Scheme overview

Scheme coverage

WorkCover administers and regulates the Workers Rehabilitation and Compensation Act 1986 and the South Australian Workers Rehabilitation and Compensation Scheme (the Scheme) established under that Act.

In accordance with the legislation, an injured worker is entitled to compensation if they suffer an injury arising from their work. The worker is covered irrespective of their work status i.e. whether they are employed on a full-time, permanent, part-time or casual basis or on a fixed-term contract. 

In the event of a workplace injury, an injured worker may be entitled to compensation if:

  • their injury was caused by their duties or happened in the course of their work
  • their employment contributed to a disease or illness, including psychological injury.

If a worker aggravates a pre-existing injury at work, they are also entitled to compensation but only if their employment contributed to the aggravation.

The Scheme covers injuries that are connected to South Australia as discussed in the Guide to Cross-Border Workers Compensation Provisions. In general, workers are covered by the South Australian Scheme if they usually work or are usually based in South Australia. This is so, even if the injury happens outside the State.

Under uniform national laws, there is a four-point test for employers to determine where their workers are covered which takes into account:

  • the State in which the worker usually works in that employment, or
  • the State in which the worker is usually based for the purposes of that employment, or
  • the State in which the employer’s principal place of business in Australia is located, or
  • the State in which the worker was injured.

There are also special provisions relating to workers working on ships.

 

Scheme entitlements

Depending on the nature of the injury, a worker's entitlements can include:

  • weekly payments of income maintenance
  • medical and associated costs reasonably incurred as a consequence of the injury or illness
  • lump-sum compensation for non-economic loss (permanent impairment).

If the claims agent assigned to the case cannot determine a claim within seven days of receipt, a worker will receive provisional weekly payments for up to 13 weeks, and/or provisional medical and like expenses. 

As noted, the Scheme covers medical and related costs reasonably incurred to diagnose and treat workplace injuries and illnesses. The specific services required will depend on the type of injury, and what is considered 'reasonable' treatment by the worker’s case manager.

The Scheme also provides for rehabilitation programs and rehabilitation and return to work plans. These assist workers and employers to manage workers' safe return to work, and to prevent further aggravation or recurrence of injuries.

Rehabilitation services are directly provided by workplace rehabilitation specialists and may be utilised by the worker's case manager as part of rehabilitation and recovery.

 

Scheme funding

The Scheme is funded by premiums paid by South Australia's employers. WorkCover generates additional revenue by investing premium funds.

Small employers are those who pay less than $20 000 base premium to WorkCover and/or pay less than $300 000 in annual remuneration to their workers. Small employer’s annual premium is based on their size and their industry’s risk level.

Medium employers are those who pay $20 000 or more and less than $500 000 base premium to WorkCover each year and pay $300 000 or more in annual remuneration to their workers. Large employers are those who pay $500 000 or more base premium to WorkCover each year.

Medium and large employer premiums are calculated based on their industry premium rate and the remuneration they pay to their workers, plus their individual claims experience.

The experience rating system is designed to reflect the claims experience performance of a business compared to other employers in the same industry. Generally, if an employer’s claims experience is better than their industry’s claims experience, they will pay less in premium and if their performance is worse, they will pay more.

The Scheme average premium rate and the individual industry premium rates are reviewed each year by the WorkCover Board and management. An external actuary assists this process by providing an independent estimate of long-term claim-related liabilities.

For more information on how the premium rate is set, see the registered employers section.

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