WorkCover WA’s Insurer and Self-insurer Principles and Standards of Practice (Principles and Standards) provide a cohesive set of service expectations to ensure insurers and self-insurers provide high quality service to injured workers and employers.
WorkCover WA developed the Principles and Standards to:
- ensure high standards of service are provided to employers and workers, and
- support effective claims handling, injury management, underwriting and administrative practices.
The Principles and Standards apply to all insurers and self-insurers from 1 July 2020.Principles
The four Principles guide decision-making in all aspects of workers’ compensation and are particularly important for aspects of service delivery not covered by the Priority Areas or Standards of Practice.
Principle 1: Transparent and Timely
Decisions and processes made by insurers and self-insurers must be fair, timely, transparent, efficient and, where practicable, informal.
Principle 2: Reasonable and Active
Insurers and self-insurers must take reasonable and proactive steps to be informed before decisions are made, and must not delay decisions once sufficient information is obtained.
Principle 3: Regular and Responsive
Regular and responsive communication must underpin the delivery of workers’ compensation services, particularly where sensitive and complex issues exist.
Principle 4: Viable and Accountable
Insurer and self-insurer processes, practices and systems should support the long term viability, accountability and performance of the workers’ compensation scheme.
Priority 1: Worker and Employer Experience
Insurer and self-insurer processes, systems and practices will ensure a fair workers’ compensation experience for workers and employers.
Priority 2: Claims Management
Insurers and self-insurers will actively manage claims to avoid employer and worker disadvantage, evidenced and supported by prompt decisions, consultation, clear policies and practices.
Priority 3: Injury Management
Insurers and self-insurers will manage claims with a primary focus on supporting a worker’s recovery and their return to work.
Priority 4: Underwriting
Insurer underwriting policies and practices will be transparent and fair.
Priority 5: Scheme Regulation and Administration
Insurers and self-insurers will comply with WorkCover WA regulatory and administrative requirements.
Priority 6: Records Management
Insurers and self-insurers will maintain records evidencing all key policies, processes and decisions.
The Standards prescribe the minimum level of service workers and employers are to expect from insurers and self-insurers. While insurers and self-insurers must meet these Standards, they are also encouraged to improve on them.
The Performance Indicators are used across all Priority Areas and Standards to measure how well insurers and self-insurers achieve this aim.
Performance Indicator 1: Number of Complaints
Identifies the number, nature, severity and outcome of complaints received by the insurer, self-insurer and WorkCover WA.
Performance Indicator 2: Number of Improvement Notices
Identifies the number, nature and severity of improvement notices issued by WorkCover WA resulting from Standards not being met.
Performance Indicator 3: Timely and Appropriate Resolutions
Reviews the timeliness and appropriateness of insurer and self-insurer response to findings from complaints, breaches and improvement notices.
Performance Indicator 4: Evidence of Documentation
Measures if all processes are documented, if files evidence actions taken, their timeliness, decisions made and the reasons for them.
Performance Indicator 5: Outcomes of Worker and Employer Surveys
Measures outcomes arising from surveys undertaken by insurers, self-insurers or WorkCover WA.
Performance Indicator 6: Outcome of Audits
Measures outcomes arising from audits and reviews undertaken by WorkCover WA.
The Claims Managers Capability Framework sets out the practices, skills and behaviours expected of claims managers in the Western Australia workers’ compensation scheme.
The Capability Framework translates the Insurer and Self-insurer Principles and Standards of Practice into observable practices and behaviours which claims managers should demonstrate when delivering scheme services.
Claims Managers Capability Framework (PDF – 473kb)
A six-part conversation series exploring the Priority Areas and promoting key messages of the Principles and Standards with service providers will be released weekly from 1 July 2020.Conversation series: An overview of the Principles and Standards
An interactive self-assessment tool to assist case managers reflect on their practices and processes in adherence to the Principles and Standards.