Glossary
Scheme Agent
The organisation appointed to manage workers compensation claims day to day on behalf of the Nominal Insurer.
Also called: claims service provider · authorised agent · claims agent
Definition
A scheme agent is an organisation appointed to manage workers compensation claims on behalf of icare's Nominal Insurer. The agent is the practical decision-maker on a claim: registering it, determining liability, arranging weekly payments, approving reasonably necessary treatment and services, and overseeing the return-to-work plan. Employers and workers usually deal with the scheme agent rather than with icare directly. Self-insurers and specialised insurers carry out the same claims-management function through their own teams. SIRA sets the rules each of them must follow.
In practice
The scheme agent is who a referral and any request for workplace rehabilitation services goes to for pre-approval, and who receives progress reports as a claim moves along. Nexus coordinates with the agent on suitable duties, timeframes and the return-to-work plan, and keeps the nominated treating doctor and employer aligned. The agent decides funding; Nexus does the coordination, not the treatment.