The employer can directly or with the assistance of an insurance broker, request WorkCover WA undertake a premium review and/or industry classification review, on the policy terms provided by an insurer licenced by WorkCover WA to underwrite workers compensation insurance in Western Australia.
For new policies, insurers are to provide a written quote of the premium determined for the industry classification, inclusive of full terms (for the identified policy period), within 14 days of receiving the completed request.
Insurers will invite policy renewal (in writing) at least 30 days prior to policy expiry. Full terms will be provided within 14 days of receiving the required renewal information, and prior to policy expiry.
An employer can only apply to WorkCover WA for a premium review if the premium determined by an insurer (for the issue or renewal of a workers compensation policy) is at least 75% or more than the recommended premium rate set by WorkCover WA. In this instance, the insurer must:
- advise the employer (or their insurance broker) of their legislative right to seek a review from WorkCover WA
- direct them to the WorkCover WA website for further information.
Where an insurer or employer is seeking to change the industry classification of a current policy, parties must be advised of this intent at least one month prior to policy expiry.
An employer (or their insurance broker) must engage with the insurer, attempting to resolve any concerns in relation to the premium or industry classification determined (for the identified policy period).
An employer must always maintain workers compensation coverage. Failure by an employer to maintain coverage is an offence under the Act and subject to penalty.
Prior to the policy expiry date of a workers compensation policy, an employer must select an insurer for continued coverage (for the identified policy period) and make payment according to the insurer’s payment terms and conditions. The insurer will commence (new policies) or maintain (policy renewal) policy coverage for the employer.
An application for review must be made within one month from the date the employer receives the policy terms (for the identified policy period) from the insurer.
In extenuating circumstances, WorkCover WA may allow a longer period for submission where concerns relating to the premium and/or industry classification determined remain unresolved. Any request for an extension must be made to WorkCover WA prior to expiry of the one month from when the employer was informed of the policy terms.
To seek a review of the premium and/or industry classification from WorkCover WA, the employer should:
- Review the Premium and Industry Classification Review Guidelines.
- Complete the Premium and Industry Classification Review Request Form.
- Concurrently email the following documents to both WorkCover WA (records@workcover.wa.gov.au) and the insurer.
- Premium and Industry Classification Review Request Form.
- Copy of the insurance policy terms, including the quotation detailing the industry classification and premium issued by the insurer.
- Ensure it is logged with WorkCover WA and the insurer within the required timeframe.
WorkCover WA will confirm parties have attempted to resolve their concerns on the premium determined and/or industry classification, and the application for review meets the timeframes.
WorkCover WA will provide the parties with a copy of the claims data, including outstanding claim estimates (up to six years of current and former insurers). Parties are then responsible for confirming the accuracy of the information, including outstanding claim estimates. In situations where claims data and/or estimates cannot be agreed upon, WorkCover WA will decide based on the information provided.
Where there is the potential for third party recovery of costs, insurers are required to provide that information to the employer/broker/authorised representative, and to quantify the expected recovery. Where there is disagreement between the insurer and the employer/broker/authorised representative on the prospect of claim recovery, WorkCover WA will decide based on the information provided.
On confirmation of the data, WorkCover WA will undertake an assessment using WorkCover WA’s actuarial model.
WorkCover WA may request parties to provide further information at any stage of the review process.
All information is assessed, with WorkCover WA’s final decision made by the WorkCover WA Board.
The WorkCover WA Board will consider all information and make one of the following findings for the identified policy period:
- Dismiss the employer’s application for review.
- Uphold the employer’s application for review and set the:
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- proper industry classification for the calculation of premium, or
- proper premium for the employer (referred to as the assessed rate), or
- proper industry classification and assessed rate for the employer.
WorkCover WA will advise parties in writing of the outcome of the review. The outcome of the review is final, with there being no opportunity for resubmission or further review.
The insurer must give effect to WorkCover WA’s decision/s as an outcome to the review process.
In meeting the insurer’s payment terms and conditions, if a premium has been paid by the employer and the WorkCover WA decision is that a lesser sum is payable, the insurer must repay the employer the amount of overpayment.