Safety, Rehabilitation and Compensation (Renewal Application Form for Approval as a Rehabilitation Program Provider) Instrument 2022
Schedule 1Approved form for renewal application for approval as a rehabilitation program provider
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Schedule 1—Approved form for renewal application for approval as a rehabilitation program provider
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RENEWAL APPLICATION FORM FOR APPROVAL
AS A REHABILITATION PROGRAM PROVIDER
INTRODUCTION
Under the Safety, Rehabilitation and Compensation Act 1988 (the Act), Comcare can both:
initially approve a person to be a rehabilitation program provider[\[1\]](#_ftn1), and
renew that person’s approval to be a rehabilitation program provider.
This form is to be used by a person applying to renew their approval as a rehabilitation program provider.
IMPORTANT INFORMATION FOR APPLICANTS
Comcare has made two legislative instruments important to any person seeking to have their approval as a rehabilitation program provider renewed. These are:
The Safety, Rehabilitation and Compensation Act (Criteria for Approval and Renewal of Rehabilitation Program Providers) Determination 2020 (the Criteria), and
The Safety, Rehabilitation and Compensation Act (Operational Standards for Rehabilitation Program Providers) Determination 2020 (the Operational Standards).
These instruments can be accessed by applicants on Comcare’s website.
The Criteria sets out the matters that a person must meet to have their approval to provide rehabilitation program services renewed. The Operational Standards sets out the matters that a person must comply with while they are approved to be a rehabilitation program provider.
For approval as a rehabilitation program provider to be renewed, Comcare must be satisfied that the applicant:
meets the relevant matters set out in the Criteria,
has complied with the Operational Standards that were in force during the person’s previous period of approval, and
is likely to be able to comply with the Operational Standards that would apply during the person’s renewed period of approval, should the person’s approval be renewed.
If Comcare is not satisfied of these things, it must refuse to renew the person’s approval as a rehabilitation program provider.
Comcare can also request additional information from applicants as part of this process.
If Comcare decides to renew the person as a rehabilitation program provider, it can also impose additional conditions on that person’s approval beyond what is in the Operational Standards.
A person seeking to have their approval to provide rehabilitation services renewed must ensure that their application:
contains sufficient information to allow Comcare to properly assess the application, and
is accompanied by the required fee (as prescribed by the Safety, Rehabilitation and Compensation Regulations 2019 Part 3).
If an application is complete and accompanied by the required fee, Comcare must process it within six months of receiving it. If Comcare requires the person to provide additional information in connection with their application, processing the application is suspended until the person provides that additional information. If the information requested is not provided within the period specified within the notice requesting the information, the application is taken to have been withdrawn.
An application must be submitted by 31 December unless otherwise advised by Comcare.
Comcare will notify the person in writing whether it has decided to renew the person’s approval or not. It will also provide reasons for its decision.
If Comcare refuses to approve your renewal as a rehabilitation program provider, you can have this decision reviewed by the Administrative Appeals Tribunal.
During the approval period, the rehabilitation program provider must participate in evaluations as required by Comcare in order to determine whether the provider is complying with the applicable conditions of approval.
Comcare is authorised by the Safety, Rehabilitation and Compensation Act 1988 and the Privacy Act 1988 to collect, use and disclose personal information. If Comcare is unable to collect, use and disclose your personal information, we may not be able to determine or approve your application. Comcare is unlikely to disclose personal information collected to an overseas recipient.
For a copy of Comcare’s Privacy Policy, to request a change of your personal information or to make a privacy complaint please refer to comcare.gov.au/privacy. You can also contact us on 1300 366 979 or email us at privacy@comcare.gov.au.
<table cellspacing="0" cellpadding="0" style="width:532.9pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:25.5pt"><td colspan="3" style="width:521.35pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle; background-color:#e6e6e6"><p><span style="font-weight:bold">Previous applications</span></p></td></tr><tr style="height:39.7pt"><td style="width:402.55pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Have you ever been refused approval, or had your approval withdrawn, to provide workplace rehabilitation services by Comcare or any other Australian workers compensation authority?</span></p></td><td style="width:45.9pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:top"><p style="text-indent:1.65pt; line-height:108%; font-size:10pt"><span></span></p><p style="text-indent:1.65pt; line-height:108%; font-size:10pt"><span></span><span style="font-family:Symbol, serif"></span><span> </span><span></span><span>Yes</span></p></td><td style="width:51.3pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:top"><p style="text-indent:1.65pt; line-height:108%; font-size:10pt"><span></span></p><p style="text-indent:1.65pt; line-height:108%; font-size:10pt"><span></span><span style="font-family:Symbol, serif"></span><span> </span><span>No</span></p></td></tr><tr><td colspan="3" style="width:521.35pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:top"><p style="text-indent:1.65pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">If ‘yes’, please provide details of the reasons for refusal or withdrawal of approval.</span></p><p style="text-indent:1.65pt; line-height:108%; font-size:10pt"><span style="font-weight:bold"></span></p><p style="text-indent:1.65pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Please also detail any steps you have taken since being refused approval to address the identified issue or issues.</span></p></td></tr><tr><td colspan="3" style="width:521.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:2.85pt 5.4pt; vertical-align:top"><p style="line-height:108%; font-size:2pt"><span></span></p></td></tr><tr style="height:25.5pt"><td colspan="3" style="width:521.35pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle; background-color:#e6e6e6"><h2 id="navPoint_10" style="text-align:left"><span>Conflicts of interest</span></h2></td></tr><tr style="height:28.35pt"><td style="width:402.55pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold"></span></p><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Do you have, or are you likely to have any actual or perceived conflict of interest between your role as an approved program provider and any other interest?</span></p><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold"></span></p></td><td style="width:45.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-family:Symbol, serif"></span><span> </span><span>Yes</span></p></td><td style="width:51.3pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span></span><span style="font-family:Symbol, serif"></span><span> </span><span>No</span></p></td></tr><tr style="height:26.8pt"><td colspan="3" style="width:521.35pt; border:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">If ‘yes’, what are the details of this conflict?</span></p><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold"></span></p><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">What steps will you take to manage this conflict?</span></p></td></tr></tbody></table>
Professional misconduct or criminal proceedings
Have any professional misconduct, discipline, criminal or civil proceedings ever been commenced against you, or anyone engaged or caused to be engaged by you, in relation to your work as a rehabilitation program provider?If ‘yes’, please provide details of any charges or complaints and the results of any proceedings.Please also provide reasons why Comcare should not reject your application.
Insurance currency
Please provide the following documentation and detailsProfessional Indemnity InsurancePublic Liability InsuranceWorkers Compensation Insurance(For each State or Territory of operation as applicable, if you have an exemption please indicate for which State/Territory)
Financial solvency
Does your organisation have, or is it likely to have, financial difficulties that may impact its financial solvency or ability to provide workplace rehabilitation services?If ‘yes’, please provide details of the issues that may impact your organisation’s financial solvency.
PART B – CONFORMING TO THE CRITERIA AND ANY CONDITIONS OF APPROVAL
Note. This part refers to a person being ‘relevantly qualified’. This is an important concept that is defined in subsection 6(4) of the Criteria. Please ensure that you understand this concept before completing this section.
Person in senior management to be relevantly qualified
<table cellspacing="0" cellpadding="0" style="width:532.9pt; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr style="height:28.35pt"><td colspan="2" style="width:521.35pt; border-bottom:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">If you are approved to provide rehabilitation services, you will be required to have at least one person as part of your senior management who is:</span></p><ul style="margin:0pt; padding-left:0pt"><li class="ListParagraph" style="margin-top:2pt; margin-left:27.6pt; margin-bottom:0pt; line-height:normal; padding-left:8.4pt; font-family:serif; font-size:10pt"><span style="font-family:Calibri, sans-serif; font-weight:bold">‘relevantly qualified’, and</span></li><li class="ListParagraph" style="margin-left:27.6pt; margin-bottom:2pt; line-height:normal; padding-left:8.4pt; font-family:serif; font-size:10pt"><span style="font-family:Calibri, sans-serif; font-weight:bold">has at least five years’ experience providing workplace rehabilitation services as a ‘relevantly qualified’ person.</span></li></ul><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Please provide the details in relation to that person:</span></p></td></tr><tr style="height:28.35pt"><td style="width:244.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Name</span><span>:</span><span></span><span></span><span></span><span></span><span></span></p></td><td style="width:266.2pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Title</span><span>:</span><span></span><span></span><span></span><span></span><span></span></p></td></tr><tr style="height:10.8pt"><td colspan="2" style="width:521.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Qualifications demonstrating that the person is ‘relevantly qualified’</span><span>:</span><span></span><span></span><span></span><span></span><span></span></p><ul style="margin:0pt; padding-left:0pt"><li class="ListParagraph" style="margin-left:27.6pt; margin-bottom:0pt; line-height:normal; padding-left:8.4pt; font-family:serif; font-size:10pt"><span style="font-family:Calibri, sans-serif; font-weight:bold">Relevant qualifications</span></li><li class="ListParagraph" style="margin-left:27.6pt; margin-bottom:0pt; line-height:normal; padding-left:8.4pt; font-family:serif; font-size:10pt"><span style="font-family:Calibri, sans-serif; font-weight:bold">Professional registration number/professional membership number/accreditation number (as applicable)</span></li></ul></td></tr><tr style="height:10.8pt"><td colspan="2" style="width:521.35pt; border-top:0.75pt solid #000000; padding:2.85pt 5.03pt; vertical-align:middle"><p style="margin-top:2pt; margin-bottom:2pt; line-height:108%; font-size:10pt"><span style="font-weight:bold">Details of that person’s experience providing workplace rehabilitation services as a ‘relevantly qualified person’:</span></p><ul style="margin:0pt; padding-left:0pt"><li class="ListParagraph" style="margin-left:27.6pt; margin-bottom:0pt; line-height:normal; padding-left:8.4pt; font-family:serif; font-size:10pt"><span style="font-family:Calibri, sans-serif; font-weight:bold">Please attach a resume</span></li></ul></td></tr></tbody></table>
Relevantly qualified
Please provide the following details for any person engaged, or who would be engaged, by you to provide rehabilitation program services should your application be approved:NameRelevant qualificationsProfessional registration number/professional membership number/accreditation number (as applicable)Has the consultant attended Comcare training for approved rehabilitation program providers?If yes, month and year of attendanceHas the consultant had more than 12 months experience providing workplace rehabilitation services?If no, identify the name and contact details of the relevantly qualified consultant responsible for supervision
Policies and practices - Induction, supervision and professional development
Please outline how your organisation:- inducts new consultants- ensures there is appropriate supervision- ensures there is compliance with professional codes of conduct- provides for learning and development
Policies and practices - Evaluation
Please outline how your organisation:- monitors quality of service delivery, including service standards- monitors outcomes of service delivery, including performance benchmarks
Rehabilitation Management
Under subsection 8(2) of the Criteria, a person applying for renewal of their approval as a rehabilitation program provider must be able to satisfy Comcare that it has appropriately managed at least five cases under any of the following laws for the 12 months prior to making this application:the Safety, Rehabilitation and Compensation Act 1988the Military Rehabilitation and Compensation Act 2004the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988the Seafarers Rehabilitation and Compensation Act 1992.Please provide details of five cases you have managed under any of the above laws:- claim number- the relevant law- commencement date of case
Return to work rate
If you are approved as a rehabilitation program provider, Comcare may require you to meet performance benchmarks as published in the Performance Monitoring Framework. The published benchmarks for the assessment of the renewal period are as follows:Same Employer – 90% return to work rateNew Employer - 60% return to work ratePlease provide the data at Appendix A with details of the rehabilitation cases managed and return to work rates achieved under:the Military Rehabilitation and Compensation Act 2004the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988the Seafarers Rehabilitation and Compensation Act 1992.Comcare will calculate your return to work rate for rehabilitation cases managed under the Safety, Rehabilitation and Compensation Act 1988.
Location of services
Comcare publishes the States/Territories where you have been approved to operate.Please provide the Comcare provider number(s) for States/Territories in which you are currently approved to operate.
Appendix A
Where a rehabilitation program commenced in the Military or Seacare schemes in the 12 months prior to making this application, please provide:- Claim ID number- Scheme (Military/ Seacare)- Outcome of service where concluded (no return to work/ at work)- Outcome of service 13 weeks post closure (no return to work/at work/not available)- Employer (New/ Same)- Cost – total of fees charged for rehabilitation program(s)
Agreement and Authorisation
Organisation name:
On behalf of the applicant:
I/We certify that the information provided in this application and in support of the application is true and correct. I understand that giving false or misleading information is a serious offence under the Criminal Code.
I/We agree to advise Comcare as soon as is reasonably practicable of any changes to the information provided in this application.
I/We certify that persons engaged or employed by the applicant have authorised the collection, use and disclosure of their personal information, by Comcare, in relation to this application and for the purposes of enabling Comcare to determine whether the applicant, a relevant principal or employee of the applicant is complying with the criteria and operational standards for workplace rehabilitation providers determined under sections 34D and 34E of the Act. In particular, I/We understand that this authorises Comcare to collect, use and disclose the personal information in order to seek confirmation of the qualifications, probity and financial standing of the applicant, relevant principals and any workplace rehabilitation provider engaged or employed by the applicant, and the likely effectiveness, availability and cost of the rehabilitation programs which may be provided by the applicant.
I/We consent or certify that persons engaged or employed by the applicant have authorised the collection, use and disclosure of their personal information by Comcare as part of this application or otherwise for, and during, the approval as a rehabilitation program provider for any purpose necessary to consider this application or otherwise determine whether I am/we are complying with any requirement or conditions imposed in relation to the approval as a rehabilitation program provider.
I/ We understand that the approval as a rehabilitation program provider may be subject to conditions imposed by Comcare as it sees fit. I am/We are aware of the requirements of the conditions of approval and I understand and accept the I/we must meet and continue to conform to the conditions of approval.
I/We understand that failure to comply with the Criteria and the Operational Standards determined under sections 34D and 34E of the Act may result in the revocation of approval under section 34Q of the Act.
I/We understand that failure to comply with any condition(s) specified in the instrument of approval may result in the revocation of approval under section 34Q of the Act.
I/We agree to advise Comcare as soon as is reasonably practicable of any changes in workplace rehabilitation providers employed or engaged by the applicant to manage return to work plans under the Act, including evidence of qualifications, experience/supervision arrangements and attendance at Comcare approved training.
This statement should be signed by the person/s authorised to make this application on behalf of an organisation.
Name and title of authorised signatory:
Signature of authorised signatory:
Date: / /
Name and title of authorised signatory:
Signature of authorised signatory:
Date: / /
Schedule 2—Repeals
Safety, Rehabilitation and Compensation Act – Section 34S – Approved form for application for renewal of a person as a rehabilitation program provider (F2019LO1193)
1 The whole of the instrument
Repeal the instrument.
Part Schedule 1 - Safety, Rehabilitation and Compensation (Renewal Application Form for Approval as a Rehabilitation Program Provider) Instrument 2022 - Approved form for renewal application for approval as a rehabilitation program provider | Zoe