GN 7.6 Transition to work
Application: This guidance applies to exempt workers
Overview
The transition to work program provides funding to address immediate or short-term barriers or needs that prevent a worker with a work-related injury from obtaining or accepting an offer of employment with a new employer.
There are two payment tiers under the transition to work program:
Tier 1: Up to $200 to help a worker prepare for job-seeking or to commence work. The payment can be used more than once provided the cumulative costs do not exceed $200.
Tier 2: Up to $5,000 to address an immediate or short-term barrier(s) preventing a worker from accepting a new employment offer (for example, travel, transitional childcare arrangements, clothing). The payment can be used more than once provided the cumulative costs do not exceed $5,000.
Eligibility
A worker is eligible if:
- they are receiving or are entitled to receive weekly payments under Part 3, Division 2 of the Workers Compensation Act 1987 (1987 Act) or have recently ceased receipt of weekly payments due to commencing employment
- they are unable to return to work with their pre-injury employer because of the injury, and there is an immediate or short-term barrier or need that prevents the worker obtaining or accepting an offer of employment
- a commutation or work injury damages settlement has not been accepted
- for tier 2 applications – they have a confirmed offer of employment with a new employer that is:
- for a period of three months or more
- for a minimum of 64 paid hours per month, or pre-injury hours if this is less than 64 paid hours per month. Fewer hours may be considered if it can be demonstrated that the worker will progress to meet this requirement within a reasonable timeframe.
Principles
The application for the transition to work program must include a detailed description of how an item of service addresses the following principles:
- The item or service must address an immediate or short-term barrier or need that prevents a worker from participating in job-seeking (tier 1) or accepting an offer of employment (tier 2).
- The item or service must be cost effective and demonstrate that other options are less effective in addressing the barrier or need.
- The application must demonstrate the worker’s capacity to maintain their financial arrangements independently when the transition to work payment has ceased.
Common strategies
Travel
Workers should use public transport where available and appropriate. If it is necessary to use a private vehicle, the vehicle must have third-party property insurance as a minimum. Private transport costs are reimbursed at 55 cents per kilometre (please refer to the current Workers compensation benefits guide for the current rate for car travel expenses).
Relocation and accommodation
Relocation costs will be considered if a job offer becomes available in another location that is well beyond normal commuting distance. Funding for short-term accommodation will also be considered provided there is a sound strategy that will enable the worker to maintain accommodation arrangements independently when the transition to work payments have ceased.
Transitional child care
Costs for childcare with a registered childcare provider will be considered, provided the worker can maintain the costs associated with the childcare arrangements independently when the transition to work payments have ceased.
Clothing and related expenses
Reasonable costs for suitable clothing and personal grooming to support a worker to obtain or commence employment will be considered where the application meets the principles of transition to work.
Uniforms or other clothes that are essential for commencing employment will be considered, but not the costs of standard issue uniforms, personal protective equipment and items of clothing that should be provided by the employer as part of their obligations under the Work Health and Safety Act 2011.
Application process
A worker’s return to work coordinator, insurer or approved workplace rehabilitation provider (provider) may prepare an application.
The person developing the application must check whether a worker has an entitlement to new employment assistance (under section 64B of the 1987 Act). It may be appropriate to confirm this with the insurer. Where the worker is entitled to claim such assistance, this entitlement must be exhausted before accessing funding under the SIRA transition to work program.
A worker who has an entitlement to new employment assistance may be eligible for funding under the SIRA transition to work program where:
- they have exhausted their entitlement to new employment assistance (this includes where an application exceeds $1,000 – note this does not apply to exempt workers), or
- the insurer disputes liability for the new employment assistance (including where the insurer does not notify the worker of a decision within the required time period).
A combined new employment assistance and transition to work application may be developed where costs required exceed $1,000 up to a maximum of $6,000. In this instance, it will be necessary to demonstrate the application meets the requirements for both a new employment assistance claim and the SIRA transition to work program. If any requirements cannot be met, justification must be provided outlining why the proposal is most likely to assist the worker to return to work.
A SIRA transition to work application is submitted using the vocational program - details form. SIRA does not prescribe an application form for new employment assistance.
Figure 1 below aims to guide application decision-making.
Assessing an application
Tier 1 program costs (costs under $200) do not require prior approval from the insurer. The provider must follow their service provision and internal quality assurance processes to confirm the application meets the SIRA transition to work requirements and relevant principles. The provider must also inform the insurer (in writing) of the specific costs relating to the application.
Tier 2 program costs must be approved by the insurer before they are incurred. The insurer will advise the worker and the person submitting the application of the assessment decision within 14 days of receiving a complete transition to work application.
If the application is not approved, the insurer must advise the worker of the SIRA appeal process.
Payment
Payments should be made in line with the amount(s) approved.
Payment should only be made where there is evidence of cost/expenditure (eg purchase order, tax invoice, receipts or record of travel such as a travel log or fares).
The insurer/agent must have controls in place to prevent duplicate payments being made and claimed.
A completed vocational program – claim for payment form and relevant invoices or receipts must be submitted to facilitate payment.
Up to $300 may be paid in advance (where appropriate) for travel. To arrange an advance payment please send the request to [email protected].
Nominal Insurer scheme agent
When the claim is with a Nominal Insurer scheme agent, the agent is responsible for administering payment of vocational program expenses.
Agent for icare Insurance for NSW
When the claim is with an agent for icare Insurance for NSW, the agent is responsible for administering payment of vocational program expenses less than $10,000.
Self-insurer or specialised insurer
When the claim is with a self or specialised insurer, the insurer is responsible for administering payment of vocational program expenses less than $2,000.
SIRA
When the claim is with an agent for icare Insurance for NSW, self-insurer or specialised insurer and the costs exceed the amounts above, SIRA will make payments.
These payments will be processed when a vocational program – claim for payment form, copy of the vocational program - details form, and relevant invoices or receipts are received at [email protected].
Note: A minimum of 10 working days is required to enable processing and payment of approved costs.
Insurer/agent reimbursement
Insurers and agents can request reimbursement from SIRA for program costs.
Insurers and agents are to ensure that all claims for reimbursement can be substantiated. Substantiated means programs are approved and supported by appropriate evidence of the expenses.
Self and specialised insurers
Reimbursements from SIRA can be claimed within six months of the costs being incurred by submitting a claim for payment, evidence of payment and relevant receipts.
Nominal insurer and agent for icare Insurance for NSW
Reimbursements from SIRA can be claimed by a tax invoice. The invoice should be accompanied by an itemised breakdown by claim and program type of the costs incurred.
For more information about making a claim for reimbursement, contact [email protected].
Phone 13 10 50
Email [email protected]