Section 4
The Injury Management Team
Role of
External Team Members
Section 4 The Injury Management Team – The Role of
External Team Members
4.1 Doctors in the workers compensation system
4.1.1 Company Doctor
4.1.2 Nominated Treating Doctor
4.1.3 Treating Specialists
4.1.4 Injury Management Consultant
4.1.5 Approved Medical Specialists
4.1.6 Medico-legal Specialists
4.2 Accredited Rehabilitation Providers
4.3 Workers Compensation Insurance Company
4.4 Trouble-shooting
Information / References4.1 Doctors in the workers compensation system
There are now many different types of doctors that an employee may have to see if they sustain an injury at work and proceed with a workers compensation claim. This is explained in the chart following Section 4.1.
4.1.1 The Company Doctor
It is not compulsory for an employer to engage the services of a company doctor, however in the meat processing industry, with its risks and frequency of injuries, it is common practice.
Depending on the particular processor, the role of the company doctor may include:
· Pre-employment medical examinations
· Q fever vaccinations
· Immediate assessment of all or selected injuries (for example some processors have systems where any employee requiring medical attention is immediately taken to the company doctor, other processors send only employees who submit workers compensation claims to their company doctor)
· Treatment of all or selected injuries
· Communication with nominated treating doctor regarding treatment and injury management
· Assistance with certificates
· Regular review of injured employees
· Assistance with disputes about injury management
· Assistance with worksite OHS.
Medical Examinations at the Request of the Employer or Insurer
After the employee has given notice of their injury, the employer and / or insurer may ask the employee to attend medical examinations. These examinations must be arranged at reasonable hours and within reasonable time frames. The employer or insurer must meet all reasonable costs, including any wages lost by the employee because of attendance at such examinations. The employee may claim reasonable travelling expenses to and from the examination and this may include a person to accompany the employee where he/she is not able to travel unescorted. Workers compensation benefits may be suspended if an employee does not attend or fails to co-operate at a properly arranged medical examination.
4.1.2 Nominated treating doctor
The employee has the right to nominate their own treating doctor. However, they cannot shop around for doctors – once a doctor is chosen, then the employee must stay with that doctor. If they wish to change doctor, they need to first discuss this with the workers compensation insurance company.
The nominated treating doctor is usually a general practitioner or practice group of practitioners, responsible for:
· Completing WorkCover Medical Certificates
· Arranging appropriate treatment
· Specifying work restrictions and advising on the suitability of duties offered by the employer
· Providing information to the insurer and employer in relation to IM and RTW plans for injured employees
· Reviewing the progress of recovery of injured employees.
Nominated treating doctors are expected to talk with employers, insurance companies and other injury management personnel about how to actually organise for an injured employee to return to work. There is a section on the WorkCover Medical Certificate which the injured employee signs to give permission for the doctor to discuss their injury management with other parties.
The RTW coordinator would contact the nominated treating doctor:
· if an employee handed in a WorkCover Medical Certificate for time off work
· If an employee handed in a WorkCover Medical Certificate for suitable duties
· If there were concerns or suspicions about a workers compensation claim.
Often nominated treating doctors are unaware of the details of a meat processing business or the range of activities that occur there. If they only have the employee’s version of how the accident happened and what kind of work they do, they may take longer to send the employee back to work.
A quick call from the RTW coordinator to the doctor to describe the job which the employee usually does and to ask the doctor to fill in a certificate sending the employee back to work as soon as the employee has recovered sufficiently, helps to give the doctor a fuller picture. The RTW coordinator especially needs to let the doctor know if suitable duties are available.
The doctor will describe the employee’s physical restrictions, which will help in the decision about suitable duties.
Contacting the nominated treating doctor can sometimes be tricky but is fortunately becoming easier as more and more nominated treating doctors realise their role in injury management. It is a good idea for the RTW coordinator to call the doctor and talk to the secretary or receptionist. By explaining the role of the RTW coordinator and concern for the injured employee, it is possible to arrange a convenient time to discuss the case with the nominated treating doctor.
If the RTW coordinator has persistent trouble getting through to the doctor, contact the claims officer or the injury management adviser at your insurance company and they will call for you.
4.1.3 Treating Specialists
Sometimes a nominated treating doctor will refer the injured employee for more specialist treatment from other doctors. These can include orthopaedic specialists, rheumatologists, neurologists, psychiatrists and many more.
Specialists usually write to the nominated treating doctor, and other parties, summarising the treatment and progress of the injured employee.
When this happens, the nominated treating doctor (general practitioner) usually continues to supply the WorkCover Medical Certificates, on advice from the treating specialist/s. Sometimes the specialists certify too.
All the above reasons for the RTW coordinator to communicate with the nominated treating doctor also apply to the treating specialists. The difference is that often the communication from the RTW coordinator will be by fax or letter rather than telephone. This is changing as the teamwork approach to injury management gains popularity.
4.1.4 Injury Management Consultant
When there is a disagreement over the suitability of duties offered by an employer, the insurer or the employer may engage the services of an Injury Management Consultant (IMC). These consultants are medical practitioners approved by WorkCover NSW specifically for the purpose of reviewing an employee’s fitness for suitable employment and the availability of suitable employment at the workplace.
An IMC's role is consultative. They will contact the employee’s nominated treating doctor to discuss the situation, with the aim of reaching an agreed course of action.
Reports by an IMC are intended to be freely available to the employer, insurer, the injured employee and the employee’s nominated treating doctor. However, the RTW coordinator may need to set up a procedure with their insurer to obtain a copy of an IMC’s report and provide the injured employee with it. Send a fax/letter/email to your insurer to obtain their agreement to provide these reports.
Referral to an IMC should be considered when any of the following situations arise:
· confused goals
· complexity of injury or workplace environment
· poor communication between insurer/employer and nominated treating doctor
· perceived conflict between the nominated treating doctor’s recommendations and the workplace requirements
· disagreement about the suitability of duties offered to an injured employee.
4.1.5 Approved Medical Specialists
An Approved Medical Specialist (AMS) is a senior practising specialist with a sound knowledge of the NSW Workers Compensation system and workplace based injury management.
AMS’s are attached to the Workers Compensation Commission to assess an employee when there is a medical dispute. Medical disputes may include the employee's condition, the employee’s fitness for employment and the level of permanent impairment.
The AMS will review the case, perhaps examine the employee, and issue a written “certificate” of their opinions that is binding and conclusive.
4.1.6 Medico-legal Specialists
These are the “second opinion” specialists used by both the employee’s solicitor and the employer’s insurer to gain another opinion on the type and extent of the employee’s injury. The use of Approved Medical Specialists by the Workers Compensation Commission is intended to halt the escalation of “second opinions” that tend to occur when a claim is disputed or has legal involvement. / WorkCover NSW 2 day course on “Introduction to RTW Coordination”
Find out more about Q fever vaccinations by visiting the new website
www.qfever.org
You can direct an injured employee to a doctor of YOUR choice
The worker has the right to choose their own nominated treating doctor but they cannot shop around – look for the reference in your insurer’s Injury Management Program
Doctors are small businesses too! Employ various strategies for contacting them
For a list of IMCs contact your insurer or WorkCover on 13 10 50.
Make sure your insurer sends you the IMC reports.
Now attached to Workers Compensation Commission, the AMS’s give conclusive opinions on permanent impairment
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The Injury Management Resource Pack 2nd Edition –April 2002 – Meat and Livestock Australia
Section 4 Injury Management Team and External Team Members
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The Injury Management Resource Pack 2nd Edition –April 2002 – Meat and Livestock Australia
Section 4 Injury Management Team and External Team Members
4.2 Accredited Rehabilitation ProvidersWorkCover accredited rehabilitation providers are health professionals who provide specialised assistance to employers to assist injured employees to return to work.
Providers are made up of multidisciplinary teams of health professionals (usually includes occupational therapists, physiotherapists, psychologists, rehabilitation counsellors) and are accredited by WorkCover NSW. Fees charged by providers are part of the claims cost and are generally paid by the insurer.
Providers are often engaged by small meat processors who do not have a RTW coordinator or by larger meat processors to help in more complex cases, such as:
· to ensure that injured employees can safely perform the requirements of their work duties
· to assist where there are industrial relations, or human resource issues
· to arrange appropriate retraining and alternative employment when the employee is unable to return to his/her pre-injury job.
Bindaree Beef Pty Ltd in Inverell NSW has the following criteria for the RTW coordinator deciding to refer to a rehabilitation provider:
* The recovery process will be of a long duration.
* Permanent impairment or dysfunction.
* The recurrence of an injury / illness.
* Injury / illness which results in lost time of three weeks or more.
* Factors unrelated to medical condition impeding recovery
* Poor reaction to injury
* Alternative duties and / or phase into work needed
* Career redirection necessary
* Recurrence of injury on return to work
* Require ergonomic assessment of workstation / duties
* Need for independent consultation / communication with treating health practitioners and doctors.
Examples and definitions of the services of accredited rehabilitation providers are provided in the following list. Although some of them sound quite complicated, they are professional terms for specific services. Providers will assess the injured employee and provide a Rehabilitation Plan of action, listing the services needed to return the injured employee to work. Providers can develop RTW Plans as part of their Rehabilitation Plans.[To be clarified]
Many people are able to refer injured employees to a provider including the employee themselves, employers, insurers, doctors, unions and solicitors. However, in order for costs to be reimbursed as part of the claim the insurer must approve the referral.
Employers must indicate, as part of their RTW Program, at least one preferred provider and assist them to develop expert knowledge of the employer’s workplace, the return to work procedures and the available suitable duties. The selection of preferred providers should take place following consultation between employers and employees, for example via an OHS Committee.
The effectiveness of the provider's performance should be evaluated. WorkCover NSW, as part of the accreditation process, sets standards for occupational rehabilitation service provision which allows their activities to be monitored. WorkCover completes regular audits of providers and compares their costs and outcomes.
Employers, too, can evaluate their own provider(s)' performance. The following sample service agreement sets standards that both the provider and the employer must achieve to work effectively together.
When the accredited rehabilitation provider contacts you make sure you:
1. Agree on the goal of the injury management, for example, will the injured employee recover from the injury or will there be long term complications?
2. Agree about suitable duties. The provider may be able to help you find suitable duties for the injured employee, however, you know more about your business. Remember suitable duties are for a short time only.
3. Agree what to do if there are no reasonable suitable duties. Sometimes it is very difficult to find work for an injured employee. If the employee cannot come back to work on your site, what is the provider going to do to help you keep your workers compensation costs down? (Remember every day that the employee is off work is adding to the costs of workers compensation).
4. Receive copies of plans and reports. Providers must write plans and progress reports about each injured employee they work with.
5. Keep in touch with the injured employee. No matter how helpful the provider is, do not expect them to be successful if you do not stay involved.
6. Review the success after each case. Ask the employee and their supervisor if they were satisfied with the provider. / Lists of providers change every 2 months. A current list of accredited providers is available on the WorkCover website
Bindaree Beef have well defined criteria for using accredited rehabilitation providers.
Put in sample rehab plan?
Service agreements are a good way to monitor the provider’s performance
Extract from the 2 day WorkCover course “Introduction to Return-to-Work Coordination”
Complaints about providers should first be discussed with the provider and then referred to WorkCover's Injury Management Branch on