OR SERVICE DELIVERY PRINCIPLES - EFFECTIVE 1 December 2016 (supersedes all previous versions)
CONTENTS
OR SERVICE DELIVERY PRINCIPLES - EFFECTIVE 1 December 2016 (supersedes all previous versions) 1
1. ABOUT THIS SCHEDULE 5
2. SERVICE TYPES 5
3. REFERRAL CONTEXT 6
Worker Choice of OR Provider 6
OR Approval Form 6
4. PROCEDURAL CONSIDERATIONS 6
Worker Representative 6
Worker Privacy Considerations 7
OR Consultant Title 7
5. INJURY EMPLOYER’S OBLIGATIONS 7
Injury Employer’s RTW Obligations 7
Determining Whether RTW with the Injury Employer has been exhausted 8
6. REPORTING 8
Report templates & recipients 8
When OR reports should not be provided to the injury employer 8
When OR reports should not be provided to a worker 8
Complete reports 9
Recommendations for other types of OR services, in reports 9
When progress reports are not required (for OES) 10
7. FUNDING REQUESTS 10
Funding requests & templates 10
Agent prior approval of OR services 10
OR provider travel 10
Contacts upon receipt of OR Approval Form 11
Managing the expectations of the parties associated with a worker’s RTW 12
Workplace meetings 12
8. SERVICE DELIVERY PRINCIPLES - RTW PRE INJURY EMPLOYER 12
Required activities as part of an Initial Report 12
Contents of an Initial Report 13
Activities as part of OES & contents of progress reports 13
Transition from OES to NES 14
Services during 13 week sustainable RTW period 14
OES where worker on PIH, not at PID 14
OES beyond six months of servicing 14
9. SERVICE DELIVERY PRINCIPLES – WORKPLACE SUPPORT SERVICES (WSS) 15
Procedural information 15
WSS RTW Case Conference with the agent 15
Principles of WSS service delivery 16
Facilitated meetings 16
Addressing employer understanding of mental injury 17
Identification of RTW barriers and facilitators 17
Managing the expectations of the parties 17
Focus initially on the RTW goal with the injury employer 18
Worker with a potential CWC within 3 months 18
When to cease WSS 18
10. SERVICE DELIVERY PRINCIPLES – RTW NEW EMPLOYER 19
Job Seeking Service (JSS) 20
CAPACITY SUPPORT SERVICE (CSS) 22
TRANSFERABLE SKILLS ANALYSIS SERVICE (TSA) 24
NES for long tail claims 24
130 Week Vocational Report - Purpose and content 25
Subsequent or supplementary 130 Week Vocational Report - Purpose 25
Worksafe Incentive Scheme for Employers (WISE) 26
11. TRAINING AND REDEPLOYMENT 26
Identifying redeployment opportunities - Pre injury employer 26
Identifying a training course - New employer 26
Retraining 27
Justification for a training course 27
Worker participation in training 27
Enrolment in a training course 27
Post retraining report 28
12. SUSPENDING AND CEASING OR SERVICES 28
When OR services should be suspended or ceased 28
Suspension – worker retraining 28
Ceasing OES if NCC first 3 months 28
Recommencing services – Pre injury employer 29
Recommencing services - New employer 29
NES during weekly payment ‘non entitlement period’ 30
13. RTW INCENTIVES - GENERAL 30
RTW incentive most usually paid once 30
RTW incentive not payable in certain circumstances 31
14. RTW INCENTIVES - FOR OR SERVICES PRE INJURY EMPLOYER 31
Worker absent for > 5 working days during 13 week sustainability period 31
15. RTW INCENTIVES - FOR OR SERVICES NEW EMPLOYER 31
Worker’s privacy following a RTW with a new employer 31
General conditions for paying an incentive – For RTW new employer 31
RTW with injury employer after NES commenced 32
OR Provider WISE placements 32
RTW incentive not payable in certain circumstances 33
Specific conditions for paying a second incentive 33
16. GP RTW CASE CONFERENCE 33
Reasons for arranging a GP RTW Case Conference 34
Advising the agent 34
Worker to be advised if others have been invited to the conference 34
Scheduling a GP RTW Case Conference 34
Confirming the agreed actions from a GP RTW Case Conference 35
Information about GP RTW Case Conference in next OR provider report 35
Expected outcome from a GP RTW Case Conference 35
OR provider fees for GP RTW Case Conference 36
GP fees for GP RTW Case Conference 36
17. GP RTW QUESTIONNAIRE 36
18. FURTHER INFORMATION 37
1. ABOUT THIS SCHEDULE
Occupational Rehabilitation (OR) services are recognised by WorkSafe Victoria (WorkSafe) to support a worker to return to work (RTW).
This Schedule provides information on the service delivery principles and requirements.
This Schedule must be read in conjunction with the “OR Fee Schedule” and replaces prior information and guidance released by WorkSafe.
Other information that should be accessed for delivering OR services includes:
· Relevant sections of WorkSafe Online Claims Manual
· Relevant legislation
· Guidance provided or released by WorkSafe related to occupational rehabilitation services
· Relevant information at WorkSafe.vic.gov.au.
2. SERVICE TYPES
OR services approved by WorkSafe fall into two main categories, namely those aimed at facilitating return to work with the pre injury employer and those for return to work with a new employer. The specific services are listed as follows:
Return to work pre injury employer:
· Original Employer Services (OES):
o For primary physical injury claims
o Workplace Support Services for primary mental injury claims (WSS)
o The Better @ Work (B@W).
Return to work new employer:
· New Employer Services (NES):
o Job Seeking Service (JSS)
o Capacity Support Service (CSS)
o Transferable Skills Analysis Service (TSA)
Agents are responsible for identifying the right claim, at the right time for a referral to these services.
3. REFERRAL CONTEXT
The agent is responsible for managing injured worker claims and Victorian insured employer premiums.
The agent is also responsible for managing the return to work obligations of workers and employers and identifying when or what return to work assistance is required.
Based on information gathered from workers, employers and treating health practitioners (THPs), agents will identify those claims that could benefit from OR services, decide when those services are most appropriate and the type of service.
Workers and employers might also request assistance with OR services, however the cost of those services can only be approved by an agent.
For more information, refer to relevant sections of WorkSafe Online Claims Manual.
Worker choice of OR Provider
Once the need for an OR service has been identified, the agent must ensure that the worker is given a list of at least three OR providers (where available) to choose from. A worker will select an OR provider from this list or if they do not choose an OR provider, the agent will choose an OR provider on their behalf.
For more information, refer to relevant sections of WorkSafe Online Claims Manual.
OR Approval form
Once the requirements of OR choice have been satisfied, an agent will advise an OR provider that OR services have been approved by sending them an OR Approval Form. Whenever possible and appropriate, the form must have relevant medical opinion/information attached confirming the worker’s capacity for work including medical restrictions or potential capacity for work.
4. PROCEDURAL CONSIDERATIONS
Worker representative
The legislation allows a worker to be represented, assisted and supported in the RTW process. A worker may request their representative be involved in meetings with, or arranged by the agent or an OR provider with the injury employer or the worker’s THP. OR reports or information prepared by an OR provider for a worker should be provided to the worker representative.
A worker may verbally advise the agent or an OR provider that a person is acting as their worker representative. On being made aware of a worker representative, the agent and an OR provider should liaise with the representative in addition to the worker when scheduling any meetings with the worker so the representative can be present.
Note that the legislation states that a worker representative cannot include a legal practitioner.
Worker Privacy Considerations
The agent and an OR provider must only communicate about information that is relevant to the provision of OR services and at all times, a worker’s privacy must be maintained. Similarly information collected about other parties in the workplace or outside the workplace must be afforded the same considerations and protections.
It is recommended that an OR provider advises a worker that information they share may be included in OR reports which are sent to them, their THP, the injury employer and the agent.
For more information, refer to relevant sections of WorkSafe Online Claims Manual.
OR Consultant Title
OR providers will use the following signature block for all correspondence related to OR service provision with the exception of emails:
OR Consultant Name
Service provided: Occupational Rehabilitation
Professional Background – Physiotherapist
5. INJURY EMPLOYER’S OBLIGATIONS
Injury employer’s RTW obligations
When reviewing whether an injury employer’s RTW obligations have been satisfied, the agent must confirm that other RTW opportunities at any workplace of the injury employer have also been fully exhausted. The exhausting of RTW opportunities may include the provision of retraining courses to address competency or skill gaps that may be limiting a worker’s suitability to perform a job at a workplace of the injury employer. Redeployment in another job at a workplace of an injury employer may also be considered.
Changing a worker's RTW goal to a new employer is a serious consideration for an agent. WorkSafe expects the RTW goal with the injury employer to remain the primary focus for the agent even where information is received that may suggest the injury employer has difficulty identifying RTW solutions for the worker or the worker is reluctant to engage in offers of pre-injury or suitable employment at an injury workplace.
Determining whether RTW with the injury employer has been exhausted
OR providers should contact the agent whenever an employer is unable to offer or continue offering suitable duties, so that the agent has an opportunity to determine whether the injury employer’s RTW obligations have been exhausted before considering a change to the RTW goal (e.g. job seeking for a new employer).
The opinion and information included by an OR provider in OR reports is important when the agent is deciding whether RTW obligations with the injury employer have been exhausted.
Information that would be helpful to an agent when determining whether injury employer RTW obligations have been met might include whether:
· There is medical evidence suggesting the worker cannot undertake or does not have a capacity for any of the duties or jobs available at the injury workplace
· The worker has relocated and a RTW is no longer practicable at the injury workplace
· The worker has resigned from the pre-injury employment
· The employer no longer has pre-injury or suitable employment available at an injury workplace
· The employer has terminated the worker’s pre-injury employment
· The employer has ceased to trade.
6. REPORTING
REPORT TEMPLATES & RECIPIENTS
An OR provider is required to use WorkSafe approved templates for reports.
OR reports for the purpose of RTW with the pre-injury employer can be provided to the worker, the worker’s THP, the injury employer and the agent to create a common understanding about the types of activities that may be needed to achieve a sustainable RTW for the worker and the progress made towards that RTW goal.
WHEN OR REPORTS SHOULD NOT BE PROVIDED TO the INJURY EMPLOYER
OR reports, advice or updates about a worker’s participation in an NES service must not be submitted or provided to the injury employer, even if the worker remains at work with them while receiving NES.
WHEN OR REPORTS SHOULD NOT BE PROVIDED TO A WORKER
An OR provider has the discretion not to provide a report to a worker if they determine an exception applies under the Privacy Act or Health Records Act, for instance:
o It would pose a serious threat to the life or health of the worker or any other person, or
o There would be an unreasonable impact on the personal privacy of a person other than the worker (although in the absence of the individual’s consent, the individual’s personal details or statements can be blanked out meaning the OR report could still be released).
Complete reports
An OR provider is required to submit a 'complete' report to the relevant parties within the respective timeframe specified in the OR Fee Schedule.
OR reports should contain sufficient information to enable all parties but most particularly the agent to have confidence about the progress made to date against the agreed activities from previous reports.
If a report cannot be submitted within the nominated timeframe an OR provider must advise the agent the reason for the delay and the expected date of submission.
OR reports must only contain information and opinion relevant to the OR service being provided. An OR provider should not provide opinion on the worker’s treatment or make suggestions about other treatment options.
When completing their most recent OR report, an OR provider is expected to consider and review the opinion and information found in previous OR reports. However, opinion or information previously provided in a report should only be referenced in a subsequent OR report respectively where it is pertinent or relevant to the worker's circumstances and RTW needs at the time the latest report is completed.
If an OR provider forms a view when preparing an OR report that the worker does not have a CWC or there is an actual or perceived barrier to RTW preventing the worker from being able to actively participate in OR services then the agent must be contacted prior to completing and distributing the report, to discuss the reasoning and to consider options.
OR reports must clearly reflect the OR provider’s independent opinion formed at the time the report was completed.
RECOMMENDATIONS FOR OTHER TYPES OF OR SERVICES, IN REPORTS
An OR providers must not make recommendations for another type of OR service in any reports. Instead, the OR provider must contact the agent to discuss.
This allows the agent to form their view about the most appropriate claims management for a worker without a worker, the THP or the injury employer having their expectations raised about any particular outcome in advance of that agent decision.
Examples of instances where an OR provider should contact an agent to discuss recommendations prior to submitting the next report might include: