Compensation Operational Guideline

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A list of operational guideline definitions.

1. What is the purpose of this operational guideline?
2. What is the relevant legislation?
3. Overview
4. Principles relating to compensation
5. Requiring a participant, or prospective participant, to take action to claim or obtain compensation
   1. When the NDIA may require a participant, or prospective participant, to take action to claim or obtain compensation
   2. When will the NDIA consider that a participant, or prospective participant, is or may be entitled to compensation?
   3. What if a participant, or prospective participant, has entered into an agreement to give up a right to compensation?
   4. Giving written notice that action must be taken
   5. How long does a participant, or prospective participant, have to comply with a notice requiring a participant, or prospective participant, to take action to claim or obtain compensation?
   6. Can the period of time in a written notice be extended?
   7. Evidencing action that has been taken
   8. Consequences of failure to comply with the requirement to take action to claim or obtain compensation
   9. The NDIA must notify a participant, or prospective participant, in writing that the action is being considered
   10. Who is responsible for the legal costs of a claim if the NDIA takes action on behalf of a participant, or prospective participant, or takes over the conduct of a claim
   11. Recovery of past NDIS amounts and costs incidental to the claim paid for by the NDIA from claims brought, or taken over by the NDIA on behalf of the participant, or prospective participant
6. Recovering past NDIS amounts from compensation
   1. When may the NDIA calculate a recoverable amount?
   2. When a recoverable amount will not be calculated
   3. Recovering amounts from compensation fixed under a judgement (other than a consent judgement) under section 106 of the NDIS Act
   4. What amount is payable to the NDIA?
   5. Recovering from compensation fixed by consent judgement or settlement
   6. What amount is payable to the NDIA?
   7. The recoverable amount is a debt due to the NDIA
7. Recovery from compensation payers and insurers
   1. What is a preliminary notice?
   2. What is the effect of a Preliminary Notice?
   3. When can the NDIA give a preliminary notice to a potential compensation payer?
   4. When can the NDIA give a preliminary notice to an insurer?
   5. What information must a preliminary notice contain? (subsection 109(3) of the NDIS Act)
   6. What is a recovery notice?
   7. Effect of a Recovery Notice
   8. When may the NDIA give a recovery notice to a compensation payer?
   9. When may the NDIA give a recovery notice to an insurer?
   10. Calculating the amount to be specified in the notice
   11. What information must a recovery notice contain?
   12. The amount specified in a recovery notice is a debt due to the Agency by the recipient of the notice
   13. Payment to the NDIA discharges the compensation payer or insurer’s liability
   14. Consequences of failing to comply with a preliminary notice or recovery notice
8. Compensation Reduction Amount (CRA)
   1. What is a CRA?
   2. In what circumstances is a CRA calculated?
   3. Why is a CRA calculated?
   4. How is a CRA calculated?
   5. Applying the CRA to a statement of participant supports
   6. For how long will a CRA be applied to statements of participant supports?
   7. What happens if the CRA is reduced to nil?
9. Calculating the Compensation Reduction Amount (CRA) when compensation is fixed by a non-consent judgment, consent judgement, or settlement and the National Disability Insurance Scheme (NDIS) component is objectively identifiable
   1. Steps for calculating the CRA where the NDIS component is fixed by a non-consent judgement, consent judgement or settlement, or is objectively identifiable
   2. Example calculation
   3. Compensation reduction amount reduced to nil
10. Calculating the compensation reduction amount (CRA) when compensation is fixed by a non-consent judgment, consent judgement, or settlement and the National Disability Insurance Scheme (NDIS) component is not objectively identifiable
    1. Steps for calculating the CRA where the NDIS component is not objectively identifiable
    2. Where the person has received more than one compensation payment for the same injury
    3. CRA reduced to nil
11. Where participant is receiving compensation under a scheme of insurance or compensation under a Commonwealth, State or Territory law (rule 3.1(c) and rules 3.17-3.18)
    1. Identifying the Compensation Reduction Amount (CRA) where the participant is receiving compensation under a scheme of insurance or scheme of compensation under a Commonwealth, State or Territory law (rules 3.17-3.18 of the Compensation Rules)
12. Agreements to give up a right to compensation (rules 3.1(d) and 3.19 of the Compensation Rules)
    1. When a participant may be considered to have entered into an agreement to give up a right to compensation
    2. How does the NDIA determine whether it was reasonable to enter into the agreement?
    3. Calculating the CRA – agreement to give up compensation (rules 3.19-3.21 of the Compensation Rules)
    4. Where there is an agreement to give up a right to compensation and another CRA has been identified in respect of the same injury
    5. Compensation reduction amount reduced to nil
13. Special Circumstances
    1. What are special circumstances?
    2. Special circumstances and recovery (section 116 of the NDIS Act)
    3. Special circumstances and Compensation Reduction Amounts (CRA’s)
    4. Information and documents required for a special circumstances determination
    5. Special circumstances and reviewable decisions
14. Review of Decisions
    1. Reviewable decisions relevant to compensation
    2. The decision to approve a statement of participant supports in a participant’s plan may include application of a Compensation Reduction Amount (CRA)