19 APRIL

NEW ZEALAND GAZETTE

899

10. Transferred Claims Payment

10.1 If, at the expiration of the Claim Management Period provided for in the Contract for Full Self Cover, an employee of the Accredited Employer, who has suffered a work-related personal injury during the Cover Period, still has or may have statutory entitlements related to that injury then:

(a) Responsibility for payments and the management of the claim must transfer to the Manager; and

(b) The Accredited Employer must agree to pay to the Manager an amount in respect of the residual liability calculated in accordance with paragraphs 10.2 and 10.3 and to accept the contingent liability in paragraph 10.4. However, the liability of the Accredited Employer is not to exceed the Limit for the relevant Cover Period set out in paragraph 16.

10.2 The amount payable in respect of the residual liability referred to in paragraph 10.1 is to be calculated by the Manager making an actuarial assessment of the then present value of the likely amounts of:

(a) Future payments of statutory entitlements of that employee (being the statutory entitlements that the Accredited Employer would have paid to or on behalf of that employee had the Claim Management Period continued indefinitely into the future); and

(b) Case management expenses.

10.3 In respect of both heads of liability under paragraph 10.2 such assessment is to be made:

(a) From information obtained from the file for such claim together with any additional information obtained by the Manager in respect of the claim (either from the Accredited Employer or otherwise);

(b) Using the same actuarial calculations (including, where appropriate, inflation allowances and discount rates) as were used by the Manager in preparing the recommendations under section 409 of the Act for the year in which the Claim Management Period terminates;

(c) Where practical, within one month after the end of the relevant Claim Management Period.

10.4 The Accredited Employer must agree that if, after the expiration of the Claim Management Period provided for in the Contract for Full Self Cover, an employee of the Accredited Employer, who has suffered a work-related personal injury during the Cover Period:

(a) Makes a claim for that work-related personal injury for the first time (whether because it is work-related gradual process, disease or infection under section 33 of the Act or otherwise); or

(b) Suffers a subsequent injury (as defined in section 112 of the Act); or

(c) Reactivates a claim (not being a claim handed over under paragraph 10.1 and for which an assessment was made under paragraphs 10.2 and 10.3),

Then the Manager is entitled to be paid by the Accredited Employer the costs of such claim. Such costs are to include a proper contribution to case management expenses but, in relation to the statutory entitlements of such employee, are not to exceed the amount that the Accredited Employer would have had to pay if the Claim Management Period was still then current. The costs are to be paid to the Manager as they are incurred by the Manager.

10.5 An Accredited Employer must agree that a certificate from the auditors of the Manager as to the matters referred to in paragraph 10.3(b) is to be conclusive evidence in the absence of manifest error.

10.6 The Manager may stipulate in the Accreditation Agreement a date by which the Accredited Employer must provide full information to the Manager about the then known unclosed claims. This is in order that the transfer of responsibility from the Accredited Employer to the Manager can be planned co-operatively and so that there is a smooth transition in the interests of the injured employee. The date so stipulated may be up to 6 months before the end of the relevant Claim Management Period.

PART 3

Provisions Common to both the Partnership Discount and Full Self Cover Plans

11. General Eligibility

11.1 An employer seeking to enter into either a Contract for Partnership Discount or a Contract for Full Self Cover must qualify under the criteria in this paragraph 11.

11.2 Section 326E(1) of the Act provides that:

The manager may not enter into an accreditation agreement with an employer unless, in the opinion of the manager, the employer -

(a) has appropriate experience in managing occupational health and safety issues positively; and

(b) has demonstrated commitment to injury prevention; and

(c) has demonstrated understanding and awareness of the importance of -

(i) rehabilitation; and

(ii) the employer’s involvement in the rehabilitation of the employer’s employees; and