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Approvals as made
This instrument revokes the Safety, Rehabilitation and Compensation Act 1988 - Section 34S - Approval of Form of Application for Renewal of Approval as a Workplace Rehabilitation Provider (Rehabilitation Program Provider) (17/10/2012) and approves the form to be used when applying to Comcare for renewal of approval as a workplace rehabilitation provider.
Administered by: Attorney-General's
Registered 12 Nov 2015
Tabling HistoryDate
Tabled HR23-Nov-2015
Tabled Senate23-Nov-2015
Date of repeal 14 Sep 2019
Repealed by Approved form for application for renewal of a person as a rehabilitation program provider

 

 

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Safety, Rehabilitation and Compensation Act 1988

Section 34S

 

APPROVAL OF FORM OF

RENEWAL APPLICATION FOR APPROVAL

AS A WORKPLACE REHABILITATION PROVIDER

 

 

 

Comcare, pursuant to section 34S of the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act), with effect on and from 1 January 2016 and for the purposes of paragraph 34K (1)(a) of the SRC Act (approved form of Renewal Application for approval as a Workplace Rehabilitation Provider):

 

1.         revokes the instrument dated 17 October 2012 registered as instrument F2012L02078 on the Federal Register of Legislative Instruments; and

 

2.         approves the attached form (Renewal Application for Approval as a Workplace Rehabilitation Provider).

 

 

Dated:  5 November 2015

 

 

The seal of Comcare was affixed

in the presence of: Lyndall Moore

 

 

 

 

 

Jennifer Taylor

Chief Executive Officer

 

 

Attachment:     Form of Renewal Application for Approval as a Workplace Rehabilitation Provider - 15 pages


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Comcare_inline_logo

 

 

RENEWAL APPLICATION FOR APPROVAL
AS A WORKPLACE REHABILITATION PROVIDER

 

 

INTRODUCTION

The Heads of Workers Compensation Authorities (HWCA) endorsed a nationally consistent framework for the approval of workplace rehabilitation providers which commenced on 1 July 2010. Refer to the HWCA document “Guide: Nationally Consistent Approval Framework for Workplace Rehabilitation Providers”.

 

IMPORTANT INFORMATION

This application must be lodged by workplace rehabilitation providers wishing to apply for a renewal of an Instrument of Approval.

An application must be submitted to each workers compensation authority in which renewal of approval is sought, and be accompanied by the prescribed fee where appropriate. Providers should refer to the appropriate workers compensation authority to obtain relevant details applicable to that jurisdiction.

If an application is not submitted or approved the provider’s approval will cease at the end of the three-year approval period (usually 30 June of the third year).

The workers compensation authority may request further information in writing from the provider. The workers compensation authority may also liaise with other workers compensation authorities, where the provider delivers workplace rehabilitation services, to exchange information about the application.

The workers compensation authority will approve a renewal application where it is satisfied the provider:

·         meets the criteria for approval and renewal of approval;

·         has demonstrated compliance with the operational standards in force since the applicant was initially approved or last renewed; and

·         is likely to comply with the operational standards in force with effect from the renewal date. 

The approved provider will be issued an Instrument of Approval for a 3-year period, until 30th June of the third year.

If an application does not conform to criteria for approval, criteria for renewal and operational standards, the provider will be requested to submit further information. If the information does not address the non-conformance, then the application is considered to be unsuccessful.

If an application is unsuccessful, the provider will be advised of the reasons for this decision and the process for appeal.

Providers who are unsuccessful are not eligible to reapply for approval unless it can be demonstrated to Comcare’s satisfaction, that the reasons for non approval no longer exist.

During the 3-year approval period, the workplace rehabilitation provider will participate in annual self-evaluations and any independent evaluations as required by the workers compensation authority to determine conformance with the Conditions of Approval.


INFORMATION TO COMPLETE THE APPLICATION

An application must be submitted by 31 December before the expiry of the three-year approval period, unless otherwise advised by the workers compensation authority.

Incomplete applications will be returned to the provider.

If there is insufficient space on the application form to complete a response, attach additional information identifying the question to which the response relates.

The provision of false or misleading information is a serious offence and will nullify the Instrument of Approval and this application.

 

 

APPLICATION CHECKLIST

Please ensure you have completed the following sections:

  PART A - business ownership details including association or connection with other organisations which supply services within the workers compensation industry

  PART B - Documentation demonstrating conformance with the Conditions of Approval, including:

  Latest Self Evaluation report

  Cases of workplace rehabilitation in each 12 month period

  RTW rates- Same and New employer

  RTW durability rate

  PART C – Jurisdiction Specific information-Any other documentation requested by the workers compensation authority (where applicable)

 Appendix 1 - A signed Statement of Commitment to the Conditions of Approval

  Appendix 2 - A signed Statement of Commitment to the Code of Conduct for Workplace Rehabilitation Providers

 Appendix 3 - A signed Self Evaluation Declaration of Conformance

  Appendix 4- Current staff details completed for each site where workplace rehabilitation services may be delivered (one sheet per site)

  Payment of the prescribed fee, where appropriate.

 Appendix 5 – Comcare Agreement and Authorisation.

 

 


PART A – APPLICANT DETAILS

     

List all jurisdictions where you are seeking renewal, and identify your home jurisdiction (i.e. where ABN is registered/ you undertake the majority of work)

  • Home-      
  •       
  •       
  •      
  •      
  •       
  •       
  •      

Provide a copy of the Instrument of Approval from the home jurisdiction (where this application is not to the home jurisdiction).

 

 

 

Organisation details

Full name of organisation:     

Trading name of organisation:      

Nature of Organisation:      

(e.g. Company, Partnership, Sole trader, Individual subsidiary of a Government body)

Name of Principal/s:

ABN/ ACN (if applicable):     

 (Attach copy of the ABN record from the Australian Business Registry):      

Organisation address:     

State:     

Postcode:     

Postal address:     

State:     

Postcode:     

Phone:      

Mobile:      

Email:     

Name of parent organisation (if applicable):     

Address of parent organisation:     

State:     

Postcode:     

Name and position of person/s authorised to sign this application on behalf of the organisation:

Name:                                                                                                             Title:     

Name:                                                                                                             Title:     

 

 

Application contact person

Name:      

Title:     

Phone:      

Mobile:      

Email:      

 

Previous applications

Has an Australian workers compensation jurisdiction refused or withdrawn approval of the organisation, owner/s and/or management, and/or any persons employed or engaged to deliver workplace rehabilitation services?

 

 Yes

 

 No

If so, please provide details

 

 

 

 

 

 

Conflict of interest

Has a conflict of interest been identified with other suppliers of services within any workers compensations authority in the current approval period?

If so, please provide details:

 

 

 Yes

 No

Detail all your organisation’s business affiliations with other suppliers of services within any of the Workers Compensation Authority:     

 

How will any actual or perceived conflict of interest be managed?

 

 

 

 

 

Professional misconduct or criminal proceedings

Outline if any proceedings have been taken (or are pending) against the organisation, owner/s and/or management, and/or any persons employed or engaged to deliver workplace rehabilitation services, in relation to professional misconduct or criminal proceedings, breaches of the Privacy Act or financial administration acts.

 

If so, please provide details of the circumstances and reasons why there is no cause to reject your organisation’s application.

 

 

 

 

 

 

Insurance currency

  • Professional Indemnity Insurance- Please detail -  Policy number-          Expiry date                Amount

 

  • Public Liability Insurance-  Please detail -                 Policy number-          Expiry date                Amount

 

  • Workers Compensation Insurance- Please detail-  Policy number-          Expiry date                Amount

 

 

 

 


PART B – CONFORMING TO THE CONDITIONS OF APPROVAL

 

Condition 2: Staff

 

Provide current staff details for each site where workplace rehabilitation services may be delivered

Send only the relevant staff listing to each jurisdiction.  (Appendix 4)

 

 

Condition 3: Person/s in management structure experience

Name:     

Title:     

Qualifications:     

 

 

 

Workplace rehabilitation experience:     

 

 

 

 

Condition 4:  Provider annual self-evaluations and other evaluations as required

 

Provide a signed Declaration of Conformity (appendix 3) to the Conditions of Approval from your organisation’s most recent annual self-evaluation, noting whether you achieved Level 1 conformance (95%), Level 2 (85%) or a Non-Conformance (<85%) rating.

 

 

Please provide a copy of any quality improvement plan implemented to address the identified non-conformities.

 

 

 

 

 

Please provide the name of person(s) who conducted the most recent provider annual self-evaluation on behalf of your organisation, their qualifications and demonstrate how they meet the requirements of an independent evaluator. Please confirm that they were not personally responsible for the aspects of the business that they evaluated.

 

 

 

 

 

 

 

If your organisation has been required to participate in an independent evaluation by the workers compensation authority, please provide a copy of the most recent independent evaluation including the quality improvement plan implemented to address any non-conformity.

 

 

 

 

 

 

 

 

Condition 5: Cases of workplace rehabilitation activity

 

Please attach case data to illustrate management of 12 cases (excludes assessment only cases) of activity consistent with the model of workplace rehabilitation within any workers compensation jurisdiction.

 

 

 

 

 

 

 

 

Condition 6: Minimum RTW rate

 

Please complete the table below for each year of the current approval period.

 

Summary of yearly performance results  (since last renewal or initial approval):

 

RTW RATE

Year 1- 01/07/      to 30/06/     

Year 2-

01/07/      to 30/06/     

Year 3 to date

01/07/      to 31/12/       

  1. Same employer RTW rate

 

 

 

  1. New employer RTW rate

 

 

 

  1. 13 week durability rate

 

 

 

                         

Please attach specific performance data relevant to each jurisdiction in which you are seeking approval.

 

Please refer to Part C- Comcare specific information for additional data requirements relating to referrals, rehabilitation outcomes for the past 12 months and service costs.

 

 

Where the required RTW rate has not been met please provide additional information explaining the reasons.

 

 

 

 

 

Condition 8: Code of Conduct

 

Please provide a signed Statement of Commitment to the Code of Conduct for Workplace Rehabilitation Providers

(Appendix 2)

 

 

Statement of Commitment to the Conditions of Approval

 

Please provide a signed Statement of Commitment to the Conditions of Approval for Workplace Rehabilitation Providers

(Appendix 1)

 

 


 

PART C- COMCARE SPECIFIC INFORMATION

As part of your renewal application the relevant workers compensation authority may focus on assessing a particular aspect of performance relating to the Principles of Workplace Rehabilitation and Conditions of Approval.

 

Additional information requested by Comcare

 

1.       Minimum number of Comcare cases

The Criteria for renewal requires the provider to have received a minimum of 5 referrals as a workplace rehabilitation provider in the 12 months prior to renewal.  This includes referrals received under one of more of the following Acts-

a.        the Safety, Rehabilitation and Compensation Act 1988

b.       the Military Rehabilitation and Compensation Act 2004

c.        the Seafarers Rehabilitation and Compensation Act 1992

 

Please indicate if this has been met or provide details explaining your individual circumstances.

 

 

2.       Rehabilitation and return to work performance

For the last 12 month period, provide an analysis and rehabilitation and return to work data for claims with a duration cohort of 0-6 months post the date of injury, 6-18 months and greater than 18 months.

 

Please indicate for these each cohort-

a.        Number of referrals received

b.       Number of cases closed with a RTW outcome (this is a return to work in any capacity)

c.        Number of cases closed with a non RTW outcome (and indicate number closed due to RCM requesting transfer to a new provider company)

d.       Rehabilitation costs

e.       Number of current open cases

f.         Other relevant information such as injury type, employer.

 

 

3.       Comcare training

Any individual employed or engaged by the workplace rehabilitation provider must seek approval from Comcare (receive a consultant ID number) and undertake the Comcare specific workplace rehabilitation provider training. 

 

Please indicate the consultant ID and training attendance as part of the completion of Appendix 4- Staff details.

 

 

 

 

 

 


APPENDIX 1 – STATEMENT OF COMMITMENT TO THE CONDITIONS OF  

                          APPROVAL

A reference to the Workers Compensation Authority is a reference to the Workers Compensation Authority who issued the Instrument of Approval.

The Conditions of Approval are:

1.   The workplace rehabilitation provider must comply with the Principles of Workplace Rehabilitation.

2.   The workplace rehabilitation provider must ensure that all services are delivered in accordance with the workplace rehabilitation model by persons who hold the minimum qualifications as defined in the Principles of Workplace Rehabilitation and in accordance with service descriptions appropriate to the Workers Compensation Authority where the approval is being sought.

3.   The workplace rehabilitation provider’s management structure must include at least one person who holds a rehabilitation consultant qualification outlined in the Principles of Workplace Rehabilitation and who is able to demonstrate five years relevant workplace rehabilitation experience.

4.   The workplace rehabilitation provider must participate in annual self-evaluations and in independent evaluations as required by the Workers Compensation Authority to demonstrate conformance with the Conditions of Approval.

5.   The workplace rehabilitation provider must demonstrate management of 12 cases (excludes assessment only cases) of workplace rehabilitation within any workers compensation jurisdiction for each 12 month period within the three year approval period. (Due consideration will be given to providers servicing rural and remote areas).

6.   The workplace rehabilitation provider must maintain the minimum return to work rate as set by the Workers Compensation Authority.

7.   The workplace rehabilitation provider must provide data to the Workers Compensation Authority consistent with the Conditions of Approval.

8.   The workplace rehabilitation provider must deliver services in compliance to the Code of Conduct for Workplace Rehabilitation Providers.

9.   The workplace rehabilitation provider’s facilities at all locations where services are delivered must provide an accessible and appropriate environment for workers, staff and visitors and comply with local workplace health and safety legislation.

10. The workplace rehabilitation provider must remain financially solvent.

11. The workplace rehabilitation provider must notify the Workers Compensation Authority in advance, or as soon as practical, if any of the following situations arise and accept that the Workers Compensation Authority will review the status of approval and determine whether the proposed arrangements conform with the Conditions of Approval:

i. the business is sold or the controlling interest in the business is taken over by a new shareholder(s), owner(s) or director(s).

ii. the business changes its trading name or location of premises.

iii. the business supplies or has connections with other suppliers of services within the   workers compensation industry.

iv. a new chief executive officer or director or head of management is appointed.

v. there is a major change in the service delivery model and/or staff which may impact on the delivery of workplace rehabilitation services.

vi. there is any other change that affects, or may affect, the provider’s service quality and procedures.

vii. the provider has entered into voluntary financial administration, becomes insolvent or is the subject of bankruptcy proceedings.

viii. there is any professional misconduct proceedings being taken against the provider or any individuals employed or engaged by the provider.

12. The workplace rehabilitation provider must accept that the Workers Compensation Authority may:

i. initiate an independent evaluation at any time during the period of the approval which may involve an evaluation of conformance to the Conditions of Approval

ii. consult with the relevant professional or industry associations in determining what are reasonable expectations regarding performance

iii. impose additional requirements

iv. exchange information with other Workers Compensation Authorities on provider performance

v. cancel approval status if the above conditions are not met.

I/We have read, understand and accept that I/we must meet and continue to conform to the Conditions of Approval and give consent for sharing of information in relation to this application and the ongoing approval.

I/We understand and are aware that any breach with the terms and conditions of the Conditions of Approval may nullify any application or Instrument of Approval issued by the Workers Compensation Authority in the event the application is approved.

To be signed by the person/s who is/are authorised to sign this application on behalf of the organisation seeking approval as a workplace rehabilitation provider.

 

Organisation name:

     

             

Name and title of authorised signatory:

     

Signature of authorised signatory:

                                                                                                                        Date:       /       /      

 

Name and title of authorised signatory:

     

Signature of authorised signatory:

                                                                                                                        Date:       /       /      

 


APPENDIX 2 – STATEMENT OF COMMITMENT TO THE CODE OF    

                           CONDUCT FOR WORKPLACE REHABILITATION PROVIDERS

 

I/We have read and agree to conform to the Code of Conduct for Workplace Rehabilitation Providers if approved as a workplace rehabilitation provider.

I/We understand and are aware that any breach of the Code of Conduct for Workplace Rehabilitation Providers may nullify any Instrument of Approval issued by the Workers Compensation Authority in the event the application is approved.

To be signed by the person/s who is/are authorised to sign this application on behalf of the organisation seeking approval as a workplace rehabilitation provider.

Organisation name:

     

                    

Name and title of authorised signatory:

     

Signature of authorised signatory:

                                                                                                                                            Date:       /       /      

 

Name and title of authorised signatory:

     

Signature of authorised signatory:

                                                                                                                                           Date:       /       /      

 

 


 

APPENDIX 3 - DECLARATION OF CONFORMANCE

   WORKPLACE REHABILITATION PROVIDER SELF EVALUATION

 

 

1)       ________________ is in conformance with the Conditions of Approval for workplace rehabilitation providers within the workers Compensation system.

                Yes / No (please circle)

 

2)       If no, please detail the Condition/s to which _________________did not comply and the corrective actions to address the non-compliance/s. (This information can be in the form of an attachment if required)

Non-compliance:


Action plan:

3)       Person(s) who conducted the evaluation:

On behalf of the organisation, the Principal Head(s) declare:

a.        the person(s) who conducted the evaluation meet the requirements of an evaluator.

Yes / No (please circle). If no please outline the persons qualifications

b.       the person(s) who conducted the evaluation were not personally responsible for the aspects of the business that they evaluated.
Yes / No (please circle). If no please outline the person’s responsibilities

 

4)       On behalf of the organisation, the Principal Head(s) acknowledges and accepts the consequences of making a false declaration.

 

To be signed by the Principal Head(s):

Name:

 

Name:

 

Signature:

 

Signature:

 

Title:

 

Title:

 

Date:

 

Date:

 


APPENDIX 4 – STAFF DETAILS - COMCARE

ORGANISATION:      __________________________________________________________________________________________________________________

ADDRESS*:      ______________________________________________________________________________________________________________________

SITE OR PROVIDER APPROVAL NUMBER, IF APPLICABLE:      _____________________________________________ DETAILS AS AT DATE:      ______________

 

Name and consultant ID

Qualifications & Comcare training attendance

Include qualification, institution, year of concurrence

Years of workplace rehabilitation experience

Basis of employment (e.g. fee-for-service, part time or full time)

Professional membership or registration (type and membership number)

Supervision arrangement for staff with less than 12 months experience

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

* Duplicate this page and table for each location in the jurisdiction where the application is submitted. Add more rows to this table if needed to list all staff members.

 

 

ORGANISATION:      __________________________________________________________________________________________________________________

ADDRESS*:      ______________________________________________________________________________________________________________________

SITE OR PROVIDER APPROVAL NUMBER, IF APPLICABLE:      ______________________________________________ DETAILS AS AT DATE:      _____________

 

Name and consultant ID

Qualifications & Comcare training attendance

Include qualification, institution, year of concurrence

Years of workplace rehabilitation experience

Basis of employment (e.g. fee-for-service, part time or full time)

Professional membership or registration (type and membership number)

Supervision arrangement for staff with less than 12 months experience

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

* Duplicate this page and table for each location in the jurisdiction where the application is submitted. Add more rows to this table if needed to list all staff member

 

 

 

 

 

 

 


Appendix 5- Comcare Agreement and Authorisation

 

Organisation name:

     

 

On behalf of the applicant:

1)                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;

2)                I/We agree to advise Comcare as soon as possible of any changes to the information provided in this application; and

3)                I/We authorise relevant persons to provide to Comcare personal information 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 SRC Act. In particular, I understand that this authorises Comcare to seek confirmation of the qualifications, probity and financial standing of the applicant, relevant principals and any workplace rehabilitation provider engaged or employed and the likely effectiveness, availability and cost of the rehabilitation programs which may be provided by the applicant.

If the applicant is approved as a workplace rehabilitation provider, I/We:

4)                understand that failure to comply with the criteria and operational standards for workplace rehabilitation providers  determined under sections 34D and 34E of the SRC Act may result in the revocation of approval under section 34Q of that Act;

5)                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 SRC Act;

6)                agree to advise Comcare in writing within one month of any changes in workplace rehabilitation providers employed or engaged by the applicant to manage return to work plans under the SRC Act, including evidence of qualifications, experience/supervision arrangements and training (including attendance at Comcare rehabilitation provider training); and

7)                agree to Comcare listing the applicant’s name, service delivery description and contact details on Comcare’s website.

 

Name and title of authorised signatory:

     

Signature of authorised signatory:

                                                                                                                                           Date:       /       /      

 

 

Name and title of authorised signatory:

     

Signature of authorised signatory:

                                                                                                                                           Date:       /       /      

 

 

 

 

 

 

 

 

 

 

OFFICE USE ONLY

Received Via:   Mail / Counter /

                                Fax / Email

Date received:      /     /     

File reference:      

Processed By:     

Authorised By:     

Instrument of Approval Issued:

 

 Yes                          No

 

Date of issue:      /     /     

 

APPLICATION REQUIREMENTS

Application fee (if applicable)

 Yes

 No

PART A- Applicant details

Home jurisdiction specified

 Yes

 No

Professional indemnity policy details

 Yes

 No

Public Liability policy details

 Yes

 No

Workers compensation policy details

 Yes

 No

PART B- Conforming to the Conditions Of Approval

Cases of Workplace Rehabilitation Activity (12 cases per year)

 Yes

 No

Current RTW data

 Yes

 No

ATTACHED DOCUMENTS

PART A

Copy of ABN/ ACN

 Yes

 No

Copy of other Workers Compensation Authority (WCA) Instrument of Approval (if applicable)

 Yes

 No

PART B

Copy of Annual Self-evaluation and other evaluations as required

 Yes

 No

Appendix 1 – Statement of commitment to Conditions of Approval signed

 Yes

 No

Appendix 2 – Statement of Commitment to the Code of Conduct signed

 Yes

 No

Appendix 3 – Declaration of Conformance - Self Evaluation

 Yes

 No

Appendix 4 – Completed staff details sheet/s

 Yes

 No

PART C- Comcare specific information

 Yes

 No

Appendix 5- Comcare Agreement and Authorisation

 Yes

 No