OR SERVICE DELIVERY PRINCIPLES - EFFECTIVE 1 December 2016 (supersedes all previous versions) CONTENT S 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
Transcript
OR SERVICE DELIVERY PRINCIPLES - EFFECTIVE 1 December 2016 (supersedes all previous versions)
CONTENT
S
OR SERVICE DELIVERY PRINCIPLES - EFFECTIVE 1 December 2016 (supersedes all previous versions)...............................................1
1. ABOUT THIS SCHEDULE..................................................................................................................................................5
2. SERVICE TYPES.................................................................................................................................................................5
Worker Choice of OR Provider...................................................................................................................................... 6
OR Approval Form........................................................................................................................................................ 6
OR Consultant Title....................................................................................................................................................... 7
Recommendations for other types of OR services, in reports.......................................................................................9
When progress reports are not required (for OES).....................................................................................................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
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
WSS RTW Case Conference with the agent...............................................................................................................15
Principles of WSS service delivery.............................................................................................................................. 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
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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
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
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
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
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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
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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.
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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.
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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.
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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:
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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:
Recommendations for retraining
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Recommendations for continuation of active RC715 OR services during a 13 week sustainability period
When considering service suspension or cessation
When NES is identified as a more appropriate service option while OES is being delivered.
WHEN PROGRESS REPORTS ARE NOT REQUIRED (FOR OES)
Changing worker circumstances or RTW may mean an OR provider is not required to submit the next Progress Report.
If a Placement Report is required then that replaces the next Progress Report that would have been due.
If a 6 Month Progress Report is due within 2 weeks of an RC701 Progress Report, then the 6 Month Progress Report replaces the RC701 Progress Report that would have been due.
Furthermore, Progress Reports are not required during a 13 week sustainability period (subject to negotiation with the agent).
7. FUNDING REQUESTS
FUNDING REQUESTS & TEMPLATES
An OR provider is required to use WorkSafe approved OR funding request templates, which may be submitted via email.
Where an OR provider submits a Funding Request the request must only include the actual OR services and the cost of those services that an OR provider reasonably expects to provide in the time period nominated within the Funding Request.
An OR provider must not seek agent approval for ‘possible’ or ‘potential’ OR services outside the period referenced in the funding request. If the worker’s circumstances change after a Funding Request has been submitted to the agent then the OR provider must seek further agent approval of OR services.
AGENT PRIOR APPROVAL OF OR SERVICES
Except where OR services have been provided to the worker by the employer under the employer excess, the Agent must approve an OR service before it is provided to a worker.
Following an initial OR Approval Form signed by the agent, agent approval is required prior to continuation of services or commencement of a new/different type of service than indicated on the initial OR Approval Form.
OR providers may proceed with continuing services when agents have not replied within 3 working days of a request however the OR provider must have attempted contacting the agent about an outstanding service funding request prior to proceeding.
OR PROVIDER TRAVEL
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Most services will be provided by an OR provider from their nearest location to the worker’s injury workplace. Most NES will be provided by an OR provider from their nearest location to where the worker resides.
An OR provider may also seek approval, from a WorkSafe Agent, for Provider Travel when services may be provided at a location other than the OR provider’s nearest location because the worker:
Has restricted or no access to public transport between their residence and where an OR provider has scheduled an appointment
Cannot drive and no-one is available to drive the worker to the location where the OR provider has scheduled the appointment
Cannot drive due to a medical restriction
The worker secures a new job and an NES Workplace Report is arranged at a workplace of the new employer.
An OR provider must separately list RC799 or RC899 Provider Travel on their invoice and ensure that the appropriate OR provider location number is referenced.
Refer to the agent Case Manager for any queries regarding reimbursement for worker travel expenses associated with participating in OR services. Also refer to WorkSafe Online Claims Manual.
CONTACTS UPON RECEIPT OF OR APPROVAL FORMIt is a requirement that the OR consultant contacts the agent, injury employer, and worker within 3 working days of receiving the OR Approval Form to clarify and establish (beyond the content of the Approval Form):
Reasons for the OR Approval
Clarify current circumstances
Establish information on prior RTW attempts
Establish the issues and RTW barriers
Check the worker and employer's availability so that they can schedule a meeting with relevant parties as soon as practicable.
If the worker has been referred for NES, then the initial contacts will also serve to clarify with the worker their understanding of why this service has been approved.
This information is expected to assist the OR consultant to form a preliminary view prior to the first servicing activities.
Note that the injury employer is not contacted for NES referrals.
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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; the worker’s THPs and the injury employer throughout OR 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
The tasks or jobs that may be available allowing for any work restrictions.
WORKPLACE MEETINGS
When the OR provider is scheduling workplace meetings, consideration must be given to separate meetings with the worker and the injury employer. Depending on the circumstances that led to the claim and what issues or barriers to RTW has been identified, a joint meeting may not be appropriate particularly as the first meeting at the workplace. If both parties agree to a joint meeting then it may be scheduled after a separate worker and employer meeting.
8. SERVICE DELIVERY PRINCIPLES - RTW PRE INJURY EMPLOYER
These minimum requirements apply across all types of OES including WSS and Better @ Work.
REQUIRED ACTIVITIES AS PART OF AN INITIAL REPORT
As part of the Initial Report, the OR consultant will establish or verify:
The worker’s pre-injury duties/tasks and hours of work
Any other duties/tasks that may be available for the worker full or part time at an injury workplace
Whether the injury employer has commenced RTW planning
Whether the worker has returned to work with the injury employer or if they returned to work why this may or may not have continued
The current medical evidence related to the worker’s capacity for work including any work restrictions
Whether a RTW date has been suggested by the agent or the worker, the worker’s THP or the injury employer.
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When completing this service, the OR provider must:
Conduct a face to face meeting with both the worker and employer
Attempt to engage the worker’s THP(s).
CONTENTS OF AN INITIAL REPORT
An Initial Report will include:
A review of the medical evidence related to the worker’s CWC including any work restrictions
List any identified actual or perceived barriers to RTW
The worker’s work status
Confirm the worker’s pre-injury duties and tasks
Recommend the duties and tasks the worker may be able to perform
Identify the pre-injury or suitable employment that may be available at the injury workplace
State whether the injury employer has commenced RTW planning and nominate an expected RTW date.
The report must provide a clear rationale for recommendations to commence or not commence an OR service.
ACTIVITIES AS PART OF OES & CONTENTS OF PROGRESS REPORTS
Progress Reports must summarise the information collected by the OR provider at the time the report was completed and include:
A review of the medical evidence related to the worker’s CWC including any work restrictions
An update on the pre-injury or suitable employment options
The progress made toward the achievement of those options
The progress made to resolve any identified actual or perceived barriers to RTW as part of the agreed activities
Whether the injury employer is carrying out any RTW planning
The date and who attended any facilitated meetings held between the worker and the injury employer and the proposed RTW date (if possible) if the worker has not achieved a RTW during the month.
The report should contain sufficient information to substantiate any recommendation being made by an OR provider and any further funding being sought for OR services.
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TRANSITION FROM OES TO NES
During Original Employer Services (OES), the OR provider will advise the Agent, through phone contact/email and regular reports of the likelihood of a RTW with the PIE. When it is determined that a RTW with the PIE is no longer feasible, services will transition from OES to NES upon approval from the Agent.
Once the Agent is satisfied that all RTW options with the PIE have been exhausted or are no longer possible, the OR provider, will finalise and forward to the Agent, worker and certifying practitioner any outstanding progress reports as well as completing a Transition report (using the appropriate template). Any outstanding OES invoices as well as an invoice for payment of the Transition report (RC760) should also be forwarded at this time.
In some cases, it may be determined that concurrent OES and NES are appropriate. This may occur for a limited period to enable appropriate transition to NES to occur.
In the event that the worker changes OR provider for NES, the previous OES provider is not required to deliver the transition service. For continuity, the provider delivering NES should be involved in the transition service
SERVICES DURING 13 WEEK SUSTAINABLE RTW PERIOD
Where a worker achieves pre injury hours but during the 13 week sustainable RTW period the worker also returns to pre injury or productive duties, RC715 OR services must become ‘inactive’.
During an ‘inactive’ period an OR provider may choose to maintain limited contact with the worker, the worker’s THP, the injury employer or the agent to accomplish a sustainable RTW. There is no payment to be made for this contact and no Progress Report is required to be submitted during an OR ’inactive’ period.
If the worker’s circumstances change, an OR provider should contact the agent immediately and discuss whether RC715 OR services need to become ‘active’ again.
It is not expected that the OR provider will submit progress reports during the 13 week sustainability period unless the worker’s circumstances change.
OES WHERE WORKER ON PIH, NOT AT PID
If the agent decides to approve an Initial Report, to commence or recommence RC715 OR services, the number of hours approved and the degree of OR provider engagement is expected to be minimal when compared to a worker who is not at work when OR servicing is approved by the agent.
If the worker has not returned to PID within 3 months or at any point of time within the 3 months of OES, then OES ceases.
OES BEYOND SIX MONTHS OF SERVICING
If the worker has not returned to the PIE or resumed PIH within 6 months of servicing then OES is to cease. The agent may conduct a review of the progress made at that point and should only approve further servicing if continuing OES will result in a RTW.
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If the agent approves further servicing there is to be a review each month up to maximum of three months of additional servicing.
Where a RC 730 has been paid prior to or after six months of OES serving then the normal rules around the 13 week sustainability period apply.
9. SERVICE DELIVERY PRINCIPLES – WORKPLACE SUPPORT SERVICES (WSS)
PROCEDURAL INFORMATION
Primary mental injury claims requiring OR are referred for an RC756 Initial Report (WSS), for an assessment to determine what services are needed to facilitate RTW with the pre-injury employer (noting that WSS is a type of OES service).
If WSS commencement is recommended, then the OR provider utilises OES service codes and WSS report templates for the duration of the WSS (including those WSS services that continue beyond the first three months of servicing)..
On all primary mental injury claims, a WSS approved OR consultant must be assigned by the OR provider.
The RTW intervention and strategy may differ across mental injury claims with or without features of a workplace relationship issue. The agent must indicate on the OR Approval Form those primary mental injury claims where a workplace relationship issue is a RTW barrier.
WSS RTW CASE CONFERENCE WITH THE AGENT
On receipt of the OR Approval Form, the OR provider is required to schedule meetings with the parties and confirm the date and time of the RTW Case Conference. This should fall within the 16 working days after the date of receipt of the OR Approval Form.
WSS RTW Case Conference and Action Plan
The RTW Case Conference is conducted on the telephone between the OR provider and agreed agent parties (Case Manager, Injury Management Advisor/Return To Work Specialist).
In addition to the content of the WSS Initial Report, the RTW Case Conference should address:
The decision whether the service is to commence, delay commencement, or not commence
Identification of individual, group or team, and organisational level RTW barriers or facilitators as relevant and appropriate
Identification of employer services or support to address contributors to the development of the injury, that if unaddressed negatively impact on safe and sustainable RTW
Services other than OR that may be beneficial to the parties.
An Action Plan will be developed by the agent and sent to the OR provider. It will include an outline of the agreed actions from the RTW Case Conference including:
The required action
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Who is to complete the action
When the action is to be completed.
Additional RTW Case Conferences may be arranged at the request of the Agent or OR Provider, as necessary.
PRINCIPLES OF WSS SERVICE DELIVERY
The OR provider identifies the most appropriate WSS Consultant to allocate to the case based on the diagnosis and workplace factors that contributed to the injury (where that information is available).
For those WSS referrals involving a workplace relationship issue, the parties may include but are not limited to:
The worker and another person who works with them in their team or work group
A worker and their direct manager or another manager the worker has come in contact with
A worker and another person who directly reports to that worker.
In some instances, the injury employer may indicate they are supportive of the worker’s RTW but where the worker remains distressed, upset or worried about the relationship issues or they continue to suggest these issues have not been satisfactorily resolved by the injury employer then their RTW potential continues to be significantly impacted upon and WSS may be appropriate.
WSS may be offered concurrently with other employer or worker actions responding to a relationship issue (e.g. formal investigation procedures or complaints in other jurisdictions such as the Fair Work Commission). This should be considered on a case by case basis. Whatever the reasons for the workplace relationship breakdown and/or the stated position of the injury employer unless an agent is confident that the workplace issues have been resolved and are no longer a RTW barrier then WSS remains a practical solution for rebuilding and re-establishing the workplace relationship to facilitate a RTW.
FACILITATED MEETINGS
Defined as meetings facilitated by the WSS Consultant, between the injured worker and others from the workplace directly involved in a workplace relationship issue.
Facilitated meetings differ to ordinary workplace meetings that occur between a worker and neutral employer representatives such as a RTW Coordinator who was not involved in the relationship issue.
The purpose of facilitated meetings is to coach and support the parties to engage in respectful and meaningful discussion about the relationship issues then generate and agree on options for managing those relationship issues in the future.
A suggested format for facilitated meetings includes the WSS Consultant:
Speaking with the parties separately in advance of the facilitated meeting date Establishing ‘ground rules’ and behavioural standards for respectful communication during the meeting Actively managing responses from each party during the meeting
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Assisting the parties to work through the issues utilising a no-fault, practical, problem-solving approach Assisting the parties to formulate specific actions (e.g., using SMART goals framework, i.e., Specific,
Measurable, Achievable, Realistic and Timed). Documents the meeting for sign off by both/all parties, if deemed appropriate by the Consultant and
parties.
The health and safety of the worker and parties must be considered when deciding whether a facilitated meeting should be conducted.
Employer funded mediation services may also be an appropriate option, where available.
ADDRESSING EMPLOYER UNDERSTANDING OF MENTAL INJURY
As part of the WSS Initial Report, the WSS Consultant will check the employer’s knowledge and understanding regarding the injured worker’s mental injury diagnosis and restrictions.
General information on common psychological conditions should be provided including an explanation of medical opinion specific to the injured worker’s diagnosis (where available), to help guide the employer on identification of suitable duties and the likely support / modifications required.
General information about common psychological conditions is available at:
The WSS Consultant is encouraged to consider the range of direct and indirect RTW barriers that have relevance to the suitability, safety, and sustainability of a RTW.
Individual, group, and organisational level factors should be considered and during the RTW Case Conference. Those factors that are beyond the scope of an ordinary OR provider activity or intervention should be noted and discussed during a RTW Case Conference to determine what other services, supports or resources the Agent can identify to assist.
The OR provider must exercise caution not to create expectations among the parties for types of interventions or services that an Agent may not be able to source, fund or approve.
MANAGING THE EXPECTATIONS OF THE PARTIES
Given the types of claims where WSS will be most appropriate, care must be exercised by the agent and the OR provider in managing the expectations of the various parties including the worker, the worker’s THP and the injury employer. At the injury employer, there may be several individuals involved depending on the circumstances that led to the claim.
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FOCUS INITIALLY ON THE RTW GOAL WITH THE INJURY EMPLOYER
WorkSafe requires the RTW goal with the injury employer to remain the primary focus for the agent even where information received suggests there may be difficulties with the injury employer identifying RTW solutions for the worker or the worker is reluctant to engage in offers of pre-injury or suitable employment.
Both the agent and the OR provider should explain to the various parties that WSS is designed to explore and determine the potential for a RTW in pre-injury or suitable employment and the WSS reports are useful resources for establishing a common understanding, identifying and resolving any actual or perceived barriers to RTW and determining a set of activities to achieve that RTW goal.
WORKER WITH A POTENTIAL CWC WITHIN 3 MONTHS
Where the agent has received medical evidence suggesting the worker does not have a CWC but potential exists for this to alter, the agent should approve a RC756 WSS Initial Report to determine what actions may be required to assist and support the worker develop a CWC within 3 months. In preparing this report, an OR provider will review the medical evidence related to the worker’s CWC including any work restrictions, identify any actual or perceived barriers to RTW, identify potential RTW opportunities at the injury workplace then determine a set of activities to assist and support the worker to RTW preferably at their PIH and carrying out their PID within 3 months.
WHEN TO CEASE WSS
If the worker has not achieved a CWC within 3 months or will have no CWC at any point of time within the 3 months of WSS, then WSS services cease. The only exception to this is where an IME report is received during the initial 3 months of WSS services suggesting a potential CWC is still possible. In this case, the agent may consider limited ongoing WSS services to enable further opportunity for a CWC to be achieved within a reasonable timeframe (most likely 1 month). If the worker has not achieved a CWC within that reasonable timeframe then WSS services cease.
If the OR provider forms the view when preparing to complete a WSS Progress Report that the worker has no CWC or will have no CWC within 3 months or there is a RTW barrier preventing them from actively participating in WSS services or the workplace relationship issue is seriously damaged and possibly irretrievable then the agent must be contacted immediately.
An OR provider should not discuss or raise the possible cessation of WSS services or raise the possible change of the RTW goal to new employer and the approval of NES to support and assist that goal with the worker, the worker’s THP or the injury employer or include in any WSS reporting until this has been discussed and approved by the agent.
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10. SERVICE DELIVERY PRINCIPLES – RTW NEW EMPLOYER
Agents are responsible for determining whether the RTW goal should shift from RTW pre injury employer to RTW new employer. In making this decision, agents will consider whether the pre injury employer has fulfilled their RTW obligations.
Agents are responsible for identifying the appropriate type of service for an injured worker. New Employer services fall into three main categories depending on the capacity of the worker at the time of the referral decision as follows:
1. Job Seeking service (JSS):
For workers with a certified CWC or For workers who have completed a Capacity Support Service and may not have a certified
capacity, but have an IME capacity
2. Capacity Support Service (CSS):
For workers with an IME capacity only
3. Transferable Skills Analysis service (TSA):
For workers without an IME or certified CWC (who satisfy relevant criteria).
These flowcharts show at a high level the different requirements for work capacity across the three NES service types:
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JOB SEEKING SERVICE (JSS)
The purpose of this service is to provide job seeking assistance to those workers who are ready to commence new employment and to provide workers with the skills and competencies necessary for independent job seeking.
There are two pathways for entry to this service:
• Workers with a certified capacity
• Workers who have completed CSS and remain certified as unfit for all work however have a CWC based on IME opinion (following discussion with Agent)
Structure of the Job Seeking Service
The intention of JSS is to provide the OR provider with sufficient flexibility for meaningful engagement with the worker about vocational options prior to finalising a JSS report (Transferable Skills Analysis report specifically for JSS) including transferable skills and suitable vocational options. Upon submitting the JSS report, it is expected that the worker and OR provider will intensively job seek over the remaining 12 week JSS period. The JSS structure and reporting is represented by the following flowchart:
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JSS Report
A JSS Report including identification of transferable skills and potential vocational options is produced 3 weeks post commencement of the service (except for workers who previously completed CSS). The main focus of this initial period of JSS in the lead up to the submission of this report is to develop rapport and support the worker with their attitudinal and emotional adjustment for active job seeking, as well as working towards documenting tangible vocational goals, developed in consultation with the worker.
The OR provider should focus on these key elements in the initial stages of JSS
• Worker engagement
• Preparation of the JSS report
• Job Seeking skills training.
The JSS report is due for completion and submission to the worker, Agent and certifying practitioner at the conclusion of week 3 of JSS. The JSS report includes:
The worker’s age, education, skills, interests and work experience
The nature of the worker’s capacity and a brief summary of the details provided in the medical information
The nature of the worker’s pre-injury employment
A list of any actual or perceived barriers to RTW
Occupation rehabilitation services, including retraining, that are being, or have been, provided to the worker
Prioritised suitable employment for which the worker is currently most suited taking into account the functional requirements of the role
The report should contain sufficient information to substantiate an OR Provider’s recommendations, observations and/or comments.
Joint RTW Job Seeking Plan
During JSS the focus is on both the worker and OR provider to actively job seeking. OR providers will utilise their expertise and judgment during this time to deliver job seeking services that best meet the needs of the worker and assists them to develop effective job seeking skills and secure suitable employment.
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Within 10 working days of completion of the 12 week period, the OR provider will submit to the worker, Agent, and certifying practitioner a Joint RTW Job Seeking Plan (using the appropriate template). This Plan will detail the activities undertaken by both the OR provider and the worker in attempting to achieve the RTW goal including brokerage activities undertaken, worker meetings and contacts as well as highlighting the reasons why the goal is yet to be achieved.
As it is an expectation that the worker will be equipped to independently job seek at the completion of JSS, the plan will also highlight the job seeking skills and the level of competency that the worker has acquired throughout this process.
Where there have been changes to the Initial JSS report (for example, if potential vocational options have altered as a result of availability on the open labour market) then this should also be reflected in the RTW Job Seeking Plan.
The plan will define the worker's independent job seeking activities that support achievement of the RTW goal and indicate what OR provider support and service will be available before the next review point.
8 weekly Job Seeking Report & review of RTW Job Seeking Plan
Upon conclusion of the 12 week JSS, workers must have the skills and competencies to continue to job seeking independently and will continue to receive ongoing job seeking assistance with 8 weekly review points.
The 8 weekly Job Seeking Report will detail the activities undertaken by both the OR provider and worker in the 8 week period, highlight barriers and consider why a RTW goal is yet to be achieved as well as detailing the strategy for the next review period.
Once the worker has received approximately 52 weeks of OR servicing in total (including CSS and JSS periods), the Agent should arrange a worker interview with all parties including worker, OR provider and if possible certifying practitioner. The aim of this interview is to review what has been done to date and determine whether other strategies can be offered to assist in achieving the RTW goal.
CAPACITY SUPPORT SERVICE (CSS)
The purpose of the Capacity Support Service (CSS) is for OR providers to establish rapport with the worker and certifying practitioner to facilitate a current work capacity (CWC) where possible and to assist the worker in potentially developing new skills and/or becoming ready to job seek
Workers can only be referred to this service if they meet the following capacity criteria:
• Have a capacity for employment based on current IME opinion but are certified with no capacity for employment.
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Structure and content of the CSS
The OR provider will plan and implement a 6 week strategy, utilising their expertise and judgment to structure the CSS to ensure it is customised to the individual needs of the worker.
The following flow chart depicts a possible structure for CSS:
GP RTW Case Conferencing
GP RTW Case Conferencing is expected to be a feature of this service. While it is up to the OR provider to determine if and when these conferences are required, they may consider whether an initial conference could assist in establishing the GP’s expectations for the intervention and a subsequent conference to review progress and capacity.
Refer to GP RTW Case Conferencing principles (section 18)
CSS Report
The OR provider submits to the worker, Agent and certifying practitioner a CSS report (Transferable Skills Analysis report specifically for CSS) which details the workers identified transferable skills and vocational options within 10 working days of completion of the 6 week service. This report will indicate whether the worker has or is expected to be certified with a capacity for suitable employment. The CSS report template must be used.
Where workers automatically transition into JSS at the completion of CSS, a JSS report will not be required.
Evidence of capacity change
At the conclusion of CSS, where the worker has a certified CWC it is expected that JSS will automatically commence and the provider will invoice accordingly.
By week 5 of CSS, where the worker remains certified as unfit for all work but has an IME to indicate CWC or where the worker has a potential CWC based on treater discussions/IME, the OR provider must discuss commencement of JSS with the Agent to ensure it is the optimal service at the optimal time.
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TRANSFERABLE SKILLS ANALYSIS SERVICE (TSA)
The purpose of this service is to conduct an assessment, followed by a case conference with the OR provider, that identifies transferable skills and potential vocational options for use by the Agent when setting strategies and for engaging the worker and certifying practitioner. A TSA forms the basis of CSS and JSS (also known as the CSS and JSS report) however it can also be used independently of these services for workers who have no capacity for employment based on certification and IME opinion.
This service recognises that the engagement of workers in discussion and planning regarding potential employment options and the steps required to realise that potential, can provide work based goals that complement functional goals.
The TSA will also serve as a document that the Agent can use for testing work capacity via communication with the treating practitioner or to provide when seeking an IME opinion.
While a TSA will not be appropriate for all workers who are certified with no capacity for employment, a referral for the service can be made where the Agent is of the opinion that:
• there is medical evidence (IME and/or certifying practitioner) to indicate that the workers injury is recovering and there is a potential for a CWC in the short term
• The worker has expressed an interest in identifying potential employment options and RTW
• The Agent is of the opinion that conducting a TSA will be the catalyst in commencing RTW discussions with the worker and certifying practitioner and facilitating capacity change
Submission of a TSA and Case conference
Upon completion of a TSA, the OR provider submits a report (using the appropriate template) to the worker, Agent and certifying practitioner within 10 working days of the assessment being completed.
Upon receipt of the report, the Agent will undertake a case conference. It is a requirement that the OR provider is involved in the case conference to discuss the validity of commencing CSS or other relevant services such as retraining.
NES FOR LONG TAIL CLAIMS
It is acknowledged that workers who have been in receipt of compensation for greater than 130 weeks may have different needs when it comes to OR servicing. The NES model allows for flexibility to ensure workers receive services that best meet these needs:
Post 130 weeks, where considered appropriate to establish a discussion regarding opportunities, a stand-alone TSA may be used to investigate retraining for workers with or without a capacity.
Where a worker has ongoing entitlements and an IME CWC only, it is expected that CSS will be offered prior to JSS.
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Where a worker does not have an ongoing entitlement to weekly benefits, a minimum of 28 weeks of servicing should be provided (see 'Continued Servicing following Termination' below). A referral straight into JSS can be considered, ensuring that adequate services are provided to the worker.
130 WEEK VOCATIONAL REPORT - PURPOSE AND CONTENT
The agent approves a 130 Week Vocational Report to assist them determine a worker’s entitlement to weekly payments post the second entitlement period (i.e. to continue weekly payments after 130 weeks of weekly payments has been paid). A 130 Week Vocational assessment cannot be requested prior to the worker reaching 90 weeks of paid/payable weekly compensation
The 130 Week Vocational Assessment Report will summarise the information collected by the OR provider at the time the report was completed and include:
The worker’s age, education, skills, interests and work experience
The nature of the worker’s capacity and the details provided in the medical information
The nature of the worker’s pre-injury employment
A list of any actual or perceived barriers to RTW
OR services, including retraining, that are being, or have been, provided to the worker
Prioritised suitable employment for which the worker is currently most suited, including details of the duties, expected wage and requirements
Identified suitable employment that exists within the workers labour market, including the worker’s accessibility to employment.
The report should contain sufficient information to substantiate an OR Provider’s recommendations, observations and/or comments.
SUBSEQUENT OR SUPPLEMENTARY 130 WEEK VOCATIONAL REPORT - PURPOSE
The agent approves a Subsequent or Supplementary 130 Week Vocational Report when there has been a change in the worker’s circumstances including, but not limited to a change in capacity, treatment or surgical intervention, provision of OR services, retraining or labour market.
The agent and an OR provider will adopt the same service requirements, processes and timelines for the approval and submission of a Subsequent or Supplementary 130 Week Vocational Report as for a 130 Week Vocational Report.
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WORKSAFE INCENTIVE SCHEME FOR EMPLOYERS (WISE)
A worker who has NES approved by an agent may also access WISE. WISE is a 12 month financial incentive of up to $26,000 paid to a new employer who offers ongoing employment of 15 hours or more a week. Most employers are eligible for WISE including interstate employers where the worker resides outside Victoria.
OR providers are required to understand policy and processes relating to WISE and promote use of WISE for workers participating in a job seeking service.
More information about WISE can be found in WorkSafe Online Claims Manual and on Worksafe’s website www.worksafe.vic.gov.au.
11. TRAINING AND REDEPLOYMENT
IDENTIFYING REDEPLOYMENT OPPORTUNITIES - PRE INJURY EMPLOYER
Some employers may have multiple workplaces and when considering what suitable employment may be available to the worker, the agent and the employer should consider what suitable employment may be available at all workplaces of the injury employer.
To assist the agent and the employer determine the suitability of that employment, a Retraining/Redeployment Report may be approved to identify whether the worker has the necessary transferable skills and abilities to perform the tasks and duties associated with the job or whether they have the competencies to be able to effectively participate in a job interview including how to handle injury-related questions.
If an OR provider forms the view that the worker requires support and assistance to prepare a resume or application covering letters or would benefit from interview skill and technique coaching, they should contact the agent to seek approval for RC715 OR services.
Alternatively, an OR provider may form the view that the worker may require some retraining to enable them to undertake the suitable employment.
An OR provider must ensure that the worker understands that a training course approval relies on the agent determining that a course is reasonable and necessary to enhance the worker’s employability.
IDENTIFYING A TRAINING COURSE - NEW EMPLOYER
An OR provider may recommend a training course to enhance a worker’s employability where their existing level of transferable skills and competencies has limited the identification of suitable employment.
Retraining can be provided where the OR provider determines this will assist in enhancing suitable employment options and achieve the RTW goal. Retraining can also be used by the OR provider as a means of motivating and engaging the worker in vocational oriented activity to support development of their CWC.
The OR provider does not need to seek Agent approval for retraining courses where the course aligns to a suitable employment option the provider has previously detailed to the Agent, retraining costs do not exceed $1000 and the course is less than 16 weeks in duration. Courses outside these criteria may still be recommended, however require Agent approval. OR providers will need to provide written justification to the Agent in the approved format to receive approval in these instances.
JUSTIFICATION FOR A TRAINING COURSE
An OR provider should not recommend a worker participate in a retraining course simply because a worker suggests they have a preference for a particular type of employment or because they show a reluctance to work in the type of suitable employment identified by an OR provider; the training identified must be to enhance employability or support the development of a current work capacity and should be aligned wherever possible to the workers pre injury role.
WorkSafe will monitor retraining to ensure appropriate courses within the criteria and consistent with the circumstances of the claim are being recommended.
WORKER PARTICIPATION IN TRAINING
When recommending a training course, the OR provider must be satisfied that the worker can complete the course as soon as practicable and that course requirements do not exceed the worker’s functional restrictions.
If the worker is at work at the time the course commences, the OR provider must consider whether the worker can remain at work or continue to participate in OR services at the same time they are participating in the course.
ENROLMENT IN A TRAINING COURSE
The worker should be encouraged to directly contact the training provider to complete the enrolment requirements. Where assistance is required, the OR provider can support this process.
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POST RETRAINING REPORT
Upon completion of the retraining course, the OR provider will submit a report to the Agent to advise of the transferable skills obtained.
It is the expectation that the OR provider and agent will be responsible for monitoring the workers progress and participation throughout the course.
12. SUSPENDING AND CEASING OR SERVICES
WHEN OR SERVICES SHOULD BE SUSPENDED OR CEASED
The OR provider may recommend to the agent that OR services are:
Suspended where medical evidence supports the worker has no CWC or will have no CWC for more than 4 weeks but is expected to have a CWC within 13 weeks,
Ceased where medical evidence supports the worker has no CWC or will have no CWC for more than 13 weeks. For RTW with the pre injury employer, cessation may also be considered if the worker has not been able to progress hours at work or PIH is unlikely in the foreseeable future.
SUSPENSION – WORKER RETRAINING
JSS and CSS can be suspended while a worker is participating in a retraining course, unless the OR provider is of the opinion that the worker can successfully market themselves to prospective employers during course completion.
An OR provider should not discuss or raise the possible suspension of any OR service with the worker and the certifying practitioner or include this possibility in any reports until this has been discussed and approved by the agent.
On receiving the agent advice to suspend services, an OR provider will forward any outstanding reports to the worker, the certifying practitioner and the agent.
CEASING OES IF NCC FIRST 3 MONTHS
Where a worker has been referred to OES with no CWC and is not work and the agent has medical evidence suggesting the worker pay have a potential CWC within 3 months, the agent may approve an OES Initial Report.
The report will help the agent determine whether OES may facilitate a change in the worker's capacity for work resulting in RTW.
If at the end of the 3 month period the worker does not have a CWC or a barrier has been identified impacting on the worker actively participating in OES, then the OR provider must contact the agent to advise they are ceasing OES.
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OES may continue for a 4th month if prior to the end of the 3rd month, the agent receives an IME or THP report suggesting CWC or a RTW may be achieved within the next month. In this case, the agent should contact the OR provider to discuss the continuation of OES for an additional 4 weeks.
RECOMMENCING SERVICES - PRE INJURY EMPLOYER
SERVICES PREVIOUSLY SUSPENDED OR CEASED
OR services may be recommenced where the worker continues to require support and assistance to RTW with the injury employer and medical evidence supports the worker has a potential CWC or has regained their CWC or can now actively participate in OR services.
The OR provider should discuss with the agent whether a new Initial Report is required.
AFTER NON-SUSTAINABLE PIH
The agent may approve further RC715 OR services after the worker achieved their PIH but this was not sustained for 13 weeks. These OR services would focus on what actions may be required to achieve a sustainable RTW outcome as soon as is practicable.
RECOMMENCING SERVICES - NEW EMPLOYERWhen considering whether a NES service should be recommenced, the agent should establish what services the worker had already completed/partially completed and whether the worker has an IME capacity only or a certified capacity The agent can then determine appropriate services based on the criteria for CSS, JSS and TSA.
It is expected that the CSS and JSS will only be paid once for each worker. However if the agent or OR provider feels that a service should be re-offered (for example if services were ceased for a significant period), this should be discussed with all parties.
SERVICES PREVIOUSLY SUSPENDED OR CEASED
NES may be recommenced where the worker continues to require support and assistance to RTW with a new employer and medical evidence supports the worker has a potential CWC or regained their CWC or can now actively participate in JSS or CSS.
AFTER NON SUSTAINABLE RTW
The agent may approve on going 8 week reviews if the worker had previously achieved a RTW but this was not sustained for 13 weeks.
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AFTER A SUSTAINABLE RTW
The agent may approve on going 8 week reviews if the worker had previously achieved a RTW but after the RTW was sustainable for 13 weeks, the RTW did not continue.
AFTER INCENTIVE PAID EMPLOYMENT CEASES OR MEDICAL EVIDENCE RECEIVED WORK IS NO LONGER SUITABLEThe agent should establish what services the worker had already completed, the circumstances (i.e. employment ceased/is no longer suitable) and the worker’s capacity, to then determine the most appropriate service for the worker based on the criteria for CSS, JSS and TSA.
NES DURING WEEKLY PAYMENT ‘NON ENTITLEMENT PERIOD’
A worker may lose their entitlement to weekly payments for a specified period known as a ‘non entitlement period’. The agent may approve a JSS or CSS for a worker during a non-entitlement period and if the worker achieves a RTW, a RTW Incentive is payable. To determine which RTW Incentive should be paid, the agent calculates the number of weeks that would have been paid to the worker at the date the JSS or CSS commenced assuming that the non-entitlement period had not been applied.
13. RTW INCENTIVES - GENERAL
A RTW Incentive is payable when the agent and an OR provider agree that the conditions for paying the incentive can be satisfied. Which RTW Incentive may be payable will depend on the number of hours being worked excluding overtime and shift allowance.
An OR commencement (for OES) is demonstrated by the OR provider submitting an RC700 or RC756 or RC200 Initial Report then after the report was submitted, RC715 OR services were provided to the worker.
An OR commencement (for NES) is demonstrated by the OR provider submitting an RC 811, which indicates that a service was provided to the worker (OR providers should refer to the business rules for the RTW Scorecard for specific OR codes representing OR commencement).
RTW INCENTIVE MOST USUALLY PAID ONCE
Most usually a RTW Incentive is only paid once on a claim, unless OR services had ceased for more than 13 weeks and subsequently the agent approved OR recommencement. In this case, the agent may consider paying a RTW Incentive again.
An OR provider may forward information or evidence to assist the agent make a decision about a worker’s sustainable RTW at 100% pre injury hours (PIH). The agent should consider this information or evidence when determining whether a RTW Incentive payment is appropriate.
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RTW INCENTIVE NOT PAYABLE IN CERTAIN CIRCUMSTANCES
A RTW Incentive is not payable if:
The worker ceased work due to a new compensable injury
The worker ceased work due to a secondary mental injury
The worker ceased work due to a non-compensable medical condition
The worker resigned
The employer withdrew duties
The employer ceased trading
The employer terminated the worker’s employment
14. RTW INCENTIVES - FOR OR SERVICES PRE INJURY EMPLOYER
Refer to the OR Fee Schedule for information on OES RTW Incentives including a description of how to count the 13 week sustainability period.
WORKER ABSENT FOR > 5 WORKING DAYS DURING 13 WEEK SUSTAINABILITY PERIOD
Where a worker receiving weekly payments at OR commencement (Original Employer Services) has more than 5 working days off work in the 13 week sustainable RTW period due to the compensable injury, a further 13 week sustainable RTW period can be calculated from when the worker commences pre injury hours again. If during this second 13 week sustainable RTW period they are again absent for more than 5 working days due to the compensable injury then no RTW Incentive is payable. In calculating the more than 5 working days during a 13 week sustainable RTW period, a part day is counted as 1 day.
15. RTW INCENTIVES - FOR OR SERVICES NEW EMPLOYER
WORKER’S PRIVACY FOLLOWING A RTW WITH A NEW EMPLOYER
The agent may request a worker provide copies of their payslips or other employment evidence to help determine which RTW Incentive may be payable. However a worker is not required to comply unless the worker is also seeking to have weekly payments paid for all or some of that 13 week sustainable RTW period. An OR provider should not ask a worker to provide them or the agent with copies of their payslips or other employment evidence.
GENERAL CONDITIONS FOR PAYING AN INCENTIVE - FOR RTW NEW EMPLOYER
Most usually a RTW Incentive is only paid once on a claim. WorkSafe expects that prior to submitting an appropriate invoice for a RTW Incentive, an OR provider and the agent will agree that an incentive is payable by mutually discussing and confirming the following:
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1. Was the RTW achieved with a new employer during a JSS or CSS service, including the 8 week review periods?
2. Was a 12 week sustained change in capacity achieved during CSS?
3. How many weeks of weekly payments had been paid at the date the NES service commenced?
4. Was the worker receiving weekly payments on the date the NES service commenced?
5. What was the number of hours being worked by the worker 13 weeks after the date they returned to work?
6. What was the amount of wages the worker was receiving 13 weeks after the date they returned to work?
7. Which RTW Incentive service code is being sought by the OR provider?
RTW WITH INJURY EMPLOYER AFTER NES COMMENCED
A RTW incentive may be paid when the OR provider who is providing NES negotiates a RTW with the injury employer and the agent and an OR provider agree that the conditions for paying the incentive can be satisfied.
If the OR provider has previously commenced RC 715 OR services for the worker, an RC750 RTW Incentive is payable. If the OR provider has NOT previously commenced RC715 OR services to the worker, an RC891 RTW incentive is payable.
OR PROVIDER WISE PLACEMENTS
The OR provider may not seek a WISE placement and sustainability payment as well as an NES placement and NES RTW incentive payment.
Where a worker was participating in a JSS or CSS at the time a WISE placement was achieved, an NES RTW Incentive may be paid.
A WISE OR provider placement fee using Payment Type Code 216 may be paid when the agent and an OR provider agree that a WISE placement was secured after a JSS or CSS was completed.
RTW INCENTIVE NOT PAYABLE IN CERTAIN CIRCUMSTANCES
WORKER ABSENT FOR MORE THAN 5 WORKING DAYS DURING 13 WEEK SUSTAINABLE RTW PERIOD
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Where a worker was receiving weekly payments at NES commencement has more than 5 working days off work in the 13 week sustainable RTW period due to the compensable injury, a further 13 week sustainable RTW period can be calculated from when the worker commences work again. If during this second 13 week sustainable RTW period they are again absent for more than 5 working days due to the compensable injury then no RTW Incentive is payable. In calculating the more than 5 working days during a 13 week sustainable RTW period, a part day is counted as 1 day.
WORKER CERTIFIED UNFIT FOR MORE THAN 10 WORKING DAYS DURING 12 WEEK JOB SEEKING SERVICE PERIOD
Where a worker who obtained a current work capacity during CSS is certified as unfit during the 12 week job seeking service period for more than 10 working days (cumulative) the capacity support incentive cannot be paid.
SELF-EMPLOYMENTAS AN OPTION DURING NES
During NES, an OR provider may form the view that self-employment is a reasonable RTW outcome for this worker. An OR provider should not discuss or support the worker following self-employment as their RTW outcome until this has been discussed and approved by the agent.
A RTW incentive is not payable where the RTW solution is self-employment
SPECIFIC CONDITIONS FOR PAYING A SECOND INCENTIVE
If the worker is participating in a JSS or CSS and a second RTW is achieved with a different employer then a second incentive can be paid. In this instance, the agent is only authorised to pay RC891 as a second RTW incentive.
16. GP RTW CASE CONFERENCE
A GP RTW Case Conference is a face to face meeting arranged by an OR provider with the worker and the worker’s GP at the GP’s rooms. An OR provider can only arrange two GP RTW Case Conferences per claim. The face-to-face component of a GP RTW Case Conference should take approximately 30 minutes to complete. An OR provider may seek up to two hours in total for the time spent on arranging and attending the GP RTW Case Conference and the sending of an Action Plan.
REASONS FOR ARRANGING A GP RTW CASE CONFERENCE
The types of reasons for arranging a GP RTW Case Conference may include but are not limited to:
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An IME or worker self-reporting suggest the worker has a work capacity however, the GP continues to provide medical certificates that the worker does not have a CWC
The OR provider has identified suitable employment, however the GP says the worker does not have a CWC
The GP and IME have a differing opinion about the worker’s degree or type of capacity or the suitability of employment available either at the injury or a new workplace
There has been a RTW at the injury workplace with restrictions to pre injury duties (PID) or pre-injury hours (PIH) and the GP will not vary their opinion about the worker’s capability to increase the duties or hours.
ADVISING THE AGENT
When an OR provider determines that a GP RTW Case Conference is needed they should telephone or email the agent. A GP RTW Case Conference can proceed unless the agent advises them within three working days of that contact that a GP RTW Case Conference is not approved.
WORKER TO BE ADVISED IF OTHERS HAVE BEEN INVITED TO THE CONFERENCE
An OR provider may also invite the agent to attend a GP RTW Case Conference. Alternatively if the RTW goal is with the injury employer then they may also be invited to attend. The worker should be advised prior to the GP RTW Case Conference where the agent or injury employer has indicated they will attend a conference. Employer representatives must not be invited to a GP RTW Case Conference once RTW pre injury employer has ceased as an option.
SCHEDULING A GP RTW CASE CONFERENCE
The worker, the GP and any other party are contacted and a mutually suitable time for the GP RTW Case Conference is agreed. The worker must be advised prior to the GP RTW Case Conference when the agent or pre-injury employer has agreed to attend the conference.
If the worker or GP decline to participate in a GP RTW Case Conference then the OR provider must contact the agent immediately.
At least one working day prior to the scheduled GP RTW Case Conference, an OR provider will confirm via email or facsimile the date, time and location of the conference with all parties who have agreed to attend.
The GP RTW Case Conference Agenda letter is required to be sent to the worker and a separate letter to the GP (refer to WorkSafe letter templates). A GP Information Sheet must be included with the GP letter to explain why a GP RTW Case Conference has been arranged. The Agenda letter and Information Sheet also explains how the GP may seek payment for their involvement.
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CONFIRMING THE AGREED ACTIONS FROM A GP RTW CASE CONFERENCE
An OR provider may complete a GP RTW Case Conference Action Plan and gain agreement from the participants to the each action prior to the conference being concluded. An OR provider may give a copy of the GP RTW Case Conference Action Plan to the worker, the GP and any other parties attending the conference at the meeting’s conclusion or alternatively within five working days (refer to WorkSafe template).
An OR provider must also email or facsimile a copy of the GP RTW Case Conference Action Plan to the agent within five working days of the date of the GP RTW Case Conference.
INFORMATION ABOUT GP RTW CASE CONFERENCE IN NEXT OR PROVIDER REPORT
Where the next OR Report falls due within five working days of the date of the GP RTW Case Conference then an OR provider should include information with that report. The GP RTW Case Conference Action Plan can be attached or alternatively the following can be included under report sections for ‘COMMENTS/ADDITIONAL INFORMATION’:
The date of and who was present at the conference
The key discussion points.
A summary of the agreed actions which may include but are not limited to the GP:
Changing or issuing a medical certificate amending the worker’s capacity for work including any medical restrictions or the number of hours that can be worked
Increasing the hours being worked or agreeing to do so when the next medical certificate is due
Agreeing to a RTW arrangement prepared by the injury employer.
EXPECTED OUTCOME FROM A GP RTW CASE CONFERENCE
Following a GP RTW Case Conference, all parties (not the employer for job detached workers) should have a better understanding of:
The OR provider’s role as an independent RTW expert
The importance of the GP’s opinion and medical certificate when determining the suitability of employment available or identified
The types of duties and hours of work available or identified
For RTW pre injury employer, what the employer and worker need to do to meet their RTW obligations
What has been agreed and included in the Action Plan.
OR PROVIDER FEES FOR GP RTW CASE CONFERENCE
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An OR provider may seek up to two hours in total for the time spent on arranging and attending the GP RTW Case Conference and the sending of an Action Plan. The inclusion of the Action Plan details in an OR report is payable as part of the fee for that particular report (e.g. next OES progress report or NES report). An OR provider may not seek additional payment under the GP RTW Case Conference fee for this activity.
An OR provider will submit an invoice for RC270 for the time spent on arranging and attending the GP RTW Case Conference and the sending of an Action Plan as well as actual Provider Travel for the time spent in travelling to and from their nearest location to the GP’s rooms.
GP FEES FOR GP RTW CASE CONFERENCE
The GP submits an invoice including their patient’s name, claim number and the date of the conference to the agent. The agent will pay for the RTW Case Conference within 28 days of receiving the GP’s invoice. A GP who also saw the worker on the same day for their regular consultation may seek payment for that consultation on the same invoice.
17. GP RTW QUESTIONNAIRE
When an OR provider determines that a GP RTW Questionnaire is needed they should telephone or email the agent for approval of the cost. A GP RTW Questionnaire can proceed unless the agent advises it is not approved.
The following principles must be considered when requesting a GP RTW Questionnaire:
OR providers must confirm with the agent that a new request for information will not duplicate a recent request sent by the agent (i.e. advise the agent that a RTW Questionnaire request will be sent by the OR provider and asking for agent contact should they feel this is inappropriate)
OR providers may determine the most appropriate questions based on individual cases (no more than 5 questions)
The GP RTW Questionnaire may be used across any OR service
GP RTW Questionnaires should be limited to obtaining information. i.e not used to pay for signing RTW plans
The GP RTW Questionnaire may be used across any OR service
A maximum of two GP RTW Questionnaires may be requested during an OR service
The OR provider is to advise the GP to invoice the agent using code MPRTW02 at a cost of $78.09 (excluding GST, accurate as at 27 January 2015) which is subject to indexation on 1 July annually.
GP RTW Questionnaires are primarily aimed at GPs however may also be completed by other types of medical practitioners. Allied health practitioners are not eligible to complete a GP RTW Questionnaire MPRTW02.
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Information obtained from the GP RTW Questionnaire must be provided to the agent (either via a copy forwarded to the agent or as a summary provided within the next OR report).
18. FURTHER INFORMATION
An agent and/or OR provider requiring clarification about OR policy, process and schedules may contact WorkSafe via [email protected]
