7Cost of claims: clause 152 (1) (a1) of the Regulation

7 Cost of claims: clause 152 (1) (a1) of the Regulation

7 Cost of claims: clause 152 (1) (a1) of the Regulation

(1) For the purposes of clause 152 (1) (a1) of the Workers Compensation Regulation 2010, the cost of claims, in relation to an injury year related to, or a period of insurance for, a policy, means the total of the costs of each individual claim of which the insurer has notice at the time of renewal of the policy concerned, being a claim made against a particular employer with respect to an injury received (or that is deemed by the Act or the former Act to have been received) during a prior injury year or the period of insurance, whichever is relevant, but not including any claim under section 10 (Journey claims) or 11 (Recess claims) of the Act.

Note—

Clause 152 (1) of the Workers Compensation Regulation 2010 provides that, in any case where a single event leads to 3 or more individual claims, the total costs of all those claims in relation to that event are not to exceed the amount that is twice the relevant large claim limit for the policy.

(2) In subclause (1), the cost of an individual claim (C) is to be calculated using the following formula:

where:

C is the cost of the individual claim.

CC is the unadjusted costs of the individual claim calculated in accordance with subclauses (3)–(5).

R% is the amount recovered as a percentage of the total cost of an individual claim calculated in accordance with subclause (6).

RTWI% is the return to work incentive percentage for the employer and is:

(a) for a small employer—0, and

(b) for an experience-rated employer—calculated with respect to the period of insurance in accordance with subclause (7).

(3) In subclause (2), CC is $150,000 (being the large claim limit for the policy) or the sum of the following at the commencement of the period of insurance, whichever is the lesser:

(a) weekly compensation payments, if any, made by the insurer in respect of the claim pursuant to the Act,

(b) provisional weekly payments of compensation, if any, under Part 3 of Chapter 7 of the 1998 Act by the insurer, being payments of compensation on the basis of provisional acceptance of liability to a worker,