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Standard 14 - referral to an injury management consultant

Injury management consultants (IMCs) should be used to provide expert advice and assistance regarding a worker’s recovery at or return to work.

Referral to an injury management consultant

Principle: Injury management consultants will be engaged to assist workers identified as at risk of delayed recovery and in circumstances where a specific issue has been identified.

 ExpectationsBenchmarks
S14.1 Insurers must only refer to an IMC when:
  • a worker has been identified at risk of delayed recovery;
  • a specific return to work or injury management issue has been identified; or
  • referral has been requested by the worker, employer, nominated treating doctor or other treating practitioner.
Evidence on claim file.
S14.2 Insurers must only refer to an IMC in circumstances where a specific return to work or injury management issue has been identified if attempts have been made to resolve the issue. Evidence on claim file.
S14.3 If an insurer refers to an IMC, the insurer must advise the nominated treating doctor that the referral has been made, provide the reasons for referral, and advise that the nominated treating doctor can be paid for time taken to communicate with the IMC. Advice provided to the doctor within five days after referral in made.
S14.4 When making a referral to an IMC, the insurer must:
  • ensure the IMC is located within the worker’s travel restrictions if the worker is required to attend the IMC;
  • ensure any special requirements of the worker are accommodated, such as those arising from gender, culture, language and accessibility;
  • consult the worker and take into consideration the injury type when deciding which IMC to engage;
  • only engage an IMC who is able to provide an appointment within a reasonable timeframe;
  • enquire whether the IMC records consultations (audio or video) and if so inform the worker and seek the workers consent for the consultation to be recorded; and
  • avoid conflicts of interest between the IMC and the nominated treating doctor or employer.
Evidence on claim file.
S14.5 Insurers must provide the worker with the following information prior any appointment with an IMC:
  • the name, speciality and qualification of the IMC and the date, time, location and likely duration of the appointment;
  • the reasons for the referral;
  • what information or documentation the worker must take to the consultation (eg. imaging or reports of investigations/tests);
  • how costs (including for travel) will be paid;
  • that the worker may be accompanied by a support person;
  • that the worker and the nominated treating doctor will both receive a copy of the report;
  • what the worker is to do if they do not believe the assessment is reasonable or if they have a complaint about the conduct of the IMC;
  • the SIRA brochure about injury management consultations; and
  • that the worker can contact WIRO or their union for assistance.
Written notification provided to the worker at least ten working days prior to an IMC appointment.
S14.6 When referring a worker to an IMC, the insurer must provide the IMC with sufficient information to support the referral, including:
  • a detailed description of the reason for referral;
  • contact details for the worker, nominated treating doctor and employer; and
  • relevant documentation from the file to enable the IMC to understand the claim.
  • Note: Referrals must not include questions concerning liability.
Referral information to be provided to IMC at least ten working days prior to an IMC appointment.
S14.7 Insurers must make subsequent IMC referrals to the same IMC unless that IMC:
  • has ceased to practise (temporarily or permanently);
  • no longer practises in a location convenient to the worker; or
  • the parties agree that a different IMC is required.
Evidence on claim file.