Oa No. 111 - Risk Indicators On Compense

COMCARE OPERATIONAL ADVICE NO. 111

RISK INDICATORS ON COMPENSE

Branch Managers
State Managers
State Operations Managers
State Rehabilitation Managers
State Review Managers
State Executive Officers
Central Office Directors

The purpose of this Operational Advice is to amend and update the information set out in Operational Advice No 91.  As a result Operational Advice No 91 is withdrawn.

2. The following definitions of Risk Indicator Types will now apply in Compense :

RISK TYPE 1

General:

Inside premiums, clear liability, low cost, cost certainty, low risk and self managing.

Specific:

.There is a specific incident with a date of injury on or after 1 July 1989; and

.incapacity not expected to exceed 28 days (cumulative); and

.medical costs estimated to be less than $1500 in total;

AND any of the following:

.visible traumatic injuries resulting from falls, collisions, cuts, blows, crushes, tears and burns; or

.fractures and strains resulting from the specific incident; or

.scheduled diseases such as stress reactions due to armed holdups or violence; or

.defined contact diseases such as brucellosis etc.; or

.injuries involving assault or violence; or

.injuries sustained on duty or during temporary absences from the workplace; or

.travelling by a direct route.

RISK TYPE 2

General:

Inside premiums, liability may be clear or contentious, high cost, cost uncertainty, high risk.  Input requires experience, knowledge and skills.  High risk and needs managing.

As a general rule, all premium cases which cannot be coded as Risk Type 1 claims should be coded as Risk Type 2.

Specific:

.There is a disease or straining incident with a date of injury on or after 1 July 1989;

AND any of the following:

.injuries as a result of disciplinary action or work disappointments; or

.injuries as a result of a complication of an earlier compensable condition or arising as a sequel to medical treatment of a compensable condition;

.or death; or

.skylarking or injuries intentionally self inflicted; or

.voluntary or unreasonable exposure to increased risk of injury; or

.injuries as a result of serious and wilful misconduct; or

.injuries sustained whilst under the influence of alcohol/drugs; or

.travelling by an indirect route or following an interruption to a journey.

RISK TYPE 3

General:

Outside premiums, current employee.

Specific:

Claims that would satisfy the criteria for Risk Type 3 would be any claim from a current employee that is non premium funded (i.e. with a date of injury before 1 July 1989).

RISK TYPE 4

General:

Outside premiums, ex‑employee.

Specific:

Claims that would satisfy the criteria for Risk Type 4 would be any claim from an ex‑employee that is non premium funded (i e. with a date of injury before 1 July 1989).

ROBERT KNAPP
Deputy Chief Executive Officer

17 July 1991