The State Insurance Regulatory Authority (SIRA) is the government organisation responsible for regulating and administering workers compensation (WC), motor accidents compulsory third party (CTP) insurance and home building compensation insurance in New South Wales (NSW).
The requirements for SIRA approval to be a workplace rehabilitation provider (provider) are outlined in part 7 of the Workers Compensation Regulation 2016 (Regulation).
The Workers Compensation Workplace Rehabilitation Provider Approval Framework (the framework) sets out the requirements for approval by SIRA for organisations delivering or seeking to deliver workplace rehabilitation services within the workers compensation scheme.
The framework sets out mandatory conditions of approval, the permitted service streams and associated practice standards, as well as relevant supervision, administrative and complaints handling processes, and is structured into the following parts:
Part 1: The workplace rehabilitation provider framework
Part 2: Conditions of approval
Part 3: Service streams
Part 4: Practice standards
Part 5: The application and approval process
Part 6: SIRA's supervision process
Part 7: Complaints handling
The framework establishes standards designed to deliver high quality, efficient and effective workplace rehabilitation services to assist workers, employers, and insurers with recovery at work and return to work.
Specifically, the framework aims to encourage providers to deliver services that:
SIRA's role is to approve providers in line with part 7 of the Regulation to:
The insurer is responsible for payment of reasonably necessary workplace rehabilitation services in accordance with section 60 of the Workers Compensation Act 1987 (1987 Act).
The insurer coordinates and manages a worker's claim, including injury management and recovery through work activities. The insurer also maintains regular communication and engagement with all stakeholders to coordinate support including workplace rehabilitation.
The insurer is responsible for early and timely engagement of an approved provider to support a worker's recovery at work. This requires the insurer to discuss the need for referral and choice of provider with the employer, worker and nominated treating doctor (if appropriate) and ensure all parties understand the role of the provider and what can be expected from the provider's involvement.
The insurer is responsible for approving and monitoring the provider's plan which includes a worker's goal/s, activities and proposed billing to support the worker's safe, timely and durable recovery at work.
The workers compensation legislation outlines the employer's obligations to support recovery at work, including the requirement to offer suitable work, where reasonably practicable - section 41 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act).
Where workplace rehabilitation services are indicated, the employer should recommend a timely referral to a provider in consultation with the insurer, worker, and worker's support team to support the worker's effective recovery at work.
A worker should take reasonable steps to recover following a workplace injury and make sure that they have a current certificate of capacity, and that the insurer has a copy.
Part 7 of the Regulation sets out the requirements for providers to seek SIRA approval to deliver workplace rehabilitation services in the NSW workers compensation scheme.
A workplace rehabilitation service is defined under section 59 of the 1987 Act as "any service provided as a workplace rehabilitation service by or on behalf of a provider of rehabilitation services approved under section 52 of the 1998 Act".
The National Occupational Health and Safety Commission defines workplace rehabilitation as a managed process involving timely intervention with appropriate and adequate services based on an assessed need. It is aimed at maintaining injured or ill employees in, or returning them to, suitable employment.
To obtain and maintain SIRA approval to deliver workplace rehabilitation services in the NSW workers compensation system, a provider must comply with the conditions of approval for workplace rehabilitation providers (clause 25 of the Regulation).
There are four conditions of approval:
1. Services must be delivered in accordance with the approved service delivery model
2. Staff who deliver services must be appropriately qualified
3. The provider must implement quality management systems and governance
4. Reporting and evaluation requirements.
The mandatory requirements for each condition of approval are outlined in Part 2 of the framework.
The conditions of approval take effect from 1 January 2022.
These conditions of approval will apply until SIRA amends, revokes, or replaces them in whole or in part. The conditions of approval replace the Nationally Consistent Approval Framework for Workplace Rehabilitation Providers previously applied in NSW.
Individuals approved via the alternate pathway previously provided by WorkCover are considered to be approved under this framework. They must cite their approval number when applying for employment with a provider or signing reports.
Updated 9 September 2021
Providers will be required to submit a service delivery model that outlines the services proposed and how they will be delivered. Providers should aim to ensure that every dollar spent delivers quality and value and optimises recovery.
Providers are encouraged to explore innovative approaches which respond to individual circumstances and addresses specific needs, including:
In developing a proposed service delivery model, providers must establish and implement a model aimed at early, safe and durable recovery at, or return to work for workers. The model must be aligned to evidence and demonstrate how services will be delivered in a cost effective, timely and proactive manner.
Services must be delivered in accordance with the approved service delivery model | |
|---|---|
a) Service delivery model requirements | The provider must submit its service delivery model with their application for approval. To be approved, the service delivery model must:
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| b) Service streams and practice standards | The provider is to deliver services in accordance with the permitted service streams (see Part 3) and adhere to the relevant practice standards (see Part 4) to SIRA's reasonable satisfaction. |
| c) Return to work planning requirements | The provider must develop a written recover at work plan or return to work plan with involved parties which outlines the workplace rehabilitation services required and include Specific, Measurable, Achievable, Relevant and Time-bound (SMART) goals. A copy must be provided to all involved parties (with the worker's consent). The provider must then deliver services according to the plan approved by the insurer and update the written plan when the worker's goals or circumstances change. |
Staff must meet and should ensure they continue to meet the minimum qualifications, skills and experience for the workplace rehabilitation services they deliver.
Providers are required to advise qualifications and services delivered by each staff member who will deliver workplace rehabilitation services to workers on the staff details form to be submitted with their application for approval.
Providers should ensure staff continue to develop skills in recovery through work, the biopsychosocial approach and knowledge of personal injury schemes.
Staff who deliver services must be appropriately qualified | |
|---|---|
a) Workplace rehabilitation management services | To be appropriately qualified, the staff must have at least 12 months’ experience or work under the supervision of another staff member who is appropriately qualified and be one of the following:
To be appropriately qualified, staff who deliver job-seeking assistance as part of workplace rehabilitation management services must:
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b) Workplace and /or functional assessments | To be appropriately qualified, the staff must have at least 12 months’ experience or work under the supervision of another staff member who is appropriately qualified, and be either an:
To be appropriately qualified to deliver workplace and/or functional assessments for workers with psychological or cognitive injury, behavioural, communication or hearing disorder, the staff must be either a psychologist with AHPRA general registration, a rehabilitation counsellor (full member) or speech pathologist (full member). |
c) Vocational assessments and/or rehabilitation counselling | To be appropriately qualified, the staff must have at least 12 months’ experience or work under the supervision of another staff member who is appropriately qualified and be one of the following:
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d) Workplace facilitated discussions | To be appropriately qualified, staff who deliver workplace facilitated discussion services must:
The staff must also:
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e) Specialist job-seeking services | Staff who deliver job-seeking assistance within a specialist job seeking service must:
Where staff have less than the required experience delivering specialist job-seeking services, they can provide services if they undertake a comprehensive induction and learning development plan, under the professional supervision of someone who meets the minimum requirements for the provision of specialist job-seeking services, until the staff member acquires the relevant years of experience. |
SIRA expects providers will implement an organisation-wide governance system to ensure reliable, consistent, safe and effective service provision to workers, employers, insurers and other relevant parties. Quality systems should be integrated with governance processes to enable organisations to actively manage and improve the safety and quality of their workplace rehabilitation service provision.
Quality management systems and governance | |
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a) | The provider must deliver services in accordance with legislation and regulatory requirements, including relevant privacy and work health and safety legislation as well as the NSW workers compensation legislation, guidelines and applicable fees orders. |
b) | The provider must comply with SIRA's workplace rehabilitation provider code of conduct. |
c) | The provider is to ensure one person in their management structure has five years' experience in a direct line of supervision of workplace rehabilitation service delivery, in addition to ensuring staff have current checks and clearances (police, security, work health and safety and child protection) appropriate for the worker and employer requirements. |
d) | The provider is to maintain appropriate insurances, including professional indemnity, workers compensation and public liability throughout the period of approval. |
e) | The provider is not to offer or accept financial incentives for referral of workers, or accept any inducement, gift, or hospitality from individuals or companies, or enter into arrangements that could be perceived to provide inducements that may influence or be seen to influence service provision. |
f) | The provider is to document and notify any real, perceived, or potential conflict of interest to the referrer and worker at the time of referral or, if a conflict or potential conflict of interest arises after referral, as soon as it arises. |
g) | The provider must have a safety and quality improvement system in line with Australian Standard AS/NZS ISO 9001 – Quality Management Systems - Requirements. |
h) | The provider must have a feedback and complaints management system that adheres to the SIRA customer conduct principles and must inform workers of the complaints process. |
Providers must ensure that workplace rehabilitation services achieve desired outcomes. Workplace rehabilitation providers are to adopt an outcomes-focused approach to the delivery of services that matter to workers and undertake an annual evaluation of their service delivery with reporting to SIRA in relation to prescribed matters.
Recovery at work measures are the primary measure used to monitor outcomes related to workplace rehabilitation service provision. SIRA will prescribe minimum outcomes measures for services to be delivered.
Reporting and evaluation requirements | |
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a) Data collection | The provider must collect accurate data as prescribed by SIRA. Data must be submitted to SIRA annually or upon request by SIRA. |
b) Outcomes | The provider must maintain minimum outcome measures as prescribed by SIRA for the service stream/s delivered as per the approved service delivery model. |
c) Provision of reports | The provider is required to submit reports to SIRA as requested, including but not limited to an annual evaluation report, staff details form and an annual report summarising:
The provider will also be required to report on any remediation actions required to address non-conformance. |
d) Notification to SIRA | The provider must inform SIRA as soon as reasonably practicable, but no longer than 30 calendar days after becoming aware of, any of the following:
(i) is in the course of being wound up, or (ii) is under administration, or (iii) is a corporation in respect of the property of which a receiver or manager (or other controller within the meaning of the Corporations Act 2001 of the Commonwealth) has been appointed, or (iv) has entered into a compromise or arrangement with its creditors, or
(i) has been convicted of an offence referred to in paragraph (c), or (ii) for any other reason would not be a fit and proper person to hold a certificate, if the certificate were held by the person. Providers must notify SIRA within 30 days if:
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e) Evaluation | The provider must perform an annual evaluation to SIRA's reasonable satisfaction and/or participate in a SIRA-initiated evaluation conducted in accordance with the legislation and approval framework. The evaluation is to be undertaken in accordance with SIRA's evaluation protocol. |
Updated 9 September 2021
The information contained in this part is to assist providers in understanding the different service streams, including their purposes, when to use a particular service stream, and things to consider when delivering a service.
Workplace rehabilitation services that assist a worker to recover at work or return to work with the same (i.e., pre-injury) employer.
Providers should use this service stream with workers when:
When assessing need:
When providing employer support:
When coordinating service/s and resources:
When developing and implementing the return-to-work plan:
Workplace rehabilitation services that assist a worker in returning to work with a new employer.
Providers should use this service stream with workers when:
When assessing need:
For return-to-work planning:
When coordinating service delivery:
When implementing the return-to-work plan:
To address barriers where a workplace relationship issue is impacting recovery at work.
Providers seeking approval can only deliver this service where the worker has a goal to return to work with their same employer.
A facilitated workplace discussion is a brief intervention that enables a SIRA-approved workplace facilitator to provide recovery through work support to parties to address issues that may be impacting the recovery at work.
The goal of the service is to offer a supportive environment to discuss current challenges and concerns that may be affecting the worker's ability to return to work.
The service is broken into two parts, Preparation (Part A) and Meeting (Part B).
Preparation (Part A)
Meeting (Part B)
The facilitated workplace discussion should be provided in a format that is appropriate to the individual circumstances and can include a telephone, video conferencing or face to face meeting.
The specialist job seeking service stream is for workers seeking employment with a new employer who may benefit from support from a workplace rehabilitation provider with job-seeking specialist skills. The specialist job seeking model identified by a workplace rehabilitation provider will outline the services delivered and may include the following:
If a workplace rehabilitation provider is applying for the specialist job seeking service stream, the application must:
SIRA has approved the below workplace rehabilitation providers to deliver specialist job seeking services in the corresponding cohort:
| Workplace rehabilitation provider | Approved cohort |
|---|---|
Advanced Personnel Management | For mature aged, and culturally and linguistically diverse workers |
Career Management Services | Recruitment model of job seeking for all workers |
Greenlight HC | For workers with acquired and traumatic brain injury and mature workers aged between 50 – 65 years |
Head2work | For workers with brain injury |
Keystone Professional | For workers with brain injury or neurological conditions |
JK Corporate Resourcing | For culturally diverse workers and workers with psychological injury |
Konekt | For workers with brain injury |
Prestige Health Services Australia | For workers with brain injury |
Rehabco | For workers with psychological injury or illness including affective disorders and trauma related disorders including PTSD |
Rehabilitation Services by Altius | For mature workers |
Any changes to the workplace rehabilitation provider’s approval for this service will be reflected in the above table.
Updated 9 September 2021
As outlined in Condition of Approval 1, the provider is to deliver services in accordance with the permitted service streams (as outlined in Part 3) and adhere to the relevant practice standards to SIRA's reasonable satisfaction.
Practice standards have been set for the assessment sub-streams of the workplace rehabilitation management service stream.
The information below outlines SIRA's practice standards for each sub-stream:
When planning the assessment, providers must:
When explaining the assessment, providers must:
When identifying and assessing work duties and tasks, providers must:
When identifying and negotiating workplace-based strategies to build capacity over time, providers must:
Providers must justify, document, and communicate assessment decisions, including:
When planning the assessment, providers must:
When explaining the assessment, providers must:
When analysing and interpreting evidence about performance criteria, providers must:
When identifying functional restoration strategies to optimise the worker's ability to meet performance criteria, providers must:
Providers must justify, document, and communicate assessment decisions, including:
When planning the assessment, providers must
When conducting the assessment, providers must:
The provider must identify a suitable, achievable employment option(s) and return to work strategy by:
The provider must justify, document, and communicate assessment decisions, including:
Updated 9 September 2021
In NSW, for organisations to deliver workplace rehabilitation services within the workers compensation scheme, they must be approved as a workplace rehabilitation provider (provider) by SIRA under section 52(4)(c) of the 1998 Act.
Prior to applying for SIRA approval, an applicant should read all parts of the framework to prepare their application and determine if they can meet and adhere to the conditions of approval.
Applicants seeking approval are to submit an Application for Approval as a Workplace Rehabilitation Provider form together with:
A completed application must be accompanied by the application fee prescribed by SIRA.
It is recommended that applicants submit their applications in October to December for SIRA assessment from 1 January to 30 March of the following year. Applications to be a SIRA approved workplace rehabilitation provider can be received up to 30 March.
Where the provider applies in the final year of a three-year approval period, they will be required to reapply the following year for the entire three-year approval period, including paying the required application fee.
The workers compensation legislation provides for criminal penalties for a person who commits fraud against the worker compensation legislation (s235A of the 1998 Act) or knowingly makes a false or misleading statement relating to a claim (s235C of the 1998 Act).
SIRA will assess new applications for approval as a workplace rehabilitation provider between 1 January to 30 March each year and will decide on an application within four months after the date of lodgement of the application.
SIRA will only assess applications outside this timeframe if SIRA has identified a need for new providers to work within the scheme. If this occurs, industry will be notified via the SIRA website.
SIRA will assess the suitability of the applicant to deliver safe and high-quality workplace rehabilitation services, including consideration of:
Upon receipt of an application for approval, SIRA will conduct a preliminary review of the application to ensure that all the required documentation has been completed and the application meets the requirements.
Incomplete applications cannot be assessed. If SIRA receives an incomplete application, the organisation will be given an opportunity to submit the required information providing the information can be assessed within the assessment period. If the information is not received, the application cannot proceed, and the organisation will be notified. Should the organisation wish to apply again, it will need to do so in the next approval round.
Complete applications will be reviewed and assessed by SIRA in line with the workers compensation legislation and conditions of approval.
SIRA will review the documentation and contact the applicant's nominated contact person to clarify any aspect of the application.
If an application for approval is successful, SIRA will issue a certificate of approval to the applicant for a period of up to three years (until 31 December of the third year of the approval period).
The certificate of approval will contain:
References to a certificate of approval for advertising purposes should be limited to the information contained on the approval certificate. Where a statement is made, it should read as follows:
'This organisation is approved by SIRA to provide workplace rehabilitation services within the NSW workers compensation system.'
Possession of a valid certificate of approval is subject to the provider's continued conformance with the conditions of approval.
Where SIRA refuses to grant or amend the certificate of approval, the applicant will be provided with an outcome of assessment letter detailing the conditions of approval that were not met.
If an applicant wishes to appeal the outcome of assessment, they must submit a written appeal and address the issues raised in the outcome of assessment letter, with specific reference to the conditions of approval that were not met.
Appeal correspondence should be addressed to Director, Health Policy, Prevention and Supervision, State Insurance Regulatory Authority.
Emailed to: providers@sira.nsw.gov.au
The appeal will be assessed by an independent review officer who was not involved in the original assessment decision.
The applicant will be advised of the outcome and reasons for the appeal decision in writing.
Approved providers who wish to deliver additionally permitted service stream/s must submit an application addressing the relevant conditions of approval.
Approved providers who wish to be granted an additional approval number for a new site should submit a completed Approval to operate at additional sites form to providers@sira.nsw.gov.au
Providers who wish to cease or withdraw from delivering workplace rehabilitation services in NSW must, as soon as practicable, inform SIRA in writing prior to ceasing service delivery.
Prior to ceasing or withdrawing from delivering services, SIRA will require that providers cooperate in the transfer of current cases to other providers.
Updated 9 September 2021
SIRA will actively monitor and supervise an approved provider's compliance with the conditions of approval.
Monitoring will be based on data SIRA holds and receives from other stakeholders (including insurers, employers and stakeholders) along with information directly from the provider.
Data may include:
SIRA's supervision process aims to be evolving, preventative and corrective by working collaboratively with providers to:
Where a provider identifies non-compliance with the conditions of approval and/or performance issues, they should advise SIRA of the non-compliance.
Providers should submit to SIRA evidence of communication to involved stakeholders and a quality improvement plan outlining how the non-compliance will be resolved.
SIRA's regulatory action will be dependent on the provider's actions, evidence, risk and the capacity of the provider to remediate the issue/s to comply with the conditions of approval.
Where SIRA identifies compliance and performance issues, dependent on evidence and risk assessment, SIRA may:
SIRA may cancel or suspend a provider's certificate of approval at any time for non-compliance with any or all of the conditions of approval.
Grounds for cancellation or suspension of a provider's certificate of approval include those outlined in clause 33, Ppart 7 of the Regulation.
Where a provider has failed to meet any or all of the conditions of approval, SIRA will advise of its intention to suspend or cancel the certificate of approval.
SIRA will give the provider an opportunity to show cause why the certificate of approval should not be suspended or cancelled. SIRA will review the response to determine if suspension or cancellation of the certificate of approval should proceed. The provider will be notified by SIRA of any decision to suspend or cancel their certificate of approval in writing.
Providers must also ensure the continuity of care for both open and closed claims in consultation with the relevant insurer and email providers@sira.nsw.gov.au to advise of these arrangements.
Updated 9 September 2021
If a provider has a complaint regarding a worker's recovery at work, this should be raised with the insurer managing the claim.
If the provider is not satisfied with the insurer outcome, or where the matter is not related to an individual claim, the matter may be raised with SIRA on 13 74 72 or by email at contact@sira.nsw.gov.au
A complaint about a workplace rehabilitation provider can be made by calling SIRA on 13 74 72 or by email to contact@sira.nsw.gov.au
On receipt of a complaint, SIRA may (where appropriate):
If a complainant's consent is not obtained, then no further action can be taken about that complaint.
However, the complaint will be recorded against the provider on SIRA's internal complaints register, which is reviewed regularly for themes and emerging trends.
Complaints and complaints management are considered by SIRA as part of its evaluation of a provider's conformance with the conditions of approval.
If you think we have done something wrong, let us know. Complaints are an important way for us to be accountable for our activities and can help identify ways for us to improve our processes and the quality of our services. We are committed to providing a fair, timely and professional response to people who make a complaint.
If you are not satisfied with our response to your complaint, contact the person you have been dealing with and request a review. Your complaint will then be escalated internally to an appropriate person for review and response.
If you are still not satisfied, you may wish to contact:
Director, Health Policy, Prevention and Supervision
State Insurance Regulatory Authority
Locked Bag 2906
Lisarow NSW 2252
Email: providers@sira.nsw.gov.au
OR
NSW Ombudsman
Level 24
580 George Street
Sydney NSW 2000
Phone: (02) 9286 1000
Toll free: 1800 451 524 (Australia wide)
Web: www.ombo.nsw.gov.au
Updated 9 September 2021
Updated 9 September 2021