Health professionals and earning capacity decisions in the CTP scheme

Nine submissions were received as part of this consultation.

The Consultation Feedback Summary provides a high level summary of the key themes articulated in those submissions. All non-confidential submissions are available on the link below.

The information provided will be used to further develop the advice.

Background

From 14 May 2019 to 21 June 2019, the State Insurance Regulatory Authority (SIRA) published proposed information and guidance for insurers and health professionals on the role and requirements for health professionals in supporting insurers to make decisions about the pre-accident earning capacity and/or post-accident earning capacity of an injured person (earning capacity decisions) in line with Schedule 1 of the Motor Accident Injuries Act 2017 (‘the Act’) and Part 4 of the Motor Accident Guidelines (‘the MAGs’).

SIRA received nine submissions from respondents from the health, insurance, and legal professions. We have included the summary of the feedback under each of the headings referred to in the proposed advice.

Required qualifications

Feedback was received on this topic from respondents who work in health.

One respondent suggested expanding the criteria so that health professionals could complete both the functional and vocational components of an assessment.

One respondent believes that provisional psychologists also have the appropriate demonstrated training and experience, so they should be included.

One respondent submits that the draft wording does not clearly provide provision for involvement of medical practitioners in the independent assessment process. Including appropriately qualified medical practitioners in the independent assessment of fitness for work and earning capacity will improve the rigour and completeness of the assessment process.

Required skills and experience

A respondent [legal] believes that parts of the document may venture beyond the scope of information and guidance material contemplated by the legislation. The document provides advice on ‘required experience and required skills’, however the MAGs and the Act provide procedures to be followed by the insurer in making decisions, to which this does not align.

The same respondent considers that the keys concepts used in the advice such as ‘reports’ and ‘organisation’, and ‘interviewing skills to test motivation’ need to be clearer and has queried whether it can be reliably determined. The ‘durable sustainable placement experience’ is also unclear.

One respondent [insurer] considers the relevant professional experience of 3 years to be an acceptable criterion.  However, they believe that a minimum of 2 years clinical experience prior to undertaking assessments should be required as some rehabilitation providers assign cases to new graduates with insufficient exposure.

The same respondent recommends a minimum of 2 years of relevant experience in completing functional psychological assessments, vocational assessments, or standardised physical functional assessments should be required. The aim is to uphold the integrity of the scheme and validity of the assessments.

The same respondent also recommends that other (compensable) psychological injuries should be added to the list for the specialised knowledge and durable sustainable placement experience. Further, 3 years of clinical experience should be required in placing people in ‘durable sustainable employment’.

One respondent [health] supports SIRA’s ongoing commitment to quality assurance and quality control.  However, they recommend rewording the required qualifications on exercise physiologist to be, ‘Exercise physiologists must have also graduated from an approved university course or completed the approved professional development to deliver workplace/function assessments’ [rather than simply ‘ESSA certification’].

Another respondent [health] believes that ‘relevant experience’ should include workplace rehabilitation and it should be a mandatory requirement.

A respondent [legal] recommends that the eligibility requirement should be carefully considered, developed and clearly explained.

The same respondent recommends that the health professional eligibility include a requirement to have practical knowledge of job placement in the real world and demonstrated success in placing people in sustainable employment in an industry of relevance to the assessment being undertaken.  Relevant professional experience should be defined to ensure it does not include experience solely associated with a vocational capacity assessment organisation.

One respondent [health] submits that there is too great of an emphasis on functional capacity in the advice. Practitioners performing assessment of fitness for work also require complex skills such as expertise in the application of legislation and workplace/organisational factors relevant to workplace health and safety and their application in individual cases. The focus on functional capacity risks and incorrect or incomplete assessment process.

Information that an Insurer may use to determine earning capacity

One respondent [health] recommends a change to this section of the legislation to allow for health professionals such as physiotherapists to be able to issue certificates for fitness for work as well as a treating medical practitioner. As of January 2019, Physiotherapists in Victoria have been certifying 11.1% of all musculoskeletal certificates which is an increase from 9% in April 2018.

One respondent [insurer] seeks clarity on the three different types of earning capacity decisions that the insurer may be required to make (pre-accident earning capacity, post-accident up to 78 weeks and post-accident earning capacity 78 weeks or more). This will assist the insurers and the health professionals understanding the different needs surrounding each type of earning capacity decision.

The same respondent noted that there are 4 criteria in the section for ‘information that an insurer may use to determine earning capacity’ and the Guidelines list 8 criteria.  IAG believes it would be better if all the criteria in the guidelines are listed in the proposed guidance to reduce the need for health professionals having to click through further documents when trying to understand/assess and support insurers the insurer’s decisions on whether employment is reasonably available.

The same respondent also recommended that recent Allied Health Recovery Requests should be listed as a source of evidence when making an earning capacity decision.

Legislative change

One respondent [legal] recommends that the SIRA develops more targeted advice for insurers about procedures for making earning capacity decisions with reference to the principles set out in Part 4 of the guidelines at division 6.2 of the Act.

The same respondent recommended that the footnote stating ‘these decisions are not medical assessment matters as defined by schedule 2 of the Act or medical matters under clause 18 of the Motor Accident Injuries Regulation’ should be reviewed with reference to subclause 18(c) of the Regulation.

The same respondent recommended that any material produced other than from the claimant’s treating health practitioner or the Authorised Health Practitioner should not be admissible in any Dispute Resolution Service proceedings.

Other issues provided in feedback  

One respondent [insurer] recommends we engage with rehabilitation providers to assess possible strategies to mitigate the risk of reduced competition in the market including rural and regional areas of speciality.

Further questions for consideration

One respondent [legal] has noted that the word ‘relevant’ is not defined and seems unclear.  The advice should be amended to identify those matters that qualify the word ‘relevant’.

One respondent [insurer] would like clarification as to whether assessments of earning capacity are able to be provided by non-authorised SIRA health practitioners. An allied health practitioner may have contributed to that determination such as a physiotherapist and Suncorp believes that their assessment should be available for use in these circumstances.