ReturnToWorkSA is responsible for the regulation of the registered insurer and self-insurers.
The maximum period of registration as a private self-insurer is five years. Self-insurer performance is reviewed at the end of every period of registration to determine whether registration should be renewed, and the length of the period of renewal.
Regulation of self-insured employers involves a range of activities. These include:
- evaluation of compliance to the requirements of registration
- monitoring and analysis of self-insured employer performance
- review of self-assessments and reports provided by self-insured employers
- employer specific terms and conditions of registration
- partnership activity to improve performance
- oversight of financial viability as it affects the ability to continue to fund claims liabilities.
Evaluation of private self-insured employers
We will undertake an evaluation of all private self-insured employers prior to the end of each registration period.
Evaluation involves desktop and site based activity to confirm whether the self-insured employer continues to meet the conditions of registration.
Evaluations are undertaken in line with the code of conduct for self-insured employers (PDF, 7971 KB) and the evaluation practice manual (DOCX, 2606 KB).
Evaluations will test the employer’s compliance to the requirements of registration as a self-insured employer, including conformance to the injury management standards (DOCX, 480 KB) and work health and safety standards (DOCX, 520 KB).
A guide to the injury management standards (DOCX, 934 KB) and guide to the work health and safety standards (DOCX, 846 KB) has been developed to assist employers in demonstrating compliance.
In addition to evaluations, ReturnToWorkSA may undertake periodic reviews of an employer’s compliance to the requirements of registration. These reviews are normally associated with a specific term and condition applied to an individual self-insured employer’s registration.
Reports and self-assessments
During a period of registration, a self-insured employer is required to provide ReturnToWorkSA with current information on its operations, liabilities and financial performance. Mandatory reporting requirements include:
- Actuarial reports and financial guarantees: These documents are required to be provided each year. Actuarial reports and financial guarantees must comply with the guideline for actuary reports and financial guarantees (DOCX, 502 KB).
- Excess of loss: A self-insured employer must maintain an excess of loss insurance policy. The requirements of the policy are contained with the code of conduct for self-insured employers (PDF, 7971 KB).
- Claims data: Claims data must be provided in accordance with a self-insured employer EDI technical specification (DOCX, 832 KB).
- Self-assessments: A completed self-assessment report (DOCX, 46 KB) must be submitted from time to time. Information in the self-assessment report will help us maintain our knowledge of self-insured employer performance and operations.
A self-insured employer can be granted a maximum period of registration of five years (three for an initial period of registration).
During the period of registration ReturnToWorkSA will maintain contact with a self-insured employer, and may request data or information from time to time. Self-insurers are expected to comply with these requests.
- Six month reviews: ReturnToWorkSA will allocate an account manager who will undertake six monthly reviews of the self-insured employer’s registration. These reviews will be used to assign a risk rating to the self-insured employer’s registration and may result in additional contact with their assigned ReturnToWorkSA Evaluator.
- Partnership Activity: A self-insured employer can elect to participate in partnership activities with its assigned Evaluator(s). These activities can assist in maintaining contact between the employer and ReturnToWorkSA. Participating in partnership activity does not replace the need for evaluation; however, outcomes from partnership activity may be used to supplement evaluation activity.
- Ad-hoc activity: ReturnToWorkSA may elect to undertake ad-hoc regulatory activity with self-insured employers such as targeted file reviews. These activities are sometimes associated with a specific term or condition of registration placed on a self-insured employer’s registration.
- Evaluation: Self-insured employers will be required to participate in an evaluation of their compliance to the requirements of registration. Evaluation ordinarily occurs six months prior to the expiry of a registration period. Evaluation time frames will vary from employer to employer.
Registration as a self-insured employer carries with it certain responsibilities and obligations. A self-insured employer must ensure the delegated powers and discretions are administered in accordance with the objects and requirements of the Return to Work Act 2014, and compliance with the terms and conditions of registration is maintained.
ReturnToWorkSA views circumstances where an employer is unable or unwilling to comply with the requirements of registration to be a serious matter. Examples of matters considered serious include, but are not limited to:
- non-provision of suitable employment, where the self-insured employer has not demonstrated it is not reasonably practicable to do so
- unreasonable exercise of delegated powers and discretions
- non-provision of life time care and support of seriously injured workers
- failure to implement an order of the South Australian Employment Tribunal
- administration of a delegation with a bias toward the interest of the self-insured employer
- material non-compliance to the requirements of the Act, or Code of conduct for self-insured employers
- material non-compliance to the requirements of the injury management standards or the work health and safety standards.
Where a self-insured employer is unable or unwilling to comply with the requirements of registration, ReturnToWorkSA may impose a sanction. Sanctions may include:
- applying a term or condition on the self-insured employer’s registration
- reducing or revoking a period of registration
- non-renewal of registration
- removal of the self-insured employer’s delegations.
ReturnToWorkSA is the insurer of last resort for private self-insured employer work injury claims.
Financial guarantees provide ReturnToWorkSA protection from the risk of insolvency or failure by a self-insured employer to make adequate provisions for its claims costs.
A self-insured employer must provide ReturnToWorkSA with an actuary report within 3 months of the end of the employer's financial year.
The actuary report is used to calculate the value of the financial guarantee. On receiving an actuary report, ReturnToWorkSA will calculate the value of the required financial guarantee and notify the self-insured employer if a new financial guarantee is required.
The minimum guarantee amount for the 2018 calendar year is $870,000.