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Appendix 2: Practice guidance - rehabilitation services during case management

Overview

Workplace rehabilitation providers can be engaged to help workers return to work following a work-related injury or illness. The workplace rehabilitation provider works with the worker, employer, doctor and insurer to achieve a recovery at work outcome.

Depending on the needs of the worker and employer, a workplace rehabilitation provider can be engaged to provide a single service (such as a workplace assessment), or provide ongoing support until the worker has achieved a safe, timely and durable return to work.

Making a referral to a workplace rehabilitation provider

Referral to a workplace rehabilitation provider can be made to help:

  • a worker return to their pre-injury role or find suitable alternative work
  • identify and design duties for the worker to help an employer meet their obligation to provide their worker with suitable work
  • identify and coordinate rehabilitation strategies that ensure workers are able to safely perform their duties
  • with equipment, retraining and workplace modification needs
  • strengthen engagement between the insurer, employer and treatment providers to ensure a focus on a safe and durable return to/recovery at work
  • deal with complex injury or communication barriers that are preventing the worker’s return to work.

An insurer may engage a workplace rehabilitation provider of their own choosing, or one nominated by the employer or worker. Insurers can search for approved workplace rehabilitation providers on SIRA’s website. Insurers should select a workplace rehabilitation provider with expertise related to the worker’s injury and industry types.

While it is usually the employer or insurer who decides which workplace rehabilitation provider to use, the worker should be consulted and given the opportunity to nominate or request a change in provider.

The insurer should make sure all parties understand the role of the workplace rehabilitation provider and what they can expect from their involvement. The insurer should provide the employer and worker with:

  • the name and contact details of the provider
  • an explanation as to why the referral has been made
  • an indication as to when the workplace rehabilitation provider will make contact
  • information that the worker has the right to request a change of provider.

Insurers should not refer to workplace rehabilitation providers for general claims management activities.

‘Standard of practice 15: Approval and payment of medical, hospital and rehabilitation services’ states that when approving services from workplace rehabilitation providers, the insurer is to ensure that the services are consistent with the Nationally Consistent Approval Framework for workplace rehabilitation providersand theNSW Supplement.

Approving a rehabilitation plan

A workplace rehabilitation provider can be engaged to achieve an agreed recovery at work goal through the development, implementation and monitoring of a rehabilitation plan. The rehabilitation plan should be submitted for the insurer’s approval and should include the:

  • the goal
  • activities required to achieve the goal, and
  • proposed costs.

Insurers are encouraged to review and either approve or reject the plan within five days to assist with timely provision of services.

The engagement of a workplace rehabilitation provider does not take away from the insurer’s responsibility to manage, monitor and update the injury management plan (section 45 of the 1998 Act). Insurers should maintain regular communication and engagement with all stakeholders to ensure that the rehabilitation plan remains relevant.

Fees and invoices

There are no gazetted fees for workplace rehabilitation providers in the NSW workers compensation system. Providers are required to obtain insurer approval for services and fees before commencing any services.

The insurer should review any invoices submitted by the workplace rehabilitation provider and check they include:

  • the worker's first and last name
  • claim number
  • payee details
  • ABN
  • name of the service provider who provided the service
  • SIRA workers compensation approval number
  • SIRA workers compensation payment classification code
  • service cost for each SIRA workers compensation payment classification code
  • the date of service
  • the date of invoice (must be on the day of or after the last date of service i.e. not before the treatment has taken place).

Insurers should call the workplace rehabilitation provider if they have questions regarding an invoice. Errors or queries can often be resolved quickly over the phone. If telephone contact is unsuccessful, then an email or letter should be sent seeking clarification.

Insurers are expected to pay provider invoices promptly, in line with ‘Standard of practice 10: Payment of invoices and reimbursements’.

Complaints about a provider

If the employer or worker raises concerns about the workplace rehabilitation provider, these should be addressed according to the insurer’s complaints handling process. Insurers should consider whether a change to a different provider is required, with serious concerns to be referred for SIRA’s attention.

Provider attendance at worker medical consultations

It is not appropriate for a workplace rehabilitation provider to attend a worker’s confidential medical consultation with their nominated treating doctor. Where a case conference is required to discuss the worker’s recovery process, insurers should ensure a case conference is scheduled separate to the worker’s medical consultation.

As stated in ‘Standard of practice 16: Case conferencing’, the insurer should also inform the worker of the intention to arrange a case conference and the reasons for it.

Where a referral is received for a workplace rehabilitation provider to attend a case conference and they have not yet met the worker, the provider should first arrange a meeting with the worker to assess and understand their requirements prior to scheduling a case conference.