Scheme design

As tribunal members it is important that you understand the context in which injured workers come to you at the tribunal. There still seems to be some confusion as to the difference between WorkCover and Q-COMP's functions for some tribunal members.

Hopefully this quick explanation will help explain the roles of the respective organisations in the Queensland workers' compensation scheme. The scheme has three main groups of players at the government level.

 

Policy: The Department of Justice and Attorney General formulates workers' compensation policy and has a unit specifically responsible for transforming government policy into legislation through Acts and Regulations. Q-COMP may be asked to provide input regarding policy from time to time but Q-COMP administers government policy, it does not create workers' compensation policy.

Insurers: Queensland has two sets of insurance arrangements for employers. An employer is either insured with WorkCover Queensland or it is self-insured. Approximately 90% of the claims under the Queensland scheme are with WorkCover Queensland. The other 10 % are spread across 24 self insured employers.

Insurers manage the claims process including payments and case management. WorkCover Queensland reports directly to the minister in terms of its performance. Self-insurers are licensed by Q-COMP and are accountable to Q-COMP in terms of performance.

Regulation: Q-COMP is an independent statutory authority with its own board that reports directly to the Minister. Q-COMP has numerous regulatory functions including:

• supporting and overseeing efficient administration of medical assessment tribunals
• reviewing insurers decisions and managing appeals
• monitoring performance and compliance of insurers
• deciding self-insurance applications
• providing rehabilitation advisory services
• maintaining a database for scheme wide reporting.

In short Q-COMP and WorkCover are different organisations with very different functions.

Q-COMP has no role in terms of the day to day management of claims.  That said, insurers are obliged to abide by the decisions of tribunals and the Review Unit. We do liaise with insurers in terms of matters relating to management of claims through numerous avenues including the Q-COMP Medical Advisor but we cannot direct WorkCover to manage a claim in a certain way.