Schedule 3 - New Employer Services (NES) descriptions & codes effective 1 July 2013
1. EXPLANATORY INFORMATION 5
2. WORKER RELATED CONSIDERATIONS AND RESPONSIBILITIES 6
2.1 Worker representative 6
2.2 Worker Privacy Considerations 6
2.3 Managing the expectations of the parties associated with a worker’s RTW 6
3. AGENT RESPONSIBILITIES 7
3.1 Agent NES Responsibilities 7
3.2 Determining whether RTW with the injury employer has been exhausted 7
3.3 Agent NES Responsibilities 8
3.4 Agent prior approval of NES services needed before services can be provided 8
3.4 NES Service Options 9
1. Worker has a CWC but not at work 9
2. Worker at work with the injury employer but this cannot continue 9
3. NES services considered as part of a 130 week entitlement review 9
3.5 Worker choice of OR Provider 10
3.6 OR Referral form 10
3.7 NES Workplace Report 10
4. OR PROVIDER NES RESPONSIBILITIES 11
4.1 WorkSafe Incentive Scheme for Employers (WISE) 11
WISE placement exclusions 11
4.2 Job brokerage, a key OR provider deliverable 12
5. NES REPORT TEMPLATES 13
5.1 Provision of NES reports 13
5.2 Complete NES reports 13
6. NES FUNDING 15
6.1 NES Funding Requests 15
6.2 NES funding sought via email 15
6.3 OR Consultant Title 15
6.4 NES Provider Travel 15
6.5 OR provider fees for GP RTW Case Conference purposes 16
7. TRAINING AND REDEPLOYMENT 17
7.1 Identifying a training course 17
OR provider identifies suitable employment but a particular competency required 17
OR provider cannot identify suitable employment and different competency required 17
Worker participation in training 17
Agent approval of a training course 17
7.2 Agent advice to worker, training course approval 18
Enrolment in a training course 18
Training Course Monitoring 19
8. SUSPENDING, CEASING AND RECOMENCING NES SERVICES 20
8.1 Suspending NES services 20
8.2 Ceasing NES services 20
8.3 Recommencing NES 20
Services previously suspended or ceased 20
After non sustainable RTW 21
After a sustainable RTW 21
After incentive paid employment ceases or medical evidence received work is no longer suitable 21
8.4 NES services during weekly payment ‘non entitlement period’ 21
9.0 RTW INCENTIVES 22
9.1 Worker’s privacy following a RTW with a new employer 22
9.2 General conditions for paying an incentive 22
9.3 RTW with injury employer after NES commenced 22
9.4 RTW with WISE during NES 22
9.5 RTW with WISE after NES completed 23
9.6 RTW incentive not payable in certain circumstances 23
Worker absent for more than 5 working days during 13 week sustainable RTW period 23
Self-employment as an option during NES 23
9.7 Specific conditions for paying a second incentive 23
10. GP RTW CASE CONFERENCE 24
10.1 Reasons for arranging a GP RTW Case Conference 24
10.2 Advising the agent 24
10.3 Worker to be advised if the agent has been invited to the conference 24
10.4 Scheduling a GP RTW Case Conference 24
10.5 Confirming the agreed actions from a GP RTW Case Conference 25
10.6 Information about GP RTW Case Conference in next OR provider report 25
10.7 Expected outcome from a GP RTW Case Conference 25
10.8 OR provider fees for GP RTW Case Conference purposes 25
10.9 GP fees for GP RTW Case Conference purposes 26
11. NES SERVICES AND FEES 27
Vocational Report 27
Subsequent Vocational Report 30
Workplace Report 31
Identifying an appropriate training course 33
Monitoring a worker’s progress in a training course 34
Vocational Counselling 35
26 Week NES 37
12 Week NES Refresher 42
NES Placement Report 43
NES RTW Incentives 43
Provider Travel including OR provider GP RTW Case Conference costs 45
130 Week Vocational Assessment Report (see also Subsequent Vocational Report) 46
WISE OR Provider fees Payment Type Code 216 48
Attachment 1 - GP RTW Case Conference – Worker Letter 49
Attachment 2 – GP RTW CASE CONFERENCE – GP LETTER 51
Attachment 3 - GP RTW Case Conference Action Plan 53
2013.1 Schedule 3 NES effective 1 July 2013 released 1 February 2014 Page 1 of 53
1. EXPLANATORY INFORMATION
New Employer Services (NES) are occupational rehabilitation (OR) services recognised by WorkSafe Victoria (WorkSafe) to support a worker to return to work (RTW) with a new employer.
This Schedule should be read in conjunction with the WorkSafe Online Claims Manual and any other guidance provided or released by WorkSafe related to those OR services known as NES services. The information contained in this Schedule replaces prior information and guidance released by WorkSafe.
Within this NES information - a reference to:
The ‘legislation’ means a reference to Victorian workers compensation legislation
A “Qualified rehabilitation professional” means a person who satisfies the qualifications, knowledge and experience for being a Workplace Rehabilitation Consultant as defined by the Nationally Consistent Approval Framework for Workplace Rehabilitation Providers (NCF)[1]
“Suitable employment” means a reference to pre-injury or suitable employment at an injury workplace unless it is referenced in the context of new employment with a new employer
A “Vocational Advisor” means a person who has received formal qualifications in and/or experience and skills in recruitment, employment or disability placement services
A “worker” means a reference to a worker including a person (a worker representative) that the worker has requested to assist and support them in the RTW process
2013.1 Schedule 3 NES effective 1 July 2013 released 1 February 2014 Page 1 of 53
2. WORKER RELATED CONSIDERATIONS AND RESPONSIBILITIES
2.1 Worker representative
The legislation allows a worker to be represented, assisted and supported in the RTW process.[2] 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 treating health practitioner (THP). NES 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.[3] On being made aware of a worker representative, the agent and an OR provider should liaise with them when scheduling any meetings with the worker so the representative can be present.
2.2 Worker Privacy Considerations
The agent and an OR provider must only communicate about information that is relevant to the provision of NES services and at all times, a worker’s privacy must be maintained. Similarly information collected about other parties 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 NES reports which are sent to them, their THP and the agent.
2.3 Managing the expectations of the parties associated with a worker’s RTW
The agent and an OR provider must exercise care in managing the expectations of the worker and the worker’s THP throughout NES service provision.
As the various parties may perceive the issues and barriers delaying or impeding the worker’s RTW differently, it falls to the OR provider as the independent RTW expert to test and verify the different perceptions particularly when they relate to:
· the worker’s capacity for work;
· the most recent medical opinion from the worker’s THP; and
· the tasks or jobs that may be available at a new workplace allowing for any work restrictions.
WorkSafe has several publications that may be helpful if a worker or the worker's THP is seeking more information about why an agent may consider a RTW with a new employer including a specific NES publication for workers. These publications can be found on WorkSafe’s website www.worksafe.vic.gov.au .
2013.1 Schedule 3 NES effective 1 July 2013 released 1 February 2014 Page 1 of 53
3. AGENT RESPONSIBILITIES
3.1 Agent NES REsponsibilities
The agent will consider NES service approval as part of their regular review of the worker’s individual circumstances and RTW needs. These considerations may include but are not limited to:
· Collecting appropriate evidence to demonstrate the injury employer has satisfied their RTW obligations under the legislation;
· Deciding with the worker, the worker’s THP or an independent medical examiner (IME) whether there are any medical issues or concerns that may be impacting or impeding the worker’s RTW with a new employer;
· Establishing then managing the worker and the worker’s THP expectations about the RTW Goal and the proposed RTW date;
· Revising their activities in response to new information or medical opinion received about the worker’s current work capacity (CWC) including any work restrictions;
· Reviewing available information or medical reports including IME and OR provider reports to identify those activities most likely to result in the worker achieving then sustaining a RTW with a new employer; and
· Arranging for supplementary or new information to be collected via medical or IME reports where gaps in information are identified, and
· Inviting the worker to attend an interview under the legislation to explain why there has been a change in RTW Goal to RTW with a new employer.
3.2 Determining whether RTW with the injury employer has been exhausted
Sometimes, the agent will form the view that the injury employer’s RTW obligations have been satisfied even when the worker has achieved some RTW at an injury workplace. The types of reasons that an agent may rely on include but are not limited to:
· 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; or
· The employer has ceased to trade.
The exhausting of RTW opportunities with the injury employer may also include providing a retraining course to the worker to gain a new competency to satisfy the requirements of suitable employment that may be available at an injury workplace.
The opinion and information included by an OR provider in the OES reports are important when the agent is deciding whether a RTW with the injury employer has been fully exhausted for a worker.
For more detail about what the agent is required to do, see 2013.2 Schedule 2 OES descriptions & codes effective 1 July 2013 released 1 February 2014 including:
o Determining whether RTW with the injury employer has been fully exhausted, page 24
o Agent Senior Review required to consider NES before 52 weeks, page 24
o NES approval, page 25
o OES & NES services at the same time, page 25
o Worker privacy where they are receiving OES and NES services at the same time, page 25
o RTW incentive payable for a RTW negotiated with injury employer after NES commenced, page 26
3.3 Agent NES Responsibilities
The agent must:
· Approve a NES services as well as agree activities with the OR provider consistent with this Schedule;
· Ensure the Novus NES process requirements are met;
· Determine at particular points in time whether NES services should continue to be approved for a worker or should be suspended or ceased; and
· Ensure that an OR provider’s service provision as well as the service outputs (NES reports and invoices) conform with WorkSafe’s expectations and NES guidelines as found in this Schedule;
An agent requiring clarification about their role and/or responsibilities or WorkSafe’s expectations for RTW and NES services provision as outlined in this Schedule should contact WorkSafe via . WorkSafe will provide a response within 48 working hours. WorkSafe may seek further information during this period and any determination will then be made within 48 hours of this further advice being received by WorkSafe.
3.4 Agent prior approval of NES services needed before services can be provided
NES services will be approved by the agent because the services are required following the worker’s work related injury; the services are reasonable and necessary for the worker’s circumstances and the costs associated with those services are reasonable.
When considering NES services, the agent should determine whether there is medical evidence that the worker has a CWC. For NES purposes, the worker’s CWC may be established from a worker’s THP certificate or an IME report.
3.4 NES Service Options
1. Worker has a CWC but not at work
Where the worker is receiving Payment Type 3 weekly payments because they have a CWC but are not at work and the agent forms the view that the injury employer’s RTW obligations have been satisfied, the agent should approve a Vocational Report. The report will help the agent determine whether a 26 Week NES may be required to assist and support the worker RTW in suitable employment with a new employer as soon as is practicable. The agent and OR provider will negotiate whether other NES services in addition to a 26 Week NES are required.
2. Worker at work with the injury employer but this cannot continue
Where the worker is not receiving weekly payments because they are at work PIH with the injury employer or they are receiving Payment Type 2 weekly payments because their RTW is not at PIH, the agent needs to determine whether a RC800 Vocational Report should be approved. The report will help the agent determine whether a 26 Week NES may be required to assist and support the worker RTW in suitable employment with a new employer as soon as is practicable. The agent and OR provider will negotiate whether other NES services in addition to a 26 Week NES are required.
3. NES services considered as part of a 130 week entitlement review
When completing a 130 Week entitlement review, the agent must be satisfied that a worker receiving Payment Type 3 weekly payments because they have a CWC but are not at work has:
· been offered every opportunity to RTW; or
· if the injury employer’s RTW obligations have been satisfied that a RTW in suitable employment with a new employer has been considered.
If the agent determines NES servicing is required then the agent will consider which of the following options is most appropriate for the worker’s circumstances.