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Claims and rehabilitation guidance for employers

For: Employers and managers Information seekers

If an employee is injured at work or has a work-related illness that results in an absence from work, it is important that they return to their normal work as quickly as possible in a way that protects and promotes their health.


Role of employers in claims and rehabilitation

As an employer, you are the central player in both the claims management process and the rehabilitation and return to work process, in accordance with the Seafarers Rehabilitation and Compensation Act 1992 (Seafarers Act).

The maritime industry has some unique factors which can impact rehabilitation and return-to-work performance including the mobile and remote nature of our workplaces, attitudinal factors, difficulty in arranging graduated return to work opportunities and the availability of suitable employment alternatives.

Despite these factors, we know that the approach of employers toward employees who are injured at work or have a work-related illness combined with effective management of the process can significantly impact the duration and cost of a claim and the prospects of a successful and durable return to work.

Your role in ensuring a quick and full recovery and an early return to work can be greatly assisted by performing your key responsibilities as an employer and other support strategies.

Key duties

Make claims forms available

Employees should be able to obtain claim forms from the master of the ship or from their employer.

  • Claim for Workers’ Compensation (Seacare form 3)
  • Claim for Permanent Impairment and Non-Economic Loss and/or Related Aids (Seacare form 4)
  • Claim for Compensation by Dependants of Deceased Employee (Seacare form 5).

Claims forms are also available from Seacare. See our forms page.

If the employee is having difficulty completing a claim form, you should encourage them to seek assistance and they should be able to seek assistance from you, as their employer.

Work with your insurer

Scheme insurances play an important role in the compensation, rehabilitation and return to work process. It is important that you meet the requirements of your policy and communicate with your insurer.

Understand your insurance policy

It is important that you fully appreciate and understand the obligations, benefits and services available under your insurance policy to maximise the value of the policy. This is especially true because workers’ compensation insurance costs are a significant element of labour costs.

It is important to work closely with your insurer to ensure that the services available under your insurance policy are maximised in the interests of a speedy and safe return to work and that the employee receives the optimum treatment and rehabilitation support.

Advise insurer of a new claim

If an employee lodges a workers’ compensation claim, you should immediately advise your insurer and forward them a copy of the claim as soon as it is received. This should be done even when you expect that the claim cost will fall below your claim excess.

This ensures that:

  • the insurer is alerted that it could expect a claim if the cost ultimately exceeds the excess and you make a call on the policy
  • the insurer develops a full understanding of your claim history and of the injured employee. This supports improved communication between employer and insurer on claim costs and cost control strategies, and also helps establish a strong working relationship.
  • the insurer’s expertise in determining claims can be used.

Use the insurer’s expertise

Insurers have claim and injury management expertise that employers may call upon.

Often the insurer may be able to suggest an appropriate rehabilitation provider that has successfully achieved positive return to work outcomes for other employers.

An insurer’s advice could lead to you adopting rehabilitation and return to work strategies not previously considered, resulting in an earlier or more durable return to work and, ultimately, lower insurance premium costs.

Determine claims made by employees

The employer is responsible for determining claims, in the Seacare scheme.

Responsibility for determinations

As the employer, you are responsible for deciding whether workers’ compensation claims and subsequent claims for benefits and support should be accepted. You are also responsible for ensuring that decisions are made within statutory timeframes.

Employers can, and often do, delegate this power to a claims manager. Any action made on a claim by a delegated person is considered to be an action by the employer.

Insurance companies are also often involved in deciding and managing a claim for workers’ compensation, as employers in the Seacare scheme are required to have workers’ compensation insurance.

Sometimes, insurance policies contain provisions that give the insurer the right to decide whether to accept or reject the employee’s injury claim. You should consult your insurance policy to see if this is the case before making any determination.

Process for determination

On receiving a claim, you can be liable for any injury or disease, death and loss or damage to property suffered by the employee that arises out of, or in the course of, their employment. You may also be liable for any continuing medical expenses, and household and attendant care services reasonably required out of the injury or illness.

You must decide the claim for workers’ compensation and any subsequent claims for benefits or supports within 12 calendar days from the day you receive the claim, unless an extension of time has been granted. You must also provide notice in writing of any decisions made.

Principles for decision-making

In making a determination under the Seafarers Act, you should have regard for the following principles:

  • Ensure that all decisions made are lawful—this includes making sure that decisions are made by correctly authorised and qualified people, that correct legal procedures are followed, that reasoning conforms with minimum legal standards, and that a decision maker is accountable for a decision and has notified the person of their right to a review.
  • Decisions conform to the principles of natural justice—this includes ensuring the employee affected by the decision has been given the opportunity to express their views and have them considered (hearing rule), the decision is based on logical and probative evidence (evidence rule) and that the decision maker is impartial and has no personal stake in the matter (bias rule).
  • Decisions are based on evidence with findings of facts—this includes determining all material questions of fact that are necessary for making a decision, not basing a decision on a fact without evidence and ensuring that every finding of fact is based on evidence that is relevant and logical to support the finding.
  • Provide reasons for all decisions—this includes providing a statement of reasons and explanation for all decisions, informing the person of their rights to review and appeal, and ensuring notes and files are kept for every decision made.
  • Decisions are timely—this includes ensuring decisions are made within the required timeframes, and requests for extensions of time and further information are made promptly.

Extension of time

You may request an extension of time from the Seacare Authority if you require additional time to make a decision. This request must be made before the time limit expires. If the Seacare Authority denies your request for an extension, you may seek a review of this decision by the Administrative Appeals Tribunal (AAT).

The time limit may also be extended if you require further information or a document in order to make a determination. You must notify the employee in writing before the time limit is reached that further information or a document is required. Examples of further information include medical certificates and witness statements.

Notification of decision

Once you have determined the claim, you must notify the employee of the decision.

Until you accept a workers’ compensation claim, compensation is not payable and a benefit cannot be claimed by the employee.

Follow the reconsideration process

If an employee is unhappy with a determination, they can request a review of your determination.

Generally speaking, employees have the same rights of review of determinations on benefits and entitlements as they do for their initial determination of liability which is decided as part of the compensation claim.

Process for review

If an employee requests a reconsideration of a claim decision, you must arrange for a Comcare officer or an Industry Panel to assist you with the reconsideration decision (at present, no Industry Panels operate in the Seacare jurisdiction). This request must be made in reasonable time to allow for the reconsideration assistance to be provided.

We also recommend that the person who made the first decision not be the person making the reconsideration. This ensures a fresh perspective and procedural fairness in reconsidering the claim.

You may request additional information regarding the employee’s injury. If the employee refuses to provide this information, without reasonable excuse, the employer may refuse to progress the reconsideration further. The employee may also submit any additional information that may assist with the determination of the claim.

You have 60 days from receipt of a request to reconsider the claim.

You may request an extension of this deadline from the Seacare Authority. Any such request must be made prior to the end of the 60-day period.

Notification of decision

Once the review is complete, the Comcare officer provides a report of the recommendations to both the employer and employee. You should ensure a copy of the report is provided to your insurer if applicable.

Once the reconsideration is complete, you are required to issue a written notice affirming, revoking or varying the initial determination.

You must provide the employee:

  • a notice in writing setting out the terms of the decision and the reasons for the decision
  • a brief statement outlining their rights to lodge an appeal with the Administrative Appeals Tribunal (AAT) for review of the decision.

Employers, their insurers and contracted service providers should implement file management and recordkeeping procedures to provide evidence of why a determination was made and to assist in management of the claim. Where you make a decision regarding a claim, you must document the reasons for the decision.

Manage claims

In managing an employee’s claim, there are requirements and best practice principles that employers should follow.

These include to:

  • assess the injured employee’s needs at an early stage and direct them to any necessary and appropriate support (including medical and rehabilitation support)
  • regularly review the needs of the injured employee and provide the appropriate support
  • where an employee has time off work, provide support in assisting them to return to work quickly and safely—including, where necessary, making any reasonable changes to workplace arrangements to assist them in their return
  • where necessary, nominate a rehabilitation case manager as soon as possible to aid the employee’s rehabilitation and return to work
  • provide the injured employee with all necessary information about workers’ compensation, including contact information and where to access forms
  • communicate with the employee in a timely manner about their claim
  • maintain confidentiality of the employee’s personal information—information should only be used for the purpose of assessing and managing the workers’ compensation claim, rehabilitation and return to work
  • keeping employees informed of their rights and responsibilities and setting clearly defined milestones in preparation for return to work
  • assessing employee needs quickly and directing them to necessary and appropriate support.

Arrange an assessment of capacity

Employers are required to assess the capability of an employee with a work-related injury or illness who has been absent from work for 28 days or more (or who is expected to be absent for 28 days or more) to undertake a rehabilitation program.

The assessment must be made by:

  • a legally qualified medical practitioner
  • other suitably qualified person, such as an approved program provider, or
  • panel of such persons.

The report provided is the assessment.

The employer must pay for the assessment.

Employees are required to attend the examination of their capacity to undergo rehabilitation. If they do not, without a reasonable excuse, their right to compensation or other benefits may be suspended.

Select an approved rehabilitation provider

If an employee is assessed as capable of undergoing a rehabilitation program, you must speak with them about the selection of a rehabilitation provider and the development of an appropriate rehabilitation program.

Discussion with the employee must occur before arranging a provider or rehabilitation program.

You must select a rehabilitation provider that has been approved by Comcare and is recognised by the Seacare Authority to provide rehabilitation programs. This accreditation ensures that the provider’s service is of an acceptable standard and complies with accepted practices within the profession. See a list of approved rehabilitation providers.

Other rehabilitation services provided by, or suggested by, an approved rehabilitation provider can also help employees to return to work as soon as possible. Services may include vocational assessment, guidance, training/retraining, counselling and placement assistance. They may also include medical, dental, psychiatric and hospital services (whether on an in-patient or out-patient basis), physical training and exercise, physiotherapy, or occupational therapy.

You may ask a rehabilitation provider to provide advice or services. The provider, in consultation with the employee’s treating medical practitioner, can give expert advice to you on the options available to help the employee recover from their injury as a pre-condition for a return to work.

Employers are also responsible for monitoring the performance of a workplace rehabilitation provider and must inform Seacare Authority of any service delivery concerns.

Arrange a rehabilitation program

A rehabilitation program is developed to assist an employee to safely remain at or return to work as soon as possible and to encourage an employee’s full physical and mental recovery.

It can cover matters such as goals for recovery, recovery and return to work time frames, expected or planned outcomes, medical and support services, and costs.

A program may include:

  • vocational assessment
  • guidance
  • training or retraining
  • counselling
  • placement assistance
  • medical, dental, psychiatric and hospital services, whether on an in-patient or out-patient basis
  • physical training and exercise
  • physiotherapy
  • occupational therapy
  • vocational training.

If key parties agree, a return to work plan may also be developed.

If an employee is assessed as capable of undertaking a rehabilitation program, as the employer you must:

  • arrange for a Comcare-approved rehabilitation provider to develop an appropriate rehabilitation program
  • consult the employee in the development of the program and ensure they understand that they are participating in a rehabilitation program
  • ensure that any rehabilitation program is tailored to the employee’s individual needs
  • ensure the employee is provided with a copy of the proposed program for comment before the program is finalised
  • make sure the program is well coordinated, accountable and results oriented
  • monitor the rehabilitation program and be involved in all decisions relating to costs and services
  • ensure there is effective closure on the rehabilitation program.

You should also visit or contact the employee at home to provide support and demonstrate the company’s commitment to their recovery and return to work.

The cost of any rehabilitation program must be paid by you, as the employer.

Employees are required to attend the rehabilitation program. If they do not, without a reasonable excuse, their right to compensation or other benefits may be suspended.

Claims reporting

Employers and operators covered by the Seacare scheme have a range of statutory reporting requirements and must provide certain information to the Seacare Authority, in accordance with the Seafarers Act. Penalties apply for non-compliance.

Reporting includes:

  • Workers' compensation insurance arrangements
  • Claims reporting
  • Claims determination reporting
  • Claim Update reports
  • Berths and Levy Return reporting.

See Employer reporting obligations for more information about how to report and when.

Support a positive return to work plan

A return to work plan is a documented plan that matches the employee’s capabilities and limitations to assist them to return to work.

Return to work process

The plan is developed in consultation with the employee and their medical practitioner and with input from the approved rehabilitation provider. It should be approved by the treating medical practitioner.

As the employer, you should:

  • ensure the return to work plan is agreed by the employee
  • ensure the employee understands that they are participating in a return to work plan
  • advise the treating medical practitioner and approved rehabilitation provider about the availability of suitable employment or graduated return to work opportunities
  • find alternative suitable employment while the employee is unable to return to sea
  • ensure a supportive environment in the work area to which the employee will return
  • assist the employee to restore self-image and reduce any stress associated with readjustment to the work environment or injury
  • aim towards returning the employee to pre-injury or similar work if practical.

Find suitable employment options

Employers must take all reasonable steps to provide employees who are undergoing or have completed a rehabilitation program with suitable employment or to help them find suitable employment.

Suitable employment is any employment, including self-employment, for which an employee is suitable considering:

  • the employee’s age
  • the employee’s experience
  • the employee’s training
  • the employee’s language
  • the employee’s other skills
  • the employee’s suitability for rehabilitation or vocational retraining
  • the likelihood that employment would reasonably require the employee to change their place of residence
  • any other relevant matters.
Graduated return to work

In some instances, a graduated return to work may be an option and should be considered. This is suitable employment performed for a temporary period as part of the rehabilitation process as a way of preparing the employee for a return to pre-injury employment. An example is employment as a supernumerary on board a ship or part-time work on shore

If graduated return to work opportunities are available on shore they could be pursued as a part-time work on a limited number of hours or as partial duties.

If graduated return to work is recommended at sea, it may be as a supernumerary on board a ship. A supernumerary position is a short-term additional berth or position, funded by the employer or insurer, to enable an employee to return to work at sea on a graduated basis, at an earlier stage than might normally be the case, as part of the rehabilitation program.

Examples of possible duties at sea are:

  • canteen or cooking duties in a supernumerary capacity
  • assistance on deck or in the engine room under supervision in a supernumerary capacity
  • bridge watch in a supernumerary capacity
  • placement in a training course where there are clear benefits recognised by both the employer and the seafarer
  • a trainer in a supernumerary capacity
  • other duties as approved by the treating medical practitioner and the seafarer’s rehabilitation provider.

If the employee declines the offer of a job as part of a rehabilitation program on board a ship or on shore without good reason, their rights to compensation payments might be suspended.

Long-term injury or illness

If the injury is severe and there is no clear indication that the employee will return to work at sea, then suitable onshore employment, including retraining opportunities, should be explored. The employer is required to take reasonable steps to find, or assist in finding, suitable employment for the employee.

In this situation, the employer should determine whether suitable employment can be found on shore with the same employer and in the industry. If not, then the employer is obliged to help the employee find suitable employment with another employer, whether inside or outside the industry.

Closure of program and claim

Before returning to work at sea, an employee must be certified as medically fit for the duties to be performed in employment. The employee will need to obtain a certificate of medical fitness from an Australian Maritime Safety Authority (AMSA) medical inspector of seamen.

A medical inspector conducts examinations, tests and interviews, and makes whatever enquiries may be appropriate, to determine whether the employee is medically fit to perform the intended duties. When determining medical fitness, a medical inspector must follow the Standards for the Medical Examination of Seafarers and Coastal Pilots set out in Marine Order 76 (Health — medical fitness) 2017. These guidelines constitute a checklist for the medical inspector when making a determination of medical fitness.

Employers may have more stringent guidelines developed by an occupational physician. Such guidelines will reflect the nature of the jobs and any specific equipment operated. When such guidelines exist, they must be followed.

Medical inspectors are appointed by the Australian Maritime Safety Authority (AMSA). Enquiries regarding medical inspectors and associated standards should be made through the AMSA offices listed on the AMSA website.

If after returning to work, the employee notifies you or the ship’s master that they notice discomfort or aggravation to their injury or illness, the employee may need to seek medical attention. If their return to work is unsuccessful because their condition was aggravated or they sustained further injury, they may need to stop work and return to workers’ compensation until fit for work.

Claims reporting

Employers and operators covered by the Seacare scheme have a range of statutory reporting requirements and must provide certain information to the Seacare Authority, in accordance with the Seafarers Act.

Penalties apply for non-compliance.

Reporting includes:

  • Workers' compensation insurance arrangements
  • Claims reporting
  • Claims determination reporting
  • Claim Update reports
  • Berths and Levy Return reporting.

See Employer reporting obligations for more information about how to report and when.

Strategies

Early intervention

Best practice involves early intervention

While the Seafarers Act requires employers to assess the capability of an employee with a work-related injury or illness who has been absent from work for 28 days or more (or who is expected to be absent for 28 days or more) to undertake a rehabilitation program, this provision is a statutory minimum.

It is now widely accepted that best practice requires intervention earlier than 28 days, and that the earlier that intervention begins the greater the chances of a successful and durable return to work.

Adopting better rehabilitation practices increases productivity in the workplace, facilitates employees’ return to optimum health and assists in the efficient management of scheme costs.

If an employee has a work-related illness or injury that results in an absence from work, it is important that they return to their normal work as quickly as possible and in a way that protects and promotes their health. It is well established that early intervention helps early recovery.

Early intervention:

  • prevents long-term absence from the workplace
  • demonstrates management commitment to the employee
  • increases the probability of a durable return to work
  • contains the costs of incapacity, and in the longer term the insurance premium or claim cost
  • promotes staff confidence and morale.

Practicing early intervention

Practicing early intervention means you should:

  • meet with the injured employee on arrival at port, ensuring proper medical treatment is provided
  • notify the employee’s family
  • provide the injured employee with a compensation claim form to complete and lodge, as well as information from the Seacare Authority
  • commence rehabilitation as soon as possible after an injury
  • ensure that an employee who is likely to be off work for 28 days or more is assessed for their capability to undertake a rehabilitation program
  • inform employees, their treating medical practitioner and rehabilitation providers about your organisation’s rehabilitation and return to work policy
  • communicate with the treating medical practitioner regarding the employee’s rehabilitation program and return to work opportunities
  • engage an approved rehabilitation provider if the employee is assessed as likely to benefit from a rehabilitation program.

For more information:

Developing a supportive workplace culture

A supportive workplace culture assists rehabilitation and return to work.

Successful rehabilitation relies on consultation and cooperation. A workplace culture that responds positively to workplace injury in an effective and supportive way is an important foundation for successful rehabilitation.

Senior managers are in a position to make a commitment to ensure that workplace injuries, absenteeism and lost productivity are kept to a minimum. Managerial commitment should be highly visible and proper processes should be followed. It is important that this becomes part of an organisation’s culture and accepted practice.

Employers should:

  • adopt a policy and guidelines on rehabilitation and return to work practice and procedures for the company
  • develop and encourage a workplace and corporate culture that supports rehabilitation and early return to work
  • appoint a relevant and experienced company official to take responsibility for the rehabilitation process. This person could be known as the rehabilitation and return to work coordinator
  • develop a practice of regular and frequent contact with employees who are or are likely to be absent for extended periods as a means of maintaining links with the workplace – this helps to demonstrate that the employee and their contribution to work is valued
  • provide management support for the rehabilitation program and return to work plan
  • develop an understanding of rehabilitation services – when, why and how they should be used.

More information

For more information, see:

Page last reviewed: 23 April 2021
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Date printed 13 Jun 2021

https://www.seacare.gov.au/claims-rehabilitation/claims-and-rehabilitation-information-for-employers