;\n- (h) filing fees or other necessary charges incurred in relation to an application to the court before the proceeding is started;\n- (i) reasonable fees for sundry items properly incurred, other than photocopying costs.","sortOrder":230},{"sectionNumber":"pt.10","sectionType":"part","heading":"Medical assessment tribunals","content":"# Medical assessment tribunals","sortOrder":231},{"sectionNumber":"sec.197","sectionType":"section","heading":"Medical assessment tribunals— Act , s 492","content":"### sec.197 Medical assessment tribunals— Act , s 492\n\nFor section 492 of the Act the following tribunals are prescribed—\nthe General Medical Assessment Tribunal;\nthe following specialty medical assessment tribunals—\nthe Cardiac Assessment Tribunal;\nthe Orthopaedic Assessment Tribunal;\nthe Dermatology Assessment Tribunal;\nthe Ear, Nose and Throat Assessment Tribunal;\nthe Neurology/Neurosurgical Assessment Tribunal;\nthe Ophthalmology Assessment Tribunal;\nthe Disfigurement Assessment Tribunal;\nthe Psychiatric Assessment Tribunal;\nthe Composite Medical Assessment Tribunal.\n- (a) the General Medical Assessment Tribunal;\n- (b) the following specialty medical assessment tribunals— (i) the Cardiac Assessment Tribunal; (ii) the Orthopaedic Assessment Tribunal; (iii) the Dermatology Assessment Tribunal; (iv) the Ear, Nose and Throat Assessment Tribunal; (v) the Neurology/Neurosurgical Assessment Tribunal; (vi) the Ophthalmology Assessment Tribunal; (vii) the Disfigurement Assessment Tribunal; (viii) the Psychiatric Assessment Tribunal;\n- (i) the Cardiac Assessment Tribunal;\n- (ii) the Orthopaedic Assessment Tribunal;\n- (iii) the Dermatology Assessment Tribunal;\n- (iv) the Ear, Nose and Throat Assessment Tribunal;\n- (v) the Neurology/Neurosurgical Assessment Tribunal;\n- (vi) the Ophthalmology Assessment Tribunal;\n- (vii) the Disfigurement Assessment Tribunal;\n- (viii) the Psychiatric Assessment Tribunal;\n- (c) the Composite Medical Assessment Tribunal.\n- (i) the Cardiac Assessment Tribunal;\n- (ii) the Orthopaedic Assessment Tribunal;\n- (iii) the Dermatology Assessment Tribunal;\n- (iv) the Ear, Nose and Throat Assessment Tribunal;\n- (v) the Neurology/Neurosurgical Assessment Tribunal;\n- (vi) the Ophthalmology Assessment Tribunal;\n- (vii) the Disfigurement Assessment Tribunal;\n- (viii) the Psychiatric Assessment Tribunal;","sortOrder":232},{"sectionNumber":"sec.198","sectionType":"section","heading":"Constitution of General Medical Assessment Tribunal— Act , s 494","content":"### sec.198 Constitution of General Medical Assessment Tribunal— Act , s 494\n\nFor section 494 of the Act , for deciding a matter referred to the General Medical Assessment Tribunal, the tribunal is constituted by—\nif the chairperson of the tribunal is a specialist—\nthe chairperson; and\n2 appointees to the panel of doctors for the tribunal who are chosen by the chairperson; or\nif the chairperson of the tribunal is not a specialist and at least 1 deputy chairperson of the tribunal is a specialist—\na deputy chairperson of the tribunal who is a specialist who is chosen by the chairperson; and\n2 appointees to the panel of doctors for the tribunal who are chosen by the deputy chairperson mentioned in subparagraph (i) ; or\notherwise—\nthe chairperson of the tribunal; and\n2 appointees to the panel of doctors for the tribunal, at least 1 of whom is a specialist, who are chosen by the chairperson of the tribunal.\nWhen choosing an appointee to the panel of doctors for the tribunal under subsection (1) (a) (ii) , (b)(ii) or (c)(ii), the chairperson or deputy chairperson must consider the medical specialty that is relevant to the matter referred to the tribunal.\nSee also section 204 in relation to consulting the secretary of the tribunal.\nIn this section—\nspecialist means a specialist in the medical specialty relevant to the matter referred to the tribunal.\n(sec.198-ssec.1) For section 494 of the Act , for deciding a matter referred to the General Medical Assessment Tribunal, the tribunal is constituted by— if the chairperson of the tribunal is a specialist— the chairperson; and 2 appointees to the panel of doctors for the tribunal who are chosen by the chairperson; or if the chairperson of the tribunal is not a specialist and at least 1 deputy chairperson of the tribunal is a specialist— a deputy chairperson of the tribunal who is a specialist who is chosen by the chairperson; and 2 appointees to the panel of doctors for the tribunal who are chosen by the deputy chairperson mentioned in subparagraph (i) ; or otherwise— the chairperson of the tribunal; and 2 appointees to the panel of doctors for the tribunal, at least 1 of whom is a specialist, who are chosen by the chairperson of the tribunal.\n(sec.198-ssec.2) When choosing an appointee to the panel of doctors for the tribunal under subsection (1) (a) (ii) , (b)(ii) or (c)(ii), the chairperson or deputy chairperson must consider the medical specialty that is relevant to the matter referred to the tribunal. See also section 204 in relation to consulting the secretary of the tribunal.\n(sec.198-ssec.3) In this section— specialist means a specialist in the medical specialty relevant to the matter referred to the tribunal.\n- (a) if the chairperson of the tribunal is a specialist— (i) the chairperson; and (ii) 2 appointees to the panel of doctors for the tribunal who are chosen by the chairperson; or\n- (i) the chairperson; and\n- (ii) 2 appointees to the panel of doctors for the tribunal who are chosen by the chairperson; or\n- (b) if the chairperson of the tribunal is not a specialist and at least 1 deputy chairperson of the tribunal is a specialist— (i) a deputy chairperson of the tribunal who is a specialist who is chosen by the chairperson; and (ii) 2 appointees to the panel of doctors for the tribunal who are chosen by the deputy chairperson mentioned in subparagraph (i) ; or\n- (i) a deputy chairperson of the tribunal who is a specialist who is chosen by the chairperson; and\n- (ii) 2 appointees to the panel of doctors for the tribunal who are chosen by the deputy chairperson mentioned in subparagraph (i) ; or\n- (c) otherwise— (i) the chairperson of the tribunal; and (ii) 2 appointees to the panel of doctors for the tribunal, at least 1 of whom is a specialist, who are chosen by the chairperson of the tribunal.\n- (i) the chairperson of the tribunal; and\n- (ii) 2 appointees to the panel of doctors for the tribunal, at least 1 of whom is a specialist, who are chosen by the chairperson of the tribunal.\n- (i) the chairperson; and\n- (ii) 2 appointees to the panel of doctors for the tribunal who are chosen by the chairperson; or\n- (i) a deputy chairperson of the tribunal who is a specialist who is chosen by the chairperson; and\n- (ii) 2 appointees to the panel of doctors for the tribunal who are chosen by the deputy chairperson mentioned in subparagraph (i) ; or\n- (i) the chairperson of the tribunal; and\n- (ii) 2 appointees to the panel of doctors for the tribunal, at least 1 of whom is a specialist, who are chosen by the chairperson of the tribunal.","sortOrder":233},{"sectionNumber":"sec.199","sectionType":"section","heading":"Chairperson and deputy chairperson of General Medical Assessment Tribunal","content":"### sec.199 Chairperson and deputy chairperson of General Medical Assessment Tribunal\n\nThe chairperson of the General Medical Assessment Tribunal must preside over meetings of the tribunal.\nHowever, if a deputy chairperson of the tribunal is chosen under section 198 (1) (b) (i) to constitute the tribunal for deciding a matter, the deputy chairperson must act as chairperson and preside over meetings of the tribunal for deciding the matter.\nAlso, if the chairperson of the tribunal is not available to attend to the business of the tribunal, other than deciding a matter mentioned in subsection (2) , a deputy chairperson of the tribunal chosen by the chairperson must act as chairperson of the tribunal.\nTo remove any doubt, it is declared that a deputy chairperson of the tribunal may act as a member of the tribunal only if the deputy chairperson has been chosen for the purpose by the chairperson under subsection (3) or under section 198 (1) (b) (i) .\n(sec.199-ssec.1) The chairperson of the General Medical Assessment Tribunal must preside over meetings of the tribunal.\n(sec.199-ssec.2) However, if a deputy chairperson of the tribunal is chosen under section 198 (1) (b) (i) to constitute the tribunal for deciding a matter, the deputy chairperson must act as chairperson and preside over meetings of the tribunal for deciding the matter.\n(sec.199-ssec.3) Also, if the chairperson of the tribunal is not available to attend to the business of the tribunal, other than deciding a matter mentioned in subsection (2) , a deputy chairperson of the tribunal chosen by the chairperson must act as chairperson of the tribunal.\n(sec.199-ssec.4) To remove any doubt, it is declared that a deputy chairperson of the tribunal may act as a member of the tribunal only if the deputy chairperson has been chosen for the purpose by the chairperson under subsection (3) or under section 198 (1) (b) (i) .","sortOrder":234},{"sectionNumber":"sec.200","sectionType":"section","heading":"Constitution of specialty medical assessment tribunal— Act , s 494","content":"### sec.200 Constitution of specialty medical assessment tribunal— Act , s 494\n\nFor section 494 of the Act , for deciding a matter referred to a specialty medical assessment tribunal, the tribunal is constituted by—\nthe chairperson of the tribunal; and\n2 appointees to the panel of doctors for the tribunal, including appointees appointed as deputy chairpersons, who are chosen by the chairperson of the tribunal.\nWhen choosing an appointee to the panel of doctors for the tribunal under subsection (1) (b) , the chairperson must consider the medical specialty that is relevant to the matter referred to the tribunal.\nSee also section 204 in relation to consulting the secretary of the tribunal.\n(sec.200-ssec.1) For section 494 of the Act , for deciding a matter referred to a specialty medical assessment tribunal, the tribunal is constituted by— the chairperson of the tribunal; and 2 appointees to the panel of doctors for the tribunal, including appointees appointed as deputy chairpersons, who are chosen by the chairperson of the tribunal.\n(sec.200-ssec.2) When choosing an appointee to the panel of doctors for the tribunal under subsection (1) (b) , the chairperson must consider the medical specialty that is relevant to the matter referred to the tribunal. See also section 204 in relation to consulting the secretary of the tribunal.\n- (a) the chairperson of the tribunal; and\n- (b) 2 appointees to the panel of doctors for the tribunal, including appointees appointed as deputy chairpersons, who are chosen by the chairperson of the tribunal.","sortOrder":235},{"sectionNumber":"sec.201","sectionType":"section","heading":"Chairperson and deputy chairperson of specialty medical assessment tribunal","content":"### sec.201 Chairperson and deputy chairperson of specialty medical assessment tribunal\n\nThe chairperson of a specialty medical assessment tribunal must preside over meetings of the tribunal.\nIf the chairperson of the tribunal is not available to attend to the business of the tribunal—\nif the tribunal has only 1 deputy chairperson—the deputy chairperson of the tribunal must act as chairperson of the tribunal; or\nif the tribunal has more than 1 deputy chairperson—a deputy chairperson of the tribunal chosen by the chairperson of the tribunal must act as chairperson of the tribunal.\n(sec.201-ssec.1) The chairperson of a specialty medical assessment tribunal must preside over meetings of the tribunal.\n(sec.201-ssec.2) If the chairperson of the tribunal is not available to attend to the business of the tribunal— if the tribunal has only 1 deputy chairperson—the deputy chairperson of the tribunal must act as chairperson of the tribunal; or if the tribunal has more than 1 deputy chairperson—a deputy chairperson of the tribunal chosen by the chairperson of the tribunal must act as chairperson of the tribunal.\n- (a) if the tribunal has only 1 deputy chairperson—the deputy chairperson of the tribunal must act as chairperson of the tribunal; or\n- (b) if the tribunal has more than 1 deputy chairperson—a deputy chairperson of the tribunal chosen by the chairperson of the tribunal must act as chairperson of the tribunal.","sortOrder":236},{"sectionNumber":"sec.202","sectionType":"section","heading":"Constitution of Composite Medical Assessment Tribunal— Act , s 494","content":"### sec.202 Constitution of Composite Medical Assessment Tribunal— Act , s 494\n\nFor section 494 of the Act , for deciding a matter referred to the Composite Medical Assessment Tribunal, the tribunal is constituted by—\nthe following chairperson—\nfor a serious personal injury matter—the chairperson of the General Medical Assessment Tribunal;\nThe chairperson of the Composite Medical Assessment Tribunal and the General Medical Assessment Tribunal may be the same person.\notherwise—the chairperson of the tribunal; and\nat least 2 but not more than 4 appointees to the panel of doctors for the tribunal chosen by the chairperson under paragraph (a) .\nWhen choosing an appointee to the panel of doctors for the tribunal under subsection (1) (b) , the chairperson must—\nconsider the medical specialty that is relevant to the matter referred to the tribunal; and\nconsult with—\nif the chairperson of the tribunal is not the chairperson of the General Medical Assessment Tribunal—the chairperson of the General Medical Assessment Tribunal; and\nthe chairperson of each specialty medical assessment tribunal relevant to the matter referred to the tribunal; and\nSee also section 204 in relation to consulting the secretary of the tribunal.\nensure the chairperson chooses at least 1 specialist for each type of injury that is a subject of the matter referred to the tribunal.\nThe number of specialists chosen under subsection (2) (c) for each type of injury must be equal.\nA worker has a post-traumatic stress disorder and a fractured arm, leg, and ribs. The tribunal would be constituted by the chairperson and—\n1 psychiatrist and 1 orthopaedic surgeon; or\n2 psychiatrists and 2 orthopaedic surgeons.\nIf, because of subsection (3) , the tribunal would be constituted by an even number of members, the chairperson must also choose an appointee to the panel of doctors for the tribunal who is a physician to be a member of the tribunal.\nA worker has 3 different types of injuries. The tribunal would be constituted by the chairperson and 3 specialists. A physician would also need to be chosen to constitute the tribunal, subject to subsection (5) .\nHowever, subsection (4) does not apply if the chairperson is a physician.\nIn this section—\nserious personal injury matter means a matter referred to the tribunal under—\nsection 500 (1) (fa) , (fb) or (fc) of the Act ; or\nthe National Injury Insurance Scheme (Queensland) Act 2016 , section 113 .\n(sec.202-ssec.1) For section 494 of the Act , for deciding a matter referred to the Composite Medical Assessment Tribunal, the tribunal is constituted by— the following chairperson— for a serious personal injury matter—the chairperson of the General Medical Assessment Tribunal; The chairperson of the Composite Medical Assessment Tribunal and the General Medical Assessment Tribunal may be the same person. otherwise—the chairperson of the tribunal; and at least 2 but not more than 4 appointees to the panel of doctors for the tribunal chosen by the chairperson under paragraph (a) .\n(sec.202-ssec.2) When choosing an appointee to the panel of doctors for the tribunal under subsection (1) (b) , the chairperson must— consider the medical specialty that is relevant to the matter referred to the tribunal; and consult with— if the chairperson of the tribunal is not the chairperson of the General Medical Assessment Tribunal—the chairperson of the General Medical Assessment Tribunal; and the chairperson of each specialty medical assessment tribunal relevant to the matter referred to the tribunal; and See also section 204 in relation to consulting the secretary of the tribunal. ensure the chairperson chooses at least 1 specialist for each type of injury that is a subject of the matter referred to the tribunal.\n(sec.202-ssec.3) The number of specialists chosen under subsection (2) (c) for each type of injury must be equal. A worker has a post-traumatic stress disorder and a fractured arm, leg, and ribs. The tribunal would be constituted by the chairperson and— 1 psychiatrist and 1 orthopaedic surgeon; or 2 psychiatrists and 2 orthopaedic surgeons.\n(sec.202-ssec.4) If, because of subsection (3) , the tribunal would be constituted by an even number of members, the chairperson must also choose an appointee to the panel of doctors for the tribunal who is a physician to be a member of the tribunal. A worker has 3 different types of injuries. The tribunal would be constituted by the chairperson and 3 specialists. A physician would also need to be chosen to constitute the tribunal, subject to subsection (5) .\n(sec.202-ssec.5) However, subsection (4) does not apply if the chairperson is a physician.\n(sec.202-ssec.6) In this section— serious personal injury matter means a matter referred to the tribunal under— section 500 (1) (fa) , (fb) or (fc) of the Act ; or the National Injury Insurance Scheme (Queensland) Act 2016 , section 113 .\n- (a) the following chairperson— (i) for a serious personal injury matter—the chairperson of the General Medical Assessment Tribunal; Note— The chairperson of the Composite Medical Assessment Tribunal and the General Medical Assessment Tribunal may be the same person. (ii) otherwise—the chairperson of the tribunal; and\n- (i) for a serious personal injury matter—the chairperson of the General Medical Assessment Tribunal; Note— The chairperson of the Composite Medical Assessment Tribunal and the General Medical Assessment Tribunal may be the same person.\n- (ii) otherwise—the chairperson of the tribunal; and\n- (b) at least 2 but not more than 4 appointees to the panel of doctors for the tribunal chosen by the chairperson under paragraph (a) .\n- (i) for a serious personal injury matter—the chairperson of the General Medical Assessment Tribunal; Note— The chairperson of the Composite Medical Assessment Tribunal and the General Medical Assessment Tribunal may be the same person.\n- (ii) otherwise—the chairperson of the tribunal; and\n- (a) consider the medical specialty that is relevant to the matter referred to the tribunal; and\n- (b) consult with— (i) if the chairperson of the tribunal is not the chairperson of the General Medical Assessment Tribunal—the chairperson of the General Medical Assessment Tribunal; and (ii) the chairperson of each specialty medical assessment tribunal relevant to the matter referred to the tribunal; and Note— See also section 204 in relation to consulting the secretary of the tribunal.\n- (i) if the chairperson of the tribunal is not the chairperson of the General Medical Assessment Tribunal—the chairperson of the General Medical Assessment Tribunal; and\n- (ii) the chairperson of each specialty medical assessment tribunal relevant to the matter referred to the tribunal; and\n- (c) ensure the chairperson chooses at least 1 specialist for each type of injury that is a subject of the matter referred to the tribunal.\n- (i) if the chairperson of the tribunal is not the chairperson of the General Medical Assessment Tribunal—the chairperson of the General Medical Assessment Tribunal; and\n- (ii) the chairperson of each specialty medical assessment tribunal relevant to the matter referred to the tribunal; and\n- (a) 1 psychiatrist and 1 orthopaedic surgeon; or\n- (b) 2 psychiatrists and 2 orthopaedic surgeons.\n- (a) section 500 (1) (fa) , (fb) or (fc) of the Act ; or\n- (b) the National Injury Insurance Scheme (Queensland) Act 2016 , section 113 .","sortOrder":237},{"sectionNumber":"sec.203","sectionType":"section","heading":"Chairperson and deputy chairperson of Composite Medical Assessment Tribunal","content":"### sec.203 Chairperson and deputy chairperson of Composite Medical Assessment Tribunal\n\nThe chairperson of the Composite Medical Assessment Tribunal under section 202 (1) (a) must preside over meetings of the tribunal.\nIf the chairperson of the tribunal under section 202 (1) (a) is not available to attend to the business of the tribunal—\nif the tribunal has only 1 deputy chairperson—the deputy chairperson of the tribunal must act as chairperson of the tribunal; or\nif the tribunal has more than 1 deputy chairperson—a deputy chairperson of the tribunal chosen by the chairperson of the tribunal must act as chairperson of the tribunal.\n(sec.203-ssec.1) The chairperson of the Composite Medical Assessment Tribunal under section 202 (1) (a) must preside over meetings of the tribunal.\n(sec.203-ssec.2) If the chairperson of the tribunal under section 202 (1) (a) is not available to attend to the business of the tribunal— if the tribunal has only 1 deputy chairperson—the deputy chairperson of the tribunal must act as chairperson of the tribunal; or if the tribunal has more than 1 deputy chairperson—a deputy chairperson of the tribunal chosen by the chairperson of the tribunal must act as chairperson of the tribunal.\n- (a) if the tribunal has only 1 deputy chairperson—the deputy chairperson of the tribunal must act as chairperson of the tribunal; or\n- (b) if the tribunal has more than 1 deputy chairperson—a deputy chairperson of the tribunal chosen by the chairperson of the tribunal must act as chairperson of the tribunal.","sortOrder":238},{"sectionNumber":"sec.204","sectionType":"section","heading":"Consultation with secretary of tribunal","content":"### sec.204 Consultation with secretary of tribunal\n\nThe chairperson of a tribunal must consult with the secretary of the tribunal about the constitution of the tribunal.","sortOrder":239},{"sectionNumber":"sec.205","sectionType":"section","heading":"Delegation by chairperson or deputy chairperson","content":"### sec.205 Delegation by chairperson or deputy chairperson\n\nA chairperson of a tribunal may delegate to the Regulator a power under this part—\nto choose an appointee to the panel of doctors for the tribunal to constitute the tribunal; or\nto choose a deputy chairperson to act as chairperson of the tribunal.\nA deputy chairperson of the General Medical Assessment Tribunal may delegate to the Regulator a power under section 198 (1) (b) (ii) to choose an appointee to the panel of doctors for the tribunal to constitute the tribunal.\nThe delegation may apply generally or be limited in its application to a particular matter.\n(sec.205-ssec.1) A chairperson of a tribunal may delegate to the Regulator a power under this part— to choose an appointee to the panel of doctors for the tribunal to constitute the tribunal; or to choose a deputy chairperson to act as chairperson of the tribunal.\n(sec.205-ssec.2) A deputy chairperson of the General Medical Assessment Tribunal may delegate to the Regulator a power under section 198 (1) (b) (ii) to choose an appointee to the panel of doctors for the tribunal to constitute the tribunal.\n(sec.205-ssec.3) The delegation may apply generally or be limited in its application to a particular matter.\n- (a) to choose an appointee to the panel of doctors for the tribunal to constitute the tribunal; or\n- (b) to choose a deputy chairperson to act as chairperson of the tribunal.","sortOrder":240},{"sectionNumber":"pt.11","sectionType":"part","heading":"Miscellaneous","content":"# Miscellaneous","sortOrder":241},{"sectionNumber":"sec.206","sectionType":"section","heading":"First responders— Act , s 36EB","content":"### sec.206 First responders— Act , s 36EB\n\nFor section 36EB (a) of the Act , each of the occupations or professions mentioned in schedule 10 is prescribed.","sortOrder":242},{"sectionNumber":"sec.207","sectionType":"section","heading":"Eligible employees— Act , s 36EC","content":"### sec.207 Eligible employees— Act , s 36EC\n\nFor section 36EC (1) (a) of the Act , each of the entities mentioned in schedule 11 is prescribed.","sortOrder":243},{"sectionNumber":"sec.208","sectionType":"section","heading":"Presumption of injury— Act , s 36ED","content":"### sec.208 Presumption of injury— Act , s 36ED\n\nFor section 36ED (1) (a) of the Act , the way prescribed is using the diagnostic criteria provided under DSM 5 for post-traumatic stress disorder.\nIn this section—\nDSM 5 means the 5th edition of the Diagnostic and statistical manual of mental disorders published by the American Psychiatric Association in 2013.\n(sec.208-ssec.1) For section 36ED (1) (a) of the Act , the way prescribed is using the diagnostic criteria provided under DSM 5 for post-traumatic stress disorder.\n(sec.208-ssec.2) In this section— DSM 5 means the 5th edition of the Diagnostic and statistical manual of mental disorders published by the American Psychiatric Association in 2013.","sortOrder":244},{"sectionNumber":"sec.209","sectionType":"section","heading":"Information statements— Act , ss 46B and 132AA","content":"### sec.209 Information statements— Act , ss 46B and 132AA\n\nFor sections 46B (3) and 132AA (2) of the Act , a statement given by an employer to a worker, or an insurer to a worker or a worker’s employer, providing information about the workers’ compensation scheme (an information statement ) must be in the approved form.\nWithout limiting the content of an information statement, the statement must include information about the provisions in the workers’ compensation scheme for a worker—\nto make an application for compensation for an injury sustained by the worker; and\nto choose the registered person who will provide medical treatment for the injury; and\nto choose who is present during medical treatment for the injury; and\nto choose a different workplace rehabilitation provider if dissatisfied with a provider chosen by the insurer; and\nto be consulted in the preparation and review of a rehabilitation and return to work plan under section 221 of the Act ; and\nto seek advice and support from a lawyer or a registered industrial organisation as the worker considers appropriate.\n(sec.209-ssec.1) For sections 46B (3) and 132AA (2) of the Act , a statement given by an employer to a worker, or an insurer to a worker or a worker’s employer, providing information about the workers’ compensation scheme (an information statement ) must be in the approved form.\n(sec.209-ssec.2) Without limiting the content of an information statement, the statement must include information about the provisions in the workers’ compensation scheme for a worker— to make an application for compensation for an injury sustained by the worker; and to choose the registered person who will provide medical treatment for the injury; and to choose who is present during medical treatment for the injury; and to choose a different workplace rehabilitation provider if dissatisfied with a provider chosen by the insurer; and to be consulted in the preparation and review of a rehabilitation and return to work plan under section 221 of the Act ; and to seek advice and support from a lawyer or a registered industrial organisation as the worker considers appropriate.\n- (a) to make an application for compensation for an injury sustained by the worker; and\n- (b) to choose the registered person who will provide medical treatment for the injury; and\n- (c) to choose who is present during medical treatment for the injury; and\n- (d) to choose a different workplace rehabilitation provider if dissatisfied with a provider chosen by the insurer; and\n- (e) to be consulted in the preparation and review of a rehabilitation and return to work plan under section 221 of the Act ; and\n- (f) to seek advice and support from a lawyer or a registered industrial organisation as the worker considers appropriate.","sortOrder":245},{"sectionNumber":"sec.210","sectionType":"section","heading":"Declaration of designated courts— Act , s 114","content":"### sec.210 Declaration of designated courts— Act , s 114\n\nThis section is made for section 114 (4) of the Act , definition designated court , paragraph (b) .\nEach court, tribunal or decision-making body stated in schedule 12 , column 2, opposite the name of a State in schedule 12 , column 1, is declared to be a designated court for the purposes of section 114 of the Act .\n(sec.210-ssec.1) This section is made for section 114 (4) of the Act , definition designated court , paragraph (b) .\n(sec.210-ssec.2) Each court, tribunal or decision-making body stated in schedule 12 , column 2, opposite the name of a State in schedule 12 , column 1, is declared to be a designated court for the purposes of section 114 of the Act .","sortOrder":246},{"sectionNumber":"sec.211","sectionType":"section","heading":"Declaration of provisions that are a State’s legislation about damages for a work related injury— Act , s 322","content":"### sec.211 Declaration of provisions that are a State’s legislation about damages for a work related injury— Act , s 322\n\nThis section is made for section 322 (2) of the Act , definition a State’s legislation about damages for a work related injury , paragraph (b) .\nThe provisions stated in schedule 12 , column 3, opposite the name of a State in schedule 12 , column 1, are declared to be the State’s legislation about damages for a work related injury.\n(sec.211-ssec.1) This section is made for section 322 (2) of the Act , definition a State’s legislation about damages for a work related injury , paragraph (b) .\n(sec.211-ssec.2) The provisions stated in schedule 12 , column 3, opposite the name of a State in schedule 12 , column 1, are declared to be the State’s legislation about damages for a work related injury.","sortOrder":247},{"sectionNumber":"sec.212","sectionType":"section","heading":"WorkCover funding and provision of programs and incentives— Act , s 385A","content":"### sec.212 WorkCover funding and provision of programs and incentives— Act , s 385A\n\nEach of the following entities is prescribed for section 385A(4) of the Act , definition prescribed entity —\nthe chief inspector under the Coal Mining Safety and Health Act 1999 ;\nthe chief inspector under the Mining and Quarrying Safety and Health Act 1999 ;\nthe chief inspector under the Petroleum and Gas (Production and Safety) Act 2004 ;\nthe general manager under the Maritime Safety Queensland Act 2002 ;\nthe chief executive of the Office of the National Rail Safety Regulator under the Rail Safety National Law (Queensland) ;\nthe chief executive officer of the National Heavy Vehicle Regulator under the Heavy Vehicle National Law (Queensland) .\n- (a) the chief inspector under the Coal Mining Safety and Health Act 1999 ;\n- (b) the chief inspector under the Mining and Quarrying Safety and Health Act 1999 ;\n- (c) the chief inspector under the Petroleum and Gas (Production and Safety) Act 2004 ;\n- (d) the general manager under the Maritime Safety Queensland Act 2002 ;\n- (e) the chief executive of the Office of the National Rail Safety Regulator under the Rail Safety National Law (Queensland) ;\n- (f) the chief executive officer of the National Heavy Vehicle Regulator under the Heavy Vehicle National Law (Queensland) .","sortOrder":248},{"sectionNumber":"sec.213","sectionType":"section","heading":"Documents and particulars to be kept— Act , s 532D","content":"### sec.213 Documents and particulars to be kept— Act , s 532D\n\nFor section 532D (1) of the Act , an employer or contractor (the person ) must keep the following documents—\nif the person must keep a time and wages record for an employee under the Industrial Relations Act 2016 , section 339 or 340 —the time and wages record;\nif the person must keep an employee’s records under the Fair Work Act 2009 (Cwlth) , section 535 —the employee record;\ndocuments, or accurate and complete copies of documents, required to be kept under a law of the Commonwealth for payments made to workers or contractors for the performance of work, including, for example—\ngroup certificates; and\ngroup employer’s reconciliation statements; and\ntax invoices to claim a GST credit; and\ninvoices from a contractor received for work;\nthe person’s profit and loss account, to the extent the account relates to payments made to workers or contractors for the performance of work.\nHowever—\nsubsection (1) does not apply to a document if the Regulator or WorkCover has given the person a notice stating that the document need not be kept by the person; and\nsubsection (1) does not apply to an employer or contractor that is a corporation that has been wound up.\nFor section 532D (1) of the Act , a document mentioned in subsection (1) (c) or (d) is not required to contain particulars the person reasonably believes are—\nconfidential; and\nnot necessary to enable the Regulator or WorkCover to calculate payments made to workers or contractors for the performance of work.\nincome and profit lines\ntax file numbers\nIn this section—\nemployee record see the Fair Work Act 2009 (Cwlth) , section 12 .\ntime and wages record see the Industrial Relations Act 2016 , section 336 .\nworker does not include a household worker.\n(sec.213-ssec.1) For section 532D (1) of the Act , an employer or contractor (the person ) must keep the following documents— if the person must keep a time and wages record for an employee under the Industrial Relations Act 2016 , section 339 or 340 —the time and wages record; if the person must keep an employee’s records under the Fair Work Act 2009 (Cwlth) , section 535 —the employee record; documents, or accurate and complete copies of documents, required to be kept under a law of the Commonwealth for payments made to workers or contractors for the performance of work, including, for example— group certificates; and group employer’s reconciliation statements; and tax invoices to claim a GST credit; and invoices from a contractor received for work; the person’s profit and loss account, to the extent the account relates to payments made to workers or contractors for the performance of work.\n(sec.213-ssec.2) However— subsection (1) does not apply to a document if the Regulator or WorkCover has given the person a notice stating that the document need not be kept by the person; and subsection (1) does not apply to an employer or contractor that is a corporation that has been wound up.\n(sec.213-ssec.3) For section 532D (1) of the Act , a document mentioned in subsection (1) (c) or (d) is not required to contain particulars the person reasonably believes are— confidential; and not necessary to enable the Regulator or WorkCover to calculate payments made to workers or contractors for the performance of work. income and profit lines tax file numbers\n(sec.213-ssec.4) In this section— employee record see the Fair Work Act 2009 (Cwlth) , section 12 . time and wages record see the Industrial Relations Act 2016 , section 336 . worker does not include a household worker.\n- (a) if the person must keep a time and wages record for an employee under the Industrial Relations Act 2016 , section 339 or 340 —the time and wages record;\n- (b) if the person must keep an employee’s records under the Fair Work Act 2009 (Cwlth) , section 535 —the employee record;\n- (c) documents, or accurate and complete copies of documents, required to be kept under a law of the Commonwealth for payments made to workers or contractors for the performance of work, including, for example— (i) group certificates; and (ii) group employer’s reconciliation statements; and (iii) tax invoices to claim a GST credit; and (iv) invoices from a contractor received for work;\n- (i) group certificates; and\n- (ii) group employer’s reconciliation statements; and\n- (iii) tax invoices to claim a GST credit; and\n- (iv) invoices from a contractor received for work;\n- (d) the person’s profit and loss account, to the extent the account relates to payments made to workers or contractors for the performance of work.\n- (i) group certificates; and\n- (ii) group employer’s reconciliation statements; and\n- (iii) tax invoices to claim a GST credit; and\n- (iv) invoices from a contractor received for work;\n- (a) subsection (1) does not apply to a document if the Regulator or WorkCover has given the person a notice stating that the document need not be kept by the person; and\n- (b) subsection (1) does not apply to an employer or contractor that is a corporation that has been wound up.\n- (a) confidential; and\n- (b) not necessary to enable the Regulator or WorkCover to calculate payments made to workers or contractors for the performance of work.\n- • income and profit lines\n- • tax file numbers","sortOrder":249},{"sectionNumber":"sec.214","sectionType":"section","heading":"Allowances and expenses for person required to attend for examination— Act , s 532S","content":"### sec.214 Allowances and expenses for person required to attend for examination— Act , s 532S\n\nFor section 532S (4) of the Act , a person required to attend for examination under chapter 12 , part 1A of the Act is entitled to the allowances and expenses to which a witness in a proceeding before the District Court is entitled.","sortOrder":250},{"sectionNumber":"sec.215","sectionType":"section","heading":"Reasons for decisions must address certain matters— Act , ss 540 and 546","content":"### sec.215 Reasons for decisions must address certain matters— Act , ss 540 and 546\n\nFor sections 540 (4) (a) and 546 (3AA) of the Act , the reasons for a decision must address the following matters—\ncitation of the provision of the Act under which the decision is made;\na statement of—\nthe evidence considered for the decision; and\nthe evidence that was accepted or rejected for the decision and why the evidence was accepted or rejected; and\nthe conclusions drawn from the evidence; and\nthe link between the evidence, the conclusions and the provision of the Act under which the decision is made ; and\nthe decision made.\nAlso, the reasons for a decision must be written in plain English.\n(sec.215-ssec.1) For sections 540 (4) (a) and 546 (3AA) of the Act , the reasons for a decision must address the following matters— citation of the provision of the Act under which the decision is made; a statement of— the evidence considered for the decision; and the evidence that was accepted or rejected for the decision and why the evidence was accepted or rejected; and the conclusions drawn from the evidence; and the link between the evidence, the conclusions and the provision of the Act under which the decision is made ; and the decision made.\n(sec.215-ssec.2) Also, the reasons for a decision must be written in plain English.\n- (a) citation of the provision of the Act under which the decision is made;\n- (b) a statement of— (i) the evidence considered for the decision; and (ii) the evidence that was accepted or rejected for the decision and why the evidence was accepted or rejected; and (iii) the conclusions drawn from the evidence; and (iv) the link between the evidence, the conclusions and the provision of the Act under which the decision is made ; and (v) the decision made.\n- (i) the evidence considered for the decision; and\n- (ii) the evidence that was accepted or rejected for the decision and why the evidence was accepted or rejected; and\n- (iii) the conclusions drawn from the evidence; and\n- (iv) the link between the evidence, the conclusions and the provision of the Act under which the decision is made ; and\n- (v) the decision made.\n- (i) the evidence considered for the decision; and\n- (ii) the evidence that was accepted or rejected for the decision and why the evidence was accepted or rejected; and\n- (iii) the conclusions drawn from the evidence; and\n- (iv) the link between the evidence, the conclusions and the provision of the Act under which the decision is made ; and\n- (v) the decision made.","sortOrder":251},{"sectionNumber":"pt.12","sectionType":"part","heading":"Savings and transitional provisions","content":"# Savings and transitional provisions","sortOrder":252},{"sectionNumber":"sec.216","sectionType":"section","heading":"Definition for part","content":"### sec.216 Definition for part\n\nIn this part—\nexpired regulation means the expired Workers’ Compensation and Rehabilitation Regulation 2014 .","sortOrder":253},{"sectionNumber":"sec.217","sectionType":"section","heading":"Date fixed for annual levy before commencement","content":"### sec.217 Date fixed for annual levy before commencement\n\nThe date fixed by the Regulator for the purpose of section 17(2) of the expired regulation, definition estimated claims liability before the commencement continues to apply to each financial year and is taken to be the specified date under section 18(2) for the financial year.\nThe date fixed by the Regulator was published in the gazette on 19 December 2014 at page 555 and is 1 February.\nSubsection (1) stops applying to a financial year starting after the commencement if the Regulator specifies a date under section 18 (2) for the financial year.\n(sec.217-ssec.1) The date fixed by the Regulator for the purpose of section 17(2) of the expired regulation, definition estimated claims liability before the commencement continues to apply to each financial year and is taken to be the specified date under section 18(2) for the financial year. The date fixed by the Regulator was published in the gazette on 19 December 2014 at page 555 and is 1 February.\n(sec.217-ssec.2) Subsection (1) stops applying to a financial year starting after the commencement if the Regulator specifies a date under section 18 (2) for the financial year.","sortOrder":254},{"sectionNumber":"sec.218","sectionType":"section","heading":"Actuarial arbiter appointed before commencement","content":"### sec.218 Actuarial arbiter appointed before commencement\n\nThis section applies to a person who, immediately before the commencement, held an appointment under section 93 of the expired regulation as the actuarial arbiter.\nThe person continues to be the actuarial arbiter under section 100 on the same terms of appointment held by the person immediately before the commencement.\n(sec.218-ssec.1) This section applies to a person who, immediately before the commencement, held an appointment under section 93 of the expired regulation as the actuarial arbiter.\n(sec.218-ssec.2) The person continues to be the actuarial arbiter under section 100 on the same terms of appointment held by the person immediately before the commencement.","sortOrder":255},{"sectionNumber":"sec.219","sectionType":"section","heading":"Chairperson and members of panel appointed before commencement","content":"### sec.219 Chairperson and members of panel appointed before commencement\n\nThis section applies to a person who, immediately before the commencement, held an appointment under section 112S of the expired regulation as the chairperson or a member of the panel.\nThe person is taken to be the chairperson or a member of the panel established under section 141 on the same terms of appointment held by the person immediately before the commencement.\n(sec.219-ssec.1) This section applies to a person who, immediately before the commencement, held an appointment under section 112S of the expired regulation as the chairperson or a member of the panel.\n(sec.219-ssec.2) The person is taken to be the chairperson or a member of the panel established under section 141 on the same terms of appointment held by the person immediately before the commencement.","sortOrder":256},{"sectionNumber":"sec.220","sectionType":"section","heading":"Legal professional costs of claim incurred in relation to proceeding in court","content":"### sec.220 Legal professional costs of claim incurred in relation to proceeding in court\n\nSection 195 applies in relation to legal professional costs of a claim incurred in relation to a proceeding in a court only if the notice of claim given under section 275 of the Act in relation to the injury the subject of the proceeding is given after the commencement.\nSubsection (1) applies even if the injury the subject of the proceeding was sustained before the commencement.\nIf the notice of claim given under section 275 of the Act in relation to the injury the subject of the proceeding was given before the commencement, section 136 of the expired regulation continues to apply in relation to the proceeding as if this regulation had not been made.\n(sec.220-ssec.1) Section 195 applies in relation to legal professional costs of a claim incurred in relation to a proceeding in a court only if the notice of claim given under section 275 of the Act in relation to the injury the subject of the proceeding is given after the commencement.\n(sec.220-ssec.2) Subsection (1) applies even if the injury the subject of the proceeding was sustained before the commencement.\n(sec.220-ssec.3) If the notice of claim given under section 275 of the Act in relation to the injury the subject of the proceeding was given before the commencement, section 136 of the expired regulation continues to apply in relation to the proceeding as if this regulation had not been made.","sortOrder":257},{"sectionNumber":"sec.221","sectionType":"section","heading":"Outlays incurred in relation to claim","content":"### sec.221 Outlays incurred in relation to claim\n\nSection 137 of the expired regulation continues to apply in relation to a current claim as if this regulation had not been made.\nSection 196 applies in relation to all other claims, even if the claim relates to an injury sustained before the commencement.\nIn this section—\ncurrent claim means a claim in relation to which—\na notice of claim was given under section 275 of the Act in relation to the injury the subject of the claim before the commencement; and\ncosts and outlays have not been finalised before the commencement.\n(sec.221-ssec.1) Section 137 of the expired regulation continues to apply in relation to a current claim as if this regulation had not been made.\n(sec.221-ssec.2) Section 196 applies in relation to all other claims, even if the claim relates to an injury sustained before the commencement.\n(sec.221-ssec.3) In this section— current claim means a claim in relation to which— a notice of claim was given under section 275 of the Act in relation to the injury the subject of the claim before the commencement; and costs and outlays have not been finalised before the commencement.\n- (a) a notice of claim was given under section 275 of the Act in relation to the injury the subject of the claim before the commencement; and\n- (b) costs and outlays have not been finalised before the commencement.","sortOrder":258},{"sectionNumber":"sec.222","sectionType":"section","heading":"Saving of operation of transitional provision","content":"### sec.222 Saving of operation of transitional provision\n\nSection 149 of the expired regulation is declared to be a law to which the Acts Interpretation Act 1954 , section 20A applies.","sortOrder":259},{"sectionNumber":"sec.223","sectionType":"section","heading":"Reference to provisions of expired regulation","content":"### sec.223 Reference to provisions of expired regulation\n\nA reference in a document to a particular provision (the former provision ) of the expired regulation may, to the extent necessary and if the context permits, be taken as a reference to a provision of this regulation all or part of which corresponds, or substantially corresponds, to the former provision.","sortOrder":260},{"sectionNumber":"sch.13-pt.1","sectionType":"part","heading":"Objectives of sch 14 (Ranges of injury scale values)","content":"# Objectives of sch 14 (Ranges of injury scale values)","sortOrder":261},{"sectionNumber":"sch.13-sec.1","sectionType":"section","heading":"Objectives of sch 14","content":"### sch.13-sec.1 Objectives of sch 14\n\nThe objectives of schedule 14 include promoting—\nconsistency of assessments of general damages awarded by courts for similar injuries; and\nsimilarity of assessments of general damages awarded by courts for different types of injury that have a similar level of adverse impact on an injured worker.\n- (a) consistency of assessments of general damages awarded by courts for similar injuries; and\n- (b) similarity of assessments of general damages awarded by courts for different types of injury that have a similar level of adverse impact on an injured worker.","sortOrder":262},{"sectionNumber":"sch.13-pt.2","sectionType":"part","heading":"How to use sch 14","content":"# How to use sch 14","sortOrder":263},{"sectionNumber":"sch.13-pt.2-div.1","sectionType":"division","heading":"Injury","content":"## Injury","sortOrder":264},{"sectionNumber":"sch.13-sec.2","sectionType":"section","heading":"Injury mentioned in sch 14","content":"### sch.13-sec.2 Injury mentioned in sch 14\n\nIn assessing the injury scale value ( ISV ) for an injury mentioned in the injury column of schedule 14 , a court must consider the range of injury scale values stated in schedule 14 for the injury.\nThe range of ISVs for the injury reflects the level of adverse impact of the injury on the injured worker.\n(sch.13-sec.2-ssec.1) In assessing the injury scale value ( ISV ) for an injury mentioned in the injury column of schedule 14 , a court must consider the range of injury scale values stated in schedule 14 for the injury.\n(sch.13-sec.2-ssec.2) The range of ISVs for the injury reflects the level of adverse impact of the injury on the injured worker.","sortOrder":265},{"sectionNumber":"sch.13-sec.3","sectionType":"section","heading":"Multiple injuries","content":"### sch.13-sec.3 Multiple injuries\n\nSubject to section 9 , in assessing the ISV for multiple injuries, a court must consider the range of ISVs for the dominant injury of the multiple injuries.\nTo reflect the level of adverse impact of multiple injuries on an injured worker, the court may assess the ISV for the multiple injuries as being higher in the range of ISVs for the dominant injury of the multiple injuries than the ISV the court would assess for the dominant injury only.\nThis section acknowledges that—\nthe effects of multiple injuries commonly overlap, with each injury contributing to the overall level of adverse impact on the injured worker; and\nif each of the multiple injuries were assigned an individual ISV and these ISVs were added together, the total ISV would generally be too high.\n(sch.13-sec.3-ssec.1) Subject to section 9 , in assessing the ISV for multiple injuries, a court must consider the range of ISVs for the dominant injury of the multiple injuries.\n(sch.13-sec.3-ssec.2) To reflect the level of adverse impact of multiple injuries on an injured worker, the court may assess the ISV for the multiple injuries as being higher in the range of ISVs for the dominant injury of the multiple injuries than the ISV the court would assess for the dominant injury only. This section acknowledges that— the effects of multiple injuries commonly overlap, with each injury contributing to the overall level of adverse impact on the injured worker; and if each of the multiple injuries were assigned an individual ISV and these ISVs were added together, the total ISV would generally be too high.\n- • the effects of multiple injuries commonly overlap, with each injury contributing to the overall level of adverse impact on the injured worker; and\n- • if each of the multiple injuries were assigned an individual ISV and these ISVs were added together, the total ISV would generally be too high.","sortOrder":266},{"sectionNumber":"sch.13-sec.4","sectionType":"section","heading":"Multiple injuries and maximum dominant ISV inadequate","content":"### sch.13-sec.4 Multiple injuries and maximum dominant ISV inadequate\n\nThis section applies if a court considers the level of adverse impact of multiple injuries on an injured worker is so severe that the maximum dominant ISV is inadequate to reflect the level of impact.\nTo reflect the level of impact, the court may make an assessment of the ISV for the multiple injuries that is higher than the maximum dominant ISV.\nHowever, the ISV for the multiple injuries—\nmust not be more than 100; and\nUnder section 306O (1) (a) of the Act , an ISV is assessed on a scale running from 0 to 100.\nshould rarely be more than 25% higher than the maximum dominant ISV.\nIf the increase is more than 25% of the maximum dominant ISV, the court must give detailed written reasons for the increase.\nIn this section—\nmaximum dominant ISV , in relation to multiple injuries, means the maximum ISV in the range for the dominant injury of the multiple injuries.\n(sch.13-sec.4-ssec.1) This section applies if a court considers the level of adverse impact of multiple injuries on an injured worker is so severe that the maximum dominant ISV is inadequate to reflect the level of impact.\n(sch.13-sec.4-ssec.2) To reflect the level of impact, the court may make an assessment of the ISV for the multiple injuries that is higher than the maximum dominant ISV.\n(sch.13-sec.4-ssec.3) However, the ISV for the multiple injuries— must not be more than 100; and Under section 306O (1) (a) of the Act , an ISV is assessed on a scale running from 0 to 100. should rarely be more than 25% higher than the maximum dominant ISV.\n(sch.13-sec.4-ssec.4) If the increase is more than 25% of the maximum dominant ISV, the court must give detailed written reasons for the increase.\n(sch.13-sec.4-ssec.5) In this section— maximum dominant ISV , in relation to multiple injuries, means the maximum ISV in the range for the dominant injury of the multiple injuries.\n- (a) must not be more than 100; and Note— Under section 306O (1) (a) of the Act , an ISV is assessed on a scale running from 0 to 100.\n- (b) should rarely be more than 25% higher than the maximum dominant ISV.","sortOrder":267},{"sectionNumber":"sch.13-sec.5","sectionType":"section","heading":"Adverse psychological reaction","content":"### sch.13-sec.5 Adverse psychological reaction\n\nThis section applies if a court is assessing an ISV where an injured worker has an adverse psychological reaction to a physical injury.\nThe court must treat the adverse psychological reaction merely as a feature of the injury.\n(sch.13-sec.5-ssec.1) This section applies if a court is assessing an ISV where an injured worker has an adverse psychological reaction to a physical injury.\n(sch.13-sec.5-ssec.2) The court must treat the adverse psychological reaction merely as a feature of the injury.","sortOrder":268},{"sectionNumber":"sch.13-sec.6","sectionType":"section","heading":"Mental disorder","content":"### sch.13-sec.6 Mental disorder\n\nThis section applies if—\na court is assessing an ISV; and\na PIRS rating for a mental disorder of an injured worker is relevant under schedule 14 .\nThe PIRS rating for the mental disorder of the injured worker is the PIRS rating accepted by the court.\nA PIRS rating is capable of being accepted by the court only if it is—\nassessed by a medical expert as required under schedules 15 and 16 ; and\nprovided to the court in a PIRS report as required under schedule 15 , section 12 .\n(sch.13-sec.6-ssec.1) This section applies if— a court is assessing an ISV; and a PIRS rating for a mental disorder of an injured worker is relevant under schedule 14 .\n(sch.13-sec.6-ssec.2) The PIRS rating for the mental disorder of the injured worker is the PIRS rating accepted by the court.\n(sch.13-sec.6-ssec.3) A PIRS rating is capable of being accepted by the court only if it is— assessed by a medical expert as required under schedules 15 and 16 ; and provided to the court in a PIRS report as required under schedule 15 , section 12 .\n- (a) a court is assessing an ISV; and\n- (b) a PIRS rating for a mental disorder of an injured worker is relevant under schedule 14 .\n- (a) assessed by a medical expert as required under schedules 15 and 16 ; and\n- (b) provided to the court in a PIRS report as required under schedule 15 , section 12 .","sortOrder":269},{"sectionNumber":"sch.13-sec.7","sectionType":"section","heading":"Aggravation of pre-existing condition","content":"### sch.13-sec.7 Aggravation of pre-existing condition\n\nThis section applies if an injured worker has a pre-existing condition that is aggravated by an injury for which a court is assessing an ISV.\nIn considering the impact of the aggravation of the pre-existing condition, the court may have regard only to the extent to which the pre-existing condition has been made worse by the injury.\n(sch.13-sec.7-ssec.1) This section applies if an injured worker has a pre-existing condition that is aggravated by an injury for which a court is assessing an ISV.\n(sch.13-sec.7-ssec.2) In considering the impact of the aggravation of the pre-existing condition, the court may have regard only to the extent to which the pre-existing condition has been made worse by the injury.","sortOrder":270},{"sectionNumber":"sch.13-pt.2-div.2","sectionType":"division","heading":"Other matters","content":"## Other matters","sortOrder":271},{"sectionNumber":"sch.13-sec.8","sectionType":"section","heading":"Court must have regard to particular provisions of sch 14","content":"### sch.13-sec.8 Court must have regard to particular provisions of sch 14\n\nIn addition to providing ranges of ISVs for particular injuries, schedule 14 sets out provisions relevant to using schedule 14 to assess an ISV for particular injuries.\nexamples of the injury\nexamples of factors affecting ISV assessment\ncomments about appropriate level of ISV\nIn assessing an ISV, a court must have regard to those provisions to the extent they are relevant in a particular case.\nThe fact that schedule 14 provides examples of factors affecting an ISV assessment is not intended to discourage a court from having regard to other factors it considers are relevant in a particular case.\n(sch.13-sec.8-ssec.1) In addition to providing ranges of ISVs for particular injuries, schedule 14 sets out provisions relevant to using schedule 14 to assess an ISV for particular injuries. examples of the injury examples of factors affecting ISV assessment comments about appropriate level of ISV\n(sch.13-sec.8-ssec.2) In assessing an ISV, a court must have regard to those provisions to the extent they are relevant in a particular case.\n(sch.13-sec.8-ssec.3) The fact that schedule 14 provides examples of factors affecting an ISV assessment is not intended to discourage a court from having regard to other factors it considers are relevant in a particular case.\n- • examples of the injury\n- • examples of factors affecting ISV assessment\n- • comments about appropriate level of ISV","sortOrder":272},{"sectionNumber":"sch.13-sec.9","sectionType":"section","heading":"Court may have regard to other matters","content":"### sch.13-sec.9 Court may have regard to other matters\n\nIn assessing an ISV, a court may have regard to other matters to the extent they are relevant in a particular case.\nthe injured worker’s age, degree of insight, life expectancy, pain, suffering and loss of amenities of life\nthe effects of a pre-existing condition of the injured worker\ndifficulties in life likely to have emerged for the injured worker whether or not the injury happened\nin assessing an ISV for multiple injuries, the range for, and other provisions of schedule 14 in relation to, an injury other than the dominant injury of the multiple injuries\n- • the injured worker’s age, degree of insight, life expectancy, pain, suffering and loss of amenities of life\n- • the effects of a pre-existing condition of the injured worker\n- • difficulties in life likely to have emerged for the injured worker whether or not the injury happened\n- • in assessing an ISV for multiple injuries, the range for, and other provisions of schedule 14 in relation to, an injury other than the dominant injury of the multiple injuries","sortOrder":273},{"sectionNumber":"sch.13-sec.10","sectionType":"section","heading":"DPI","content":"### sch.13-sec.10 DPI\n\nThe extent of DPI is an important consideration, but not the only consideration, affecting the assessment of an ISV.","sortOrder":274},{"sectionNumber":"sch.13-sec.11","sectionType":"section","heading":"Medical report stating DPI","content":"### sch.13-sec.11 Medical report stating DPI\n\nIf a medical report states a DPI, it must state how the DPI is decided, including—\nthe clinical findings; and\nhow the impairment is calculated; and\nif the DPI is based on criteria provided under AMA 5—\nthe provisions of AMA 5 setting out the criteria; and\nif a range of percentages is available under AMA 5 for an injury of the type being assessed—the reason for assessing the injury at the selected point in the range.\nHowever, the medical report must not identify—\nan item in schedule 14 to which the injury belongs; or\nan ISV for the injury.\nFor requirements about tendering a medical report into evidence in a proceeding for a claim for personal injury damages, see the Uniform Civil Procedure Rules 1999 , chapter 11 , part 5 .\n(sch.13-sec.11-ssec.1) If a medical report states a DPI, it must state how the DPI is decided, including— the clinical findings; and how the impairment is calculated; and if the DPI is based on criteria provided under AMA 5— the provisions of AMA 5 setting out the criteria; and if a range of percentages is available under AMA 5 for an injury of the type being assessed—the reason for assessing the injury at the selected point in the range.\n(sch.13-sec.11-ssec.2) However, the medical report must not identify— an item in schedule 14 to which the injury belongs; or an ISV for the injury. For requirements about tendering a medical report into evidence in a proceeding for a claim for personal injury damages, see the Uniform Civil Procedure Rules 1999 , chapter 11 , part 5 .\n- (a) the clinical findings; and\n- (b) how the impairment is calculated; and\n- (c) if the DPI is based on criteria provided under AMA 5— (i) the provisions of AMA 5 setting out the criteria; and (ii) if a range of percentages is available under AMA 5 for an injury of the type being assessed—the reason for assessing the injury at the selected point in the range.\n- (i) the provisions of AMA 5 setting out the criteria; and\n- (ii) if a range of percentages is available under AMA 5 for an injury of the type being assessed—the reason for assessing the injury at the selected point in the range.\n- (i) the provisions of AMA 5 setting out the criteria; and\n- (ii) if a range of percentages is available under AMA 5 for an injury of the type being assessed—the reason for assessing the injury at the selected point in the range.\n- (a) an item in schedule 14 to which the injury belongs; or\n- (b) an ISV for the injury.\n- For requirements about tendering a medical report into evidence in a proceeding for a claim for personal injury damages, see the Uniform Civil Procedure Rules 1999 , chapter 11 , part 5 .","sortOrder":275},{"sectionNumber":"sch.13-sec.12","sectionType":"section","heading":"Greater weight to assessments based on AMA 5","content":"### sch.13-sec.12 Greater weight to assessments based on AMA 5\n\nThis section does not apply to a medical assessment of scarring or of a mental disorder.\nIn assessing an ISV, a court must give greater weight to a medical assessment of a DPI based on the criteria for the assessment of a DPI provided under AMA 5 than to a medical assessment of a DPI not based on the criteria.\n(sch.13-sec.12-ssec.1) This section does not apply to a medical assessment of scarring or of a mental disorder.\n(sch.13-sec.12-ssec.2) In assessing an ISV, a court must give greater weight to a medical assessment of a DPI based on the criteria for the assessment of a DPI provided under AMA 5 than to a medical assessment of a DPI not based on the criteria.","sortOrder":276},{"sectionNumber":"sch.13-sec.13","sectionType":"section","heading":"Greater weight to assessments of PIRS rating","content":"### sch.13-sec.13 Greater weight to assessments of PIRS rating\n\nIn assessing an ISV, a court must give greater weight to a PIRS report provided as required under schedule 15 than to another medical assessment of the permanent impairment caused by a mental disorder.","sortOrder":277},{"sectionNumber":"sch.13-sec.14","sectionType":"section","heading":"ISV must be a whole number","content":"### sch.13-sec.14 ISV must be a whole number\n\nAn ISV assessed by a court must be a whole number.\nUnder section 306O (1) (a) of the Act , an ISV is assessed on a scale running from 0 to 100.","sortOrder":278},{"sectionNumber":"sch.14-pt","sectionType":"part","heading":null,"content":"","sortOrder":279},{"sectionNumber":"sch.14-pt.1","sectionType":"part","heading":"Central nervous system and head injuries","content":"# Central nervous system and head injuries","sortOrder":280},{"sectionNumber":"sch.14-sec.1","sectionType":"section","heading":"Quadriplegia","content":"### sch.14-sec.1 Quadriplegia\n\nExamples of factors affecting ISV assessment\n75 to 100\npresence and extent of pain\nextent of any residual movement\ndegree of insight\nadverse psychological reaction\nlevel of function and pre-existing function\ndegree of independence\nability to participate in daily activities, including employment\npresence and extent of secondary medical complications\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate only if the injured worker has assisted ventilation, full insight, extreme physical limitation and gross impairment of ability to communicate.","sortOrder":281},{"sectionNumber":"sch.14-sec.2","sectionType":"section","heading":"Paraplegia","content":"### sch.14-sec.2 Paraplegia\n\nExamples of factors affecting ISV assessment\n60 to 80\npresence and extent of pain\nextent of any residual movement\nadverse psychological reaction\nlevel of function and pre-existing function\ndegree of independence\nability to participate in daily activities, including employment\nloss of reproductive or sexual function\nbowel or bladder incontinence\npresence and extent of secondary medical complications","sortOrder":282},{"sectionNumber":"sch.14-sec.3","sectionType":"section","heading":"Hemiplegia or severe paralysis of more than 1 limb","content":"### sch.14-sec.3 Hemiplegia or severe paralysis of more than 1 limb\n\nComment\nIncomplete paralysis causing a DPI of less than 40% must be assessed under part 6 if it is the only injury or the dominant injury of multiple injuries.\nExamples of factors affecting ISV assessment for item 3\nThe same examples apply as for item 2.\n3.1\nComplete or nearly complete paralysis\n60 to 80\n3.2\nOther paralysis, causing whole person impairment of at least 40%\n45 to 60","sortOrder":283},{"sectionNumber":"sch.14-sec.4","sectionType":"section","heading":"Monoplegia","content":"### sch.14-sec.4 Monoplegia\n\nComment\nSee items 5, 6 and 7 and part 6 .","sortOrder":284},{"sectionNumber":"sch.14-sec.5","sectionType":"section","heading":"Extreme brain injury","content":"### sch.14-sec.5 Extreme brain injury\n\nComment\nThe injury will involve major trauma to the brain with severe permanent impairment.\n5.1\nSubstantial insight remaining\n71 to 100\nComment about appropriate level of ISV for item 5.1\nAn ISV at or near the top of the range will be appropriate only if the injured worker needs full-time nursing care and has the following—\nsubstantial insight despite gross disturbance of brain function\nsignificant physical limitation and destruction of pre-existing lifestyle\nepileptic seizures\ndouble incontinence\nlittle or no language function\nlittle or no meaningful response to environment.\nAn injured worker with an injury for which an ISV at or near the top of the range is appropriate may have some ability to follow basic commands, recovery of eye opening, return of postural reflex movement and return to pre-existing sleep patterns.\nExamples of factors affecting ISV assessment for item 5.1\ndegree of insight\nlife expectancy\nextent of bodily impairment\n5.2\nSubstantially reduced insight\nComment for items 5.2.1 and 5.2.2\nThe injured worker will have major trauma to the brain with severe permanent impairment.\nThe injured worker’s insight of his or her condition may change.\nInsight may be impaired in the degree, or continuity of, appreciation of the injured worker’s condition.\nExamples of factors affecting ISV assessment for items 5.2.1 and 5.2.2\nThe same examples apply as for an item 5.1 injury, but reducing levels of insight progressively reduce the level of suffering and the appropriate level of ISV.\n5.2.1\nThe injured worker will have partial or complete insight (as evidenced by appropriate responses to physical or emotional stimuli) for not more than half of the person’s waking hours.\n36 to 70\n5.2.2\nThe injured worker will have infrequent periods of partial insight and will show unreliable, rare or limited responses to physical or emotional stimuli.\n16 to 35\n5.3\nGrossly reduced insight\n10 to 15\nComment for item 5.3\nThe injured worker will be in a persistent vegetative state and have little or no insight.\nComment about appropriate level of ISV for item 5.3\nIf some minor awareness of loss remains, an ISV at or near the top of the range may be appropriate.","sortOrder":285},{"sectionNumber":"sch.14-sec.6","sectionType":"section","heading":"Serious brain injury","content":"### sch.14-sec.6 Serious brain injury\n\nComment\n56 to 70\nThe injured worker will be very seriously disabled.\nExample of the injury\nserious brain damage causing—\nphysical impairment, for example, limb paralysis; or\ncognitive impairment with marked impairment of intellect and personality\nExamples of factors affecting ISV assessment\ndegree of insight\nlife expectancy\nextent of physical limitations\nextent of cognitive limitations\nextent of sensory limitation, for example, limitation of hearing or sense of taste or smell\nlevel of function and pre-existing function\ndegree of independence\nability to communicate\nbehavioural or psychological changes\nepilepsy or a high risk of epilepsy\npresence of and extent of secondary medical complications\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate only if the injured worker substantially depends on others and needs substantial professional and other care.","sortOrder":286},{"sectionNumber":"sch.14-sec.7","sectionType":"section","heading":"Moderate brain injury","content":"### sch.14-sec.7 Moderate brain injury\n\nComment\n21 to 55\nThe injured worker will be seriously disabled, but the degree of the injured worker’s dependence on others, although still present, is lower than for an item 6 injury.\nExamples of factors affecting ISV assessment\ndegree of insight\nlife expectancy\nextent of physical limitations\nextent of cognitive limitations\nextent of sensory limitation, for example, limitation of hearing or sense of taste or smell\nlevel of function and pre-existing function\ndegree of independence\nability to communicate\nbehavioural or psychological changes\nepilepsy or a high risk of epilepsy\npresence of, and extent of, secondary medical complications\nComment about appropriate level of ISV\nAn ISV of 21 to 25 will be appropriate if there is reduced concentration and memory, or reduced mood control, and either or both—\nreduced capacity for employment\na noticeable interference with lifestyle and leisure.\nAn ISV of 26 to 40 will be appropriate if there is an increased risk of epilepsy and either or both—\na moderate cognitive impairment\nloss of, or greatly reduced capacity for, employment.\nAn ISV of 41 to 55 will be appropriate if there is no capacity for employment, and 1 or more of the following—\nmoderate to severe cognitive impairment\nmarked personality change\ndramatic effect on speech, sight or other senses\nepilepsy or a high risk of epilepsy.","sortOrder":287},{"sectionNumber":"sch.14-sec.8","sectionType":"section","heading":"Minor brain injury","content":"### sch.14-sec.8 Minor brain injury\n\nComment\n6 to 20\nThe injured worker will make a good recovery and be able to take part in normal social life and to return to work. There may be minor problems persisting that prevent a restoration of normal function.\nExamples of factors affecting ISV assessment\nseverity of any physical injury causing the brain damage, having regard to—\nany medical assessment made immediately after the injury was caused, for example, CT or MRI scans, an ambulance officer’s assessment or hospital emergency unit assessment; and\nany post-traumatic amnesia\nextent of any ongoing, and possibly permanent, disability\nextent of any personality change\ndepression\ndegree of insight\nlife expectancy\nextent of physical limitations\nextent of cognitive limitations\nextent of sensory limitation, for example, limitation of hearing or sense of taste or smell\nlevel of function and pre-existing function\ndegree of independence\nability to communicate\nbehavioural or psychological changes\nepilepsy or a high risk of epilepsy\npresence of, and extent of, secondary medical complications\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if the injured worker has—\nan increased risk of epilepsy; and\nongoing reduced concentration and memory, or reduced mood control, that does not significantly interfere with the person’s ability to take part in normal social life or return to work.","sortOrder":288},{"sectionNumber":"sch.14-sec.9","sectionType":"section","heading":"Minor head injury, other than an injury mentioned in pt 3","content":"### sch.14-sec.9 Minor head injury, other than an injury mentioned in pt 3\n\nComment\n0 to 5\nBrain damage, if any, is minimal.\nExamples of the injury\nuncomplicated skull fracture\nconcussion with transitory loss of consciousness and no residual effect\nExamples of factors affecting ISV assessment\nseverity of any physical injury causing brain damage\nlength of time to recover from any symptoms\nextent of ongoing symptoms\npresence of, or absence of, headaches\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate for an injury from which the injured worker fully recovers within a few weeks.\nAn ISV at or near the top of the range will be appropriate if there is an uncomplicated skull fracture and there are associated concussive symptoms of dizziness, headache and memory loss persisting for less than 6 months.","sortOrder":289},{"sectionNumber":"sch.14-pt.2","sectionType":"part","heading":"Mental disorders","content":"# Mental disorders","sortOrder":290},{"sectionNumber":"sch.14-sec","sectionType":"section","heading":null,"content":"### Section sch.14-sec\n\nGeneral comment for items 10 to 13\nThis part includes references to ratings on the psychiatric impairment rating scale stated in schedule 16 ( PIRS ratings ). Under schedule 13 , section 6 of this regulation, a PIRS rating is capable of being accepted by a court only if it is assessed by a medical expert as required under schedules 15 and 16 and provided to the court in a PIRS report.\nExamples of factors affecting ISV assessment for items 10 to 13\nPIRS rating\ndegree of insight\nage and life expectancy\npain and suffering\nloss of amenities of life\nlikelihood difficulties would have emerged in any event\nif there is extreme psychological trauma, for example, intense helplessness or horror, the immediate adverse psychological reaction","sortOrder":291},{"sectionNumber":"sch.14-sec.10","sectionType":"section","heading":"Extreme mental disorder","content":"### sch.14-sec.10 Extreme mental disorder\n\nExample of the injury\n41 to 65\na mental disorder with a PIRS rating between 31% and 100%\nComment about appropriate level of ISV\nDespite a very high PIRS rating, an ISV at or near the bottom of the range may be appropriate if the injured worker has reduced insight.","sortOrder":292},{"sectionNumber":"sch.14-sec.11","sectionType":"section","heading":"Serious mental disorder","content":"### sch.14-sec.11 Serious mental disorder\n\nExample of the injury\n11 to 40\na mental disorder with a PIRS rating between 11% and 30%","sortOrder":293},{"sectionNumber":"sch.14-sec.12","sectionType":"section","heading":"Moderate mental disorder","content":"### sch.14-sec.12 Moderate mental disorder\n\nComment\n2 to 10\nThere is generally only moderate impairment.\nExample of the injury\na mental disorder with a PIRS rating between 4% and 10%","sortOrder":294},{"sectionNumber":"sch.14-sec.13","sectionType":"section","heading":"Minor mental disorder","content":"### sch.14-sec.13 Minor mental disorder\n\nComment\n0 to 1\nFor many persons who have suffered the injury there will be little or no impact on their lives.\nExample of the injury\na mental disorder with a PIRS rating between 0% and 3%","sortOrder":295},{"sectionNumber":"sch.14-pt.3","sectionType":"part","heading":"Facial injuries","content":"# Facial injuries","sortOrder":296},{"sectionNumber":"sch.14-pt.3-div.1","sectionType":"division","heading":"Skeletal injuries of the facial area","content":"## Skeletal injuries of the facial area","sortOrder":297},{"sectionNumber":"sch.14-sec-oc.2","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.2\n\nExamples of factors affecting ISV assessment for items 14 to 22\nextent of skeletal or functional damage\ndegree of cosmetic damage or disfigurement\nadverse psychological reaction\navailability of cosmetic repair","sortOrder":298},{"sectionNumber":"sch.14-sec.14","sectionType":"section","heading":"Extreme facial injury","content":"### sch.14-sec.14 Extreme facial injury\n\nComment\n26 to 45\nThe injury will involve severe traumatic injury to the face requiring substantial reconstructive surgery.\nExamples of the injury\na Le Fort I fracture or Le Fort II fracture if the degree of incapacity and disfigurement after reconstructive surgery will be very severe\na Le Fort III fracture causing incapacity in daily activities\nLe Fort I fracture, Le Fort II fracture and Le Fort III fracture are defined in schedule 18 .\nAdditional example of factor affecting ISV assessment\nthe extent of any neurological impairment or effect on the airway","sortOrder":299},{"sectionNumber":"sch.14-sec.15","sectionType":"section","heading":"Serious facial injury","content":"### sch.14-sec.15 Serious facial injury\n\nComment\n14 to 25\nThe injury will involve serious traumatic injury to the face requiring reconstructive surgery that is not substantial.\nExamples of the injury\na Le Fort I fracture or Le Fort II fracture if the degree of incapacity and disfigurement after reconstructive surgery will not be very severe\na Le Fort III fracture if no serious deformity will remain after reconstructive surgery\na serious or multiple fracture of the nasal complex either or both—\nrequiring more than 1 operation; and\ncausing 1 or more of the following—\npermanent damage to the airway\npermanent damage to nerves or tear ducts\nfacial deformity\na serious cheekbone fracture that will require surgery and cause serious disfigurement and permanent effects despite reconstructive surgery, for example, hyperaesthesia or paraesthesia\na very serious multiple jaw fracture that will—\nrequire prolonged treatment; and\ndespite reconstructive surgery, cause permanent effects, for example, severe pain, restriction in eating, paraesthesia or a risk of arthritis in the joints\na severed trunk of the facial nerve (7th cranial nerve), causing total paralysis of facial muscles on 1 side of the face\nAdditional examples of factors affecting ISV assessment\nany neurological impairment or effect on the airway\npermanent cosmetic deformity\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the injury causes permanent cosmetic deformity, asymmetry of 1 side of the face and limited adverse psychological reaction.\nAn ISV at or near the top of the range will be appropriate if the injury causes serious bilateral deformity and significant adverse psychological reaction.","sortOrder":300},{"sectionNumber":"sch.14-sec.16","sectionType":"section","heading":"Moderate facial injury","content":"### sch.14-sec.16 Moderate facial injury\n\nExamples of the injury\n6 to 13\na simple cheekbone fracture, requiring minor reconstructive surgery, from which the injured worker will fully recover with little or no cosmetic damage\na fracture of the jaw causing—\npermanent effects, for example, difficulty in opening the mouth or in eating; or\nhyperaesthesia or paraesthesia in the area of the fracture\na displaced fracture of the nasal complex from which the injured worker will almost fully recover after surgery\nsevered branches of the facial nerve (7th cranial nerve) with paralysis of some of the facial muscles\na severed sensory nerve of the face with minor permanent paraesthesia","sortOrder":301},{"sectionNumber":"sch.14-sec.17","sectionType":"section","heading":"Minor facial injury","content":"### sch.14-sec.17 Minor facial injury\n\nExamples of the injury\n0 to 5\na simple cheekbone fracture, for which surgery is not required and from which the injured worker will fully recover\na simple jaw fracture, requiring immobilisation and from which the injured worker will fully recover\na stable fracture of the joint process of the jaw\na displaced fracture of the nasal complex requiring only manipulation\na simple undisplaced fracture of the nasal complex, from which the injured worker will fully recover\na severed sensory nerve of the face, with good repair causing minimal or no paraesthesia","sortOrder":302},{"sectionNumber":"sch.14-sec.18","sectionType":"section","heading":"Injury to teeth or gums","content":"### sch.14-sec.18 Injury to teeth or gums\n\nComment\nThere will generally have been a course of treatment as a result of the injury.\nAdditional examples of factors affecting ISV assessment\nextent and degree of discomfort during treatment\ndifficulty with eating\nComment about appropriate level of ISV\nIf protracted dentistry causes the injury, the ISV may be higher than the ISV for the same injury caused by something else.\n18.1\nLoss of or serious damage to more than 3 teeth, serious gum injury or serious gum infection\n6 to 10\n18.2\nLoss of or serious damage to 2 or 3 teeth, moderate gum injury or moderate gum infection\n3 to 5\n18.3\nLoss of or serious damage to 1 tooth, minor gum injury or minor gum infection\n0 to 2","sortOrder":303},{"sectionNumber":"sch.14-pt.3-div.2","sectionType":"division","heading":"Scarring to the face","content":"## Scarring to the face","sortOrder":304},{"sectionNumber":"sch.14-sec-oc.3","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.3\n\nGeneral comment for items 19 to 22\nThis division will usually apply to an injury involving skeletal damage only if the skeletal damage is minor.","sortOrder":305},{"sectionNumber":"sch.14-sec.19","sectionType":"section","heading":"Extreme facial scarring","content":"### sch.14-sec.19 Extreme facial scarring\n\nExamples of the injury\n21 to 45\nwidespread area scarring, for example, over the side of the face or another whole area\nsevere contour deformity\nsignificant deformity of the mouth or eyelids with muscle paralysis or tic\nComment about appropriate level of ISV\nAn ISV in the upper half of the range may be appropriate if the injured worker is relatively young, the cosmetic damage is very disfiguring and the adverse psychological reaction is severe.\nAn ISV at or near the top of the range will be appropriate if the injury is caused by burns that resulted in loss of the entire nose, eyelids or ears.","sortOrder":306},{"sectionNumber":"sch.14-sec.20","sectionType":"section","heading":"Serious facial scarring","content":"### sch.14-sec.20 Serious facial scarring\n\nExamples of the injury\n11 to 20\nsubstantial disfigurement and significant adverse psychological reaction\nsevere linear scarring\ndiscoloured hypertrophic (keloid) scarring\natrophic scarring\nserious contour defects","sortOrder":307},{"sectionNumber":"sch.14-sec.21","sectionType":"section","heading":"Moderate facial scarring","content":"### sch.14-sec.21 Moderate facial scarring\n\nComment\n6 to 10\nAny adverse psychological reaction is small, or having been considerable at the outset, has greatly diminished.\nExamples of the injury\nscarring, the worst effects of which will be reduced by plastic surgery that will leave minor cosmetic damage\nscars crossing lines of election with discoloured, indurated, hypertrophic or atrophic scarring, of moderate severity","sortOrder":308},{"sectionNumber":"sch.14-sec.22","sectionType":"section","heading":"Minor facial scarring","content":"### sch.14-sec.22 Minor facial scarring\n\nExamples of the injury\n0 to 5\na single scar able to be camouflaged\nmore than 1 very small scar if the overall effect of the scars is to mar, but not to markedly affect, appearance and adverse psychological reaction is minor\nalmost invisible linear scarring, in lines of election, with normal texture and elevation","sortOrder":309},{"sectionNumber":"sch.14-pt.4","sectionType":"part","heading":"Injuries affecting the senses","content":"# Injuries affecting the senses","sortOrder":310},{"sectionNumber":"sch.14-pt.4-div.1","sectionType":"division","heading":"General comment","content":"## General comment","sortOrder":311},{"sectionNumber":"sch.14-sec-oc.4","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.4\n\nGeneral comment for items 23 to 35\nInjuries mentioned in this part are commonly symptoms of brain or nervous system injury.","sortOrder":312},{"sectionNumber":"sch.14-pt.4-div.2","sectionType":"division","heading":"Injuries affecting the eyes","content":"## Injuries affecting the eyes","sortOrder":313},{"sectionNumber":"sch.14-sec.23","sectionType":"section","heading":"Total sight and hearing impairment","content":"### sch.14-sec.23 Total sight and hearing impairment\n\nComment\n90 to 100\nThe injury ranks with the most devastating injuries.\nExamples of factors affecting ISV assessment\ndegree of insight\nage and life expectancy","sortOrder":314},{"sectionNumber":"sch.14-sec.24","sectionType":"section","heading":"Total sight impairment","content":"### sch.14-sec.24 Total sight impairment\n\nExamples of factors affecting ISV assessment\n50 to 80\ndegree of insight\nage and life expectancy","sortOrder":315},{"sectionNumber":"sch.14-sec.25","sectionType":"section","heading":"Complete sight impairment in 1 eye with reduced vision in the other eye","content":"### sch.14-sec.25 Complete sight impairment in 1 eye with reduced vision in the other eye\n\nComment about appropriate level of ISV\n25 to 50\nAn ISV at or near the top of the range will be appropriate if there is serious risk of further significant deterioration in the remaining eye.","sortOrder":316},{"sectionNumber":"sch.14-sec.26","sectionType":"section","heading":"Complete sight impairment in 1 eye or total loss of 1 eye","content":"### sch.14-sec.26 Complete sight impairment in 1 eye or total loss of 1 eye\n\nExamples of factors affecting ISV assessment\n26 to 30\nthe extent to which the injured worker’s activities are adversely affected by the impairment or loss\nassociated scarring or cosmetic damage\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a minor risk of sympathetic ophthalmia.","sortOrder":317},{"sectionNumber":"sch.14-sec.27","sectionType":"section","heading":"Serious eye injury","content":"### sch.14-sec.27 Serious eye injury\n\nExamples of the injury\n11 to 25\na serious but incomplete loss of vision in 1 eye without significant risk of loss or reduction of vision in the other eye\nan injury causing double vision that is not minor and intermittent","sortOrder":318},{"sectionNumber":"sch.14-sec.28","sectionType":"section","heading":"Moderate eye injury","content":"### sch.14-sec.28 Moderate eye injury\n\nExample of the injury\n6 to 10\nminor but permanent impairment of vision in 1 eye, including if there is double vision that is minor and intermittent","sortOrder":319},{"sectionNumber":"sch.14-sec.29","sectionType":"section","heading":"Minor eye injury","content":"### sch.14-sec.29 Minor eye injury\n\nExample of the injury\n0 to 5\na minor injury, for example, from being struck in the eye, exposed to smoke or other fumes or being splashed by liquids—\ncausing initial pain and temporary interference with vision; and\nfrom which the injured worker will fully recover within a relatively short time","sortOrder":320},{"sectionNumber":"sch.14-pt.4-div.3","sectionType":"division","heading":"Injuries affecting the ears","content":"## Injuries affecting the ears","sortOrder":321},{"sectionNumber":"sch.14-sec-oc.5","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.5\n\nComment for items 30 to 33\nThe injuries commonly, but not always, involve hearing loss. If the injury is to a single ear, the binaural loss must be assessed.\nExamples of factors affecting ISV assessment for item 30 to 33 injuries\nwhether the injury has an immediate effect, allowing the injured worker no opportunity to adapt, or whether it occurred over a period of time, for example, from exposure to noise\nwhether the injury was suffered at an early age so that it has affected or will affect speech\nwhether the injury will affect balance\nthe extent to which former activities will be affected\npresence of tinnitus","sortOrder":322},{"sectionNumber":"sch.14-sec.30","sectionType":"section","heading":"Extreme ear injury","content":"### sch.14-sec.30 Extreme ear injury\n\nDefinition of injury\n36 to 55\nThe injury involves a binaural hearing loss of at least 80%.\nAdditional examples of factors affecting ISV assessment\nassociated problems, for example, severe tinnitus, moderate vertigo, a moderate vestibular disturbance or headaches\navailability of hearing aids or other devices that may reduce the hearing loss\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if the injury happened at an early age so as to prevent or to seriously affect the development of normal speech.","sortOrder":323},{"sectionNumber":"sch.14-sec.31","sectionType":"section","heading":"Serious ear injury","content":"### sch.14-sec.31 Serious ear injury\n\nDefinition of injury\n26 to 35\nThe injury involves—\na binaural hearing loss of at least 50% but less than 80%; or\nsevere permanent vestibular disturbance.\nComment about appropriate level of ISV\nAn ISV in the lower half of the range will be appropriate if there is no speech impairment or tinnitus.\nAn ISV in the upper half of the range will be appropriate if there is speech impairment and tinnitus.","sortOrder":324},{"sectionNumber":"sch.14-sec.32","sectionType":"section","heading":"Moderate ear injury","content":"### sch.14-sec.32 Moderate ear injury\n\nDefinition of injury\n11 to 25\nThe injury involves—\na binaural hearing loss of at least 20% but less than 50%; or\nsignificant permanent vestibular disturbance.\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there are problems associated with the injury, for example, severe tinnitus, moderate vertigo, a moderate vestibular disturbance or headaches.","sortOrder":325},{"sectionNumber":"sch.14-sec.33","sectionType":"section","heading":"Minor ear injury","content":"### sch.14-sec.33 Minor ear injury\n\nDefinition of injury\nThe injury involves a binaural hearing loss of less than 20%.\nComment\nThis item covers the bulk of hearing impairment cases.\nThe injury is not to be judged simply by the degree of hearing loss.\nThere will often be a degree of tinnitus present.\nThere may also be minor vertigo or a minor vestibular disturbance causing loss of balance.\nA vestibular disturbance may increase the level of ISV.\n33.1\nModerate tinnitus or hearing loss, or both\n6 to 10\n33.2\nMild tinnitus with some hearing loss\n4 to 5\n33.3\nSlight or occasional tinnitus with slight hearing loss or an occasional vestibular disturbance, or both\n0 to 3","sortOrder":326},{"sectionNumber":"sch.14-pt.4-div.4","sectionType":"division","heading":"Impairment of taste or smell","content":"## Impairment of taste or smell","sortOrder":327},{"sectionNumber":"sch.14-sec.34","sectionType":"section","heading":"Total loss of taste or smell, or both","content":"### sch.14-sec.34 Total loss of taste or smell, or both\n\nComment about appropriate level of ISV\n6 to 9\nAn ISV at or near the bottom of the range will be appropriate if there will be a total loss of either taste or smell.\nAn ISV at or near the top of the range will be appropriate if there will be a total loss of both taste and smell.","sortOrder":328},{"sectionNumber":"sch.14-sec.35","sectionType":"section","heading":"Partial loss of taste or smell, or both","content":"### sch.14-sec.35 Partial loss of taste or smell, or both\n\nComment about appropriate level of ISV\n0 to 5\nAn ISV at or near the bottom of the range will be appropriate if there will be a partial loss of either taste or smell.\nAn ISV at or near the top of the range will be appropriate if there will be a partial loss of both taste and smell.","sortOrder":329},{"sectionNumber":"sch.14-pt.5","sectionType":"part","heading":"Injuries to internal organs","content":"# Injuries to internal organs","sortOrder":330},{"sectionNumber":"sch.14-pt.5-div.1","sectionType":"division","heading":"Chest injuries","content":"## Chest injuries","sortOrder":331},{"sectionNumber":"sch.14-sec-oc.6","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.6\n\nExample of factor affecting ISV assessment for items 36 to 39\nthe level of any reduction in the capacity for employment and enjoyment of life","sortOrder":332},{"sectionNumber":"sch.14-sec.36","sectionType":"section","heading":"Extreme chest injury","content":"### sch.14-sec.36 Extreme chest injury\n\nComment\n46 to 65\nThe injury will involve severe traumatic injury to the chest, or a large majority of the organs in the chest cavity, causing a high level of disability and ongoing medical problems.\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there will be total removal of 1 lung or serious heart damage, or both, with serious and prolonged pain and suffering and significant permanent scarring.","sortOrder":333},{"sectionNumber":"sch.14-sec.37","sectionType":"section","heading":"Serious chest injury","content":"### sch.14-sec.37 Serious chest injury\n\nComment\n21 to 45\nThe injury will involve serious traumatic injury to the chest or organs in the chest cavity, causing serious disability and ongoing medical problems.\nExamples of the injury\na trauma to 1 or more of the following, causing permanent damage, physical disability and impairment of function—\nthe chest\nthe heart\n1 or both of the lungs\nthe diaphragm\nan injury that causes the need for oxygen therapy for about 16 to 18 hours a day\nExample of factors affecting ISV assessment\nthe need for a permanent tracheostomy\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if, after recovery, there are both of the following—\nserious impairment to cardio-pulmonary function;\na DPI for the injury of, or of nearly, 40%.","sortOrder":334},{"sectionNumber":"sch.14-sec.38","sectionType":"section","heading":"Moderate chest injury","content":"### sch.14-sec.38 Moderate chest injury\n\nExample of the injury\n11 to 20\nthe injury will involve serious traumatic injury to the chest or organs in the chest cavity, causing moderate disability and ongoing medical problems\nExamples of factors affecting ISV assessment\nduration and intensity of pain and suffering\nthe DPI of lung or cardiac function, as evidenced by objective test results\nthe need for a temporary tracheostomy for short-term airway management\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there will be the loss of a breast without significant adverse psychological reaction.\nAn ISV in the lower half of the range will be appropriate if there was a pneumothorax, or haemothorax, requiring intercostal catheter insertion.\nAn ISV at or near the top of the range will be appropriate if there are multiple rib fractures causing—\na flail segment (flail chest) requiring mechanical ventilation in the acute stage; and\nmoderate permanent impairment of cardio-pulmonary function.","sortOrder":335},{"sectionNumber":"sch.14-sec.39","sectionType":"section","heading":"Minor chest injury","content":"### sch.14-sec.39 Minor chest injury\n\nExamples of factors affecting ISV assessment for items 39.1 and 39.2\ncomplexity of any fractures\nextent of injury to underlying organs\nextent of any disability\nduration and intensity of pain and suffering\n39.1\nComplicated or significant fracture, or internal organ injury, that substantially resolves\n5 to 10\nComment\nThe injury will involve significant or complicated fractures, or internal injuries, that cause some tissue damage but no significant long-term effect on organ function.\nExamples of the injury\nmultiple fractures of the ribs or sternum, or both, that may cause cardio-pulmonary contusion\ninternal injuries that cause some tissue damage but no significant long-term effect on organ function\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a fractured sternum that substantially resolves, and there is some ongoing pain and activity restriction.\nAn ISV at or near the top of the range will be appropriate if the injury causes significant persisting pain and significant activity restriction.\n39.2\nSoft tissue injury, minor fracture or minor internal organ injury\n0 to 4\nComment\nThe injury will involve a soft tissue injury, minor fracture, or minor and non-permanent injury to internal organs.\nThere may be persistent pain from the chest, for example, from the chest wall or sternocostal or costochondral joints.\nExamples of the injury\na single penetrating wound, causing some tissue damage but no long-term effect on lung function\nan injury to the lungs caused by the inhalation of toxic fumes or smoke that will not permanently interfere with lung function\na soft tissue injury to the chest wall, for example, a laceration or serious seatbelt bruising\nfractured ribs or a minor fracture of the sternum causing serious pain and disability for weeks, without internal organ damage or permanent disability\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a soft tissue injury from which the injured worker will fully recover.\nAn ISV at or near the top of the range will be appropriate if there is an injury causing a small pneumothorax that does not require intercostal catheter insertion, and from which the injured worker will fully recover.","sortOrder":336},{"sectionNumber":"sch.14-pt.5-div.2","sectionType":"division","heading":"Lung injuries other than asthma","content":"## Lung injuries other than asthma","sortOrder":337},{"sectionNumber":"sch.14-sec-oc.7","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.7\n\nGeneral comment for items 40 to 43\nThe level of an ISV for lung disease often reflects the fact that the disease is worsening and there is a risk of the development of secondary medical consequences.\nExamples of factors affecting ISV assessment for items 40 to 43\na history of smoking tobacco will reduce the level of ISV\nadverse psychological reaction may increase the level of ISV","sortOrder":338},{"sectionNumber":"sch.14-sec.40","sectionType":"section","heading":"Extreme lung injury","content":"### sch.14-sec.40 Extreme lung injury\n\nExamples of the injury\n46 to 65\ndiagnosed lung cancer\nlung disease involving serious disability causing severe pain and dramatic impairment of function and quality of life\na recurrent pulmonary embolism resulting in failure of the right side of the heart requiring a lung transplant, heart transplant or both\nAdditional examples of factors affecting ISV assessment\nage\nlikelihood of progressive worsening\nduration and intensity of pain and suffering","sortOrder":339},{"sectionNumber":"sch.14-sec.41","sectionType":"section","heading":"Serious lung injury","content":"### sch.14-sec.41 Serious lung injury\n\n41.1\nSerious lung injury if progressive worsening of lung function\n25 to 45\nExample of item 41.1\nlung disease, for example, emphysema, causing—\nsignificantly reduced and worsening lung function\nprolonged and frequent coughing\ndisturbance of sleep\nrestriction of physical activity, employment and enjoyment of life\nAdditional examples of factors affecting ISV assessment for item 41.1\nthe possibility of lung cancer developing may increase the level of ISV\nthe need for continuous oxygen therapy\n41.2\nSerious lung injury if no progressive worsening of lung function\n11 to 24\nExamples of item 41.2\nlung disease causing breathing difficulties, short of disabling breathlessness, requiring frequent use of an inhaler\nlung disease causing a significant effect on employment and social life, including inability to tolerate a smoky environment, with an uncertain prognosis\na recurrent pulmonary embolism causing pulmonary hypertension and cor pulmonale","sortOrder":340},{"sectionNumber":"sch.14-sec.42","sectionType":"section","heading":"Moderate lung injury","content":"### sch.14-sec.42 Moderate lung injury\n\nExamples of the injury\n6 to 10\nbronchitis that does not cause serious symptoms, with little or no serious or permanent effect on employment or social life\na pulmonary embolism requiring anticoagulant therapy for at least 1 year or pulmonary endarterectomy","sortOrder":341},{"sectionNumber":"sch.14-sec.43","sectionType":"section","heading":"Minor lung injury","content":"### sch.14-sec.43 Minor lung injury\n\nExamples of the injury\n0 to 5\nlung disease causing slight breathlessness, with—\nno effect on employment; and\nthe likelihood of substantial and permanent recovery within a few years after the injury is caused\na pulmonary embolism requiring anticoagulant therapy for less than 1 year\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is lung disease causing temporary aggravation of bronchitis, or other chest problems, that will resolve within a few months.","sortOrder":342},{"sectionNumber":"sch.14-pt.5-div.3","sectionType":"division","heading":"Asthma","content":"## Asthma","sortOrder":343},{"sectionNumber":"sch.14-sec.44","sectionType":"section","heading":"Extreme asthma","content":"### sch.14-sec.44 Extreme asthma\n\nComment\n31 to 55\nThe most serious cases may confine a person to the home and destroy capacity for employment.\nExample of the injury\nsevere and permanent disabling asthma causing—\nprolonged and frequent coughing\ndisturbance of sleep\nsevere restriction of physical activity and enjoyment of life\ngross reduction of capacity for employment","sortOrder":344},{"sectionNumber":"sch.14-sec.45","sectionType":"section","heading":"Severe asthma","content":"### sch.14-sec.45 Severe asthma\n\nExample of the injury\n11 to 30\nchronic asthma, with a poor prognosis, causing—\nbreathing difficulties\nthe need to frequently use an inhaler\nsignificantly reduced capacity for employment","sortOrder":345},{"sectionNumber":"sch.14-sec.46","sectionType":"section","heading":"Moderate asthma","content":"### sch.14-sec.46 Moderate asthma\n\nExample of the injury\n6 to 10\nasthma, with symptoms that include bronchitis and wheezing, affecting employment or social life","sortOrder":346},{"sectionNumber":"sch.14-sec.47","sectionType":"section","heading":"Minor asthma","content":"### sch.14-sec.47 Minor asthma\n\nExample of the injury\n0 to 5\nasthma with minor symptoms that has no effect on employment or social life\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is asthma treated by a general practitioner that will resolve within 1 year after the injury is caused.","sortOrder":347},{"sectionNumber":"sch.14-pt.5-div.4","sectionType":"division","heading":"Injuries to male reproductive system","content":"## Injuries to male reproductive system","sortOrder":348},{"sectionNumber":"sch.14-sec-oc.8","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.8\n\nGeneral comment for items 48 to 51\nThis division applies to injuries caused by physical trauma rather than as a secondary result of a mental disorder.\nFor a mental disorder that causes loss of reproductive system function, see part 2 (Mental disorders).\nSterility is usually either—\ncaused by surgery, chemicals or disease; or\ncaused by a traumatic injury that is often aggravated by scarring.\nExamples of factors affecting ISV assessment for items 48 to 51\nadverse psychological reaction\neffect on social and domestic life","sortOrder":349},{"sectionNumber":"sch.14-sec.48","sectionType":"section","heading":"Impotence and sterility","content":"### sch.14-sec.48 Impotence and sterility\n\nAdditional examples of factors affecting ISV assessment\n5 to 37\nage\nwhether the injured worker has children\nwhether the injured worker intended to have children or more children\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the sterility has little impact.\nAn ISV in the lower half of the range will be appropriate if an injured worker with children may have intended to have more children and has uncomplicated sterility, without impotence or any aggravating features.\nAn ISV in the upper half of the range will be appropriate if a young injured worker without children has uncomplicated sterility, without impotence or any aggravating features.\nAn ISV at or near the middle of the range will be appropriate if a middle-aged injured worker with children has sterility and permanent impotence.\nAn ISV at or near the top of the range will be appropriate if a young injured worker has total impotence and loss of sexual function and sterility.","sortOrder":350},{"sectionNumber":"sch.14-sec.49","sectionType":"section","heading":"Loss of part or all of penis","content":"### sch.14-sec.49 Loss of part or all of penis\n\nAdditional examples of factors affecting ISV assessment\n5 to 25\nextent of the penis remaining\navailability of a prosthesis\nextent to which sexual activity will be possible","sortOrder":351},{"sectionNumber":"sch.14-sec.50","sectionType":"section","heading":"Loss of both testicles","content":"### sch.14-sec.50 Loss of both testicles\n\nComment\nSee item 48 because sterility results.\nAdditional example of factor affecting ISV assessment\nlevel of any pain or residual scarring","sortOrder":352},{"sectionNumber":"sch.14-sec.51","sectionType":"section","heading":"Loss of 1 testicle","content":"### sch.14-sec.51 Loss of 1 testicle\n\nAdditional examples of factors affecting ISV assessment\n2 to 10\nage, cosmetic damage or scarring\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the injury does not reduce reproductive capacity.","sortOrder":353},{"sectionNumber":"sch.14-pt.5-div.5","sectionType":"division","heading":"Injuries to female reproductive system","content":"## Injuries to female reproductive system","sortOrder":354},{"sectionNumber":"sch.14-sec-oc.9","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.9\n\nGeneral comment for items 52 and 53\nThis division applies to injuries caused by physical trauma rather than as a secondary result of a mental disorder.\nFor a mental disorder that causes loss of reproductive system function, see part 2 (Mental disorders).\nExamples of factors affecting ISV assessment for items 52 and 53\nextent of any physical trauma\nwhether the injured worker has children\nwhether the injured worker intended to have children or more children\nage\nscarring\ndepression or adverse psychological reaction\neffect on social and domestic life","sortOrder":355},{"sectionNumber":"sch.14-sec.52","sectionType":"section","heading":"Infertility","content":"### sch.14-sec.52 Infertility\n\n52.1\nInfertility causing severe effects\n16 to 35\nExample of item 52.1\ninfertility with severe depression, anxiety and pain\n52.2\nInfertility causing moderate effects\n9 to 15\nExample of item 52.2\ninfertility without any medical complication if the injured worker has a child or children\nComment about appropriate level of ISV for item 52.2\nAn ISV at or near the top of the range will be appropriate if there is significant adverse psychological reaction.\n52.3\nInfertility causing minor effects\n0 to 8\nExample of item 52.3\ninfertility if—\nthe injured worker was unlikely to have had children, for example, because of age; and\nthere is little or no adverse psychological reaction","sortOrder":356},{"sectionNumber":"sch.14-sec.53","sectionType":"section","heading":"Any other injury to the female reproductive system","content":"### sch.14-sec.53 Any other injury to the female reproductive system\n\n53.1\nPost-menopausal hysterectomy\n5 to 15\n53.2\nFemale impotence\n5 to 15\nComment for item 53.2\nThe injury may be correctable by surgery.\nAdditional examples of factors affecting ISV assessment for item 53.2\nthe level of sexual function or the extent of any corrective surgery\n53.3\nAn injury causing an inability to give birth by normal vaginal delivery, for example, because of pelvic ring disruption or deformity\n4 to 15\nComment for item 53.3\nThe injury may be correctable by surgery.\n53.4\nInjury to female genitalia or reproductive organs, or both\n3 to 25\nComment about appropriate level of ISV for item 53.4\nAn ISV at or near the bottom of the range will be appropriate if there is a laceration or tear with good repair.\nAn ISV at or near the middle of the range will be appropriate if the injury causes development of a prolapse or fistula.\nAn ISV at or near the top of the range will be appropriate if the injury causes the early onset of menopause or irregular hormonal activity.\n53.5\nReduced fertility, caused by, for example, trauma to ovaries or fallopian tubes\n3 to 8\nComment about appropriate level of ISV for item 53.5\nAn ISV in the lower half of the range will be appropriate if the injury is caused by a delay in diagnosis of an ectopic pregnancy.","sortOrder":357},{"sectionNumber":"sch.14-pt.5-div.6","sectionType":"division","heading":"Injuries to digestive system","content":"## Injuries to digestive system","sortOrder":358},{"sectionNumber":"sch.14-sec.54","sectionType":"section","heading":"Extreme injury to the digestive system caused by trauma","content":"### sch.14-sec.54 Extreme injury to the digestive system caused by trauma\n\nExamples of the injury\n19 to 40\nsevere permanent damage to the digestive system, with ongoing debilitating pain and discomfort, diarrhoea, nausea and vomiting that—\nare not controllable by drugs; and\ncause weight loss of at least 20%\nDigestive system is defined in schedule 18 .\nan injury to the throat requiring a permanent gastrostomy\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is an injury to the throat requiring a temporary gastrostomy for more than 1 year and permanent dietary changes, for example, a requirement for a soft food diet.\nAn ISV at or near the top of the range will be appropriate if there is an injury to the throat requiring a permanent gastrostomy, with significant ongoing symptoms.\nExamples of factors affecting ISV assessment\nthe extent of any voice or speech impairment\nneed for ongoing endoscopic procedures","sortOrder":359},{"sectionNumber":"sch.14-sec.55","sectionType":"section","heading":"Serious injury to the digestive system caused by trauma","content":"### sch.14-sec.55 Serious injury to the digestive system caused by trauma\n\nExamples of the injury\n11 to 18\na serious injury causing long-term complications aggravated by physical strain\nan injury requiring a feeding tube for between 3 and 12 months\nExamples of factors affecting ISV assessment\nthe extent of any ongoing voice or speech impairment\nwhether a feeding tube was required, and if so, for how long it was required","sortOrder":360},{"sectionNumber":"sch.14-sec.56","sectionType":"section","heading":"Moderate injury to the digestive system caused by trauma","content":"### sch.14-sec.56 Moderate injury to the digestive system caused by trauma\n\nExamples of the injury\n6 to 10\na simple penetrating stab wound, causing some permanent tissue damage, but with no significant long-term effect on digestive function\nan injury requiring a feeding tube for less than 3 months\nExamples of factors affecting ISV assessment\nwhether a feeding tube was required, and if so, for how long it was required\nwhether dietary changes are required to reduce the risk of aspiration because of impaired swallowing","sortOrder":361},{"sectionNumber":"sch.14-sec.57","sectionType":"section","heading":"Minor injury to the digestive system caused by trauma","content":"### sch.14-sec.57 Minor injury to the digestive system caused by trauma\n\nExamples of the injury\n0 to 5\na soft tissue injury to the abdomen wall, for example, a laceration or serious seatbelt bruising to the abdomen or flank, or both\na minor injury to the throat or tongue causing temporary difficulties with swallowing or speech\na laceration of the tongue requiring suturing","sortOrder":362},{"sectionNumber":"sch.14-sec-oc.10","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.10\n\nGeneral comment for items 58 to 61\nThere is a marked difference between those comparatively rare cases having a long-term or even permanent effect on quality of life and cases in which the only ongoing symptom is an allergy, for example, to specific foods, that may cause short-term illness.","sortOrder":363},{"sectionNumber":"sch.14-sec.58","sectionType":"section","heading":"Extreme injury to the digestive system not caused by trauma","content":"### sch.14-sec.58 Extreme injury to the digestive system not caused by trauma\n\nExample of the injury\n13 to 35\nsevere toxicosis—\ncausing serious acute pain, vomiting, diarrhoea and fever, requiring hospitalisation for days or weeks; and\nalso causing 1 or more of the following—\nongoing incontinence\nhaemorrhoids\nirritable bowel syndrome; and\nhaving a significant impact on the capacity for employment and enjoyment of life\nComment about appropriate level of ISV\nAn ISV in the lower half of the range will be appropriate if the injury causes a chronic infection, that requires prolonged hospitalisation, that will not resolve after antibiotic treatment for 1 year.","sortOrder":364},{"sectionNumber":"sch.14-sec.59","sectionType":"section","heading":"Serious injury to the digestive system not caused by trauma","content":"### sch.14-sec.59 Serious injury to the digestive system not caused by trauma\n\nExamples of the injury\n6 to 12\nserious but short-term food poisoning causing diarrhoea and vomiting—\ndiminishing over 2 to 4 weeks; and\nwith some remaining discomfort and disturbance of bowel function and impact on sex life and enjoyment of food, over a few years\nconstant abdominal pain, causing significant discomfort, for up to 18 months caused by a delay in diagnosis of an injury to the digestive system\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is an adverse response to the administration of a drug that—\nrequires admission to an intensive care unit; and\ndoes not cause any permanent impairment; and\ncauses the need for ongoing drug therapy for life.\nAn ISV in the upper half of the range will be appropriate if a chronic infection—\nrequires prolonged hospitalisation and additional treatment; and\nwill be resolved by antibiotic treatment within 1 year.\nAn ISV at or near the bottom of the range will be appropriate if there is an adverse response to the administration of a drug that—\nrequires admission to an intensive care unit; and\ndoes not cause any permanent impairment; and\ndoes not cause the need for ongoing drug therapy for life.","sortOrder":365},{"sectionNumber":"sch.14-sec.60","sectionType":"section","heading":"Moderate injury to the digestive system not caused by trauma","content":"### sch.14-sec.60 Moderate injury to the digestive system not caused by trauma\n\nExamples of the injury\n3 to 5\nfood poisoning—\ncausing significant discomfort, stomach cramps, change of bowel function and fatigue; and\nrequiring hospitalisation for days; and\nwith symptoms lasting a few weeks; and\nfrom which the injured worker will fully recover within 1 or 2 years\nan infection that is resolved by antibiotic treatment, with or without additional treatment in hospital, within 3 months after the injury is caused\nan adverse response to the administration of a drug, causing any of the following continuing over a period of more than 7 days, and requiring hospitalisation—\nvomiting;\nshortness of breath;\nhypertension;\nskin irritation","sortOrder":366},{"sectionNumber":"sch.14-sec.61","sectionType":"section","heading":"Minor injury to the digestive system not caused by trauma","content":"### sch.14-sec.61 Minor injury to the digestive system not caused by trauma\n\nExamples of the injury\n0 to 2\ndisabling pain, cramps and diarrhoea, ongoing for days or weeks\na localised infection, requiring antibiotic treatment, that heals within 6 weeks after the start of treatment\nan adverse response to the administration of a drug, causing any of the following continuing over a period of not more than 7 days, and not requiring hospitalisation—\nvomiting;\nshortness of breath;\nhypertension;\nskin irritation\nintermittent abdominal pain for up to 6 months caused by a delay in diagnosis of an injury to the digestive system","sortOrder":367},{"sectionNumber":"sch.14-pt.5-div.7","sectionType":"division","heading":"Kidney or ureter injuries","content":"## Kidney or ureter injuries","sortOrder":368},{"sectionNumber":"sch.14-sec-oc.11","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.11\n\nGeneral comment for items 62 to 65\nAn injury to a ureter or the ureters alone, without loss of, or serious damage to, a kidney will generally be assessed under item 64 or 65.\nExamples of factors affecting ISV assessment for items 62 to 65\nage\nrisk of ongoing kidney or ureter problems, complications or symptoms\nneed for future medical procedures","sortOrder":369},{"sectionNumber":"sch.14-sec.62","sectionType":"section","heading":"Extreme injury to kidneys or ureters","content":"### sch.14-sec.62 Extreme injury to kidneys or ureters\n\n62.1\nLoss of both kidneys causing loss of renal function and requiring permanent dialysis or transplant\n56 to 75\n62.2\nSerious damage to both kidneys, requiring temporary or intermittent dialysis\n31 to 55\nExamples of factors affecting ISV assessment\nthe effect of dialysis and loss of kidney function on activities of daily living\nthe length of time for which dialysis was required or the frequency of intermittent dialysis\nongoing requirement for medication, for example, to control blood pressure\nwhether the injury caused the need for dietary changes, and if so, for how long\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if dialysis was required for an initial 3-month period, with intermittent dialysis required after that.\nAn ISV at or near the top of the range will be appropriate if the injury required dialysis for about 1 year and ongoing dietary changes and medication.","sortOrder":370},{"sectionNumber":"sch.14-sec.63","sectionType":"section","heading":"Serious injury to kidneys or ureters","content":"### sch.14-sec.63 Serious injury to kidneys or ureters\n\nComment\n19 to 30\nThe injury may require temporary dialysis for less than 3 months.\nExample of the injury\nloss of 1 kidney if there is severe damage to, and a risk of loss of function of, the other kidney\nComment about appropriate level of ISV\nThe higher the risk of loss of function of the other kidney, the higher the ISV.","sortOrder":371},{"sectionNumber":"sch.14-sec.64","sectionType":"section","heading":"Moderate injury to kidneys or ureters","content":"### sch.14-sec.64 Moderate injury to kidneys or ureters\n\nExamples of the injury\n11 to 18\nloss of 1 kidney, with no damage to the other kidney\nan injury to a ureter or the ureters that requires surgery or placement of stents","sortOrder":372},{"sectionNumber":"sch.14-sec.65","sectionType":"section","heading":"Minor injury to kidneys or ureters","content":"### sch.14-sec.65 Minor injury to kidneys or ureters\n\nExample of the injury\n0 to 10\na laceration or contusion to 1 or both of the kidneys\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is an injury to a kidney causing a contusion.\nAn ISV at or near the top of the range will be appropriate if a partial removal of a kidney is required.","sortOrder":373},{"sectionNumber":"sch.14-pt.5-div.8","sectionType":"division","heading":"Liver, gall bladder or biliary tract injuries","content":"## Liver, gall bladder or biliary tract injuries","sortOrder":374},{"sectionNumber":"sch.14-sec-oc.12","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.12\n\nExamples of factors affecting ISV assessment for items 66 to 69\nwhether there are recurrent episodes of infection or obstruction\nwhether there is a risk of developing biliary cirrhosis","sortOrder":375},{"sectionNumber":"sch.14-sec.66","sectionType":"section","heading":"Extreme injury to liver, gall bladder or biliary tract","content":"### sch.14-sec.66 Extreme injury to liver, gall bladder or biliary tract\n\nExample of the injury\n51 to 70\nloss, or injury causing effective loss, of liver function, requiring constant substitutional therapy\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there are recurrent episodes of liver failure that require hospital admission and medical management but do not require liver transplantation.\nAn ISV at or near the top of the range will be appropriate if the injury requires liver transplantation.","sortOrder":376},{"sectionNumber":"sch.14-sec.67","sectionType":"section","heading":"Serious injury to liver, gall bladder or biliary tract","content":"### sch.14-sec.67 Serious injury to liver, gall bladder or biliary tract\n\nExample of the injury\n36 to 50\nserious damage causing loss of over 30% of the tissue of the liver, but with some functional capacity of the liver remaining","sortOrder":377},{"sectionNumber":"sch.14-sec.68","sectionType":"section","heading":"Moderate injury to liver, gall bladder or biliary tract","content":"### sch.14-sec.68 Moderate injury to liver, gall bladder or biliary tract\n\nExample of the injury\n16 to 35\na laceration or contusion to the liver, with a moderate effect on liver function\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the injury causes impaired liver function with symptoms of intermittent nausea and vomiting.\nAn ISV at or near the bottom of the range will also be appropriate if there is a gall bladder injury with recurrent infection or symptomatic stone disease, the symptoms of which may include, for example, pain or jaundice.\nAn ISV at or near the middle of the range will be appropriate if the injury involves removal of the gall bladder causing a bile duct injury.\nAn ISV at or near the top of the range will be appropriate if—\nsurgery is required to remove not more than 30% of the liver; or\nbile ducts require repair, for example, placement of stents.\nAn ISV at or near the top of the range will also be appropriate if there is an injury to the gall bladder, that despite biliary surgery, causes ongoing symptoms, infection or the need for further endoscopic surgery.","sortOrder":378},{"sectionNumber":"sch.14-sec.69","sectionType":"section","heading":"Minor injury to liver, gall bladder or biliary tract","content":"### sch.14-sec.69 Minor injury to liver, gall bladder or biliary tract\n\nComment\n3 to 15\nAn injury within this item should not require surgery to the liver.\nExample of the injury\na laceration or contusion to the liver, with a minor effect on liver function\nComment about appropriate level of ISV\nAn ISV in the lower half of the range will be appropriate if there is an uncomplicated removal of the gall bladder with no ongoing symptoms.","sortOrder":379},{"sectionNumber":"sch.14-pt.5-div.9","sectionType":"division","heading":"Bowel injuries","content":"## Bowel injuries","sortOrder":380},{"sectionNumber":"sch.14-sec-oc.13","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.13\n\nExamples of factors affecting ISV assessment for items 70 to 73\nage\nrisk of ongoing bowel problems, complications or symptoms\nneed for future surgery\nthe degree to which dietary changes are required to manage chronic pain or diarrhoea caused by the injury","sortOrder":381},{"sectionNumber":"sch.14-sec.70","sectionType":"section","heading":"Extreme bowel injury","content":"### sch.14-sec.70 Extreme bowel injury\n\nExample of the injury\n41 to 60\nan injury causing a total loss of natural bowel function and dependence on colostomy","sortOrder":382},{"sectionNumber":"sch.14-sec.71","sectionType":"section","heading":"Serious bowel injury","content":"### sch.14-sec.71 Serious bowel injury\n\nExample of the injury\n19 to 40\na serious abdominal injury causing either or both of the following—\nimpairment of bowel function (which often requires permanent or long-term colostomy, leaving disfiguring scars);\nrestrictions on employment and diet","sortOrder":383},{"sectionNumber":"sch.14-sec.72","sectionType":"section","heading":"Moderate bowel injury","content":"### sch.14-sec.72 Moderate bowel injury\n\nComment about appropriate level of ISV\n7 to 18\nAn ISV at or near the bottom of the range will be appropriate if—\nthe injury requires an ileostomy or colostomy for less than 3 months; and\nbowel function returns to normal; and\nthere are no ongoing symptoms.\nAn ISV at or near the top of the range will be appropriate if—\nthe injury requires temporary surgical diversion of the bowel, for example, an ileostomy or colostomy; and\nthere is ongoing intermittent abnormal bowel function requiring medication.","sortOrder":384},{"sectionNumber":"sch.14-sec.73","sectionType":"section","heading":"Minor bowel injury","content":"### sch.14-sec.73 Minor bowel injury\n\nExample of the injury\n3 to 6\nan injury causing tears to the bowel, with minimal ongoing bowel problems","sortOrder":385},{"sectionNumber":"sch.14-pt.5-div.10","sectionType":"division","heading":"Bladder, prostate or urethra injuries","content":"## Bladder, prostate or urethra injuries","sortOrder":386},{"sectionNumber":"sch.14-sec-oc.14","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.14\n\nExamples of factors affecting ISV assessment for items 74 to 77\nage\nrisk of ongoing bladder, prostate or urethra problems, complications or symptoms\nneed for future surgery","sortOrder":387},{"sectionNumber":"sch.14-sec.74","sectionType":"section","heading":"Extreme bladder, prostate or urethra injury","content":"### sch.14-sec.74 Extreme bladder, prostate or urethra injury\n\nExample of the injury\n40 to 60\nan injury causing a complete loss of bladder function and control, with permanent dependence on urostomy","sortOrder":388},{"sectionNumber":"sch.14-sec.75","sectionType":"section","heading":"Serious bladder, prostate or urethra injury","content":"### sch.14-sec.75 Serious bladder, prostate or urethra injury\n\nExample of the injury\n19 to 39\nan injury causing serious impairment of bladder control, with some incontinence\nComment about appropriate level of ISV\nAn ISV in the upper half of the range will be appropriate if there is serious ongoing pain.","sortOrder":389},{"sectionNumber":"sch.14-sec.76","sectionType":"section","heading":"Moderate bladder, prostate or urethra injury","content":"### sch.14-sec.76 Moderate bladder, prostate or urethra injury\n\nExample of the injury\n7 to 18\nan injury causing continued impairment of bladder control, with minimal incontinence and minimal pain\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a laceration of the urethra, that required surgical repair and caused intermittent infection or bladder dysfunction.\nAn ISV at or near the top of the range will be appropriate if there is—\nincreased urinary frequency of more than once every 2 hours throughout the day and more than 3 times at night that is unresponsive to treatment; or\nan ongoing requirement for minor surgery, for example, cystoscopy or urethral dilation.","sortOrder":390},{"sectionNumber":"sch.14-sec.77","sectionType":"section","heading":"Minor bladder, prostate or urethra injury","content":"### sch.14-sec.77 Minor bladder, prostate or urethra injury\n\nExample of the injury\n3 to 6\na bladder injury, from which the injured worker will fully recover, with some relatively long-term interference with natural bladder function","sortOrder":391},{"sectionNumber":"sch.14-pt.5-div.11","sectionType":"division","heading":"Pancreas and spleen injuries","content":"## Pancreas and spleen injuries","sortOrder":392},{"sectionNumber":"sch.14-sec.78","sectionType":"section","heading":"Injury to the pancreas","content":"### sch.14-sec.78 Injury to the pancreas\n\nComment about appropriate level of ISV\n10 to 35\nAn ISV at or near the bottom of the range will be appropriate if there is a contusion to the pancreas that heals.\nAn ISV at or near the middle of the range will be appropriate if there are chronic symptoms, for example, pain or diarrhoea.\nAn ISV at or near the top of the range will be appropriate if—\nthere are chronic symptoms with significant weight loss of between 10% and 20% of body weight, and pancreatic enzyme replacement is required; or\nan injury to the pancreas causes diabetes.\nExamples of factors affecting ISV assessment\nthe extent of any ongoing risk of internal infection and disorders, for example, diabetes\nthe need for, and outcome of, further surgery, for example, surgery to manage pain caused by stone disease, infection or an expanding pseudocyst","sortOrder":393},{"sectionNumber":"sch.14-sec.79","sectionType":"section","heading":"Loss of spleen (complicated)","content":"### sch.14-sec.79 Loss of spleen (complicated)\n\nExample of the injury\n8 to 20\nloss of spleen if there will be a risk, that is not minor, of ongoing internal infection and disorders caused by the loss\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the injury leads to a splenectomy, with intermittent symptoms of pain, nausea and vomiting that settle.\nAn ISV at or near the middle of the range will be appropriate if—\nthe injury leads to a splenectomy, with serious infection after the splenectomy; and\nthe infection requires surgical or radiological intervention.\nAn ISV at or near the top of the range will be appropriate if the injury leads to a splenectomy, with portal vein thrombosis after the splenectomy.","sortOrder":394},{"sectionNumber":"sch.14-sec.80","sectionType":"section","heading":"Injury to the spleen or uncomplicated loss of spleen","content":"### sch.14-sec.80 Injury to the spleen or uncomplicated loss of spleen\n\nExample of the injury\n0 to 7\nlaceration or contusion to the spleen that—\nhas been radiologically confirmed; and\nhas no ongoing bleeding; and\nis managed conservatively; and\nresolves fully\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there has been removal of the spleen (splenectomy), with little or no risk of ongoing infections and disorders caused by the loss of the spleen.","sortOrder":395},{"sectionNumber":"sch.14-pt.5-div.12","sectionType":"division","heading":"Hernia injuries","content":"## Hernia injuries","sortOrder":396},{"sectionNumber":"sch.14-sec.81","sectionType":"section","heading":"Severe hernia","content":"### sch.14-sec.81 Severe hernia\n\nExample of the injury\n11 to 20\na hernia if after repair there is either or both—\nongoing pain; or\na restriction on physical activities, sport or employment","sortOrder":397},{"sectionNumber":"sch.14-sec.82","sectionType":"section","heading":"Moderate hernia","content":"### sch.14-sec.82 Moderate hernia\n\nExample of the injury\n6 to 10\na hernia that after repair has some real risk of recurring in the short-term","sortOrder":398},{"sectionNumber":"sch.14-sec.83","sectionType":"section","heading":"Minor hernia","content":"### sch.14-sec.83 Minor hernia\n\nExample of the injury\n0 to 5\nan uncomplicated inguinal hernia, whether or not repaired","sortOrder":399},{"sectionNumber":"sch.14-pt.6","sectionType":"part","heading":"Orthopaedic injuries","content":"# Orthopaedic injuries","sortOrder":400},{"sectionNumber":"sch.14-pt.6-div.1","sectionType":"division","heading":"Cervical spine injuries","content":"## Cervical spine injuries","sortOrder":401},{"sectionNumber":"sch.14-sec-oc.15","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.15\n\nGeneral comment for items 84 to 88\nThis division does not apply to the following injuries (that are dealt with in items 1 to 3)—\nquadriplegia\nparaplegia\nhemiplegia or severe paralysis of more than 1 limb.\nCervical spine injuries, other than those dealt with in items 1 to 3, range from cases of very severe disability to cases of a minor strain, with no time off work and symptoms only suffered for 2 or 3 weeks.\nSymptoms associated with nerve root compression or damage can not be taken into account in assessing an ISV under item 84, 85 or 86 unless objective signs are present of nerve root compression or damage, for example—\nCT or MRI scans or other radiological evidence\nmuscle wasting\nclinical findings of deep tendon reflex loss, motor weakness and loss of sensation.","sortOrder":402},{"sectionNumber":"sch.14-sec.84","sectionType":"section","heading":"Extreme cervical spine injury","content":"### sch.14-sec.84 Extreme cervical spine injury\n\nComment\n41 to 75\nThese are extremely severe injuries that cause gross limitation of movement and serious interference with performance of daily activities.\nThe injury will involve significant upper or lower extremity impairment and may require the use of an adaptive device or prosthesis.\nExamples of the injury\na total neurological loss at a single level\nsevere multilevel neurological dysfunction\nstructural compromise of the spinal canal with extreme upper or lower extremity motor and sensory impairments\nfractures involving more than 50% compression of a vertebral body with neural compromise\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI of about 29%.\nAn ISV at or near the top of the range will be appropriate if there is a cervical spine injury causing monoplegia of the dominant upper limb and a DPI of at least 60%.","sortOrder":403},{"sectionNumber":"sch.14-sec.85","sectionType":"section","heading":"Serious cervical spine injury","content":"### sch.14-sec.85 Serious cervical spine injury\n\nComment\n16 to 40\nThe injury will cause serious upper extremity impairment or serious permanent impairment of the cervical spine.\nThe injury may involve—\na change of motion segment integrity; or\nbilateral or multilevel nerve root compression or damage.\nExamples of the injury\nloss of motion in a motion segment because of a surgical or post-traumatic fusion\na fracture involving more than 25% compression of 1 vertebral body\nan injury showing objective signs of nerve root damage after surgery\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if—\nthe injured worker has had surgery and symptoms persist; or\nthere is a fracture involving 25% compression of 1 vertebral body.\nAn ISV in the middle of the range will be appropriate if there is a fracture involving about 50% compression of a vertebral body, with ongoing pain.\nAn ISV at or near the top of the range will be appropriate if—\nthe injured worker has had a fusion of vertebral bodies that has failed, leaving objective signs of significant residual nerve root damage and ongoing pain, affecting 1 side of the body; and\nthere is a DPI of about 28%.","sortOrder":404},{"sectionNumber":"sch.14-sec.86","sectionType":"section","heading":"Moderate cervical spine injury—fracture, disc prolapse or nerve root compression or damage","content":"### sch.14-sec.86 Moderate cervical spine injury—fracture, disc prolapse or nerve root compression or damage\n\nComment about appropriate level of ISV\n5 to 15\nAn ISV at or near the top of the range will be appropriate if—\nthere is a disc prolapse for which there is radiological evidence at an anatomically correct level; and\nthere are symptoms of pain and 3 or more of the following objective signs that are anatomically localised to an appropriate spinal nerve root distribution—\nsensory loss;\nloss of muscle strength;\nloss of reflexes;\nunilateral atrophy; and\nthe impairment has not improved after non-operative treatment.\nAn ISV of about 10 will be appropriate if there is a fracture of a vertebral body with up to 25% compression, and ongoing pain.\nAn ISV at or near the bottom of the range will be appropriate for an uncomplicated fracture of a posterior element of 1 or more of the vertebral segments, for example, spinous or transverse processes, without neurological impairment.","sortOrder":405},{"sectionNumber":"sch.14-sec.87","sectionType":"section","heading":"Moderate cervical spine injury—soft tissue injury","content":"### sch.14-sec.87 Moderate cervical spine injury—soft tissue injury\n\nComment\n5 to 10\nThe injury will cause moderate permanent impairment, for which there is objective evidence, of the cervical spine.\nComment about appropriate level of ISV\nAn ISV of not more than 10 will be appropriate if there is a DPI of 8% caused by a soft tissue injury for which there is no radiological evidence.","sortOrder":406},{"sectionNumber":"sch.14-sec.88","sectionType":"section","heading":"Minor cervical spine injury","content":"### sch.14-sec.88 Minor cervical spine injury\n\nComment\n0 to 4\nInjuries within this item include a whiplash injury with no ongoing symptoms, other than symptoms that are merely a nuisance, remaining more than 18 months after the injury is caused.\nThere will be no objective signs of neurological impairment.\nExample of the injury\na soft tissue or whiplash injury if symptoms are minor and the injured worker recovers, or is expected to recover, from the injury to a level where the injury is merely a nuisance within 18 months after the injury is caused\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the injury will resolve without any ongoing symptoms within months after the injury is caused.\nAn ISV at or near the top of the range will be appropriate if the injury, despite improvement, causes headaches and some ongoing pain.","sortOrder":407},{"sectionNumber":"sch.14-pt.6-div.2","sectionType":"division","heading":"Thoracic or lumbar spine injuries","content":"## Thoracic or lumbar spine injuries","sortOrder":408},{"sectionNumber":"sch.14-sec-oc.16","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.16\n\nGeneral comment for items 89 to 93\nThis division does not apply to the following injuries (that are dealt with in items 1 to 3)—\nquadriplegia\nparaplegia\nhemiplegia or severe paralysis of more than 1 limb.\nThoracic or lumbar spine injuries, other than those dealt with in items 1 to 3, range from cases of very severe disability to cases of a minor strain, with no time off work and symptoms suffered only for 2 or 3 weeks.\nSymptoms associated with nerve root compression or damage can not be taken into account in assessing an ISV under item 89, 90 or 91 unless objective signs are present of nerve root compression or damage, for example—\nCT or MRI scans or other radiological evidence\nmuscle wasting\nclinical findings of deep tendon reflex loss, motor weakness and loss of sensation.","sortOrder":409},{"sectionNumber":"sch.14-sec.89","sectionType":"section","heading":"Extreme thoracic or lumbar spine injury","content":"### sch.14-sec.89 Extreme thoracic or lumbar spine injury\n\nComment\n36 to 60\nThese are extremely severe injuries causing gross limitation of movement and serious interference with performance of daily activities. There may be some motor or sensory loss, and some impairment of bladder, ano-rectal or sexual function.\nExample of the injury\na fracture involving compression of a thoracic or lumbar vertebral body of more than 50%, with neurological impairment\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 25%.\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of at least 45%.","sortOrder":410},{"sectionNumber":"sch.14-sec.90","sectionType":"section","heading":"Serious thoracic or lumbar spine injury","content":"### sch.14-sec.90 Serious thoracic or lumbar spine injury\n\nComment\n16 to 35\nThe injury will cause serious permanent impairment in the thoracic or lumbar spine.\nThe injury may involve—\nbilateral or multilevel nerve root damage; or\na change in motion segment integrity, for example, because of surgery.\nExample of the injury\na fracture involving at least 25% compression of 1 thoracic or lumbar vertebral body\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if—\nthe injured worker has had surgery and symptoms persist; or\nthere is a fracture involving 25% compression of 1 vertebral body.\nAn ISV in the middle of the range will be appropriate if there is a fracture involving 50% compression of a vertebral body, with ongoing pain.\nAn ISV at or near the top of the range will be appropriate if the injured worker has had a fusion of vertebral bodies that has failed—\nleaving objective signs of significant residual nerve root damage and ongoing pain, affecting 1 side of the body; and\ncausing a DPI of 24%.","sortOrder":411},{"sectionNumber":"sch.14-sec.91","sectionType":"section","heading":"Moderate thoracic or lumbar spine injury—fracture, disc prolapse or nerve root compression or damage","content":"### sch.14-sec.91 Moderate thoracic or lumbar spine injury—fracture, disc prolapse or nerve root compression or damage\n\nComment about appropriate level of ISV\n5 to 15\nAn ISV at or near the top of the range will be appropriate if—\nthere is a disc prolapse for which there is radiological evidence at an anatomically correct level; and\nthere are symptoms of pain and 3 or more of the following objective signs, that are anatomically localised to an appropriate spinal nerve root distribution—\nsensory loss;\nloss of muscle strength;\nloss of reflexes;\nunilateral atrophy; and\nthe impairment has not improved after non-operative treatment.\nAn ISV of about 10 will be appropriate if there is a fracture of a vertebral body with up to 25% compression, and ongoing pain.\nAn ISV at or near the bottom of the range will be appropriate for an uncomplicated fracture of a posterior element of 1 or more of the vertebral segments, for example, spinous or transverse processes, without neurological impairment.","sortOrder":412},{"sectionNumber":"sch.14-sec.92","sectionType":"section","heading":"Moderate thoracic or lumbar spine injury—soft tissue injury","content":"### sch.14-sec.92 Moderate thoracic or lumbar spine injury—soft tissue injury\n\nComment\n5 to 10\nThe injury will cause moderate permanent impairment, for which there is objective evidence, of the thoracic or lumbar spine.\nComment about appropriate level of ISV\nAn ISV of not more than 10 will be appropriate if there is a DPI of 8% caused by a soft tissue injury for which there is no radiological evidence.","sortOrder":413},{"sectionNumber":"sch.14-sec.93","sectionType":"section","heading":"Minor thoracic or lumbar spine injury","content":"### sch.14-sec.93 Minor thoracic or lumbar spine injury\n\nExample of the injury\n0 to 4\na soft tissue injury of the thoracic or lumbar spine with no—\nsignificant clinical findings\nfractures\ndocumented neurological impairment\nsignificant loss of motion segment integrity\nother objective signs of impairment relating to the injury\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate, whether or not the injured worker continues to suffer some ongoing pain, if the injury will substantially reach maximum medical improvement, with only minor symptoms, within about 18 months after the injury is caused.\nAn ISV at or near the bottom of the range will be appropriate if the injury will resolve without any ongoing symptoms within months after the injury is caused.","sortOrder":414},{"sectionNumber":"sch.14-pt.6-div.3","sectionType":"division","heading":"Shoulder injuries","content":"## Shoulder injuries","sortOrder":415},{"sectionNumber":"sch.14-sec-oc.17","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.17\n\nGeneral comment for items 94 to 97\nInjuries under items 94 to 97 include subluxations or dislocations of the sternoclavicular joint, acromioclavicular joint or glenohumeral joint.\nSoft tissue injuries may involve the musculoligamentous supporting structures of the joints.\nFractures may involve the clavicle, the scapula (shoulder blade) and the humerus.\nComment about appropriate level of ISV for items 94 to 97\nAn ISV at or near the top of the range will generally only be appropriate if the injury is to the shoulder of the dominant upper limb.","sortOrder":416},{"sectionNumber":"sch.14-sec.94","sectionType":"section","heading":"Extreme shoulder injury","content":"### sch.14-sec.94 Extreme shoulder injury\n\nComment\n31 to 50\nThese are the most severe traumatic injuries causing gross permanent impairment.\nExamples of the injury\na severe fracture or dislocation, with secondary medical complications\njoint disruption with poor outcome after surgery\ndegloving\npermanent nerve palsies\nAdditional comment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI of 45% and complete loss of all shoulder function of the dominant upper limb.","sortOrder":417},{"sectionNumber":"sch.14-sec.95","sectionType":"section","heading":"Serious shoulder injury","content":"### sch.14-sec.95 Serious shoulder injury\n\nComment\n16 to 30\nThe injury will involve serious trauma to the shoulder causing serious permanent impairment.\nExamples of the injury\na crush injury\na serious fracture with secondary arthritis\nnerve palsies from which the injured worker will partially recover\nestablished non-union of a clavicular or scapular fracture despite open reduction and internal fixation (ORIF)\nestablished non-union of a clavicular or scapular fracture if surgery is not appropriate or not possible, and there is significant functional impairment\nAdditional comment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 25% and the injury is to the dominant upper limb.","sortOrder":418},{"sectionNumber":"sch.14-sec.96","sectionType":"section","heading":"Moderate shoulder injury","content":"### sch.14-sec.96 Moderate shoulder injury\n\nExamples of the injury\n6 to 15\ntraumatic adhesive capsulitis with discomfort, limitation of movement and symptoms persisting or expected to persist for about 2 years\npermanent and significant soft tissue disruption, for example, from tendon tears or ligament tears\na fracture, from which the injured worker has made a reasonable recovery, requiring open reduction and internal fixation\nnerve palsies from which the injured worker has made a good recovery\npainful persisting dislocation of the acromioclavicular joint\nan injury to the sternoclavicular joint causing permanent, painful instability\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 6%.\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 12% and the injury is to the dominant upper limb.","sortOrder":419},{"sectionNumber":"sch.14-sec.97","sectionType":"section","heading":"Minor shoulder injury","content":"### sch.14-sec.97 Minor shoulder injury\n\nExamples of the injury\n0 to 5\nsoft tissue injury with considerable pain from which the injured worker makes an almost full recovery in less than 18 months\nfracture from which the injured worker has made an uncomplicated recovery\nstrain injury of the acromioclavicular joint or sternoclavicular joint","sortOrder":420},{"sectionNumber":"sch.14-pt.6-div.4","sectionType":"division","heading":"Amputation of upper limbs","content":"## Amputation of upper limbs","sortOrder":421},{"sectionNumber":"sch.14-sec-oc.18","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.18\n\nComment about appropriate level of ISV for items 98 to 99.3\nAn ISV at or near the top of the range will generally only be appropriate if the amputation is of the dominant upper limb.","sortOrder":422},{"sectionNumber":"sch.14-sec.98","sectionType":"section","heading":"Loss of both upper limbs, or loss of 1 arm and extreme injury to the other arm","content":"### sch.14-sec.98 Loss of both upper limbs, or loss of 1 arm and extreme injury to the other arm\n\nComment\n55 to 85\nThe effect of the injury is to reduce the injured worker to a state of considerable helplessness.\nExamples of factors affecting ISV assessment\nwhether the amputations are above or below the elbow (the loss of the elbow joint adds greatly to the disability)\nthe length of any stump suitable for use with a prosthesis\nseverity of any phantom pains\nAdditional comment about appropriate level of ISV\nAn ISV of 70 to 85 will be appropriate if—\nboth upper limbs are amputated at the shoulder; or\n1 arm is amputated at the shoulder, and there is a loss of function in the other arm, causing a DPI of 60%.\nAn ISV of 65 to 80 will be appropriate if—\nboth upper limbs are amputated through the elbow or above the elbow but below the shoulder; or\n1 arm is amputated through the elbow or above the elbow but below the shoulder, and there is a loss of function in the other arm, causing a DPI of 57%.\nAn ISV of 55 to 75 will be appropriate if—\nboth upper limbs are amputated below the elbow; or\n1 arm is amputated below the elbow, and there is a loss of function in the other arm, causing a DPI of 54%.","sortOrder":423},{"sectionNumber":"sch.14-sec.99","sectionType":"section","heading":"Loss of 1 upper limb","content":"### sch.14-sec.99 Loss of 1 upper limb\n\nExamples of factors affecting ISV assessment\nwhether the amputation is above or below the elbow (the loss of the elbow joint adds greatly to the disability)\nwhether the amputation was of the dominant arm\nthe length of any stump suitable for use with a prosthesis\nseverity of any phantom pains\nextent of any disability in the other arm\n99.1\nAn upper limb amputation at the shoulder\n50 to 65\n99.2\nAn upper limb amputation through the elbow or above the elbow but below the shoulder\n40 to 65\nAdditional comment about appropriate level of ISV for item 99.2\nAn ISV at or near the bottom of the range will generally be appropriate if there is an amputation through the elbow.\nAn ISV at or near the top of the range will be appropriate if there is a short stump because a short stump may create difficulties in the use of a prosthesis.\n99.3\nAn upper limb amputation below the elbow\n35 to 60\nAdditional comment about appropriate level of ISV for item 99.3\nAn ISV at or near the top of the range will be appropriate if there is an amputation through the forearm with residual severe pain in the stump and phantom pains.","sortOrder":424},{"sectionNumber":"sch.14-pt.6-div.5","sectionType":"division","heading":"Elbow injuries","content":"## Elbow injuries","sortOrder":425},{"sectionNumber":"sch.14-sec-oc.19","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.19\n\nComment about appropriate level of ISV for items 100 to 103\nAn ISV at or near the top of the range will generally only be appropriate if the injury is to the elbow of the dominant upper limb.","sortOrder":426},{"sectionNumber":"sch.14-sec.100","sectionType":"section","heading":"Extreme elbow injury","content":"### sch.14-sec.100 Extreme elbow injury\n\nComment\n26 to 50\nThe injury will involve an extremely severe elbow injury, falling short of amputation, leaving little effective use of the elbow joint.\nExamples of the injury\na DPI for the injury of between 24% and 42%\na complex elbow fracture, or dislocation, with secondary complications\njoint disruption, with poor outcome after surgery\ndegloving\npermanent nerve palsies\nan injury causing severe limitation of elbow movement with the joint constrained in a non-functional position","sortOrder":427},{"sectionNumber":"sch.14-sec.101","sectionType":"section","heading":"Serious elbow injury","content":"### sch.14-sec.101 Serious elbow injury\n\nComment\n13 to 25\nThe injury will involve significant disability and require major surgery.\nExamples of the injury\na serious fracture with secondary arthritis\na crush injury\nnerve palsies from which the injured worker will partially recover\npermanent, poor restriction of range of motion with the elbow constrained in a satisfactory functional position\nAdditional comment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 23% and the injury is to the elbow of the dominant upper limb.","sortOrder":428},{"sectionNumber":"sch.14-sec.102","sectionType":"section","heading":"Moderate elbow injury","content":"### sch.14-sec.102 Moderate elbow injury\n\nComment\n6 to 12\nThe injury will cause moderate long-term disability but does not require protracted surgery.\nExamples of the injury\nsoft tissue disruption, for example, a ligament or tendon tear\na fracture, from which the injured worker has made a reasonable recovery, requiring open reduction and internal fixation\nnerve palsies from which the injured worker has made a good recovery\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 5%.\nAn ISV at or near the top of the range will be appropriate if there is a moderately severe injury to the elbow of the dominant upper limb—\nrequiring prolonged treatment; and\ncausing a DPI of 10%.","sortOrder":429},{"sectionNumber":"sch.14-sec.103","sectionType":"section","heading":"Minor elbow injury","content":"### sch.14-sec.103 Minor elbow injury\n\nComment\n0 to 5\nThe injury will cause no permanent damage and no permanent impairment of function.\nExamples of the injury\na fracture with an uncomplicated recovery\na soft tissue injury with pain, minor tennis elbow syndrome or laceration","sortOrder":430},{"sectionNumber":"sch.14-pt.6-div.6","sectionType":"division","heading":"Wrist injuries","content":"## Wrist injuries","sortOrder":431},{"sectionNumber":"sch.14-sec-oc.20","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.20\n\nComment about appropriate level of ISV for items 104 to 107\nAn ISV at or near the top of the range will generally only be appropriate if the injury is to the wrist of the dominant upper limb.","sortOrder":432},{"sectionNumber":"sch.14-sec.104","sectionType":"section","heading":"Extreme wrist injury","content":"### sch.14-sec.104 Extreme wrist injury\n\nComment\n25 to 40\nThe injury will involve severe fractures, or a dislocation, causing a high level of permanent impairment.\nExamples of the injury\na severe fracture or dislocation with secondary joint complications\njoint disruption with poor outcome after surgery\ndegloving\npermanent nerve palsies\nAdditional comment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 36% and the injury is to the wrist of the dominant upper limb.","sortOrder":433},{"sectionNumber":"sch.14-sec.105","sectionType":"section","heading":"Serious wrist injury","content":"### sch.14-sec.105 Serious wrist injury\n\nExamples of the injury\n16 to 24\nan injury causing significant permanent loss of wrist function, for example, severe problems with gripping or pushing objects, but with some useful movement remaining\nnon-union of a carpal fracture\nsevere carpal instability\nAdditional comment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 20% and the injury is to the wrist of the dominant upper limb.","sortOrder":434},{"sectionNumber":"sch.14-sec.106","sectionType":"section","heading":"Moderate wrist injury","content":"### sch.14-sec.106 Moderate wrist injury\n\nExamples of the injury\n6 to 15\na wrist injury that is not serious and causes some permanent disability, for example, some persisting pain and stiffness\npersisting radio-ulnar instability\nrecurrent tendon subluxation or entrapment\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 6%.\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 12%.","sortOrder":435},{"sectionNumber":"sch.14-sec.107","sectionType":"section","heading":"Minor wrist injury","content":"### sch.14-sec.107 Minor wrist injury\n\nExamples of the injury\n0 to 5\na fracture from which the injured worker almost fully recovers\na soft tissue injury, for example, severe bruising\ncontinued pain following carpal tunnel release","sortOrder":436},{"sectionNumber":"sch.14-pt.6-div.7","sectionType":"division","heading":"Hand injuries","content":"## Hand injuries","sortOrder":437},{"sectionNumber":"sch.14-sec-oc.21","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.21\n\nGeneral comment for items 108 to 119\nHands are cosmetically and functionally the most important part of the upper limbs.\nComment about appropriate level of ISV for items 108 to 119\nThe appropriate ISV for loss of a hand is only a little less than the appropriate ISV for the loss of the relevant arm.\nAn ISV at or near the top of the range will generally be appropriate if the injury is to the dominant hand.","sortOrder":438},{"sectionNumber":"sch.14-sec.108","sectionType":"section","heading":"Total or effective loss of both hands","content":"### sch.14-sec.108 Total or effective loss of both hands\n\nExample of the injury\n51 to 75\na serious injury causing extensive damage to both hands making them little more than useless\nExamples of factors affecting ISV assessment\nthe level of residual capacity left in either hand\nseverity of any phantom pains if there has been an amputation or amputations\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if both hands remain attached to the forearms and are of some cosmetic importance.\nAn ISV at or near the top of the range will be appropriate if both hands are amputated through the wrist.","sortOrder":439},{"sectionNumber":"sch.14-sec.109","sectionType":"section","heading":"Serious injury to both hands","content":"### sch.14-sec.109 Serious injury to both hands\n\nComment\n40 to 50\nThe injury will involve significant loss of function in both hands, for example, loss of 50% or more of the use of each hand.","sortOrder":440},{"sectionNumber":"sch.14-sec.110","sectionType":"section","heading":"Total or effective loss of 1 hand","content":"### sch.14-sec.110 Total or effective loss of 1 hand\n\nExamples of the injury\n35 to 60\na crushed hand that has been surgically amputated\ntraumatic amputation of all fingers and most of the palm\nExample of factor affecting ISV assessment\nseverity of any phantom pain if there has been an amputation\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there has been an amputation of the fingers at the metacarpophalangeal joints, but the thumb remains, and there is a DPI for the injury of 32%.\nAn ISV at or near the top of the range will be appropriate if—\nthere has been amputation of the dominant hand at the wrist; and\nthere is residual severe pain in the stump and ongoing complications, for example, chronic regional pain syndrome or neuroma formation.","sortOrder":441},{"sectionNumber":"sch.14-sec.111","sectionType":"section","heading":"Amputation of the thumb or part of the thumb","content":"### sch.14-sec.111 Amputation of the thumb or part of the thumb\n\nExamples of factors affecting ISV assessment\n15 to 28\nthe level of amputation, for example, at carpo metacarpal (CMC) joint, through the distal third of the thumb metacarpal, at the metacarpophalangeal (MCP) joint or thumb interphalangeal (IP) joint\nwhether the injury is to the dominant hand\nthe extent of any damage to the fingers\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if—\nthere has been an amputation through the interphalangeal joint of the thumb; and\nthere is a DPI for the injury of 11%.\nAn ISV at or near the middle of the range will be appropriate if there has been an amputation through the proximal phalanx.\nAn ISV at or near the top of the range will be appropriate if—\nthere has been an amputation at the base of the thumb at the carpometacarpal (CMC) joint level of the dominant hand; and\nthere are ongoing debilitating complications.","sortOrder":442},{"sectionNumber":"sch.14-sec.112","sectionType":"section","heading":"Amputation of index, middle and ring fingers, or any 2 of them","content":"### sch.14-sec.112 Amputation of index, middle and ring fingers, or any 2 of them\n\nComment\n15 to 30\nThe amputation will cause complete loss or nearly complete loss of 2 or all of the following fingers of the hand—\nindex finger\nmiddle finger\nring finger.\nExample of factor affecting ISV assessment\nthe level of the amputation, for example, whether the hand has been made to be of very little use and any remaining grip is very weak\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if 2 fingers, whether index, middle or ring fingers, are amputated at the level of the proximal interphalangeal joints.\nAn ISV at or near the middle of the range will be appropriate if there is a DPI for the injury of 19%.\nAn ISV at or near the top of the range will be appropriate if—\nthe index, middle and ring fingers are amputated at the level of the metacarpophalangeal joint (MCP joint) or there is a DPI for the injury of at least 27%; and\nthe injury is to the dominant hand.","sortOrder":443},{"sectionNumber":"sch.14-sec.113","sectionType":"section","heading":"Amputation of individual fingers","content":"### sch.14-sec.113 Amputation of individual fingers\n\nExamples of factors affecting ISV assessment\n5 to 20\nwhether the amputation was of the index or middle finger\nthe level of the amputation\nany damage to other fingers short of amputation\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if—\nthere has been an amputation at the level of the distal interphalangeal joint of the little or ring finger; or\nthere is a DPI for the injury of 3%.\nAn ISV of not more than 11 will be appropriate if—\nthere has been an amputation of the index or middle finger at the proximal interphalangeal joint (PIP joint); or\nthere is a DPI for the injury of 8%.\nAn ISV at or near the top of the range will be appropriate if there is complete loss of the index or middle finger of the dominant hand, and serious impairment of the remaining fingers causing a DPI of at least 15%.","sortOrder":444},{"sectionNumber":"sch.14-sec.114","sectionType":"section","heading":"Amputation of thumb and all fingers","content":"### sch.14-sec.114 Amputation of thumb and all fingers\n\nComment\nAs the injury will cause effective loss of the hand, see item 110.","sortOrder":445},{"sectionNumber":"sch.14-sec.115","sectionType":"section","heading":"Any other injury to 1 or more of the fingers or the thumb","content":"### sch.14-sec.115 Any other injury to 1 or more of the fingers or the thumb\n\nComment about appropriate level of ISV for items 115.1 to 115.4\nAn ISV of not more than 5 will be appropriate if substantial function of the hand remains.\nExamples of factors affecting ISV\nwhether the injury is to the thumb, or index or middle finger\nany damage to other fingers\nwhether the injury is to the dominant hand\n115.1\nExtreme injury to 1 or more of the fingers or the thumb\n16 to 25\nExample of the injury\ntotal loss of function of 1 or more of the fingers, with the joints ankylosed in non-functional positions\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 14%.\nAn ISV at or near the top of the range will be appropriate if there is an injury to the thumb of the dominant hand causing total loss of function of the thumb.\n115.2\nSerious injury to 1 or more of the fingers or the thumb\n11 to 15\nExamples of the injury\na severe crush injury causing ankylosis of the fingers\na bursting wound, or an injury causing severe finger damage, causing residual scarring and dysfunction\nan injury leaving a digit that interferes with the remaining function of the hand\ndivision of 1 or more of the long flexor tendons of the finger, with unsuccessful repair\n115.3\nModerate injury to 1 or more of the fingers or the thumb\n6 to 10\nComment\nThere will be permanent discomfort, pain or sensitive scarring.\nExamples of the injury\nmoderate injury to the thumb or index finger causing loss of movement or dexterity\na crush injury causing multiple fractures of 2 or more fingers\ndivision of 1 or more of the long flexor tendons of the finger, with moderately successful repair\nAdditional comment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 8% and the injury is to the dominant hand.\n115.4\nMinor injury to 1 or more of the fingers or the thumb\n0 to 5\nExample of the injury\nan uncomplicated fracture or soft tissue injury that has healed with minimal residual symptoms\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a straightforward fracture of 1 or more of the fingers, with complete resolution within a short time.\nAn ISV at or near the top of the range will be appropriate if there has been—\na fracture causing minor angular or rotational malunion of the thumb, or index or middle finger, of the dominant hand; or\nsome adherence of a tendon following surgical repair, limiting full function of the digit.","sortOrder":446},{"sectionNumber":"sch.14-sec.116","sectionType":"section","heading":"Extreme hand injury","content":"### sch.14-sec.116 Extreme hand injury\n\nComment\n31 to 45\nThe injury will involve a severe traumatic injury to the hand, that may include amputation of part of the hand, causing gross impairment of the hand.\nA hand injury causing a DPI for the injury of 35% will generally fall within this item.\nExamples of the injury\nan injury reducing a hand’s capacity to 50% or less\nan injury involving the amputation of several fingers that are rejoined to the hand leaving it clawed, clumsy and unsightly\nan amputation of some fingers and part of the palm causing grossly reduced grip and dexterity and gross disfigurement\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the injured hand has some residual usefulness for performing activities of daily living.\nAn ISV at or near the top of the range will be appropriate if the injured hand—\nhas little or no residual usefulness for performing activities of daily living; and\nis the dominant hand.","sortOrder":447},{"sectionNumber":"sch.14-sec.117","sectionType":"section","heading":"Serious hand injury","content":"### sch.14-sec.117 Serious hand injury\n\nExamples of the injury\n16 to 30\na severe crush injury causing significantly impaired function despite surgery\nserious permanent tendon damage\nAdditional comment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 20%.","sortOrder":448},{"sectionNumber":"sch.14-sec.118","sectionType":"section","heading":"Moderate hand injury","content":"### sch.14-sec.118 Moderate hand injury\n\nExamples of the injury\n6 to 15\na crush injury, penetrating wound or deep laceration, requiring surgery\nmoderately serious tendon damage\na hand injury causing a DPI for the injury of between 5% and 12%","sortOrder":449},{"sectionNumber":"sch.14-sec.119","sectionType":"section","heading":"Minor hand injury","content":"### sch.14-sec.119 Minor hand injury\n\nExamples of the injury\n0 to 5\na soft tissue injury, or an injury that does not require surgery, with nearly full recovery of hand function","sortOrder":450},{"sectionNumber":"sch.14-pt.6-div.8","sectionType":"division","heading":"Upper limb injuries, other than injuries mentioned in divs 3 to 7","content":"## Upper limb injuries, other than injuries mentioned in divs 3 to 7","sortOrder":451},{"sectionNumber":"sch.14-sec-oc.22","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.22\n\nComment about appropriate level of ISV for items 120 to 123\nAn ISV at or near the top of the range will generally only be appropriate if the injury is to the dominant upper limb.","sortOrder":452},{"sectionNumber":"sch.14-sec.120","sectionType":"section","heading":"Extreme upper limb injury, other than an injury mentioned in divs 3 to 7","content":"### sch.14-sec.120 Extreme upper limb injury, other than an injury mentioned in divs 3 to 7\n\nComment\n36 to 65\nThe injury will involve an extremely serious upper limb injury, falling short of amputation, leaving the injured worker little better off than if the whole arm had been lost.\nExamples of the injury\na serious brachial plexus injury affecting peripheral nerve function\na non-union of a fracture, with peripheral nerve damage to the extent that an arm is nearly useless\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 31%.\nAn ISV at or near the top of the range will be appropriate if—\nthere is a complete brachial plexus lesion shown by a flail arm and paralysis of all muscles of the hand; and\nthe injury is to the dominant limb.\nAn ISV at or near the top of the range will also be appropriate if there is a serious crush injury that causes a DPI for the injury of 55%.","sortOrder":453},{"sectionNumber":"sch.14-sec.121","sectionType":"section","heading":"Serious upper limb injury, other than an injury mentioned in divs 3 to 7","content":"### sch.14-sec.121 Serious upper limb injury, other than an injury mentioned in divs 3 to 7\n\nExamples of the injury\n21 to 35\na serious fracture of the humerus, radius or ulna, or any combination of the humerus, radius and ulna, if there is significant permanent residual impairment of function\na brachial plexus injury requiring nerve grafts with partial recovery of shoulder and elbow function and normal hand function\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 16%.\nAn ISV at or near the top of the range will be appropriate if there is an injury to the dominant limb causing a DPI of 30%.","sortOrder":454},{"sectionNumber":"sch.14-sec.122","sectionType":"section","heading":"Moderate upper limb injury, other than an injury mentioned in divs 3 to 7","content":"### sch.14-sec.122 Moderate upper limb injury, other than an injury mentioned in divs 3 to 7\n\nExamples of the injury\n6 to 20\na fracture that causes impairment of associated soft tissues, including nerves and blood vessels\na fracture with delayed union or infection\nmultiple fractures of the humerus, radius or ulna, or multiple fractures of any combination of the humerus, radius and ulna\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 6%.\nAn ISV in the lower half of the range will be appropriate if there is a complicated fracture of the humerus, radius or ulna, or any combination of the humerus, radius and ulna—\nrequiring open reduction and internal fixation; and\nfrom which the injured worker has recovered or is expected to recover.\nAn ISV at or near the top of the range will be appropriate if there is a crush injury causing significant skin or muscle loss with permanent residual impairment.\nAn ISV at or near the top of the range will also be appropriate if there is a DPI for the injury of 15%.","sortOrder":455},{"sectionNumber":"sch.14-sec.123","sectionType":"section","heading":"Minor upper limb injury, other than an injury mentioned in divs 3 to 7","content":"### sch.14-sec.123 Minor upper limb injury, other than an injury mentioned in divs 3 to 7\n\nExample of the injury\n0 to 5\nan uncomplicated fracture of the humerus, radius or ulna, or any combination of the humerus, radius and ulna, from which the injured worker has fully recovered within a short time\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there are soft tissue injuries, lacerations, abrasions and contusions, from which the injured worker will fully or almost fully recover.\nAn ISV at or near the top of the range will be appropriate if there is a brachial plexus injury from which the injured worker has substantially recovered within a few weeks, leaving some minor functional impairment.","sortOrder":456},{"sectionNumber":"sch.14-pt.6-div.9","sectionType":"division","heading":"Pelvis or hip injuries","content":"## Pelvis or hip injuries","sortOrder":457},{"sectionNumber":"sch.14-sec-oc.23","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.23\n\nGeneral comment for items 124 to 127\nThe most serious injuries to the pelvis or hips can be as devastating as a leg amputation and will have similar ISVs.\nHowever, the appropriate ISV for other injuries to the pelvis or hips will generally be no higher than about 20.\nExamples of factors affecting ISV assessment for items 124 to 127\nexceptionally severe specific sequelae will increase the level of ISV\nthe availability of remedies, for example, a total hip replacement is an important factor in assessing an ISV\nage","sortOrder":458},{"sectionNumber":"sch.14-sec.124","sectionType":"section","heading":"Extreme pelvis or hip injury","content":"### sch.14-sec.124 Extreme pelvis or hip injury\n\nExamples of the injury\n46 to 65\nan extensive pelvis fracture\ndegloving\npermanent nerve palsies\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 40%.\nAn ISV at or near the top of the range will be appropriate if the injured worker is not able to mobilise without a wheelchair and is relatively young.","sortOrder":459},{"sectionNumber":"sch.14-sec.125","sectionType":"section","heading":"Serious pelvis or hip injury","content":"### sch.14-sec.125 Serious pelvis or hip injury\n\nComment\n26 to 45\nThere will be substantial residual disability, for example, severe lack of bladder and bowel control, sexual dysfunction, or deformity making the use of 2 canes or crutches routine.\nExamples of the injury\na fracture dislocation of the pelvis involving both ischial and pubic rami\ntraumatic myositis ossificans with formation of ectopic bone around the hip\na fracture of the acetabulum leading to degenerative changes and leg instability requiring an osteotomy, with the likelihood of future hip replacement surgery\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate for an injury causing a DPI for the injury of 20%.","sortOrder":460},{"sectionNumber":"sch.14-sec.126","sectionType":"section","heading":"Moderate pelvis or hip injury","content":"### sch.14-sec.126 Moderate pelvis or hip injury\n\nExamples of the injury\n11 to 25\na significant pelvis or hip injury, with no major permanent disability\na hip fracture requiring a hip replacement\na fracture of the sacrum extending into the sacro-iliac joint causing ongoing significant symptoms and a DPI of at least 10%\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 10%.\nAn ISV at or near the top of the range will be appropriate if there is a fracture requiring a hip replacement that is only partially successful, so that there is a clear risk of the need for revision surgery.","sortOrder":461},{"sectionNumber":"sch.14-sec.127","sectionType":"section","heading":"Minor pelvis or hip injury","content":"### sch.14-sec.127 Minor pelvis or hip injury\n\nExamples of the injury\n0 to 10\nan uncomplicated fracture of 1 or more of the bones of the pelvis or hip that does not require surgery or cause permanent impairment\nundisplaced coccygeal fractures\nundisplaced or healed pubic rami fractures\nan injury to the coccyx for which surgery is required and is successfully performed\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a soft tissue injury from which the injured worker fully recovers.\nAn ISV at or near the middle of the range will be appropriate if there is a DPI for the injury of 5%.\nAn ISV at or near the top of the range will be appropriate if the person has ongoing coccydynia and difficulties with sitting.","sortOrder":462},{"sectionNumber":"sch.14-pt.6-div.10","sectionType":"division","heading":"Amputation of lower limbs","content":"## Amputation of lower limbs","sortOrder":463},{"sectionNumber":"sch.14-sec-oc.24","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.24\n\nExamples of factors affecting ISV assessment for items 128 and 129\nthe level of each amputation\nseverity of any phantom pain\npain in the stumps\nextent of any ongoing symptoms","sortOrder":464},{"sectionNumber":"sch.14-sec.128","sectionType":"section","heading":"Loss of both lower limbs above or through the knee","content":"### sch.14-sec.128 Loss of both lower limbs above or through the knee\n\nComment about appropriate level of ISV\n55 to 70\nAn ISV at or near the top of the range will be appropriate if each amputation is near the hips so neither stump can be used with a prosthesis.","sortOrder":465},{"sectionNumber":"sch.14-sec.129","sectionType":"section","heading":"Below the knee amputation of both lower limbs","content":"### sch.14-sec.129 Below the knee amputation of both lower limbs\n\nComment about appropriate level of ISV\n50 to 65\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 48%.\nAn ISV at or near the top of the range will be appropriate if—\nboth legs are amputated just below the knees leaving little or no stumps for use with prostheses; and\nthere is poor quality skin cover; and\nthere is a chronic regional pain syndrome.","sortOrder":466},{"sectionNumber":"sch.14-sec-oc.25","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.25\n\nExamples of factors affecting ISV assessment for items 130 and 131\nthe level of the amputation\nseverity of any phantom pain\nwhether there have been problems with a prosthesis, for example, pain and further damage to the stump","sortOrder":467},{"sectionNumber":"sch.14-sec.130","sectionType":"section","heading":"Above or through the knee amputation of 1 lower limb","content":"### sch.14-sec.130 Above or through the knee amputation of 1 lower limb\n\nComment about appropriate level of ISV\n35 to 50\nAn ISV at or near the bottom of the range will be appropriate if the amputation is through or just above the knee.\nAn ISV at or near the top of the range will be appropriate if the amputation is near the hip and a prosthesis can not be used.","sortOrder":468},{"sectionNumber":"sch.14-sec.131","sectionType":"section","heading":"Below the knee amputation of 1 lower limb","content":"### sch.14-sec.131 Below the knee amputation of 1 lower limb\n\nComment about appropriate level of ISV\n31 to 45\nAn ISV at or near the bottom of the range will be appropriate in a straightforward case of a below-knee amputation with no complications.\nAn ISV at or near the top of the range will be appropriate if there is an amputation close to the knee joint, leaving little or no stump for use with a prosthesis.","sortOrder":469},{"sectionNumber":"sch.14-pt.6-div.11","sectionType":"division","heading":"Lower limb injuries, other than injuries mentioned in division 9 or 10 or divs 12 to 15","content":"## Lower limb injuries, other than injuries mentioned in division 9 or 10 or divs 12 to 15","sortOrder":470},{"sectionNumber":"sch.14-sec.132","sectionType":"section","heading":"Extreme lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15","content":"### sch.14-sec.132 Extreme lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15\n\nComment\n31 to 55\nThese are the most severe injuries short of amputation, leaving the injured worker little better off than if the whole leg had been lost.\nExamples of the injury\nextensive degloving of the lower limb\nan injury causing gross shortening of the lower limb\na fracture that has not united despite extensive bone grafting\nserious neurovascular injury\na lower limb injury causing a DPI of 40%","sortOrder":471},{"sectionNumber":"sch.14-sec.133","sectionType":"section","heading":"Serious lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15","content":"### sch.14-sec.133 Serious lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15\n\nComment\n21 to 30\nRemoval of extensive muscle tissue and extensive scarring may have a significant enough impact to fall within this item.\nAn injury to multiple joints or ligaments causing instability, prolonged treatment and a long period of non-weight-bearing may have a significant enough impact to fall within this item, but generally only if those results are combined.\nExample of the injury\nmultiple complex fractures of the lower limb that are expected to take years to heal and cause serious deformity and serious limitation of mobility\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 16%.\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 25%.","sortOrder":472},{"sectionNumber":"sch.14-sec.134","sectionType":"section","heading":"Moderate lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15","content":"### sch.14-sec.134 Moderate lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15\n\nExamples of the injury\n11 to 20\na fracture causing impairment of associated soft tissues, including nerves and blood vessels\na fracture with delayed union or infection\nmultiple fractures of the femur, tibia or fibula, or multiple fractures of any combination of the femur, tibia and fibula\nExamples of factors affecting ISV assessment\nperiod of non-weight-bearing\npresence or risk of degenerative change\nimperfect union of a fracture\nmuscle wasting\nlimited joint movement\nunsightly scarring\npermanently increased vulnerability to future damage\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 10%.\nAn ISV at or near the middle of the range will be appropriate if there is a deep vein thrombosis requiring treatment for life.\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 15%.","sortOrder":473},{"sectionNumber":"sch.14-sec.135","sectionType":"section","heading":"Minor lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15","content":"### sch.14-sec.135 Minor lower limb injury, other than an injury mentioned in division 9 or 10 or divs 12 to 15\n\nExample of the injury\n0 to 10\nan uncomplicated fracture of the femur, tibia or fibula, from which the injured worker has fully recovered\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a deep vein thrombosis requiring treatment for less than 6 months, from which the injured worker will fully recover.\nAn ISV at or near the bottom of the range will also be appropriate if—\nthere are soft tissue injuries, lacerations, cuts, bruising or contusions, from which the injured worker will fully or almost fully recover; and\nany residual disability will be minor.\nAn ISV at or near the top of the range will be appropriate if there is a deep vein thrombosis requiring treatment for at least 1 year.\nAn ISV at or near the top of the range will also be appropriate if the injured worker is left with impaired mobility or a defective gait.\nAn ISV at or near the top of the range will also be appropriate if there is a DPI for the injury of 9%.","sortOrder":474},{"sectionNumber":"sch.14-pt.6-div.12","sectionType":"division","heading":"Knee injuries","content":"## Knee injuries","sortOrder":475},{"sectionNumber":"sch.14-sec-oc.26","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.26\n\nGeneral comment for items 136 to 139\nThe availability of remedies, for example, a total knee replacement, is an important factor in assessing an ISV under this division.","sortOrder":476},{"sectionNumber":"sch.14-sec.136","sectionType":"section","heading":"Extreme knee injury","content":"### sch.14-sec.136 Extreme knee injury\n\nExample of the injury\n25 to 40\na severe knee injury if there is a disruption of the joint, gross ligamentous damage, loss of function after unsuccessful surgery, lengthy treatment and considerable pain\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 20%.\nAn ISV at or near the top of the range will be appropriate if a total knee replacement was needed and—\nit is very likely that the knee replacement will need to be repeated; or\nthere are ongoing severe symptoms, poor function and a DPI for the injury of more than 30%.","sortOrder":477},{"sectionNumber":"sch.14-sec.137","sectionType":"section","heading":"Serious knee injury","content":"### sch.14-sec.137 Serious knee injury\n\nComment\n11 to 24\nThe injury may involve—\nongoing pain, discomfort, limitation of movement, instability or deformity; and\na risk, in the long-term, of degenerative changes caused by damage to the joint surfaces, muscular wasting or ligamentous or meniscal injury.\nExample of the injury\na leg fracture extending into the knee joint, causing pain that is constant, permanent and limits movement or impairs agility\nComment about appropriate level of ISV\nAn ISV at or near the middle of the range will be appropriate if there is a ligamentous injury, that required surgery and prolonged rehabilitation, causing a DPI of 15% and functional limitation.","sortOrder":478},{"sectionNumber":"sch.14-sec.138","sectionType":"section","heading":"Moderate knee injury","content":"### sch.14-sec.138 Moderate knee injury\n\nExamples of the injury\n6 to 10\na dislocation or torn cartilage or meniscus causing ongoing minor instability, wasting and weakness\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is a DPI for the injury of 8%.","sortOrder":479},{"sectionNumber":"sch.14-sec.139","sectionType":"section","heading":"Minor knee injury","content":"### sch.14-sec.139 Minor knee injury\n\nExamples of the injury\n0 to 5\na partial cartilage, meniscal or ligamentous tear\na laceration\na twisting or bruising injury","sortOrder":480},{"sectionNumber":"sch.14-pt.6-div.13","sectionType":"division","heading":"Ankle injuries","content":"## Ankle injuries","sortOrder":481},{"sectionNumber":"sch.14-sec-oc.27","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.27\n\nComment about appropriate level of ISV for items 140 to 143\nThe appropriate ISV for the vast majority of ankle injuries is 1 or 2.","sortOrder":482},{"sectionNumber":"sch.14-sec.140","sectionType":"section","heading":"Extreme ankle injury","content":"### sch.14-sec.140 Extreme ankle injury\n\nExamples of the injury\n21 to 35\na transmalleolar fracture of the ankle with extensive soft tissue damage causing 1 or more of the following—\nsevere deformity with varus or valgus malalignment;\na risk that any future injury to the relevant leg may lead to a below-knee amputation of the leg;\nmarked reduction in walking ability with constant dependence on walking aids;\ninability to place the relevant foot for even load-bearing distribution\nan ankylosed ankle in a severely misaligned position with severe ongoing pain and other debilitating complications\na DPI for the injury of more than 20%\nExamples of factors affecting ISV assessment\na failed arthrodesis\nregular disturbance of sleep\nneed for an orthosis for load bearing and walking","sortOrder":483},{"sectionNumber":"sch.14-sec.141","sectionType":"section","heading":"Serious ankle injury","content":"### sch.14-sec.141 Serious ankle injury\n\nExample of the injury\n11 to 20\nan injury requiring a long period of treatment, a long time in plaster or insertion of pins and plates, if—\nthere is permanent significant ankle instability; or\nthe ability to walk is severely limited on a permanent basis\nExamples of factors affecting ISV assessment\nunsightly scarring\nthe significance of any malunion\na requirement for modified footwear\nwhether, and to what degree, there is swelling following activity\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 10%.\nAn ISV at or near the top of the range will be appropriate if a major tendon controlling foot or ankle movement is severed.","sortOrder":484},{"sectionNumber":"sch.14-sec.142","sectionType":"section","heading":"Moderate ankle injury","content":"### sch.14-sec.142 Moderate ankle injury\n\nExample of the injury\n6 to 10\na fracture, ligamentous tear or similar injury causing moderate disability, for example—\ndifficulty in walking on uneven ground\nawkwardness on stairs\nirritation from metal plates\nresidual scarring\nAdditional comment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is a DPI for the injury of 6%.","sortOrder":485},{"sectionNumber":"sch.14-sec.143","sectionType":"section","heading":"Minor ankle injury","content":"### sch.14-sec.143 Minor ankle injury\n\nExample of the injury\n0 to 5\na sprain, ligamentous or soft tissue injury or minor or undisplaced fracture\nExamples of factors affecting ISV assessment\nwhether the injured worker has fully recovered from the injury, and if not, whether there is any tendency for the ankle to give way\nwhether there is scarring, aching or discomfort","sortOrder":486},{"sectionNumber":"sch.14-pt.6-div.14","sectionType":"division","heading":"Foot injuries","content":"## Foot injuries","sortOrder":487},{"sectionNumber":"sch.14-sec.144","sectionType":"section","heading":"Amputation of both feet","content":"### sch.14-sec.144 Amputation of both feet\n\nExamples of factors affecting ISV assessment\n32 to 65\nseverity of any phantom pain\npain in the stumps\nextent of any ongoing symptoms\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there are amputations of both feet at the forefoot (transmetatarsal level amputations).\nAn ISV of about 40 will be appropriate if there are amputations of both feet at the mid foot (tarsometatarsal level or Lisfranc amputations).\nAn ISV at or near the top of the range will be appropriate if each amputation is at the level of the ankle (Syme’s amputation) and the stumps can not be used with prostheses.","sortOrder":488},{"sectionNumber":"sch.14-sec.145","sectionType":"section","heading":"Amputation of 1 foot","content":"### sch.14-sec.145 Amputation of 1 foot\n\nExamples of factors affecting ISV assessment\n20 to 35\nseverity of any phantom pain\npain in the stump\nextent of any ongoing symptoms\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if the amputation is at the forefoot (transmetatarsal level amputation).\nAn ISV of about 26 will be appropriate if the amputation is at the mid foot (tarsometatarsal level or Lisfranc amputation).\nAn ISV at or near the top of the range will be appropriate if the amputation is at the level of the ankle (Syme’s amputation) and the stump can not be used with a prosthesis.","sortOrder":489},{"sectionNumber":"sch.14-sec.146","sectionType":"section","heading":"Extreme foot injury that is not an amputation","content":"### sch.14-sec.146 Extreme foot injury that is not an amputation\n\nComment\n13 to 25\nThere will be permanent and severe pain or very serious permanent disability.\nExample of the injury\nan unusually severe foot injury causing a DPI of 15% or more, for example, a heel fusion or loss of the tibia-calcaneum angle\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is subtalar fibrous ankylosis in a severely malaligned position, ongoing pain and a DPI for the injury of 24%.","sortOrder":490},{"sectionNumber":"sch.14-sec.147","sectionType":"section","heading":"Serious foot injury","content":"### sch.14-sec.147 Serious foot injury\n\nExamples of the injury\n9 to 12\na severe midfoot deformity causing a DPI of 8%\na lower level loss of the tibia-calcaneum angle","sortOrder":491},{"sectionNumber":"sch.14-sec.148","sectionType":"section","heading":"Moderate foot injury","content":"### sch.14-sec.148 Moderate foot injury\n\nExample of the injury\n4 to 8\na displaced metatarsal fracture causing permanent deformity, with ongoing symptoms of minor severity, for example, a limp that does not prevent the injured worker engaging in most daily activities","sortOrder":492},{"sectionNumber":"sch.14-sec.149","sectionType":"section","heading":"Minor foot injury","content":"### sch.14-sec.149 Minor foot injury\n\nExample of the injury\n0 to 3\na simple metatarsal fracture, ruptured ligament, puncture wound or similar injury\nComment about appropriate level of ISV\nAn ISV of 2 or less will be appropriate if there is a straightforward foot injury, for example, a fracture, laceration or contusions, from which the injured worker will fully recover.","sortOrder":493},{"sectionNumber":"sch.14-pt.6-div.15","sectionType":"division","heading":"Toe injuries","content":"## Toe injuries","sortOrder":494},{"sectionNumber":"sch.14-sec.150","sectionType":"section","heading":"Extreme toe injury","content":"### sch.14-sec.150 Extreme toe injury\n\nExamples of factors affecting ISV assessment for items 150.1 to 150.3\nwhether the amputation was traumatic or surgical\nextent of the loss of the forefoot\nresidual effects on mobility\n150.1\nAmputation of all toes\n8 to 20\nComment about appropriate level of ISV\nAn ISV at or near the middle of the range will be appropriate if the amputation is through the metatarsophalangeal joints (MTP joints) of all toes.\nAn ISV at or near the top of the range will be appropriate if there is complete amputation of all toes and amputation of a substantial part of the forefoot.\n150.2\nAmputation of the great toe\n6 to 12\nExample of factor affecting ISV assessment for item 150.2\nthe level at which the amputation happens or any ongoing symptoms\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there is complete loss of the great toe and ball of the foot caused by an amputation through the first metatarsal bone.\n150.3\nAmputation of individual lesser toes\n3 to 5\nExample of factor affecting ISV assessment for item 150.3\nthe level at which the amputation happens or any ongoing symptoms\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is an amputation of 1 lesser toe and—\nthere is no ongoing pain; and\nthere is little or no loss of function of the foot; and\nthe cosmetic effect of the amputation is minor.\nAn ISV at or near the top of the range will be appropriate if there is complete amputation of all lesser toes and part of the forefoot.","sortOrder":495},{"sectionNumber":"sch.14-sec.151","sectionType":"section","heading":"Serious toe injury","content":"### sch.14-sec.151 Serious toe injury\n\nComment\n8 to 12\nThe injury will cause serious and permanent disability.\nExamples of the injury\na severe crush injury causing ankylosis of the toes\na bursting wound, or an injury causing severe toe damage, with significant symptoms","sortOrder":496},{"sectionNumber":"sch.14-sec.152","sectionType":"section","heading":"Moderate toe injury","content":"### sch.14-sec.152 Moderate toe injury\n\nComment\n4 to 7\nThere will be permanent discomfort, pain or sensitive scarring.\nExamples of the injury\na moderate injury to the great toe\na crush injury causing multiple fractures of 2 or more toes\nComment about appropriate level of ISV\nAn ISV at or near the top of the range will be appropriate if there has been more than 1 unsuccessful operation, or there are persisting stabbing pains, impaired gait or similar effects.","sortOrder":497},{"sectionNumber":"sch.14-sec.153","sectionType":"section","heading":"Minor toe injury","content":"### sch.14-sec.153 Minor toe injury\n\nExample of the injury\n0 to 3\na relatively straightforward fracture or soft tissue injury\nComment about appropriate level of ISV\nAn ISV of 1 will be appropriate if there is a straightforward fracture of 1 or more toes with complete resolution within a short time.","sortOrder":498},{"sectionNumber":"sch.14-pt.6-div.16","sectionType":"division","heading":"Limb disorders","content":"## Limb disorders","sortOrder":499},{"sectionNumber":"sch.14-sec-oc.28","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.28\n\nGeneral comment\nThe ISV for a limb disorder must be assessed having regard to the item of this schedule that—\nrelates to the part of the body affected by the disorder; and\nis for an injury that has a similar level of adverse impact to the disorder.\nExamples of a limb disorder\ntenosynovitis (inflammation of synovial sheaths of tendons usually resolving with rest over a short period and sometimes leading to ongoing symptoms of loss of grip and dexterity)\nperipheral nerve injury (the constriction of the motor or sensory nerves or thickening of surrounding tissue, for example, carpal tunnel syndrome or sciatica)\nepicondylitis (inflammation around the elbow joint, for example, medially (golfer’s elbow) or laterally (tennis elbow))\nvascular disorders, for example, deep vein thrombosis\nExamples of factors affecting ISV assessment\nwhether the disorder is bilateral or one-sided\nthe level of pain, swelling, tenderness or crepitus or other symptoms\nthe capacity to avoid a recurrence of symptoms\nthe ability to engage in daily activities\nthe availability and likely benefit of surgery\nwhether the disorder is to a dominant or non-dominant limb","sortOrder":500},{"sectionNumber":"sch.14-pt.7","sectionType":"part","heading":"Scarring to parts of the body other than the face","content":"# Scarring to parts of the body other than the face","sortOrder":501},{"sectionNumber":"sch.14-sec-oc.29","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.29\n\nGeneral comment\nThis part applies to external appearance and physical condition of the skin only, and includes scarring to the scalp, trunk and limbs.\nFacial scarring must be assessed under part 3 , division 2 .\nThis part does not apply to adhesions, or scarring, of internal organs.\nThis part will usually apply to an injury involving skeletal damage only if the skeletal damage is minor.\nMany of the physical injuries mentioned in this schedule involve some scarring from the initial injury and subsequent surgery, including skin grafting, to repair the injury and this has been taken into account in fixing the range of ISVs for the injuries.\nThe ISV range for an injury causing a closed fracture of a limb takes into account the potential need for open reduction and internal fixation of the fracture and the resulting surgical wound and scar.\nExamples of factors affecting ISV assessment for items 154.1 to 154.4\nlocation of a scar\nage\nadverse psychological reaction\nlikelihood of a scar fading or becoming less noticeable over time","sortOrder":502},{"sectionNumber":"sch.14-sec.154","sectionType":"section","heading":"Scarring to a part of the body other than the face","content":"### sch.14-sec.154 Scarring to a part of the body other than the face\n\n154.1\nExtreme scarring to a part of the body other than the face\n14 to 25\nComment about appropriate level of ISV\nAn ISV at or near the bottom of the range will be appropriate if there is—\nextensive scarring to 1 or more of the limbs and significant cosmetic disfigurement; and\neither—\nthe need to keep the limb or limbs covered or wear special clothing; or\nongoing limitation in the ability to participate in activities because of cosmetic disfigurement or functional impairment.\nAn ISV at or near the top of the range will be appropriate if there is gross permanent scarring over an extensive area or areas of the body, with ongoing pain and other symptoms.\n154.2\nSerious scarring to a part of the body other than the face\n9 to 13\nComment\nThere is serious scarring—\nrequiring extensive medical treatment or surgery; and\ncausing significant ongoing limitation in the ability to participate in activities because of cosmetic disfigurement or functional impairment.\nExamples of the injury\nsignificant scarring over the upper and lower arm requiring skin grafting if—\nthere are post-operative complications requiring additional medical treatment for up to 18 months; and\nthere is maximum medical improvement within 2 years after the scarring is caused\nhypertrophic (keloid) scarring caused by a burn to the front of the neck, with an intermittent sensation of burning, itching or irritation\n154.3\nModerate scarring to a part of the body other than the face\n4 to 8\nExamples of the injury\nseveral noticeable scars that are hypertrophic (keloid)\na significant linear scar in an area of cosmetic importance, for example, the front of the neck\n154.4\nMinor scarring to a part of the body other than the face\n0 to 3\nExamples of the injury\nscarring caused by a superficial burn that heals within a few weeks and causes some minor change of pigmentation in a noticeable area\na single noticeable scar, or several superficial scars, to 1 or both of the legs, arms or hands, with some minor cosmetic damage","sortOrder":503},{"sectionNumber":"sch.14-pt.8","sectionType":"part","heading":"Burn injuries","content":"# Burn injuries","sortOrder":504},{"sectionNumber":"sch.14-sec-oc.30","sectionType":"section","heading":null,"content":"### Section sch.14-sec-oc.30\n\nGeneral comment\nThe ISV for a burn injury must be assessed having regard to the item of this schedule that—\nrelates to the part of the body affected by the burn injury; and\nis for an injury that has a similar level of adverse impact to the burn injury.\nBurns to the face must be assessed under part 3 , division 2 .\nIn burns cases, the ISV for an injury to a part of the body causing functional impairment will generally be at or near the top of the range for an injury to that part of the body.\nIn serious burns cases, the effects of scarring are more comprehensive and less able to be remedied than the effects of scarring from other causes.","sortOrder":505},{"sectionNumber":"sch.14-pt.9","sectionType":"part","heading":"Injuries affecting hair","content":"# Injuries affecting hair","sortOrder":506},{"sectionNumber":"sch.14-sec.155","sectionType":"section","heading":"Extreme injury affecting head hair","content":"### sch.14-sec.155 Extreme injury affecting head hair\n\nExample of the injury\n11 to 15\ntotal permanent loss of head hair","sortOrder":507},{"sectionNumber":"sch.14-sec.156","sectionType":"section","heading":"Serious injury affecting head hair","content":"### sch.14-sec.156 Serious injury affecting head hair\n\nExample of the injury\n4 to 10\ndamage to head hair, caused by, for example, defective waving or tinting, if—\nthe physical effect of the damage is—\ndermatitis; or\ntingling or burning of the scalp, causing dry, brittle hair that breaks off or falls out, or both; and\nthe physical effect leads to depression, loss of confidence and inhibited social life\nComment about appropriate level of ISV\nAn ISV in the upper half of the range will be appropriate if—\nthinning continues and prospects of regrowth are poor; or\nthere is a partial loss of areas of hair and regrowth is slow.","sortOrder":508},{"sectionNumber":"sch.14-sec.157","sectionType":"section","heading":"Moderate injury affecting head hair or loss of body hair","content":"### sch.14-sec.157 Moderate injury affecting head hair or loss of body hair\n\nExamples of the injury\n0 to 3\nhair that has been pulled out leaving bald patches\nthe same example mentioned in item 156 but with fewer or only moderate symptoms\nExample of factor affecting ISV assessment\nlength of time before regrowth","sortOrder":509},{"sectionNumber":"sch.14-pt.10","sectionType":"part","heading":"Dermatitis","content":"# Dermatitis","sortOrder":510},{"sectionNumber":"sch.14-sec.158","sectionType":"section","heading":"Extreme dermatitis","content":"### sch.14-sec.158 Extreme dermatitis\n\nExample of the injury\n11 to 20\npermanent dermatitis having a severe effect on employment and domestic capability, with some mental disorder","sortOrder":511},{"sectionNumber":"sch.14-sec.159","sectionType":"section","heading":"Serious dermatitis","content":"### sch.14-sec.159 Serious dermatitis\n\nExample of the injury\n8 to 10\ndermatitis that—\nlasts for years or indefinitely; and\ninvolves cracking and soreness; and\naffects employment and domestic capability; and\ncauses marked adverse psychological reaction","sortOrder":512},{"sectionNumber":"sch.14-sec.160","sectionType":"section","heading":"Moderate dermatitis","content":"### sch.14-sec.160 Moderate dermatitis\n\nExample of the injury\n3 to 7\ndermatitis lasting for a significant period, but settling with treatment or a change of personal conduct, or both","sortOrder":513},{"sectionNumber":"sch.14-sec.161","sectionType":"section","heading":"Minor dermatitis","content":"### sch.14-sec.161 Minor dermatitis\n\nExample of the injury\n0 to 2\nitching, skin irritation or a rash, alone or in combination, that resolves with treatment within a few months of the start of treatment","sortOrder":514},{"sectionNumber":"sch.15-pt.1","sectionType":"part","heading":"Explanation of the PIRS","content":"# Explanation of the PIRS","sortOrder":515},{"sectionNumber":"sch.15-sec.1","sectionType":"section","heading":"PIRS rates permanent impairment caused by mental disorder","content":"### sch.15-sec.1 PIRS rates permanent impairment caused by mental disorder\n\nThe PIRS stated in schedule 16 rates permanent impairment caused by a mental disorder.\nPIRS ratings are referred to in schedule 14 , part 2 . A PIRS rating is capable of being accepted by a court under schedule 13 , section 6 only if it is—\nassessed by a medical expert as required under this schedule and schedule 16 ; and\nprovided to the court in a PIRS report as required under section 12 .\n- (a) assessed by a medical expert as required under this schedule and schedule 16 ; and\n- (b) provided to the court in a PIRS report as required under section 12 .","sortOrder":516},{"sectionNumber":"sch.15-sec.2","sectionType":"section","heading":"Areas of functional impairment","content":"### sch.15-sec.2 Areas of functional impairment\n\nThe PIRS consists of 6 scales, each of which rates permanent impairment in an area of function.\nEach scale has 5 classes of impairment, ranging from little or no impairment to total impairment.\n(sch.15-sec.2-ssec.1) The PIRS consists of 6 scales, each of which rates permanent impairment in an area of function.\n(sch.15-sec.2-ssec.2) Each scale has 5 classes of impairment, ranging from little or no impairment to total impairment.","sortOrder":517},{"sectionNumber":"sch.15-pt.2","sectionType":"part","heading":"Assessment of PIRS rating","content":"# Assessment of PIRS rating","sortOrder":518},{"sectionNumber":"sch.15-sec.3","sectionType":"section","heading":"Medical expert must comply with requirements","content":"### sch.15-sec.3 Medical expert must comply with requirements\n\nA medical expert must comply with this schedule and schedule 16 in assessing a PIRS rating for a mental disorder of an injured worker.\nThe medical expert may give an assessment only if the medical expert has examined the injured worker.\n(sch.15-sec.3-ssec.1) A medical expert must comply with this schedule and schedule 16 in assessing a PIRS rating for a mental disorder of an injured worker.\n(sch.15-sec.3-ssec.2) The medical expert may give an assessment only if the medical expert has examined the injured worker.","sortOrder":519},{"sectionNumber":"sch.15-sec.4","sectionType":"section","heading":"How to assess a PIRS rating","content":"### sch.15-sec.4 How to assess a PIRS rating\n\nTo assess a PIRS rating for a mental disorder of an injured worker, a medical expert must follow the steps stated in this section.\nSection 8 provides an example completed worksheet that could be used to assess a PIRS rating.\nStep 1—for each area of functional impairment stated in the PIRS, the medical expert must—\ndecide which level of impairment stated in the PIRS describes the level of impairment caused by the mental disorder of the injured worker; and\nread off from the PIRS the class, for example, class 1, that corresponds to the level that has been decided.\nIn deciding which level to choose for an area of functional impairment, the medical expert—\nmust have regard to—\nthe examples of indicators of the level of impairment stated in the PIRS for the area to the extent they are relevant in a particular case; and\nall factors the medical expert considers relevant to the injured worker’s level of impairment, including, for example, the injured worker’s age and pre-existing functional capacity for the area; and\nmay have regard to the range of percentages of impairment stated in the PIRS for the area as a guide to the level of impairment.\nThe examples of impairment stated in the PIRS assume a full pre-existing functional capacity for the area which may not be appropriate in a particular case.\nStep 2—the medical expert must list the class number of the 6 classes read off under step 1 in ascending order.\nStep 3—the medical expert must work out the median of the class numbers (the median class score ) under section 6 .\nStep 4—the medical expert must work out the total of the class numbers (the total class score ) by adding together all of the class numbers.\nStep 5—from the conversion table in section 7 , the medical expert must read off the percentage impairment that corresponds to the particular median class score when found in conjunction with the particular total class score.\nSubject to section 5 , the percentage impairment is the PIRS rating assessed by the medical expert for the mental disorder of the injured worker.\n(sch.15-sec.4-ssec.1) To assess a PIRS rating for a mental disorder of an injured worker, a medical expert must follow the steps stated in this section. Section 8 provides an example completed worksheet that could be used to assess a PIRS rating.\n(sch.15-sec.4-ssec.2) Step 1—for each area of functional impairment stated in the PIRS, the medical expert must— decide which level of impairment stated in the PIRS describes the level of impairment caused by the mental disorder of the injured worker; and read off from the PIRS the class, for example, class 1, that corresponds to the level that has been decided.\n(sch.15-sec.4-ssec.3) In deciding which level to choose for an area of functional impairment, the medical expert— must have regard to— the examples of indicators of the level of impairment stated in the PIRS for the area to the extent they are relevant in a particular case; and all factors the medical expert considers relevant to the injured worker’s level of impairment, including, for example, the injured worker’s age and pre-existing functional capacity for the area; and may have regard to the range of percentages of impairment stated in the PIRS for the area as a guide to the level of impairment. The examples of impairment stated in the PIRS assume a full pre-existing functional capacity for the area which may not be appropriate in a particular case.\n(sch.15-sec.4-ssec.4) Step 2—the medical expert must list the class number of the 6 classes read off under step 1 in ascending order.\n(sch.15-sec.4-ssec.5) Step 3—the medical expert must work out the median of the class numbers (the median class score ) under section 6 .\n(sch.15-sec.4-ssec.6) Step 4—the medical expert must work out the total of the class numbers (the total class score ) by adding together all of the class numbers.\n(sch.15-sec.4-ssec.7) Step 5—from the conversion table in section 7 , the medical expert must read off the percentage impairment that corresponds to the particular median class score when found in conjunction with the particular total class score.\n(sch.15-sec.4-ssec.8) Subject to section 5 , the percentage impairment is the PIRS rating assessed by the medical expert for the mental disorder of the injured worker.\n- (a) decide which level of impairment stated in the PIRS describes the level of impairment caused by the mental disorder of the injured worker; and\n- (b) read off from the PIRS the class, for example, class 1, that corresponds to the level that has been decided.\n- (a) must have regard to— (i) the examples of indicators of the level of impairment stated in the PIRS for the area to the extent they are relevant in a particular case; and (ii) all factors the medical expert considers relevant to the injured worker’s level of impairment, including, for example, the injured worker’s age and pre-existing functional capacity for the area; and\n- (i) the examples of indicators of the level of impairment stated in the PIRS for the area to the extent they are relevant in a particular case; and\n- (ii) all factors the medical expert considers relevant to the injured worker’s level of impairment, including, for example, the injured worker’s age and pre-existing functional capacity for the area; and\n- (b) may have regard to the range of percentages of impairment stated in the PIRS for the area as a guide to the level of impairment.\n- (i) the examples of indicators of the level of impairment stated in the PIRS for the area to the extent they are relevant in a particular case; and\n- (ii) all factors the medical expert considers relevant to the injured worker’s level of impairment, including, for example, the injured worker’s age and pre-existing functional capacity for the area; and","sortOrder":520},{"sectionNumber":"sch.15-sec.5","sectionType":"section","heading":"Assessment if pre-existing mental disorder","content":"### sch.15-sec.5 Assessment if pre-existing mental disorder\n\nIf an injured worker has a pre-existing mental disorder, a medical expert must—\nwork out a percentage impairment for the pre-existing mental disorder at the time immediately before the injury using the steps stated in section 4 (the pre-injury rating ); and\nwork out a percentage impairment for the current mental disorder using the steps stated in section 4 (the post-injury rating ); and\nsubtract the pre-injury rating from the post-injury rating.\nThe remaining percentage impairment is the PIRS rating assessed by the medical expert for the mental disorder of the injured worker.\nSee also section 11 .\n(sch.15-sec.5-ssec.1) If an injured worker has a pre-existing mental disorder, a medical expert must— work out a percentage impairment for the pre-existing mental disorder at the time immediately before the injury using the steps stated in section 4 (the pre-injury rating ); and work out a percentage impairment for the current mental disorder using the steps stated in section 4 (the post-injury rating ); and subtract the pre-injury rating from the post-injury rating.\n(sch.15-sec.5-ssec.2) The remaining percentage impairment is the PIRS rating assessed by the medical expert for the mental disorder of the injured worker. See also section 11 .\n- (a) work out a percentage impairment for the pre-existing mental disorder at the time immediately before the injury using the steps stated in section 4 (the pre-injury rating ); and\n- (b) work out a percentage impairment for the current mental disorder using the steps stated in section 4 (the post-injury rating ); and\n- (c) subtract the pre-injury rating from the post-injury rating.","sortOrder":521},{"sectionNumber":"sch.15-sec.6","sectionType":"section","heading":"How to work out a median class score","content":"### sch.15-sec.6 How to work out a median class score\n\nA median class score is the number that would fall at the middle point between the third class number and the fourth class number if all the class numbers are listed in ascending order.\nIf the median class score under subsection (1) is not a whole number, the median class score must be rounded up to the nearest whole number.\nA median class score, as opposed to a mean class score or average class score, has the advantage of not being too influenced by 1 extreme score.\n(sch.15-sec.6-ssec.1) A median class score is the number that would fall at the middle point between the third class number and the fourth class number if all the class numbers are listed in ascending order.\n(sch.15-sec.6-ssec.2) If the median class score under subsection (1) is not a whole number, the median class score must be rounded up to the nearest whole number. A median class score, as opposed to a mean class score or average class score, has the advantage of not being too influenced by 1 extreme score.","sortOrder":522},{"sectionNumber":"sch.15-sec.7","sectionType":"section","heading":"Conversion table","content":"### sch.15-sec.7 Conversion table\n\nThis section sets out the conversion table for use under section 4 .\nConversion table for percentage impairment\nMedian class score\n1\n2\n3\n4\n5\nTotal class score\n6\n0%\n7\n0%\n8\n1%\n9\n1%\n4%\n10\n2%\n5%\n11\n2%\n5%\n12\n2%\n6%\n13\n3%\n7%\n11%\n14\n3%\n7%\n13%\n15\n8%\n15%\n16\n9%\n17%\n17\n9%\n19%\n31%\n18\n10%\n22%\n34%\n19\n24%\n37%\n20\n26%\n41%\n21\n28%\n44%\n61%\n22\n30%\n47%\n65%\n23\n50%\n70%\n24\n54%\n74%\n25\n57%\n78%\n26\n60%\n83%\n27\n87%\n28\n91%\n29\n96%\n30\n100%","sortOrder":523},{"sectionNumber":"sch.15-sec.8","sectionType":"section","heading":"Example worksheet","content":"### sch.15-sec.8 Example worksheet\n\nThis section sets out an example of a completed worksheet that could be used to assess a PIRS rating for a mental disorder.\nArea of functional impairment\nClass\nSelf-care and personal hygiene\n1\nSocial and recreational activities\n2\nTravel\n3\nSocial functioning\n5\nConcentration, persistence and pace\n5\nAdaptation\n5\nList of class numbers in ascending order:\n1\n2\n3\n5\n5\n5\nMedian class score (using section 6 ):\n4\nTotal class score:\n21\nPercentage impairment (using conversion table in section 7 ):\n44%\nPIRS rating (if no pre-existing mental disorder):\n44%","sortOrder":524},{"sectionNumber":"sch.15-pt.3","sectionType":"part","heading":"Particular cases","content":"# Particular cases","sortOrder":525},{"sectionNumber":"sch.15-sec.9","sectionType":"section","heading":"Refusal of treatment","content":"### sch.15-sec.9 Refusal of treatment\n\nThis section applies if an injured worker refuses treatment that could lead to a significant improvement in the level of permanent impairment caused by a mental disorder of the injured worker.\nDespite the injured worker’s refusal of treatment, a medical expert may assess a PIRS rating for the mental disorder of the injured worker.\nThe refusal of treatment must not affect the medical expert’s assessment of the PIRS rating.\nThe medical expert must note the refusal of treatment in the PIRS report and state in the report the likely effect of treatment and any reasons known to the medical expert for the refusal of treatment.\nSubsection (6) applies if a PIRS report given to a court states that the injured worker refuses treatment that could lead to a significant improvement in the level of permanent impairment caused by the mental disorder of the injured worker.\nThe court may, in assessing the ISV for an injury or multiple injuries of the injured worker, take into account the refusal of treatment and the matters stated in the PIRS report under subsection (4) .\nIn this section—\nPIRS report means a report under section 12 .\n(sch.15-sec.9-ssec.1) This section applies if an injured worker refuses treatment that could lead to a significant improvement in the level of permanent impairment caused by a mental disorder of the injured worker.\n(sch.15-sec.9-ssec.2) Despite the injured worker’s refusal of treatment, a medical expert may assess a PIRS rating for the mental disorder of the injured worker.\n(sch.15-sec.9-ssec.3) The refusal of treatment must not affect the medical expert’s assessment of the PIRS rating.\n(sch.15-sec.9-ssec.4) The medical expert must note the refusal of treatment in the PIRS report and state in the report the likely effect of treatment and any reasons known to the medical expert for the refusal of treatment.\n(sch.15-sec.9-ssec.5) Subsection (6) applies if a PIRS report given to a court states that the injured worker refuses treatment that could lead to a significant improvement in the level of permanent impairment caused by the mental disorder of the injured worker.\n(sch.15-sec.9-ssec.6) The court may, in assessing the ISV for an injury or multiple injuries of the injured worker, take into account the refusal of treatment and the matters stated in the PIRS report under subsection (4) .\n(sch.15-sec.9-ssec.7) In this section— PIRS report means a report under section 12 .","sortOrder":526},{"sectionNumber":"sch.15-sec.10","sectionType":"section","heading":"Cognitive impairment","content":"### sch.15-sec.10 Cognitive impairment\n\nIf a medical expert assessing a PIRS rating for a mental disorder of an injured worker suspects the injured worker has a cognitive impairment, the medical expert must take into account the following factors—\nthe relevant medical history of the injured worker;\nany medical treatment, and progress towards rehabilitation, for the cognitive impairment;\nany results of radiological scans, including CT and MRI scans, electroencephalograms and psychometric tests made available to the medical expert.\n- (a) the relevant medical history of the injured worker;\n- (b) any medical treatment, and progress towards rehabilitation, for the cognitive impairment;\n- (c) any results of radiological scans, including CT and MRI scans, electroencephalograms and psychometric tests made available to the medical expert.","sortOrder":527},{"sectionNumber":"sch.15-sec.11","sectionType":"section","heading":"Pre-existing mental disorder","content":"### sch.15-sec.11 Pre-existing mental disorder\n\nIf a medical expert assessing a PIRS rating for a mental disorder of an injured worker considers the injured worker had a pre-existing mental disorder, the medical expert must—\nmake appropriate enquiry into the pre-existing mental disorder; and\nconsider any psychiatric or psychological reports made available to the medical expert.\n- (a) make appropriate enquiry into the pre-existing mental disorder; and\n- (b) consider any psychiatric or psychological reports made available to the medical expert.","sortOrder":528},{"sectionNumber":"sch.15-pt.4","sectionType":"part","heading":"Report of PIRS rating","content":"# Report of PIRS rating","sortOrder":529},{"sectionNumber":"sch.15-sec.12","sectionType":"section","heading":"Court to be given PIRS report","content":"### sch.15-sec.12 Court to be given PIRS report\n\nThis section applies if a party to a proceeding wants a court to accept a PIRS rating assessed by a medical expert for a mental disorder of an injured worker.\nThe party must give the court a written report from the medical expert stating the following matters—\nthe mental disorder diagnosed by the medical expert;\nthe PIRS rating assessed by the medical expert for the mental disorder of the injured worker;\nhow the PIRS rating was assessed, including—\nfor each area of functional impairment stated in the PIRS—\nthe relevant clinical findings; and\nthe level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and\nthe class stated in the PIRS that corresponds to the level that was decided; and\nthe median class score and total class score worked out under section 4 ; and\nif the injured worker had a pre-existing mental disorder, the information mentioned in subparagraphs (i) and (ii) in relation to the pre-injury rating and the post-injury rating as defined under section 5 ;\ndetails of any cognitive impairment of the injured worker.\n(sch.15-sec.12-ssec.1) This section applies if a party to a proceeding wants a court to accept a PIRS rating assessed by a medical expert for a mental disorder of an injured worker.\n(sch.15-sec.12-ssec.2) The party must give the court a written report from the medical expert stating the following matters— the mental disorder diagnosed by the medical expert; the PIRS rating assessed by the medical expert for the mental disorder of the injured worker; how the PIRS rating was assessed, including— for each area of functional impairment stated in the PIRS— the relevant clinical findings; and the level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and the class stated in the PIRS that corresponds to the level that was decided; and the median class score and total class score worked out under section 4 ; and if the injured worker had a pre-existing mental disorder, the information mentioned in subparagraphs (i) and (ii) in relation to the pre-injury rating and the post-injury rating as defined under section 5 ; details of any cognitive impairment of the injured worker.\n- (a) the mental disorder diagnosed by the medical expert;\n- (b) the PIRS rating assessed by the medical expert for the mental disorder of the injured worker;\n- (c) how the PIRS rating was assessed, including— (i) for each area of functional impairment stated in the PIRS— (A) the relevant clinical findings; and (B) the level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and (C) the class stated in the PIRS that corresponds to the level that was decided; and (ii) the median class score and total class score worked out under section 4 ; and (iii) if the injured worker had a pre-existing mental disorder, the information mentioned in subparagraphs (i) and (ii) in relation to the pre-injury rating and the post-injury rating as defined under section 5 ;\n- (i) for each area of functional impairment stated in the PIRS— (A) the relevant clinical findings; and (B) the level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and (C) the class stated in the PIRS that corresponds to the level that was decided; and\n- (A) the relevant clinical findings; and\n- (B) the level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and\n- (C) the class stated in the PIRS that corresponds to the level that was decided; and\n- (ii) the median class score and total class score worked out under section 4 ; and\n- (iii) if the injured worker had a pre-existing mental disorder, the information mentioned in subparagraphs (i) and (ii) in relation to the pre-injury rating and the post-injury rating as defined under section 5 ;\n- (d) details of any cognitive impairment of the injured worker.\n- (i) for each area of functional impairment stated in the PIRS— (A) the relevant clinical findings; and (B) the level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and (C) the class stated in the PIRS that corresponds to the level that was decided; and\n- (A) the relevant clinical findings; and\n- (B) the level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and\n- (C) the class stated in the PIRS that corresponds to the level that was decided; and\n- (ii) the median class score and total class score worked out under section 4 ; and\n- (iii) if the injured worker had a pre-existing mental disorder, the information mentioned in subparagraphs (i) and (ii) in relation to the pre-injury rating and the post-injury rating as defined under section 5 ;\n- (A) the relevant clinical findings; and\n- (B) the level of impairment stated in the PIRS that the medical expert decided described the level of impairment caused by the mental disorder of the injured worker; and\n- (C) the class stated in the PIRS that corresponds to the level that was decided; and","sortOrder":530}],"analysis":{"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":8,"scope_assessment":{"changed":false,"description":"The regulation appears to be a comprehensive restatement and update of existing workers' compensation regulatory machinery in Queensland, commencing 1 September 2025. It covers the expected operational detail for a mature workers' compensation scheme — employer insurance, premium assessment, self-insurance licensing, actuarial liability calculation, and dispute resolution — without apparent expansion beyond the subject matter of the enabling Act. The scope is broad but consistent with the title and the type of subordinate legislation typically made under a workers' compensation statute."},"complexity_factors":["Multiple distinct regulatory regimes operating in parallel: standard employer insurance, self-insurance, and post-cancellation arrangements","Heavy cross-referencing to the parent Act (Workers' Compensation and Rehabilitation Act) and internal sections, requiring readers to hold multiple documents simultaneously","Intricate actuarial calculation requirements with specific technical parameters (central estimates, risk-free rate of return, prudential margins, 7% administration expense loading)","Layered dispute resolution process involving appointed actuaries, second actuaries, arbiters, and the Regulator — each with different roles and timelines","Complex financial adjustment mechanisms when liabilities transfer between entities (e.g. group membership changes, licence cancellations)","Tiered penalty/interest structures with time-sensitive triggers and compounding effects","Multiple defined terms with overlapping or similar names (e.g. 'appointed actuary,' 'second appointed actuary,' 'assessment day,' 'application day,' 'cancellation day' — each defined differently per division)","Premium calculation formulas referencing external gazette notices for rates, creating dependency on information outside the regulation itself","Instalment plan provisions with cascading consequences on policy validity and additional premiums","Separate treatment of household workers creating multiple carve-outs throughout the employer insurance provisions"],"plain_english_summary":"This Regulation fills in the operational rules for Queensland’s workers’ compensation system, prescribing how employers buy and renew WorkCover, how premiums and penalties are calculated, and detailed levy and actuarial rules and timelines for self‑insurers and the actuarial reports that support them.\n\nIt affects employers, injured workers, self‑insuring organisations, WorkCover and dispute arbiters; late declarations or unpaid premiums can trigger penalties, policy lapses and direct financial liability."},"kimi_summary":{"_metrics":{"completionTokens":792},"content_quality":"ok","complexity_score":9,"scope_assessment":{"changed":false,"description":"This appears to be a standard re-enactment or consolidation of the Workers' Compensation and Rehabilitation Regulation. The scope remains consistent with the original purpose of providing detailed operational rules for Queensland's workers' compensation scheme, covering employer insurance, self-insurance, compensation calculations, rehabilitation, and dispute resolution. The transitional provisions in Part 12 suggest this is a replacement regulation rather than an expansion of scope."},"complexity_factors":["Extensive cross-referencing to the Workers' Compensation and Rehabilitation Act and multiple schedules","Numerous defined terms including technical actuarial and medical terminology","Complex conditional logic with multiple nested exceptions (e.g., premium calculations with different rules for household workers, self-insurers, and instalment plans)","Detailed actuarial calculation requirements with multiple formulas and variables","Multiple dispute resolution pathways involving actuaries, arbiters, and tribunals","Extensive procedural requirements with strict timeframes (e.g., 35 days for actuarial reports, 60 business days for information provision)","Overlapping jurisdictions between WorkCover, the Regulator, self-insurers, and medical assessment tribunals","Detailed eligibility criteria for serious personal injuries requiring specific medical assessments and functional measures","Complex transitional provisions preserving arrangements under the expired 2014 regulation"],"plain_english_summary":"This is a Queensland regulation that sets out detailed rules for workers' compensation and rehabilitation. It covers:\n\n**Employer Insurance (Part 2)**\n- How employers apply for and renew WorkCover policies\n- How premiums are calculated based on wages, including special rules for board and lodging\n- Payment options including instalment plans for employers facing financial hardship\n- Penalties for late premium payment (5% if within 30 days, 10% if 30-60 days, 10% plus interest after 60 days)\n- How former employers can cancel policies when they stop employing workers\n\n**Self-Insurance (Part 2, Division 3)**\n- Large employers can apply to become self-insurers (paying a $15,000-$20,000 fee)\n- How their annual levy is calculated based on estimated claims liability\n- What happens when self-insurers cancel their licence or change group membership\n\n**Calculating Liability (Part 3)**\n- Complex actuarial processes for calculating outstanding and total liability when employers enter or exit self-insurance\n- Appointment of actuaries, preparation of reports, and dispute resolution through an arbiter\n- Special rules for \"non-scheme employers\" who leave the workers' compensation system\n\n**Compensation (Part 4)**\n- How normal weekly earnings are calculated for injured workers\n- What evidence is needed to claim compensation\n- Lump sum payments for permanent impairment, with extra amounts for workers with 30%+ impairment\n- Special compensation for workers with terminal conditions who can't sue for damages\n- Treatment, care and support payments for workers with serious spinal cord injuries, brain injuries, amputations, burns, or blindness\n\n**Rehabilitation (Part 5)**\n- Employers above certain wage thresholds must appoint rehabilitation coordinators\n- Their role includes early communication with injured workers and coordinating return-to-work plans\n\n**Damages and Legal Costs (Parts 7-9)**\n- Detailed requirements for notices of claim\n- How general damages are calculated using injury scale values (0-100 scale)\n- Rules for legal costs in court proceedings\n\n**Medical Assessment (Part 10)**\n- Establishes various medical assessment tribunals (General, Cardiac, Orthopaedic, etc.) to resolve disputes about injuries\n\nThe regulation is highly technical, with extensive cross-referencing to the Workers' Compensation and Rehabilitation Act and numerous schedules containing tables, scales, and detailed criteria."},"flash_summary":{"complexity_score":9,"scope_assessment":{"changed":false,"description":"This regulation largely operationalises the Act rather than expanding its substantive scope. It prescribes technical methods, timeframes, reporting content, rates and dispute procedures that implement powers already in the Act (for example, premium assessments, self‑insurer levies, actuarial determinations, tribunal constitution and treatment entitlement rules). Notable features that concentrate decision‑making (the actuarial arbiter with finality (secs 100–103)) and prescribe actuarial assumptions (e.g. no prudential margin, inclusion of 7% administration expenses (secs 30, 62)) are implementation choices within the Act’s framework rather than a material extension of the statutory scheme. The regulation therefore changes implementation detail and administrative burden rather than the scheme’s legal scope."},"complexity_factors":["Very large regulation with numerous Parts, Divisions and Schedules (many cross‑referenced)","Extensive actuarial regime: multiple appointment streams, required assumptions, firm deadlines (e.g. 35 days) across Parts 3 & schs (secs 30,31,62,63)","Arbiter mechanism with finality and narrow appeal route; selection panel includes multiple stakeholders (secs 100–104)","Many cross‑references to the principal Act (dozens of specific section citations throughout)","Multiple conditional flows and time limits (provisional vs actual levies, referral thresholds, periods for payment and notification)","Numerical formulas and thresholds (rates, proportion calculations, QOTE‑linked thresholds, fee units) scattered across text (secs 15,17,18,147)","Complex medico‑legal methodology (PIRS conversion table, median/total class score algorithm) in schedules 15–16","Nested disputes processes: agreement → second actuary → arbiter (secs 65–68)","Multiple specialist reporting standards and prescribed report content (medical, occupational therapy, actuarial)","Transitional and savings provisions preserving prior regulation interactions (pt.12)"],"plain_english_summary":"**What this regulation does (mechanics first)**\n\n- Sets out detailed administrative and technical rules that put the Workers’ Compensation and Rehabilitation Act into operation. It does not change the Act’s high‑level policy but prescribes how many Act powers are to be exercised (forms, time limits, formulas, assessment methods and decision processes). Key mechanical items include:\n  - Employer insurance: how employers apply for and renew WorkCover policies, when a policy takes effect, annual wage declarations and late‑payment penalties (secs 5–11).  Interest rates on instalment plans and late payments are fixed by WorkCover’s board or the Regulator and published in the gazette (secs 10, 22). \n  - Self‑insurance mechanics: application fees, annual levies, how levies are calculated (specified date, estimated claims liability and rate), provisional and final levy procedures, and how premiums are set for former self‑insurers (secs 17–25). \n  - Actuarial calculations and reporting: detailed rules requiring appointed actuaries (for WorkCover, insurers, self‑insurers or former self‑insurers) to use actuarial standards, a central estimate, the risk free rate, include 7% for claims administration expenses, exclude prudential margins, and produce written reports within specified deadlines (secs 26–66, 72–85, 50–57, 81–85, 83–85). \n  - Dispute resolution between actuaries/insurers: where parties (WorkCover, insurers, Regulator, self‑insurer, former self‑insurer, members) cannot agree on liabilities the Regulator refers reports to an appointed actuarial arbiter; the arbiter decides within strict bounds and the decision is final except for jurisdictional error (secs 100–104, 34, 45, 56, 68, 87, 97, 102–103).\n  - Compensation and damages standards: methods for calculating Normal Weekly Earnings (NWE), lump sum compensation (DPI × statutory maximum), supplementary lump sums and graduated scales for particular injuries, occupational therapist assessment forms and caring allowance calculations tied to the Commonwealth carer pension rate (secs 105–121, schedules 2–4, 8). \n  - Standards and panels for additional permanent impairment compensation (section 193A): eligibility tests, insurer notice, review panel procedures, time limits and finality of panel decisions (secs 122–141). \n  - Treatment, care and support payments (serious personal injury): eligibility criteria for defined injuries, assessment requirements (who may assess, what evidence is needed), support plan content, intervals for reassessment, payment request rules and cost caps tied to the regulation’s table of costs (secs 151–175, 161–174). \n  - Medical assessment tribunals: which tribunals exist, how they are constituted, who appoints chairpersons and members, and delegation rules (secs 197–205). \n  - Court and costs rules for damages claims: prescribed particulars in notices of claim, pre‑proceeding and post‑proceeding cost scales and allowable outlays (secs 177–196, schedules 9 and 17). \n  - Permanent impairment of mental disorder (PIRS): a prescribed 6‑scale method for assessing and reporting permanent psychiatric impairment; strict requirements for medical experts and report content; and how courts are to use PIRS with injury scale values (schedules 15–16 and related sections).\n\n**Who it affects**\n\n- Employers (all sizes): premium notices, wage declarations (deadlines and late penalties), instalment plans and the obligation to appoint rehabilitation coordinators once size thresholds are met (secs 6–11, 8, 10, 149).  Employers who are or wish to be self‑insurers face significant actuarial reporting and levy rules (secs 17–25, 58–68). \n- Self‑insurers, former self‑insurers and group employers: detailed actuarial calculations, levy methodology, information disclosure and transfer of claims data when membership changes or licences cancel (many rules in pt.3). \n- WorkCover and private insurers: operational responsibilities (issuing policies, paying or collecting adjusted amounts, providing claims information, appointing actuaries), and discretion to approve instalment plans and payment requests (secs 6, 10, 35–36, 79). \n- Injured workers and claimants: rules for calculating NWE, eligibility definitions for treatment/care payments, PIRS and ISV guidance used by courts (secs 105–109, 151–175, schedules 13–16). \n- Actuaries, medical experts and tribunal/panel members: new or clarified obligations about standards, timeframes and report content (secs 30–35, 31, 63, sch.15). \n- The Regulator, arbiter and ministerial appointees: appointment powers, specification of dates/rates and administrative rules (secs 18, 100, 142).\n\n**Why it matters (practical effects and the trade‑offs)**\n\n- Predictability and technical standardisation: the regulation standardises actuarial methods (central estimate, risk free rate, 7% admin loading, no prudential margin) and medical assessment formats (PIRS, occupational therapist reports). That reduces disagreement about method but transfers weight to appointed actuaries and medical experts (secs 30, 62, sch.15). \n\n- Cashflow and cost impacts for employers and self‑insurers: levies, premium formulas and late‑payment penalties (5%, 10% then interest) create clear financial incentives to comply on time (secs 11, 22). Interest rates and some rates are set by WorkCover’s board or the Regulator and published by gazette notice (secs 10, 22, 18). \n\n- Compliance burden and implementation risk: frequent, prescriptive reporting deadlines (many actuarial reports due within 35 days; summary reports within 2 months), strict data currency requirements and forms increase administrative costs for self‑insurers, employers and medical/actuarial service providers (secs 31, 32, 42, 54, 75, 84). Data quality and timeliness are critical to actuarial results (secs 30, 62). \n\n- Centralised, final dispute resolution: the actuarial arbiter has a tight selection process (panel of six nominators) and decisions are final except for jurisdictional error; the arbiter’s costs are allocated equally between the contesting parties (secs 100–104). Finality reduces protracted litigation but concentrates the power to resolve high‑value actuarial disputes in a single decision‑maker. The selection mechanism gives nominating roles to the Regulator, WorkCover and the Association of Self Insured Employers (sec 100). \n\n- Effects on legal remedies and court processes: the schedules give courts practical tools (injury scale ranges, PIRS, conversion tables). Medical evidence must explain how impairment was calculated (sch.13‑sec.11, sch.15‑sec.12). That increases technicality of court evidence and favours properly formatted expert reports. \n\n**Who pays and who decides (summary)**\n\n- Payers: employers (premiums, late charges), self‑insurers (levies), non‑scheme employers (finalised liabilities), insurers (caring allowances, costs where ordered) and parties to actuarial disputes (share arbiter costs) (secs 7–11, 18–25, 88, 104, 147). \n- Decision‑makers: WorkCover (policy/claims administration), the Regulator (levy dates, appointing actuarial arbiter), appointed actuaries (calculations and reports), the arbiter (binding actuarial decisions), insurers (entitlement decisions and approvals of treatment), and review panels (193A) and courts (ISV/DPI assessments) (secs 18, 28–35, 100–103, 122–141, sch.13)."}},"importantCases":[],"_links":{"self":"/api/acts/workers-compensation-and-rehabilitation-regulation-2025","history":"/api/acts/workers-compensation-and-rehabilitation-regulation-2025/history","analysis":"/api/acts/workers-compensation-and-rehabilitation-regulation-2025/analysis","conflicts":"/api/acts/workers-compensation-and-rehabilitation-regulation-2025/conflicts","importantCases":"/api/acts/workers-compensation-and-rehabilitation-regulation-2025/important-cases","documents":"/api/acts/workers-compensation-and-rehabilitation-regulation-2025/documents"}}