906 NEW ZEALAND GAZETTE No. 41

Employer has, to any of its employees who suffer a work-related personal injury during the Cover Period or to the Manager, to meet the statutory entitlements of such employees and associated costs as provided for in the relevant Accreditation Agreement.

17.2 Nothing in paragraph 17.1 is to prevent:

(a) An Accredited Employer entering into an agreement (for adequate consideration) with a treatment provider for the meeting of costs of treatment (as provided for in Part 1 of Schedule 1 to the Act); or

(b) Where an Accredited Employer is a member of a group of companies (as that expression is defined in section 2 of the Financial Reporting Act 1993), the requisite statutory entitlement being provided by another member of that group.

18. Delegations

18.1 The responsibilities of each Accredited Employer are to be personal to that employer.

18.2 Notwithstanding paragraph 18.1 and paragraph 11.3(c)(ii), an Accredited Employer may utilise the services of a third party to provide claim and case management services provided:

(a) The Accredited Employer retains overall responsibility for claim and case management; and

(b) The Accredited Employer maintains direct personal involvement with the claimant’s injury management and rehabilitation; and

(c) The third party provider has, in the opinion of the Manager, the functional capacity to carry out its responsibilities under the Act and this Framework; and

(d) The Accredited Employer makes full disclosure of the relationship (including the nature of the third party provider’s obligations) that exists or will exist with the third party provider; and

(e) The Accredited Employer will procure that the third party provider undertakes to the Accredited Employer and the Manager to advise treatment providers as to who has the ultimate responsibility for managing the claim and paying the treatment expenses; and

(f) The Accredited Employer first obtains the consent of the Manager. Such consent is not to be unreasonably withheld if the Manager is satisfied that the requirements of subparagraphs (a), (b), (c), (d) and (e) and the objectives of the Act have been met. The Manager may impose reasonable conditions as part of any such consent.

19. Reporting and Information

19.1 Every Accredited Employer must agree to regularly report to the Manager on claims, the provision of statutory entitlements and expenses arising during the Cover Period and ensuing Claim Management Period. Such reports are to be at the frequency specified in their Accreditation Agreement being not more frequent than 1 month nor less frequent than 3 months. The reports are to be in the form specified by the Manager. Such reports must at least meet the requirements of section 194(1)(g) and (7) of the Act.

19.2 The Accredited Employer must agree that all information received by an Accredited Employer in relation to work-related personal injury claims made by an employee of that employer, or created by the Accredited Employer for the purpose of managing that claim, is, as far as possible, the property of the Manager and:

(a) The Manager is entitled to access to that information at all reasonable times;

(b) Where the employee has more than one employer the Accredited Employer consents to the sharing with the other employer such information as the Manager considers necessary to fulfil the obligations of the Manager to the employee under the Act.

19.3 Every Accredited Employer must agree to provide to each employee, without charge, a written statement, in plain English, that specifies the procedures and requirements under its Accreditation Agreement in relation to the lodging of claims, provision of treatment, handling of claims, assessment of incapacity, assessment of capacity for work, and dispute resolution.

20. Monitoring and Audit Framework

20.1 The Manager must maintain an active monitoring and audit programme of Accredited Employers to ensure the entry requirements set out in paragraph 11 are maintained and that claimant interests are appropriately addressed.

20.2 This active monitoring and audit programme must include:

(a) A review of the reporting of claims details and expenditure. This information is to be utilised to provide regular comparative benchmarking reports for the Manager and the individual Accredited Employer and their third party providers (if any) and to allow the identification of any follow-up issues while still protecting privacy and commercial sensitivity;

(b) Onsite audits at least annually of individual Accredited Employer claims management performance. Such audits are to include and to be consistent with the criteria and tests in paragraph 11;