Unless your employer is self-insured, WorkCover has contracted a private company as its claims agent – Employers Mutual – that is responsible for most of the day-to-day decisions relating to your claim.

Employers Mutual’s claims managers use the Injury and Case Management Manual (ICMM) produced by WorkCover as the major reference point for day-to-day claims management services. Contact Employers Mutual on (08) 8127 1100.

A case manager is employed by the claims agent or your self-insured employer to manage workers rehabilitation and compensation matters. They have a responsibility to determine your claim and make decisions in accordance with the Act. Your case manager will work with you, your employer, doctor and rehabilitation provider to coordinate your return to work process. In all situations, you should remain in contact with your case manager.

If you are injured or become sick because of your work, your employer has an important role to play to help you recover and return safely to work. Your employer needs to provide alternative duties and suitable work  (where possible) cooperatively with the case manager, rehabilitation providers and doctors to ease you back into work when you are medically assessed as ready. It is important that you keep in touch with your boss if you are away from work.

A health provider helps with medical or health care so you can return to work or the community. Your doctor, physiotherapist or specialist are all health providers and they should all work together to help you recover. Health providers must be registered with a relevant board, and/or have an agreement with WorkCoverSA. You can choose your own health provider or view a list of recognised providers and services.

There are two kinds of rehabilitation providers that might help you return to safe work or the community. There are medical rehabilitation providers such as occupational therapists, physiotherapists and psychologists who assist with medical rehabilitation. There are also workplace rehabilitation consultants who work with you and your case manager to coordinate return to work services, including liaising with doctors and employers.

The Minister for Industrial Relations is ultimately responsible both for workers rehabilitation and compensation and occupational health and safety in South Australia.

WorkCover is funded by employers to manage a balanced and financially sound system that rehabilitates, compensates and returns injured workers to safe workplaces and the community.

There are a number of independent organisations that can discuss workers rehabilitation and compensation issues with you. While we recognise the role these groups play in providing advice, WorkCover cannot endorse the specific advice they may give to injured workers.

SA Unions Advocacy Service
Phone: (08) 8279 222

This is an independent service funded by WorkCover and managed by SA Unions. The service provides a confidential dispute resolution and advocacy service to eligible workers who need assistance with workers compensation disputes. The advocates are experienced in workers compensation and provide representation in the Workers Compensation Tribunal. This service is largely targeted at unrepresented workers who are not able to afford legal support. You do not have to be a union member to use this service.

Support Groups

You have a right to legal representation at any time, and will probably need representation if you have a case before the Workers Compensation Tribunal. You should be aware that legal services are not free, although some or all of your legal costs may be covered.

For a free service, contact SA Unions on the number provided on page 10 (you do not have to be a union member to use this service).

The Workers Compensation Tribunal can help workers with undetermined claims or review decisions made about a claim by the claims agent. Workers have several conciliation options once a Notice of dispute is lodged with the Tribunal.

For more information see our fact sheet Help if you’re not satisfied – A guide to workers compensation disputes or call (08) 8207 0999 or see the South Australian Industrial Relations Tribunal website at www.industrialcourt.sa.gov.au.

Some employers (with 30 or more employees) are required to appoint a trained rehabilitation and return to work coordinator. The rehabilitation and return to work coordinator is a person who has knowledge of the workplace and is available to help the employer and the worker in the return to work process.

Medical Panels SA is an independent body to WorkCover, specifically set-up to deal with workers compensation medical disputes. When a dispute involves opposing medical opinions eg, about your injury or capacity for work, medical questions will be referred to, and an opinion provided, by a medical panel. A medical panel will form its opinion within 60 days of a referral. You will receive written confirmation of this opinion, which you may discuss with your case manager.

The WorkCover Ombudsman runs an independent office set up to investigate complaints relating to the operation of the WorkCover Scheme.

The Ombudsman, who reports to the Minister for Industrial Relations, implements the 'safety net' for injured workers, testing the reasonableness of decisions to stop weekly payments.

The Ombudsman:

• reviews the operation of the Act and recommends improvements
• investigates and seeks to resolve complaints from workers, employers and other interested parties about administrative actions under the Act
• investigates issues associated with the rehabilitation and return to work of injured workers
• assists WorkCover and employers to establish their own processes for handling complaints
• reviews decisions to discontinue weekly payments and can suspend those decisions while the dispute is proceeding before the Workers Compensation Tribunal where it appears to the WorkCover Ombudsman that the decision is not reasonably open.

To contact the Office of the WorkCover Ombudsman phone (08) 8463 6593, or toll free on 1800 195 202 or visit www.wcombudsmansa.com.au.