A Fresh Approach in Workplace Insurance
 

Service Providers

Insurer Liaison/Premium Management/Claims Management

Each of these areas is vital when it comes to managing Workers Compensation premiums. Ensuring that the right Insurance provider and staff are available to the client, having cost- effective strategies in place when it comes to dealing with claims and advising clients on their premium liability, are integral features of the service provided by Affida.

Our specialist service provider in these areas is well-versed in the complexities of Workers Compensation systems around Australia, with more than 20 years experience serving a wide array of clients in the Australian market.

Our services include, but are not limited to:

Insurer Liaison
Ensuring that an employer has the right Insurance provider in place is vital. It is equally important to have the right staff at the Insurer to deal with specific employer requirements. The Affida model manages the relationship with the Insurer, with a clear expectation of the best possible service delivery for Affida clients. Our providers have dedicated teams at each Insurer, ensuring a consistent approach for Affida clients. Service Level Agreements are also in place committing Insurers to delivering specific outcomes, so that the needs of Affida clients are met in every instance.

Claims Management
  • Developing and implementing reporting procedures for notification of injuries to the Insurer
  • Attending claims reviews with the Insurer, as required and/or pre-arranged at the commencement of each policy period
  • Ongoing involvement in claims to ensure that the desired outcomes are achieved within a timely manner. Assistance is provided in regard to all aspects of claims management, including injury management and claims estimates
  • Service teams have been established at each Insurer to ensure that all claims are managed consistently by the same claims service team
  • Assisting with the completion of appeals to Workcover Authorities in regards to claim disputes.
Premium Management
  • Monitoring of premium payments throughout the policy period
  • Thorough checking of all premium calculations completed in regards to renewal and adjustment
  • Service teams established at each Insurer to ensure that all policies are managed and processed by the one underwriting service team
  • Assisting with the completion and review of all documentation in regards to renewal/adjustment of the Workers Compensation insurance policy
  • Certificates of currency provided on request
  • Assisting with the completion of appeals to the Workcover Authority in regards to premium disputes
  • Providing premium projections, as required. Projections are usually provided on a quarterly basis.

Legal Services

When a Workers Compensation claim is litigated, the Agent selects a legal firm to handle the matter on their behalf, as well as the employer. The nominated firm is typically part of a panel of legal firms for that particular Agent. Panel firms are experienced and qualified to carry out legal work on behalf of Agents.

As an integral part of Affida’s service offering, our legal providers are available to handle litigated claims. While they act on behalf of the Agents, the benefit is that they are our client’s preferred legal provider. In addition to acting on litigated claims, our legal specialists can also assist with the determination of liability, tail claims and industrial relations advice.

In essence, they are your workplace legal providers.

Key services include:

Claims Management

Our legal providers can assist employers in dealing with the complexities of a litigated Workers Compensation claim. This may involve reviewing liability, reduction and/or the termination of benefits, and assessing alternative employment possibilities and future earning capacity. The end result is a clear direction on how to manage complex claims, while communicating with all relevant parties during the process. Ultimately, the goal is to minimise the cost of claims.

Ongoing Advice

Legal advice is not just required when a claimant takes legal action. There are cases where a legal opinion and/or advice can set the ground work for handling a potentially difficult claim (e.g. issues in relation to causation, the extent of the injury itself, past medical history and/or previous claims), as well as related industrial relations issues.

Our legal specialists can assist in all aspects of a claim and at every stage of the process. This ensures that correct action is taken from the outset.

Recoveries

While part of the claims management process, recoveries is a key aspect of the work that Affida’s legal team undertakes. Agents have an obligation to pursue possible recoveries against 3rd parties that are at fault in relation to Workers Compensation claims. It is, however, crucial to have the right information from the beginning to ensure that the Agent can pursue the recovery and that, as a result, an employer’s premium is not affected.

Industrial Relations

Invariably, Workers Compensation matters involve aspects of industrial and workplace relations. At times, the industrial relations issue may arise before the Workers Compensation claim, while in other instances, it commences once the claim is under way. Our legal team can assist and advise in an area of the law that is constantly changing, ensuring that you are well-informed of your rights and obligations as an employer in industrial relation matters involving Workers Compensation.

Rehabilitation

Rehabilitation providers become involved in a claim to facilitate an injured employee’s return-to-work, or alternatively, to assist in looking for alternative employment. Rehabilitation providers are usually chosen from a panel by the Agent. The employer, however, retains the right to choose their rehabilitation provider.

Affida’s providers in this area are fully accredited and offer a comprehensive suite of Workers Compensation-related services, including:

  • Rehabilitation services and return-to-work
  • Alternative employment assistance and training
  • Section 40 make-up pay assessments
  • Vocational assessments
  • Functional capacity assessment
  • Critical incident response.

Investigations

Obtaining accurate information quickly can be vital in determining the outcome of a Workers Compensation claim. Whether it is obtaining a clear and accurate factual account of an incident, or providing effective surveillance, information from a trusted source is critical.

Our Provider Panel includes professional investigators who deal with all Agents in the market. They are highly experienced investigators able to collate and analyse data and present information in a clear format.

Surveillance

Surveillance can be an important strategy when dealing with a Workers Compensation claim. It can be used, for example, to establish potential fraud by claimants. Frequently, through surveillance, a claimant’s true capacity and ability to perform daily activities can be established. Effective surveillance (combined with medical assessments) can contribute to a claim being declined, or exposure to an employer reduced.

Factual Investigations

Factual Investigations can be used for a variety of reasons in relation to Workers Compensation claims. They can be a way of establishing and documenting relevant facts and information relating to an injury or incident. This includes conducting interviews with the employees involved and/or any witnesses.

A comprehensive and accurate factual report can assist in determining liability and in identifying possible recovery opportunities. It can also highlight potential exposures for an employer, allowing them to address issues arising from investigations.

Risk Management

Risk Management encompasses accident and injury prevention, catastrophe and evacuation procedures, accident investigation, OH&S exposures and much more. A well-structured, compliance-driven risk management system can significantly assist in minimising exposures all businesses face.

Our Risk Management providers can undertake a simple training module in a specific area of your business, or conduct a total assessment and implementation of a full risk management and reporting system. Key services include:

  • OH&S gap analysis audits
  • Fire, emergency & evacuation training
  • Hazardous materials response
  • Confined spaces entry
  • Manual handling training
  • Security training and awareness.

Medical Services

Having a medical provider that can assist with returning injured employees to the workplace and preventing claims in the workplace is vital. Unfortunately, many employers fail to address this aspect in dealing with Workers Compensation and employing new staff.

Affida’s preferred medical providers can offer a wide range of services to assist employers with the complexities of the medical aspects of Workers Compensation, workplace injuries and employing new staff.

Our services include but are not limited to:

  • Company Doctor Service – an injured worker has a choice of which treating doctor they want to use. Having a company doctor on board assists in getting injured workers back to the workplace quicker. It also assists in identifying suitable duties, as the company doctor knows the employer’s workplace.
  • Pre-employment Screening – a wide range of pre-employment services are available, including functional capacity, pre-existing injuries, cholesterol and triglyceride testing, hearing tests and drug screening.
  • Wellbeing & Preventative Programs – preventing illness, injury and maintaining a healthy workforce is vital and results in not only less Workers Compensation claims but a more productive workplace. A range of services are available, including general health education and testing (i.e. blood pressure, cholesterol, quit smoking programs, weight loss program).
  • Other Services – after hours service, injury management consultations, minor surgery onsite, management of muscular-skeletal injuries, return-to-work assessments, vaccinations, physiotherapy, hydrotherapy, and education seminars for employers.