Return to Work Corporation (Claims Management—Contractual Arrangements) Regulations 2025

The Regulations centre on a small set of interconnected legal concepts: authorised contract, Claims Agent's services, delegation, performance-based contracting, corporate control over claim allocation, financial and liability separation, monitoring and evaluation methods, and operational prerequisites.

Authorised contract is the key legal device. Regulation 4 defines the terms or effects a contract must include to qualify as authorised under the Corporation Act reference in the Regulations, and thereby permits the Corporation to delegate certain powers to a private sector body. That authorisation is limited to contracts that confer powers referred to in section 14(3) of the Corporation Act, excluding the power to collect premiums, payments and fees, and that otherwise meet the operational and governance requirements set out in r 4(1) and (2).

Claims Agent's services is defined in reg 3 as the services provided under such a contract. The Regulations delineate what those services may include: management and determination of claims under the Return to Work Act 2014, and implementation or management of programs aimed at recovery and return to work (r 4(1)(c)). The scope of these services is to be specified within each contract, so the term works as a contractual umbrella rather than a precise statutory duty.

Delegation and statutory function exercise are permitted, but constrained. A Claims Agent may exercise such of the Corporation's statutory functions, powers and discretions as are necessary to perform its contract functions (r 4(1)(d)), and for the contract purposes the agent is to be appointed a delegate under s 17 of the Corporation Act (r 4(1)(e)). These provisions create a legal mechanism for private bodies to carry out functions that have statutory character, while retaining an administrative formality of delegation under s 17.

Performance-based contracting is emphasised. Initial terms are capped at five years, with extension rights for periods not exceeding five years, and renewals are conditional upon the Claims Agent achieving "a satisfactory level of performance in the opinion of the Corporation" and on agreement of financial terms for the extension (r 4(1)(a) and (b)). Fee arrangements are expressly tied to quality, successful performance, and other performance measures, including outcomes related to claims or scheme operation (r 4(1)(i) and (j)). The Regulations require contracts to include a method for monitoring and evaluating performance, and an agreed method for improving performance (r 4(2)(b)(i) and (ii)). The Corporation may adjust fees based on evaluations performed in accordance with those methods (r 4(1)(j)).

Corporate control over claim allocation and operational prerequisites are explicit. The Corporation retains authority to determine the number and identity of claims managed by the Claims Agent (r 4(1)(h)), to step in and take over management or determination of claims for specified reasons (r 4(1)(k)), to withhold approval for assignment or subcontracting (r 4(1)(n)), and to require use of specified IT systems and approved training programs (r 4(1)(p) and (q)). The requirement of a certificate of readiness from the Corporation before the Claims Agent may commence managing claims (r 4(1)(r)) establishes a formal gating mechanism.

Financial and liability separation is a central constraint. The Regulations state the Corporation’s liability to pay compensation under the Return to Work Act 2014 is not underwritten by the Claims Agent (r 4(1)(f)), and that the Claims Agent is not entitled to receive or invest premiums, payments or fees paid by employers under that Act (r 4(1)(g)). Those provisions separate statutory compensation obligations and premium flow from the commercial arrangements with the agent.

Governance concepts are mandated. Contracts must regulate external service provider use (r 4(2)(a)), include a code of conduct consistent with specified statutory provisions (r 4(2)(b)(iii)), and provide mechanisms for monitoring, evaluation and agreed improvement. The Regulations therefore require explicit governance constructs to be embedded in contractual documentation, rather than leaving governance entirely to private negotiation.

Continuity and repeal are also concepts to note. Contracts extended or assigned in accordance with the specified terms remain authorised contracts (r 4(3)). Schedule 1 expressly repeals the 2015 Regulations, creating a single, updated regulatory instrument governing these contractual arrangements.

Primary parties affected are the Return to Work Corporation of South Australia (the Corporation) and private sector entities that enter into authorised contracts as Claims Agents. Regulation 4(1) explicitly contemplates contracts between the Corporation and a private sector body described as the Claims Agent. The Corporation retains numerous decision-making powers under the Regulations: it determines which claims, and how many, are assigned to a Claims Agent (r 4(1)(h)); it decides whether the Claims Agent has achieved a satisfactory level of performance for extensions (r 4(1)(b)(i)); it agrees the financial terms for any extension (r 4(1)(b)(ii)); it may issue a certificate of readiness before the agent begins services (r 4(1)(r)); it may step in to take over claims management or determination for reasons specified in the contract (r 4(1)(k)); it may terminate contracts or exercise other remedies on breach (r 4(1)(l)); and it may withhold approval for assignment or use of subcontractors (r 4(1)(n)). Those provisions allocate significant control and discretion to the Corporation in practice.

Claims Agents are affected in their commercial scope, operational design and financial arrangements. They are authorised to manage and determine claims and implement return-to-work programs as agent for the Corporation (r 4(1)(c)). They may be authorised to exercise the Corporation’s statutory functions to the extent necessary to perform their contractual functions (r 4(1)(d)), and must be appointed as delegates under s 17 for that purpose (r 4(1)(e)). However, Claims Agents cannot underwrite the Corporation’s statutory compensation liability (r 4(1)(f)), cannot receive or invest employer premiums (r 4(1)(g)), and cannot commence managing claims until the Corporation issues a certificate of readiness (r 4(1)(r)). They must use Corporation-specified IT on Corporation-determined terms (r 4(1)(p)) and implement employee training programs subject to Corporation requirements and approval (r 4(1)(q)). They must also comply with a code of conduct consistent with s 3 of the Return to Work Act 2014 and s 12 of the Return to Work Corporation Act (r 4(2)(b)(iii)) and act in accordance with section 185 of the Return to Work Act 2014 as it applies to the Corporation (r 4(1)(o)).

Employers and injured workers are indirectly affected. Employers continue to pay premiums under the Return to Work Act 2014, but the Regulations prohibit the Claims Agent from receiving or investing those premiums (r 4(1)(g)), preserving the flow of premium funds outside the agent’s control. Injured workers will have claims managed or determined by either the Corporation or an authorised Claims Agent, but the Regulations make clear the Corporation’s statutory liability to pay compensation remains intact (r 4(1)(f)). The practical effect is that while private agents perform operational tasks, statutory financial obligations and premium stewardship remain with statutory entities.

External service providers and subcontractors are affected by explicit regulatory constraints. A contract must regulate the Claims Agent’s use of external providers (r 4(2)(a)), and assignment or subcontracting requires Corporation approval which the Corporation may withhold at its discretion (r 4(1)(n)). This means suppliers and subcontractors will often be engaged only through structures approved by the Corporation and in line with contract rules.

Regulatory and administrative staff within the Corporation will be affected operationally. The Corporation is given decision nodes that require oversight and exercise of discretion: performance evaluation for extensions, approval of training programs and IT systems, issuance of certificates of readiness, step-in powers, assignment approvals and fee adjustments. Those functions create ongoing administrative work and discretion-dependent risk.

Finally, the Regulations affect the legal framework itself by repealing the 2015 Regulations (Schedule 1). Any contracts authorised under the 2015 Regulations will have to be considered against the new regulatory template where extensions or new contracts are negotiated.

The Regulations distribute duties and rights primarily through contract terms that must be included or may be included for a contract to qualify as an authorised contract.

Duties of the Claims Agent under an authorised contract

• Manage and determine claims under the Return to Work Act 2014, and implement or manage programs to assist or encourage recovery and return to work, as agent for the Corporation (r 4(1)(c)). The precise scope is to be specified in the contract.
• Act in accordance with section 185 of the Return to Work Act 2014 as it applies to the Corporation, whether employed or engaged by the Claims Agent (r 4(1)(o)).
• Use information technology systems of a kind specified by the Corporation on terms and conditions determined by the Corporation (r 4(1)(p)).
• Prepare, maintain and implement an employee training program in accordance with Corporation requirements, and submit the program or specified parts for approval (r 4(1)(q)).
• Observe a code of conduct consistent with section 3 of the Return to Work Act 2014 and section 12 of the Return to Work Corporation Act 1994, as included in the contract (r 4(2)(b)(iii)).
• Regulate use of external service providers in the manner required by the contract (r 4(2)(a)).
• Comply with monitoring, evaluation and performance improvement methods agreed in the contract (r 4(2)(b)(i) and (ii)).
• Not receive or invest premiums, payments or fees paid by employers under the Return to Work Act 2014 (r 4(1)(g)).
• Refrain from commencing management and determination of claims until a certificate of readiness is issued by the Corporation (r 4(1)(r)).
• Not assign the contract or parts of it, or use subcontractors, without Corporation approval, which approval may be withheld at the Corporation’s discretion (r 4(1)(n)).

Rights of the Claims Agent under an authorised contract

• The right to manage and determine claims as agent, and to exercise such statutory functions, powers and discretions of the Corporation as necessary for performance of its contractual functions, as specified in the contract (r 4(1)(c) and (d)).
• The ability to be appointed a delegate under section 17 of the Corporation Act for the purposes of providing services under the contract (r 4(1)(e)).
• A contractual right to a fee paid by the Corporation in consideration for its services, subject to contractual adjustment mechanisms (r 4(1)(i)).

Duties and rights of the Corporation under an authorised contract

• Duty to specify the number and identity of claims to be managed by the Claims Agent, in a manner specified from time to time (r 4(1)(h)).
• Right to determine whether a Claims Agent’s performance is satisfactory for the purpose of extending the contract (r 4(1)(b)(i)), and the right to agree financial terms for extension (r 4(1)(b)(ii)).
• Right to step in and take over management or determination of specific claims or classes of claims at any time for reasons specified in the contract (r 4(1)(k)).
• Right to adjust the fee paid to the Claims Agent on the basis of quality, performance and other performance measures, and for any other reason (r 4(1)(i) and (ii)).
• Right to terminate the contract in the event of breach, or to exercise other remedies or sanctions as appropriate (r 4(1)(l)).
• Right to terminate the Claims Agent’s services, or part of them, taking into account performance or other agreed bases (r 4(1)(m)).
• Discretion to withhold approval for assignment or subcontracting (r 4(1)(n)).
• Duty to issue a certificate of readiness certifying the Claims Agent is ready to provide the service before the agent begins managing and determining claims (r 4(1)(r)).

Other formal duties and constraints

• Contracts must include mechanisms for monitoring and evaluating the Claims Agent’s performance, a mutually agreed method for performance improvement, and a code of conduct consistent with specified statutory provisions (r 4(2)(b)(i)-(iii)).
• Contracts must regulate the use of external service providers by the Claims Agent (r 4(2)(a)).
• Contracts extended or assigned in accordance with the permitted terms continue as authorised contracts (r 4(3)).

Enforcement and remedial rights

• The Regulations specify contractual remedies as the primary enforcement mechanism: termination for breach, other remedies and sanctions as provided in the contract, step-in rights and fee adjustment powers (r 4(1)(k), (l), (m), (i)). The Regulations do not themselves specify statutory pecuniary penalties or criminal offences; they create a contractual framework that affords the Corporation specific remedial rights for non-compliance or unsatisfactory performance.

These duties and rights create a contracting template that places operational execution with a private body, while retaining legal liability, premium stewardship and significant operational control with the Corporation. The Regulations embed performance-linked fee mechanisms and require governance arrangements to be expressly agreed and documented in contracts.

The Regulations do not create an express suite of statutory penalties, fines or criminal offences within their text. Enforcement mechanisms and penalties are primarily contractual and administrative, embedded in the rights and remedies that the Corporation may exercise under an authorised contract.

Contractual enforcement mechanisms provided for or contemplated by the Regulations include:

• Termination for breach. Regulation 4(1)(l) expressly allows the Corporation, in the event of a breach by the Claims Agent, to terminate the contract. The regulation also contemplates "other remedies or sanctions" that may be appropriate in the circumstances, but leaves the specification of those remedies to the contract itself.
• Step-in rights. Regulation 4(1)(k) gives the Corporation the contractual right to step in at any time, for such reasons as may be specified in the contract, and take over management or determination of a specific claim or classes of claims. This is an administrative remedy that interrupts performance and reassigns operational control.
• Partial or full termination on performance grounds. Regulation 4(1)(m) permits the Corporation to terminate the Claims Agent's services, or part of those services, having regard to performance or on other agreed bases. This creates a contractual termination right tied to performance evaluations.
• Fee adjustments. Regulation 4(1)(i) provides for the Corporation to adjust the fee payable to the Claims Agent having regard to quality, degree of successful performance and other performance measures. Regulation 4(1)(ii) permits fee adjustments for any other reason. Fee reduction is a de facto enforcement tool and an economic lever available to the Corporation.
• Approval powers construed as control. The Corporation’s power to withhold approval for assignment or subcontracting (r 4(1)(n)), and to require specific IT systems and training program approvals (r 4(1)(p) and (q)), create indirect enforcement or compliance levers. Withholding approval can suspend arrangements that a Claims Agent may seek to implement.

What the Regulations do not supply in terms of enforcement

• They do not set out civil pecuniary penalties that are immediately payable for specific contraventions of the Regulations. The Regulations rely on contractual remedies rather than new statutory sanctions.
• They do not designate criminal offences within the text for breaches of their specific clauses.
• They do not specify a dispute resolution regime; those matters are left to contract drafting, subject to any applicable Acts.

Legal and administrative enforcement implications

• The Regulations’ reliance on contract terms means that enforcement will commonly proceed under contract law, through contractual dispute processes, termination notices, claims for damages, or performance remediation procedures agreed by the parties.
• The appointment of Claims Agents as delegates under s 17 of the Return to Work Corporation Act 1994 (r 4(1)(e)) and the provision permitting exercise of statutory functions (r 4(1)(d)) may create points of legal accountability where the performance of delegated statutory functions raises questions about administrative law obligations or the Corporation’s residual legal responsibilities. The Regulations do not specify judicial review mechanisms or administrative sanction processes; those questions would arise under the relevant Acts and common law principles outside the text of these Regulations.
• The Regulations’ provision that the Claims Agent must act in accordance with section 185 of the Return to Work Act 2014 as it applies to the Corporation (r 4(1)(o)) suggests statutory duties in that provision will bind agents in some form, but the Regulations do not themselves define consequences for breach of section 185.

Practical enforcement pathways

• The Corporation can use contract drafting to create precise remedies, timelines, default events, performance thresholds and dispute resolution procedures. The Regulations prespecify broad classes of remedies that may be included but leave specificity to the contract.
• Where disputes arise about application of statutory functions delegated to agents, or about whether agent actions are consistent with statutory duties that apply to the Corporation, such disputes may engage statutory interpretation and administrative law avenues under the relevant Acts, but the Regulations do not set those processes out.

In summary, enforcement under these Regulations is primarily through contractual rights and administrative controls retained by the Corporation: termination, step-in, fee adjustments, and approval powers. The Regulations do not, in themselves, create independent statutory penalty provisions.

The Regulations are expressly framed to operate in the statutory ecosystem created by the Return to Work Corporation of South Australia Act 1994 and the Return to Work Act 2014. They cross‑refer to particular sections of those Acts and require certain contractual consistency with statutory provisions.

Primary statutory interactions

• Return to Work Corporation of South Australia Act 1994. The Regulations authorise contracts for the purposes of section 14(4)(d) of the Corporation Act (r 4(1) preamble). They require that, for the purpose of providing the Claims Agent’s services, the Claims Agent is to be a delegate of the Corporation under section 17 of that Act (r 4(1)(e)). The Regulations also require that contracts include a code of conduct consistent with section 12 of the Corporation Act (r 4(2)(b)(iii)). These references create a direct legal relationship between delegation and the statutory framework governing the Corporation’s powers.
• Return to Work Act 2014. The Regulations treat management and determination of claims as functions under the Return to Work Act 2014 (r 4(1)(c)). They also require that the Claims Agent, or a person employed or engaged by the Claims Agent, act in accordance with section 185 of the Return to Work Act 2014 as it applies to the Corporation (r 4(1)(o)). The Regulations further preserve the Corporation’s statutory liability to pay compensation under the Return to Work Act 2014, by expressly providing that the Corporation’s liability is not underwritten by the Claims Agent (r 4(1)(f)). Finally, the Regulations prohibit Claims Agents from receiving employer premiums payable under the Return to Work Act 2014 (r 4(1)(g)).

Consequences of delegation and statutory function exercise

• Delegation under section 17 is the formal mechanism by which the Corporation may enable a private body to exercise statutory functions. The Regulations require that the contract provide for delegation under section 17 (r 4(1)(e)). Because the Regulations permit the Claims Agent to exercise such statutory functions, powers and discretions as are necessary to perform its contract functions (r 4(1)(d)), questions may arise about the limits of delegation, the Corporation’s residual statutory accountability, and the legal character of decisions made by delegates. The Regulations themselves do not define the legal consequences of delegated decisions, leaving those matters to the relevant Acts and general administrative law.

Partition of financial flows and liabilities

• Reg 4(1)(f) and (g) create legal boundaries: the Corporation retains liability to pay compensation under the Return to Work Act 2014 and the Claims Agent is prohibited from receiving premiums payable by employers under that Act. This preserves statutory financial arrangements under the Return to Work Act 2014 and prevents commercialisation of premium receipt or investment via the Claims Agent contract.

Contractual governance vis-à-vis statutory duties

• The Regulations require contracts to include a code of conduct consistent with section 3 of the Return to Work Act 2014, and section 12 of the Corporation Act (r 4(2)(b)(iii)). Those statutory provisions will therefore frame expected standards of conduct for Claims Agents as incorporated into contracts, but the Regulations do not themselves restate the substantive content of those sections.

Limits on the scope of authorised delegation

• The Regulations exclude from authorisation the power to collect premiums, payments and fees, even if that power is referenced among the Corporation’s powers in section 14(3) of the Corporation Act (r 4(1) opening). Thus, although the Regulations permit exercise of many statutory powers necessary for claims management, they explicitly preclude transferring premium collection or investment tasks to private agents.

Interaction with contract and administrative law

• The Regulations frame a contract-based regulatory ecosystem. Remedies for breach and enforcement are primarily contractual. Where actions by the Claims Agent involve delegated statutory functions, questions of administrative law, judicial review, or statutory interpretation under the relevant Acts may arise. The Regulations do not prescribe how conflicts between contract terms and statutory duties would be resolved if they occur; statutory supremacy principles in applicable Acts will govern those conflicts.

Repeal of prior subordinate instrument

• Schedule 1 repeals the Return to Work Corporation (Claims Management,Contractual Arrangements) Regulations 2015, meaning that the 2015 regulatory instrument is displaced by this 2025 instrument. Contracts and practices established under the 2015 Regulations will need to be reconciled with the new regulatory template where relevant.

In short, the Regulations operate as an instrument that integrates private contracting for claims management into the statutory architecture of the Return to Work scheme, by mandating delegation formalities, preserving statutory financial and compensation responsibilities, and requiring contractual alignment with certain statutory codes of conduct and standards.

The Regulations are presented as a principal instrument made in 2025. The tabulated legislative history at the end of the instrument provides limited metadata: the instrument is numbered 15 for 2025, was referenced in the Gazette on 1 May 2025 at page 824, and has a stated commencement date of 4 December 2025 (Legislative history notes; reg 2). There are no amendments recorded within the text of the instrument itself.

Key amendment and repeal steps embedded in the instrument

• Repeal of the 2015 Regulations. Schedule 1 expressly repeals the Return to Work Corporation (Claims Management,Contractual Arrangements) Regulations 2015. This is a consequential repeal, bringing the 2015 regime to an end and replacing it with the 2025 regulatory template.
• No further amendments. The document as supplied does not include any later amending instruments, transitional provisions beyond the certificate of readiness requirement, or sunset clauses. There is no textual history of previous amendments to the 2025 Regulations included in the source.

Commencement provision

• The Regulations specify a commencement date of 4 December 2025 (reg 2). The Gazette reference indicates the instrument was published earlier in the year, on 1 May 2025, but with a later operational commencement date. The gap between publication and commencement creates an implementation window during which parties can prepare for compliance.

Implications for contracts in existence prior to repeal

• The Regulations do not specify transitional arrangements for contracts entered under the 2015 Regulations, nor do they state whether previously authorised contracts remain valid following repeal. However, reg 4(3) confirms that a contract extended pursuant to a permitted term, or assigned in accordance with the assignment rule, continues as an authorised contract. That clause operates within the definition of authorised contracts in the 2025 Regulations rather than providing detailed transitional rules for contracts authorised under the repealed 2015 Regulations. The source does not supply further transition provisions.

Absence of amendment history elements

• The instrument lacks recorded amendments, schedules with staged implementation beyond the certificate requirement, or footnotes indicating transitional provisions. Users should therefore treat the instrument as the primary operative instrument from its commencement date, and consult the Gazette notification and the enabling Acts for any further legislative or administrative materials that might frame transitional handling. Those materials are not part of the text provided.

In sum, the principal amendment event recorded within the source is the repeal of the 2015 Regulations by Schedule 1. The 2025 Regulations themselves are presented as the operative framework as from 4 December 2025, with no internal amendment history noted in the instrument.

The Regulations supplied contain no references to case law, judicial decisions, or prior litigation. There are no named cases in the text, and the instrument does not describe any judicial interpretation of the provisions it contains. The absence of litigation references in the Regulations has several immediate implications for users and contracting parties.

Absence of authoritative judicial interpretation

• Because there is no litigation history recorded in the instrument, the contractual and statutory interactions it contemplates have not, as far as the Regulations themselves show, been the subject of judicial interpretation within the text. That means the precise legal contours of several open questions will depend on future administrative practice, contract drafting, and, potentially, litigation or tribunal review.

Areas likely to attract legal disputes

• Delegation and exercise of statutory functions. The Regulations permit a Claims Agent to exercise such of the Corporation’s statutory functions, powers and discretions as are necessary to perform contractual functions (r 4(1)(d)), and they require delegation under section 17 of the Corporation Act (r 4(1)(e)). Disputes are foreseeable about the appropriate scope of delegated powers, whether particular decisions are properly within the agent’s delegated authority, and the Corporation’s residual accountability for decisions taken by a delegate.
• Fee adjustments and "any other reason". The Regulations allow the Corporation to adjust fees for quality and performance and "for any other reason" (r 4(1)(i) and (ii)). That open-ended formulation could produce disputes about the reasonableness of fee adjustments and the contractual processes that must be followed before adjustments are made.
• Step-in and termination rights. The Corporation’s power to step in and take over management of claims, and its termination powers on breach or performance grounds (r 4(1)(k), (l) and (m)), may give rise to disputes about whether the contractual conditions for step-in or termination have been met, and about compensation for premature termination.
• Use of subcontractors and assignment approvals. The discretion conferred on the Corporation to withhold approval for assignment or subcontracting (r 4(1)(n)) may lead to litigation where a Claims Agent advances operational necessity arguments against withheld approvals.

Implication of no recorded litigation

• The legal landscape will be shaped by contract drafting, Corporation policy, and the first disputes that arise under authorised contracts. Until courts or tribunals provide authoritative interpretations, parties will rely heavily on the express terms of each contract and on administrative practice to resolve ambiguous areas.

Practical caution

• Parties preparing contracts under these Regulations should anticipate points of uncertainty and either negotiate highly detailed contractual processes for fee adjustment, performance measurement, step-in triggers and approval processes, or expect that future litigation or tribunal decisions may be relied upon to clarify grey areas. The Regulations themselves do not provide judicial guidance or precedent.

In short, the Regulations contain no litigation history. This increases the importance of careful contract drafting and robust governance arrangements to manage legal risk and to crystallise dispute resolution procedures in the absence of statutory case law guidance.

The Regulations set up a framework that appears straightforward, but several aspects create sharp practical and legal friction points that contracting parties and compliance officers should note.

Open-ended fee adjustment power

• Regulation 4(1)(i)(ii) permits the Corporation to adjust the Claims Agent’s fee "for any other reason". That phrasing is wide-ranging and potentially unpredictable. Although fee adjustments can be linked to evaluation methods in r 4(1)(j), the bracketed "for any other reason" retains broad unilateral adjustment capacity. Claims Agents should be wary that revenue streams could be adjusted with limited contractual constraints unless detailed protections are negotiated in the contract.

Discretionary renewal test

• Extension rights for up to five years are conditional on the Claims Agent achieving a "satisfactory level of performance, in the opinion of the Corporation" (r 4(1)(b)(i)). The test is a subjective standard vested in the Corporation. Unless the contract adds objective performance thresholds and dispute mechanisms, renewals could hinge on the Corporation’s subjective view.

Unpredictable volume and allocation of work

• The Corporation determines the number of claims and identity of claims to be managed by the Claims Agent, "in a manner specified by the Corporation from time to time" (r 4(1)(h)). This allows the Corporation to alter a Claims Agent’s workload and case mix over time. That produces volume risk and potential mismatches between staffing, fee structures and operational capacity.

Step-in and partial termination risk

• The Corporation may step in and take over management or determination of specific claims or classes of claims at any time for reasons specified in the contract (r 4(1)(k)), and may terminate the Claims Agent’s services or part of them with regard to performance (r 4(1)(m)). These rights allow operational interruption and partial service removal, which can have material commercial impacts. Contracts must address consequences, notice periods and compensation for such events.

Assignment and subcontracting hurdles

• The Claims Agent cannot assign the contract or make use of subcontractors without Corporation approval, which the Corporation may withhold at its discretion (r 4(1)(n)). This affects the agent’s ability to restructure, to outsource specialist functions or to assign rights in the event of insolvency. Approval at the Corporation’s discretion is a control point that can hinder operational flexibility.

IT and training terms dictated by the Corporation

• The contract must require the agent to use information technology systems of a kind specified by the Corporation on terms and conditions determined by the Corporation (r 4(1)(p)), and a training program must meet Corporation requirements and be submitted for approval (r 4(1)(q)). The Corporation controls technology standards and learning curricula. The cost, timing and contractual liability around compliance with those specifications can be material.

No underwriting, no premium access

• The Regulations make plain that the Claims Agent cannot underwrite the Corporation’s liability to pay compensation (r 4(1)(f)) and cannot receive or invest premiums or payments paid by employers under the Return to Work Act 2014 (r 4(1)(g)). Those constraints limit revenue models for Claims Agents, prevent risk transfer in the form of underwriting, and restrict financial intermediation opportunities.

Certificate of readiness prerequisite

• The agent may not provide claims management services until the Corporation issues a certificate of readiness (r 4(1)(r)). That certificate is a gating mechanism; its issuance will be subject to Corporation assessment processes that should be clarified in contract. Delays in issuance will postpone revenue and may expose agents to carrying costs.

"Act in accordance with" statutory provisions without textual clarity

• The agent and its personnel must act "in accordance with section 185 of the Return to Work Act 2014, as it applies to the Corporation" (r 4(1)(o)), and the contract must include a code of conduct consistent with section 3 of the Return to Work Act 2014 and section 12 of the Corporation Act (r 4(2)(b)(iii)). The Regulations do not restate those statutory provisions. Parties must therefore examine the Acts to determine the practical obligations created by those cross-references. The absence of those texts in the Regulations means obligations could be extensive yet not visible on the face of the contract.

Monitoring, evaluation and improvement methods need agreement

• Contracts must include methods for monitoring and evaluating performance and an agreed method for improving performance (r 4(2)(b)(i) and (ii)). The Regulations require these elements, but leave the content and thresholds to agreement. If the methods are poorly defined, disputes about whether performance metrics have been met, or whether remedial steps are adequate, are likely.

Continuation of extended or assigned contracts

• Regulation 4(3) states that contracts extended pursuant to compliant terms, or assigned in accordance with the assignment rule, continue as authorised contracts. However, because assignment requires Corporation approval which may be withheld, the practical ability to effect assignments is limited, and the continuation clause may not facilitate effective commercial transfer if approval is denied.

Repeal risks for existing arrangements

• Schedule 1 repeals the 2015 Regulations. There is no detailed transitional provision in the text for existing contracts under the 2015 Regulations. Parties should check whether their contracts remain authorised and how the repeal affects obligations and operational arrangements in practice, particularly where contracts span both instruments.

In short, the Regulations concentrate discretion with the Corporation in ways that can materially affect a Claims Agent’s revenues, operational model and ability to subcontract or assign. Robust drafting around fee adjustment, performance metrics, notice periods, consequences of step-in, dispute resolution and certification is essential to mitigate these "gotchas".

Compliance requires alignment of contract drafting, operational readiness, governance arrangements, information technology, workforce training, and ongoing performance monitoring with the requirements set out in the Regulations.

Contract drafting and negotiation

• Ensure the contract explicitly contains the terms required by r 4(1) and r 4(2). Those matters include: initial term not exceeding five years (r 4(1)(a)); extension rights consistent with r 4(1)(b); scope clauses that specify the management and determination of claims, and recovery and return-to-work programs (r 4(1)(c)); delegation clauses under section 17 of the Corporation Act (r 4(1)(e)); express confirmation that the Corporation’s compensation liability is not underwritten by the Claims Agent (r 4(1)(f)); prohibition on receiving or investing employer premiums (r 4(1)(g)); allocation clauses for number and identity of claims as required by the Corporation (r 4(1)(h)); fee clauses allowing adjustment as contemplated by r 4(1)(i) and (j); step-in and termination clauses consistent with r 4(1)(k), (l) and (m); assignment and subcontracting clauses requiring Corporation approval (r 4(1)(n)); obligations to comply with section 185 of the Return to Work Act 2014 (r 4(1)(o)); IT and training program clauses complying with r 4(1)(p) and (q); and the certificate of readiness condition (r 4(1)(r)). Also include the mandatory elements from r 4(2): regulation of external service providers, monitoring and evaluation methods, agreed methods for performance improvement, and a code of conduct consistent with statutory cross-references.

Performance metrics and fee mechanisms

• Negotiate clear, objective performance metrics and an agreed evaluation methodology in accordance with r 4(2)(b)(i) and r 4(2)(b)(ii). Specify frequency of evaluation, data sources, dispute mechanisms for contested evaluations, and a clear process for fee adjustments tied to the evaluations per r 4(1)(j). Where the Regulations permit fee adjustments "for any other reason" (r 4(1)(i)(ii)), seek contractual limits or procedural safeguards, such as notice periods, consultation requirements or caps, to reduce unpredictability.

Assignment, subcontracting and external providers

• Build into subcontracting arrangements the approvals processes required by the Corporation. Anticipate that the Corporation may withhold approval and ensure critical subcontracting or supplier arrangements are pre-approved or structured so that operational continuity is preserved. Where external providers are necessary, document their roles, performance obligations and data handling arrangements to ensure the primary contract can satisfy the Reg 4(2)(a) requirement to regulate use of external providers.

IT systems and information governance

• Prepare to adopt information technology systems of the kind specified by the Corporation and accept the Corporation-determined terms and conditions (r 4(1)(p)). Budget for potential system adaptation costs, integration timelines, cybersecurity measures, data sovereignty and data security obligations. Ensure contractual clarity on liability for system failures, data breaches and continuity obligations.

Training and workforce readiness

• Design an employee training program that meets Corporation requirements and submit the program, or specified parts of it, for approval as required by r 4(1)(q). Maintain records of training delivery, assessment outcomes and continuous professional development as part of monitoring and evaluation regimes.

Delegation and statutory compliance

• Ensure delegation under section 17 of the Corporation Act is properly documented and that actions taken by the agent are consistent with statutory duties that apply to the Corporation. Identify which statutory functions will be exercised, define decision-making protocols, and implement quality assurance and legal compliance checks to align delegated actions with statutory requirements and the code of conduct referenced in r 4(2)(b)(iii).

Certificate of readiness process

• Engage with the Corporation early to understand criteria for the certificate of readiness required under r 4(1)(r). Prepare evidence and operational demonstrations that the Corporation will reasonably expect, such as system testing outcomes, staff training records, governance documentation and performance measurement frameworks.

Monitoring, reporting and continuous improvement

• Implement the monitoring and evaluation methods agreed in the contract. Ensure data collection, performance dashboards and reporting mechanisms are in place to support periodic evaluations, fee adjustments, and discussions about improvement methods under r 4(2)(b)(ii). Include root cause analysis and corrective action plans linked to contractual improvement methods.

Managing commercial and financial constraints

• Accept that the agent cannot receive or invest employer premiums (r 4(1)(g)) and cannot underwrite compensation liability (r 4(1)(f)). Structure commercial models accordingly, for example by pricing services for claims handling and rehabilitation programs rather than aiming to capture premium investment returns.

Dispute resolution and termination planning

• Negotiate clear dispute resolution procedures, notice periods and compensation approaches for step-in events and termination on breach or performance grounds (r 4(1)(k), (l) and (m)). Include provisions for dispute escalation, interim remedies, and mitigation obligations to reduce business interruption on disputes.

Governance, compliance and audits

• Prepare for audits or reviews as part of the monitoring and evaluation methods. Maintain compliance records and documentation evidencing adherence to the code of conduct, performance metrics, training approvals and IT system standards. Anticipate the Corporation’s right to step in and be ready to provide reciprocal information and access to enable oversight.

Transitional considerations and repeal effects

• Where existing contracts were authorised under the repealed 2015 Regulations, confirm whether those contracts need amendment to reflect the 2025 template, particularly if extensions, assignments or variations are contemplated after the 4 December 2025 commencement date.

Practical checklist

• Draft contracts to include all required elements from regs 4(1) and 4(2).
• Negotiate objective performance metrics, evaluation methods and fee adjustment safeguards.
• Secure clarity on certificate of readiness criteria and process.
• Budget for IT system compliance and training program approvals.
• Limit reliance on subcontracting unless approvals are secured.
• Exclude premium receipt and underwriting from revenue models.
• Establish monitoring, reporting and audit-ready systems.
• Include dispute resolution and compensation provisions for step-in and termination events.

Delivering compliance under the Regulations is therefore a combined exercise of careful contracting, operational readiness, and ongoing administrative discipline to satisfy the Corporation’s specified oversight and approval prerogatives.