Sickness and injury

Are you helping a sick or injured employee? There are ways that we can assist.

You need to know…

There are some important differences between CSS, PSS, and PSSap that you should be aware of when it comes to helping your sick or injured employees.

PSSap

Insurance

If your employee is a PSSap customer, they may have access to lifePLUS cover insurance—which may include income protection and total and permanent disability (TPD) benefits. Because PSSap customers initiate their own insurance claims, you may not be aware that an employee has submitted a claim. For privacy reasons, we must generally have authority from our customer to discuss their insurance matters with you.

Invalidity Retirement

Your employee may also be eligible for superannuation benefits from PSSap if they retire on medical grounds. Either you or your employee may apply for an Invalidity Retirement Certificate (IRC) if your employee is to be medically retired, or if they are permanently incapacitated. An IRC will provide confirmation that your employee meets the definition of being permanently incapacitated and is eligible to receive superannuation benefits.

If your employee has lifePLUS cover, the IRC may not be issued until any outstanding insurance claim has been finalised. This is because the insurer may be working with the employee directly on rehabilitation or return to work opportunities, or seeking additional medical evidence that may assist us in making the right decision regarding your employee’s capacity to work again.

CSS and PSS

CSS and PSS do not have an insurance component (with the exception of Additional Death and Invalidity Cover (ADIC) for eligible PSS members), however members may be entitled to superannuation benefits on the grounds of permanent invalidity or death. CSS and PSS customers may also be eligible to partial invalidity benefits. Any claim for invalidity benefits must be made by you on behalf of your employee. Customers of PSS who have ADIC, can make an additional claim directly through us.

Customers with a PSSap Ancillary account may also have lifePLUS cover and should contact us to discuss any possible lifePLUS cover claims.

If you are helping a sick or injured employee who is not a member of a CSC scheme, you should let them know that they may be covered by insurance under their own super scheme and encourage them to call their super fund to enquire about making a claim. 

LifePLUS cover

Customers of PSSap may have access to insurance through lifePLUS cover. There are two types of cover: lifePLUS auto cover and lifePLUS choice cover.

lifePLUS auto is generally provided on an opt-out basis to eligible permanent and non-ongoing contract employees. Eligible casual employees can access lifePLUS auto on an opt-in basis. If your employee is covered under lifePLUS auto cover, it’s likely that they have income protection, death and TPD insurance.

PSSap customers can apply for lifePLUS choice cover if they wish to customise their insurance to better suit their needs.

If your employee is a PSSap customer, they can find out exactly what they’re covered for by logging into member services online, or by reading through their annual statement from us.

For more details on lifePLUS cover, see the Insurance and your super booklet and the lifePLUS Key Facts Sheet

How lifePLUS cover works to help customers get the right outcome

Our lifePLUS income protection and TPD cover are designed to complement each other. They allow eligible PSSap customers to receive ongoing income replacement, including super contributions, and access ongoing support via vocational rehabilitation and return-to-work services, for a benefit period of up to 5 years. Our TPD benefits generally have a waiting period of 2 years.

This approach allows us to better understand the customer’s needs and ensure that the customer gets the right outcome in the long term.

Encourage members to talk to us early

It’s important that a sick or injured PSSap customer contacts us as early as possible about claiming on their insurance, even if they have an existing employment process or Comcare claim underway.  We will help our customer to understand what insurance options are available to them, and guide them through the process of how and when to make a claim.

Income Protection

PSSap customers don’t have to use all of their sick leave before making a claim for income protection. However, your agency’s enterprise agreement (or similar employment arrangement) may require all paid sick leave to be used before your employee can take unpaid sick leave. It’s important to note that any payments made by your agency to your employee, including sick leave payments, will reduce the amount of income protection payable.

During the claim notification process, we will assess our customer to see if they qualify for our early intervention program. The program allows us to support our customer by connecting them with early intervention, wellness and rehabilitation services while they undergo the claims process. 

Total and permanent disability 

If a PSSap customer is suffering from a medical condition that renders them unable to continue working in any capacity, they may wish to make a claim for total and permanent disability (TPD) insurance through lifePLUS cover. A TPD claim is initiated by our customer.

There are qualifying periods that apply to TPD claims. This means that a PSSap customer may not be eligible to make a claim until they’ve been unable to perform any work due to their injury or illness for that qualifying period, which can be up to 24 months. The length of the qualifying period differs depending on the customer’s situation and can be waived entirely for certain conditions.

If your employee stops working because of their medical condition it’s important that they speak to us as soon as possible. This way we can assist them as much as possible before their qualifying period has been met.

Terminal Illness

As part of a PSSap customer’s Death and TPD Cover, they also have a Terminal Illness benefit. The Terminal Illness benefit is equal to their Death cover. PSSap customers with a life expectancy of less than 24 months should be encouraged to contact us as soon as possible so we can provide them with information about their insurance.

Invalidity retirement

If a PSSap customer is to be medically retired under invalidity retirement, you will need to submit the Application for Issue of Invalidity Retirement Certificate (SPC) form to us along with supporting evidence. You can find helpful information below:
A quick guide to invalidity retirement for PSSap members
Assisting terminally ill PSSap members
PSSap doctor’s report checklist
PSSap application for issue of invalidity retirement certificate (SPC) form 

 

Invalidity retirement

Customers of CSS and PSS who are totally and permanently incapacitated may be able to medically retire and claim an invalidity benefit through us.

Medical retirement is not possible unless we issue an IRC, if your employee is:
• a customer of CSS and under age 65 or
• a customer of PSS and under age 60

You can find more helpful information about invalidity retirement via the links below:

Guidelines for invalidity retirement

CSS and PSS invalidity notes

Assisting terminally ill CSS and PSS members

CSS and PSS doctor’s report checklist for invalidity retirement

CSS application for issue of invalidity retirement certificate (SPC) form

PSS application for issue of invalidity retirement certificate (SPC) form 

  

Note: You no longer need to provide a SM2 form completed by an independent medical examiner when submitting an invalidity retirement application.

 Pre-assessment payments

Employees who are customers of CSS and PSS may be eligible to receive pre-assessment payments (PAPs) before an IRC is issued if they:
• are likely to be totally and permanently incapacitated
• have been off work for 28 consecutive days
• have expired all of their sick leave
• are not receiving compensation payments
• are not a limited benefits member.

More information can be found in the CSS and PSS invalidity notes above.

Our PAP calculator will assist you to pay and seek reimbursement of PAPs paid to a customer.

Partial invalidity pensions

Customers of CSS and PSS may be eligible for a partial invalidity pension (PIP) if they have suffered a permanent decrease in salary due to a change to their work hours and/or redeployment to a lower position which is attributed to a physical or mental incapacity.

Use the links below to learn more about PIPs:

PSS PIP notes

CSS PIP notes

Informal reduction in hours – delegate’s instrument

Informal redeployment – delegate’s instrument

CSS medical officers ’ report checklist for PIP applications

PSS medical officers’ report checklist for PIP applications

PSS medical officers’ report checklist for reviewing PIPs 

PIP application (SPP) form 

Our PSS PIP calculator will assist you to pay and seek reimbursement of a PSS PIP.

Approved Medical Practitioners

Below is a list of the current providers of approved medical practitioners who are to be used when obtaining a report on whether or not a member is totally and permanently incapacitated in preparation for an application for an invalidity retirement certificate.

 

Provider Contact details for bookings
AMLG 1300 554 361
http://ausmedlegal.com.au/
eReports 1300 130 963
admin@ereports.com.au
MedHealth Pty Ltd (MLCOA) http://www.mlcoa.com.au/
Medico-Legal Reporting Services of Australia (MLRSA) 1300 130 963
http://mlrsa.com.au/
Red Health 1300 130 963
http://redhealth.com.au
enquiry@redhealth.com.au

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