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PSYCHOLOGISTS AND COUNSELLORS’ GUIDE TO WORKCOVER NSW

1. INTRODUCTION

This manual has been produced by WorkCover NSW to provide psychologists, counsellors and insurers with information about policies and procedures in relation to the provision of psychological treatment and counselling services for injured workers in NSW. The aim of the manual is to promote best practice in delivery of psychological treatment and counselling services within the NSW workers compensation system.

WorkCover’s injury management system is designed to provide a framework that enables early, safe and durable return to work for injured workers. This should be the focus of any treatment provided, and is achieved in part through effective communication between the nominated treating doctor, insurer, employer and relevant health professionals. Psychologists and counsellors assist in this process by providing information and advice regarding treatment requirements, functional ability, capacity for work, potential barriers that may impact upon the return to work process and strategies to address those barriers.

It is important to note that all psychological treatment and counselling services must be aimed at progressively increasing an injured worker’s capacity to work and ability to independently manage their condition, and must have an end point. Psychological treatment and counselling services should not be focused on addressing pre-existing conditions or problems not related to the compensatable injury.

This manual refers to fee schedules and reporting requirements introduced by the Workers Compensation (Psychologists Fees) Order 2010 and the Workers Compensation (Counsellors Fees) Order 2010. All references contained in this guide refer to these orders and the fees contained in the schedules to these orders. A summary of the fees is provided in section 6 – Fees payable, however further detail regarding the fees and procedures is contained in the fees orders.

All references in this guide to treatment providers refer to psychologists and counsellors.

All references to insurer in this guide refer to scheme agents, self insurers and specialised insurers.

2. THE NSW WORKERS COMPENSATION SYSTEM

Workers compensation provides valuable no-fault protection for workers and their employers in the event of a workplace-related injury or disease. Through workers compensation, injured workers can receive income support, reasonably necessary treatment and vocational rehabilitation services, to assist them return to work.

All NSW employers must have a workers compensation policy covering all employees.

WorkCover NSW regulates the New South Wales workers compensation system. The system operates under the Workers Compensation Act 1987 and the Workplace Injury Management and Workers Compensation Act 1998, and associated regulations.

The workers compensation system comprises:

  • the NSW Workers Compensation Scheme
  • self insurers that bear their own liabilities and claims risk
  • specialised insurers, including Treasury Managed Fund that manage claims for NSW State government departments.

When there is an injury at work, the employer, the injured worker and the insurer all have responsibilities to ensure that the injury is reported promptly and appropriate action taken to ensure that the injured worker recovers from their injury and returns to work. An injured worker is entitled to seek compensation if their work is a substantial contributing factor to their injury. In the case of psychological injury, an injured worker is entitled to seek compensation if their work related injury is not the result of the reasonable actions taken or proposed to be taken by or on behalf of the employer with respect to transfer, demotion, promotion, performance appraisal, discipline, retrenchment or dismissal of workers or provision of employment benefits to workers.

Roles of participants

The injured worker

When there is an injury at work, the injured worker must:

  • seek medical attention
  • notify the employer as soon as possible
  • record their name, the date and cause of the injury in the employer’s Register of Injuries
  • sign the WorkCover medical certificate, if one is required
  • participate and cooperate with the development and implementation of an injury management plan
  • comply with requests made by the insurer with regard to their claim
  • make all efforts to return to work as soon as possible.

An injured worker is entitled to choose their treatment provider. If the treatment delivered by that treatment provider is not effective in achieving suitable outcomes the insurer may request that the injured worker choose another treatment provider.

The employer

Employers in NSW are responsible for providing a safe and healthy workplace. Every employer must have a workers compensation insurance policy covering all employees. They must establish a workplace return to work program, which is consistent with the insurer’s injury management program.

Where compensation is or may be payable, an employer must contact their insurer within 48 hours of notification of injury.

Employers must forward any completed claim forms to their insurer within seven days. They must also provide suitable employment unless it is not reasonably practicable to do so.

The insurer

In NSW, seven organisations operate as Scheme Agents in the NSW WorkCover Scheme and deliver claims and policy services under commercial contracts. Their contact details are listed in Appendix 1.

Some organisations are licensed by WorkCover to be self-insurers or specialised insurers. An employer with a self-insurer’s licence carries its own underwriting risk and control its own claims administration. Specialised insurers have a restricted licence to underwrite workers compensation risks specific to a particular industry or class of business or employer. A list of self and specialised insurers is available on the WorkCover website (www.workcover.nsw.gov.au).

Insurer responsibilities

After being advised by the employer that a worker has suffered an injury, the insurer must:

  • commence provisional liability payments of weekly benefits and medical expenses within 7 days, unless a reasonable excuse exists,
  • contact the worker, the employer, and the treating doctor (if required) within three days, and consult with all relevant parties to ensure that the worker receives necessary assistance to recover and return to work
  • develop an injury management plan for the worker in consultation with the employer, the doctor and the worker
  • provide the employer and worker with information regarding the injury management plan
  • keep the employer informed of significant steps taken or proposed under the injury management plan.

Benefits payable to injured workers

Depending on the individual claim and the type, nature and severity of the injury, benefits payable to injured workers may include:

  • weekly benefits
  • reasonably necessary medical or related treatment and occupational rehabilitation services
  • damage to items of personal property
  • lump sums for non-economic loss (permanent impairment, pain and suffering).

Workplace injury management

The purpose of injury management is to facilitate the prompt, safe and durable return to work of an injured worker. It includes treatment of the injury, rehabilitation back to work, retraining into a new skill or new job (if necessary), management of the workers compensation claim and the employment practices of an employer. Everyone involved is required to cooperate and participate in injury management, including the insurer, employer, injured worker, nominated treating doctor and all treating practitioners.

The earlier an injury is treated and managed, the sooner the worker will return to work and recover from the injury. This means less downtime and lost productivity, as well as a saving in claims costs (and therefore lower premiums) for employers.

In New South Wales a planned approach to injury management is required. Return to work plans should be staged and upgrades are encouraged to progress recovery. Upgrades should be in line with information on current work capacity and prognosis provided by the nominated treating doctor in collaboration with all treatment providers. It is thus essential that treatment providers communicate with the nominated treating doctor to advise of treatment progress and expected outcomes.

Suitable duties are short-term work duties, agreed between the employer the injured worker and the nominated treating doctor to assist the injured worker’s rehabilitation. Suitable duties must comply with a current medical certificate, and may include:

  • parts of the job the worker was doing before the injury
  • the same job, but on reduced hours
  • different duties with the same employer
  • the same job or a different job with a different employer
  • training opportunities
  • a combination of some or all the above.

Treatment review

WorkCover NSW has established a network of independent consultants to provide support for treatment providers and insurers to understand whether treatment is reasonably necessary. Referral to an independent consultant is made by an insurer and may be at the request of the treatment provider.

(See Section 7: Independent consultants)

Dispute prevention and resolution

When an insurer makes a decision to decline claim liability or refuse a request for a benefit, including medical and related treatment benefits, they must explain the decision to the injured worker in writing and provide copies of all relevant reports and documents. An injured worker can ask for a review of the insurer’s decision and can seek advice from WorkCover’s Claims Assistance Service (CAS).

The Claims Assistance Service (CAS) provides assistance to injured workers and employers with enquiries about workers compensation and injury management. The service provides information about injury and accident notifications, making a claim, entitlements and the dispute resolution process. The aim of the service is to prevent an issue from turning into a dispute that needs to be addressed by the Workers Compensation Commission.

The telephone number of the WorkCover Assistance Service is 13 10 50.

If the disagreement is unable to be resolved with the assistance of CAS, the worker may apply to the Workers Compensation Commission for resolution of a dispute. The Workers Compensation Commission is an independent statutory tribunal within the justice system in New South Wales to resolve workers compensation disputes between injured workers and employers, e.g. disputes about weekly compensation for loss of income, payment of medical expenses and compensation for permanent impairment/pain and suffering. It provides a single place to help parties come to agreement about a dispute (conciliation) or, when needed, will make a decision about a dispute (arbitration). The telephone number for the Workers Compensation Commission is 1300 368 040.

Further information

The following guidelines are available for reference on the WorkCover website (www.workcover.nsw.gov.au):

  • Guidelines for Claiming Compensation Benefits
  • Guidelines for Employers Return to Work Programs

The website for the Workers Compensation Commission is www.wcc.nsw.gov.au

3. TREATMENT PRINCIPLES

The Treatment Principles for the Provision of Psychological and Counselling Services promote the concept that psychological and counselling services are goal oriented, evidence based and clinically justified. The Principles aim to enhance the communication between insurers, and practitioners providing psychological and counselling services and inform practitioners of the expectations of WorkCover and the Motor Accidents Authority of NSW about the management of injured workers.

The 5 principles outlined in the document are:

1. Measurable treatment effectiveness is demonstrated.

Key messages:

  • Treatment effectiveness is demonstrated through the achievement of functional goals.
  • Best practice includes the use of functional and standardised outcome measures to demonstrate progress toward and achievement of agreed functional goals.
  • Functional outcome measures are:
    • specific
    • behavioural
    • appropriate to the injured person’s condition
    • related to the goals of treatment
    • related to the impact of environmental and personal factors on recovery.
  • Standardised outcome measures are:
    • reliable
    • valid, normed and responsive to change
    • appropriate to the injured person’s condition
    • related to the goals of treatment
    • sensitive to the impact of environmental and personal factors on recovery.

2. Treatment goals relate to improving function and resuming usual activity, including return to work

Key messages:

  • Goals are functional and SMART – Specific, Measurable, Achievable, Relevant & Timed.
  • Progress toward goal achievement is regularly assessed and recorded.
  • When an injured person is not progressing as expected, the treating practitioner is responsible for implementing an alternative treatment plan.

3. A biopsychosocial approach is essential for the management and treatment of persistent pain and psychological injuries

Key messages:

  • A biopsychosocial approach maximises recovery and minimises the impact of persistent pain and/or ongoing psychological injury.
  • Psychosocial and biological factors that influence the injured person’s experience of pain, disability and psychological distress are assessed and managed by treating practitioners.
  • Early identification of the barriers to recovery, particularly psychosocial risk factors, helps determine the most effective treatment approach.
  • Treatment planning includes identifying, considering and addressing any environmental factors (personal and workplace) impeding the injured person’s recovery.

4. Treatment focuses on self management by the injured person

Key messages:

  • Empowering the injured person is a key treatment strategy and is incorporated in all phases of injury management.
  • The injured person is empowered when they:
    • are educated about the nature of their problem, appropriate management strategies and their prognosis
    • have appropriate and effective self management strategies
    • manage their condition as independently as possible.
  • Treatment of an injured person with pain and/or psychological injury is based on education and focused on function, return to work and promotion of self management.
  • An injured person with ongoing psychological injury and/or persistent pain is educated about relapses and provided with strategies to manage these episodes.

5. Treatment is based on the best evidence available.

Key messages:

  • Treating practitioners use the best evidence available to inform their treatment decision making.
  • Systematic reviews, (evidence based) clinical practice guidelines and critically appraised papers provide the most comprehensive and objective source of research evidence.

See Appendix 2: Treatment Principles for the provision of psychological or counselling services.

Services for workers with a soft tissue injury

Services for workers with a soft tissue injury (and psychosocial barriers) are to be delivered according to the management approach outlined in the Work Cover publication Improving outcomes: Integrated, active management of workers with soft tissue injury (2008).

The publication provides advice about important principles and activities that reduce the risk of long term disability and work loss in workers with soft tissue injury. The publication is available on the Work Cover website: www.workcover.nsw.gov.au or from the WorkCover publications hotline 1300 799 003.

4. REASONABLY NECESSARY TREATMENT

WHAT IS ‘REASONABLY NECESSARY’ TREATMENT

An insurer is only liable to pay for reasonably necessary treatment services related to the workplace injury. The factors underlying reasonably necessary treatment are:

  • appropriateness of treatment
  • availability of alternative treatments
  • cost of treatment
  • effectiveness (actual or potential) of treatment
  • usage of treatment in similar cases (or acceptance).

Appropriateness

To be appropriate, treatment must serve a purpose. It must have the capacity to:

  • lessen the effects of injury
  • cure
  • alleviate
  • sustain status quo
  • retard progressive deterioration.

Effectiveness

The degree to which the treatment will potentially alleviate the consequences of the injury.

Alternatives

The treatment provided must progress the injured worker towards better health. If alternative avenues of treatment would more substantially alleviate the problem, it would be difficult to regard the treatment in question as reasonably necessary.

Cost

There must be an expected positive benefit, given the cost involved, that should deliver the expected health outcomes for the worker.

Acceptance

Whether or not a particular treatment approach has been used in similar cases, or is generally accepted by clinical peers, guides the decision about what is reasonably necessary treatment.

5. PROCEDURES

These procedures are effective from 1 January 2010 and apply to all open claims where psychological treatment or counselling is being provided. This includes claims where psychological treatment or counselling commenced prior to this date.

WORKCOVER APPROVAL NUMBER

Suitable Practitioners

Psychologists or counsellors who deliver services to injured workers in NSW must be approved by WorkCover and provide their WorkCover approval number on all tax invoices submitted to the insurer. The WorkCover approval number is specific to the service provider and is not to be used by any other person. WorkCover will approve the following service providers:

  1. Psychologists who are fully registered in the Australian state or territory where the service is being delivered and who meet the WorkCover approval criteria
  2. Counsellors who are:
    • Full clinical members of the Counselling and Psychotherapists Association of NSW (CAPA) and who meet the WorkCover approval criteria
    • Mental health social workers accredited through the Australian Association of Social Workers (AASW) and who meet the WorkCover approval criteria

    WorkCover criteria for approval are:

    • agreement to deliver evidence based and outcomes focused treatment
    • agreement to deliver services in accordance with WorkCover’s administrative arrangements and communication protocols
    • agreement to deliver services within the individual treatment provider’s scope of practice, education and experience
    • being a fit and proper person to provide services to injured workers (ie no upheld criminal charges or civil proceedings, no upheld complaints lodged with any health services ombudsman, professional body, department or regulator)
    • agreement to practice ethically and to undertake ongoing professional development
  • adherence to quality standards for all practice locations
    • display of, an appropriate Code of Ethics which addresses duty of care, professional conduct and patient confidentiality
    • adherence to that Code of Conduct
    • a dedicated room suitable for consultation, and a toilet available for client use
    • a practice facility which ensures a safe environment for staff, clients and visitors
    • equipment for sending and receiving communication electronically
    • a business records management system that ensures records are suitable for professional and financial audits
    • quality assurance systems which support continuous practice improvement
    • public liability insurance
    • agreement that WorkCover may request a treatment provider to engage a supervisor in order to maintain approval number where it is determined appropriate
  • maintain professional registration and professional indemnity insurances. Where covered by one’s employer’s professional indemnity, evidence of this insurance together with a letter from the employer verifying that the treatment provider is covered under the policy, must be provided
  • agreement to notify WorkCover immediately of any changes to the information contained in the application for approval
  • attendance at WorkCover prescribed training within six months of receiving an approval number – an approval number will be provisionally provided upon processing of the application and confirmed after attendance at the prescribed training.

Approval process

  • meet the WorkCover approval criteria
  • complete the “Psychologist/Counsellor WorkCover Approval” form:
    • download form from the WorkCover website
    • complete, agree, sign and attach required evidence of insurances
    • send to the Provider Services Branch via email/fax/post

    WorkCover will review the application within 10 business days and will either:

  • email the approval number
  • request additional information if the application is incomplete
  • advise the provider they are ineligible.
  • Attend the WorkCover prescribed one day training course within 6 months of being issued with an approval number. Enrolment for the training course is to be arranged directly with the Australian Psychological Society who are contracted on behalf of WorkCover to run the training. If a treatment provider does not attend the course within 6 months, the WorkCover approval number may be withdrawn. The treatment provider must obtain an approval number prior to applying to attend the training course. All services delivered by the treatment provider are invoiced using their WorkCover approval number, regardless of location. No other person, including an employee, associate or locum may deliver services using that WorkCover approval number.

A list of approved treatment providers is available on the WorkCover website (www.workcover.nsw.gov.au) (updated daily). WorkCover provides monthly advice to insurers of the names and approval numbers of approved services providers.

REFERRAL FOR PSYCHOLOGICAL OR COUNSELLING SERVICES

Protocols for referral and approval of payment for services

The nominated treating doctor or treating psychiatrist is responsible for referring the injured worker for psychological and counselling services. No services are to be provided without referral from the nominated treating doctor or treating psychiatrist. Where a treating psychiatrist provides the referral, the nominated treating doctor is to be informed by the psychiatrist.

An insurer, workplace rehabilitation provider or other health care practitioner may recommend that psychological or counselling services be provided. However, only the nominated treating doctor or treating psychiatrist may refer for these services. This referral may be included in the management plan on the WorkCover medical certificate.

An injured worker is entitled to choose their WorkCover approved treatment provider. Upon referral the treatment provider should check that there is no conflict of interest in them providing treatment/counselling. This is particularly important for workplace rehabilitation providers who also provide non-treatment services.

Insurers pay for services that are reasonably necessary. When the treatment provider receives a referral from the nominated treating doctor or treating psychiatrist, the insurer should be contacted to advise that the worker has been referred for treatment, confirm liability status and that the insurer agrees that the services are necessary and will pay for them.

If an initial consultation is provided without contacting the insurer to confirm liability status and insurer agreement that the services are reasonably necessary, the treatment provider may not be paid by the insurer for delivering the service. If the insurer does not agree to fund treatment at the time of referral, an alternative funding arrangement should be discussed with the injured person.

No prior formal written insurer approval is required for the initial consultation and up to a further 5 treatment sessions.

Previous psychological treatment or counselling from another provider

It is the responsibility of the treatment provider to determine if the worker has received previous psychological treatment or counselling in order to facilitate treatment planning.
If the injured worker has previously received treatment, contact should be made with the treatment provider to discuss treatment outcomes, identified barriers and number of treatment sessions provided. The initial consultation fee includes the cost of liaison with the previous treatment provider and the preparation of a management plan if required.

AFTER THE INITIAL CONSULTATION

An essential component of management, following the initial consultation, is communicating with other relevant parties to discuss the worker’s management, and formulate common goals. This includes:

  • communication with the referrer (a component of the initial consultation service as defined in the Fees Order)
  • contact with the nominated treating doctor to discuss information relating to diagnosis, proposed treatment and services, treatment, and the return to work goals.
  • contact with the worker’s employer (return to work coordinator) or workplace rehabilitation provider to:
    • gain information relating to the worker’s pre-injury duties
    • enquire about the availability of suitable duties
    • discuss proposed treatment, and worker’s expected recovery (especially in relation to return to work).

Reasonable costs for the time taken to liaise with the nominated treating doctor, insurer and employer about the return to work plan may be charged as case conferencing, provided the focus of the communication relates to planning the worker’s return to work.

With regard to workers with soft tissue injury and psychosocial barriers, the Work Cover publication Improving outcomes: Integrated, active management of workers with soft tissue injury (2008) provides important information about key activities undertaken following the initial consultation, including:

  • discussing risk factors for long term disability and work loss with other relevant parties
  • discussing the results of the initial assessment with other relevant parties to formulate an expectation of recovery
  • focusing on the worker remaining at/returning to work to promote recovery
  • educating the worker about to how to successfully manage their condition
  • promoting a self management approach to treatment.

PSYCHOLOGICAL AND COUNSELLING MANAGEMENT PLAN

The purpose of a management plan is to provide justification, based on clinical reasoning, for service delivery. It allows the treatment provider to succinctly inform the insurer about treatment aims and outcomes so that insurers may make decisions about reasonably necessary treatment. Proposed treatment must have an outcomes focus, and must clearly explain how treatment will assist the injured worker to return to work or stay at work.

When to submit a management plan

7 – 12 Sessions:

Any treatment or counselling provided after the initial six sessions (including the initial consultation) must have prior approval from the insurer. Therefore, completion and submission of a Psychological or Counselling Management Plan is required if the treatment provider intends to provide more than six sessions. The plan must be submitted to the nominated treating doctor or treating psychiatrist for endorsement and insurer for approval of up to six more sessions, before providing any treatment or counselling beyond the initial six sessions.

Ideally, the treatment plan should be submitted prior to the sixth session, allowing time for processing so that there is no disruption to service continuity. It is recommended that a management plan be submitted after session 4 if it is considered that more than 6 sessions is required. The treatment provider must submit a new treatment plan for each subsequent block of 6 sessions.

More than 12 sessions:

It is expected that approval will only be provided for more than 12 sessions after a review by an independent consultant. If supported by the independent consultant and agreed by the insurer, a management plan must be submitted for any subsequent blocks of six treatment or counselling sessions.

If an insurer determines that such a review is unnecessary, they will advise the treating practitioner of this and the number of additional sessions that are approved.

Resumption of treatment

The resumption of treatment/counselling after previous treatment has ceased does not automatically entitle the worker to another 6 treatment sessions without insurer pre-approval. However there are two exceptions:

  • when treatment/counselling resumes with the same practitioner within a 3 month period from the last treatment/session and less than 6 treatments/sessions were provided originally
  • when treatment/counselling resumes within a 3 month period under a previously approved plan the treatment/counselling is deemed to have resumed within the same episode of care, and the submission of a management plan is not required, until it is considered likely that treatment/counselling will extend beyond the number of sessions already approved.

If a worker ceased treatment/counselling more than three months previously, and returns for additional treatment/counselling for the same injury, this is considered to be a new episode of care. In this instance, an initial consultation would be required to facilitate the submission of a new management plan. The treatment provider cannot utilise any remaining treatment/ counselling sessions that may have been approved under the previous episode of care.

Completing and submitting the management plan

A copy of the Psychological and Counselling Management Plan template is provided in Appendix 3. The Plan may be downloaded, photocopied or printed from WorkCover’s website (www.workcover.nsw.gov.au).

Explanatory notes for completing each section of the plan are provided in Appendix 4. The plan is to be completed during a session, in cooperation with the injured worker. There is no additional fee payable for completion of the Psychological and Counselling Management Plan.

Insurer agreement

Insurers will consider the request for further treatment and advise approval or non-approval within 10 working days of receipt of the management plan. The insurer will record their agreement on the plan and return it to the treatment provider. If the insurer does not agree to the management plan, they will advise the treatment provider in writing, giving reasons. If the treatment provider has not received a response from the insurer within 10 working days, the insurer is considered to be in agreement with the management plan that treatment/ counselling is reasonably necessary.

Should the management plan contain insufficient information and further consultation between the insurer and the treatment provider does not resolve the matter, the insurer may refer the matter to an independent consultant for an opinion. Where a management plan is not submitted, the insurer is not liable for the cost of sessions beyond the initial six sessions.

In addition to gaining agreement with proposed treatment/counselling, the management plan provides an opportunity to communicate important information to the insurer about factors that may affect the worker’s recovery and return to work. Consequently, where the treatment provider does not receive a timely response from the insurer the treatment provider may consider it beneficial to contact the insurer by phone.

It is important to note that when an insurer indicates their agreement with the management plan, they are agreeing that the proposed treatment is “reasonably necessary” on the basis of the information available to the insurer at that time. Additional information received subsequent to approval and during the course of treatment or counselling may lead the insurer to decide that the balance of the treatment in that plan is not ‘reasonably necessary’. In this instance the insurer will inform both the worker and the treatment provider of the date that this decision would take effect. However it is ultimately the worker’s responsibility to notify the treatment provider of this decision.

Problems in relation to approval of a Psychological and Counselling Management Plan by an insurer that is unable to be resolved should be directed in writing to:

Provider Services Branch

Locked Bag 2906

Lisarow, NSW 2252

or by email to provider.services@workcover.nsw.gov.au.

Communication with the insurer

The Management Plan is not intended to be the sole communication tool but is intended to provide salient information in straightforward cases to enable an insurer to make a decision about reasonably necessary treatment. Communication between the insurer and treatment provider may also be enhanced by:

  • Case conferencing

Case conferencing is a valuable tool used to promote a shared understanding of the worker’s capacity for work, barriers to return to work and strategies to facilitate return to work. It may occur in a face-to-face meeting or teleconference with the nominated treating doctor, workplace rehabilitation provider, employer, insurer and/or worker and the focus of discussion must be a worker’s return to work plan. File notes of case conferences should be documented in the treatment provider’s records indicating discussion and outcomes as this information may be required for invoicing purposes. Discussion between treating doctors and treatment providers relating to treatment is considered a normal interaction between referring doctor and practitioner and is not to be charged as a case conference item.

  • Report writing

In some circumstances the insurer may require more detailed information than that provided on the management plan and may request that the treatment provider prepare a report. A written request and prior approval from the insurer is required before a treatment provider provides such reports. No prepayment is provided for reports.

6. FEES PAYABLE

Services provided by a WorkCover approved treatment provider attract a maximum fee as set out in the Workers Compensation (Psychologists Fees) Order 2010 and the Workers Compensation (Counsellors Fees) Order 2010 made under the Workers Compensation Act 1987. There is no opportunity for WorkCover approved treatment providers to levy upon the insurer or injured worker a fee that exceeds the maximum fee set out in the Fees Order.

Each service descriptor has its own payment classification code for the purposes of identifying the type of service delivered. The payment classification codes, service descriptors and fees payable are set out in the tables below.

Payment Classification Codes and Fees – Psychological and Counselling Services January 2010

Psychological Services

CODE
DESCRIPTOR
Fee
PSY 001
Initial Consultation

The first service provided by the WorkCover approved psychologist and may include:

  • History taking
  • Assessment
  • Goal setting and treatment planning
  • Treatment
  • Clinical recording
  • Communication with referrer and insurer
  • Preparation of a management plan (when indicated).

The service is 1:1 for the entire consultation.

$180 per session
PSY 002
Standard Consultation

Sessions provided subsequent to the initial consultation and may include:

  • Re-assessment
  • Treatment
  • Clinical recording and preparation of a management plan (if required).

The service is 1:1 for the entire consultation.

$150 per session
PSY 003
Report Writing

Written report requested by the insurer, other than
the management plan, providing details of treatment, progress and work capacity. Prior approval and agreement of costs is required.

$150 per hour (maximum 1 hour)
PSY 004
Case Conferencing

Case conference means a face-to-face meeting or teleconference with the nominated treating doctor, workplace rehabilitation provider, employer, insurer and/ or worker to discuss a worker’s return to work plan and/or strategies to improve a worker’s ability to return to work. File notes of case conferences are to be documented in the psychologist’s records indicating discussion and outcomes. This information may be required for invoicing purposes. Discussion between treating doctors and practitioners relating to treatment is considered a normal interaction between referring doctor and practitioner and is not to be charged as a case conference item.

$150 per hour (pro rata)
PSY 005
Travel

Occurs where the most appropriate clinical management of the patient requires the psychologist to travel away from their normal practice.

Travel costs do not apply where the psychologist provides contracted services to facilities such as private hospitals. Insurer pre-approval must be obtained for this service.

$1.40 per km
PSY 006
Group

Where a psychologist delivers a common service to more than one person at the same time, for example; group therapy. The maximum group size is six (6) participants.

A management plan is required for each worker participant.

$45 per person per session
Inclusions/Exclusions

Include only services provided by WorkCover approved psychologists pursuant to Sections 59 and 60, Workers Compensation Act 1987 No. 70 and WorkCover’s gazetted rate under s61 (2) of that Act.

Counselling Services

CODE
DESCRIPTOR
Fee
COU 002
Initial Consultation

The first service provided by the WorkCover approved counsellor and may include:

  • History taking
  • Assessment
  • Goal setting and treatment planning
  • Treatment
  • Clinical recording
  • Communication with referrer and insurer
  • Preparation of a management plan (when indicated).

The service is 1:1 for the entire consultation.

$134 per session
COU 003
Standard Consultation

Sessions provided subsequent to the initial consultation and may include:

  • Re-assessment
  • Treatment
  • Clinical recording and preparation of a management plan (if required).

The service is 1:1 for the entire consultation.

$120 per session
COU 004
Report Writing

Written report requested by the insurer, other than the management plan, providing details of treatment, progress and work capacity. Prior approval and agreement of costs is required.

$120 per hour (maximum 1 hour)
COU 005
Case Conferencing

Case conference means a face-to-face meeting or teleconference with the nominated treating doctor, workplace rehabilitation provider, employer, insurer and/ or worker to discuss a worker’s return to work plan and/or strategies to improve a worker’s ability to return to work. File notes of case conferences are to be documented in the counsellor’s records indicating discussion and outcomes. This information may be required for invoicing purposes. Discussion between treating doctors and practitioners relating to treatment is considered a normal interaction between referring doctor and practitioner and is not to be charged as a case conference item.

$120 per hour (pro rata)
COU 006
Travel

Occurs where the most appropriate clinical management of the patient requires the counsellor to travel away from their normal practice.

Travel costs do not apply where the counsellor provides contracted services to facilities such as private hospitals. Insurer pre-approval must be obtained for this service.

$1.40 per km per session
COU 007
Group

Where a counsellor delivers a common service to more than one person at the same time, for example; group therapy. The maximum group size is six (6) participants.

A management plan is required for each worker participant.

$38 per person per session
Inclusions/Exclusions

Include only services provided by WorkCover approved counsellors pursuant to Sections 59 and 60, Workers Compensation Act 1987 No. 70 and WorkCover’s gazetted rate under s61 (2) of that Act.

Payment will not be made for the delivery of more than one consultation on the same day.

Fees for cancellation or failure to attend

No fees are payable for cancellation or failure to attend scheduled sessions. Treatment providers are encouraged to implement scheduling systems which maximise attendance rates.

Pre-payment for planned services

Insurers do not pay in advance of services being provided, including report writing, even where approval has been given to provide those services.

PROVIDER INVOICE

Payment for services will be made in accordance with the Psychologist Fees Order 2010 and the Counsellor Fees Order 2010. For insurer payment, the treatment provider is required to forward an itemised invoice including the following information:

  • the words ‘Tax Invoice’ stated prominently
  • the name of the practitioner who provided the service and practice details
  • WorkCover NSW approval number of the treatment provider who provided the service
  • the date the tax invoice was issued
  • the provider’s Australian Business Number (ABN)
  • the injured worker’s name and claim number
  • date of each service
  • appropriate WorkCover NSW payment classification code
  • service cost for each WorkCover NSW classification code
  • a brief description of each service item provided, including issues addressed
  • payee details.

Commutations and work injury damages settlements

Commutation and work injury damages settlements for workers compensation claimants remove ongoing liability for treatment expenses from the effective date of the commutation or work injury damages settlement. This means that the insurer will not pay for any services delivered after the effective date of the settlement. If an injured worker is in the process of seeking a commutation or work injury damages settlement, the treatment provider should ensure that the injured worker advises of the effective date as soon as possible.

7. INDEPENDENT CONSULTANTS

WorkCover NSW has appointed a network of independent consultants who provide an independent opinion regarding allied health service delivery on a case by case basis, at the request of the insurer. Referral to an independent consultant is intended to achieve the following objectives:

  • review of service delivery by expert treatment providers with clinical experience in the management of work-related injuries
  • education and advice for insurers and treatment providers on a case by case basis regarding good treatment outcomes
  • negotiation with the treatment provider to determine the best outcome for the injured worker
  • control of costs by making recommendations for appropriate, effective treatment or recommending the cessation of service delivery that is not reasonably necessary, and
  • assist insurers and employers to better understand when and how much psychological treatment and/or counselling is reasonably necessary.

All independent consultants have agreed to meet conditions of appointment which are specified in Appendix 5. The list of current consultants is at Appendix 6.

The services provided by independent consultants are paid for by the insurer, and are charged as a cost to the claim.

An integral component of the peer review process is consultation with the treatment provider. Treatment providers may be contacted by an independent consultant to discuss the current and proposed treatment for an injured worker. Treatment providers are required to participate in discussions with an independent consultant. No fee is payable.

WHEN USE OF AN INDEPENDENT CONSULTANT MIGHT BE CONSIDERED

It is expected that referral to an independent consultant will occur where a treatment provider requests more than 12 sessions for an injured worker. The review by the independent consultant may include:

  • excessive sessions proposed without progress towards achieving treatment and return to work goals
  • the reasonable necessity of treatment
  • the ongoing need for treatment.

A treatment provider may also request the involvement of an independent consultant.

THE PROCESS OF REVIEW BY AN INDEPENDENT CONSULTANT

A flow chart is included in Appendix 7 to explain the process of review by an independent consultant.

The insurer selects an independent consultant from the list and forwards a referral to the consultant, including any relevant documentation. Following review of the documentation, the consultant may contact the treatment provider to discuss treatment. If both parties agree that ongoing treatment is to continue for a specified period or is to cease, the independent consultant will inform the insurer and the treating treatment provider of this in writing.

If the independent consultant and the treatment provider cannot agree that the proposed treatment is reasonably necessary, the independent consultant will advise the insurer who
will arrange for the worker to be assessed by either the same independent consultant or an alternate independent consultant. On completion of this assessment, the consultant will again contact the treatment provider. The independent consultant will then provide a written report to the insurer and the treatment provider with recommendations regarding future treatment requirements, indicating if these recommendations are agreed by the treatment provider.

The insurer’s decision about funding of future treatment will take account of the recommendations of the independent consultant as well as the information available at the time. The recommendations of the independent consultant are not binding but assist in guiding decisions about future treatment.

COMPLAINTS ABOUT INDEPENDENT CONSULTANTS

Complaints in relation to the conduct of an independent consultant that are unable to be resolved should be referred in writing to:

Manager, Allied Health Providers WorkCover NSW, Locked Bag 2906, Lisarow, NSW 2252 or by email to: provider.services@workcover.nsw.gov.au.

8. OTHER PARTIES IN THE WORKERS COMPENSATION SYSTEM

The Workplace Injury Management and Workers Compensation Act 1998 identifies specific responsibilities for insurers, employers, medical practitioners, treatment providers and approved treatment providers designed to encourage the safe, timely and durable return of injured workers to the workplace. Information regarding the roles that some of these parties have in the system are outlined below.

MEDICAL PRACTITIONERS:

Nominated treating doctors

Every worker who suffers a significant injury (ie an injury that prevents a worker from doing their usual job more than seven consecutive calendar days) must nominate a treating doctor who will liaise with the worker, employer, insurer and other treatment providers about injury management and return to work planning.

The nominated treating doctor is responsible for issuing a medical certificate, which states the worker’s diagnosis, restrictions, conditions, capacity and recommended treatment. The information provided on the WorkCover medical certificate assists the insurer to develop individual injury management plans. Treating practitioners providing psychological and counselling services are encouraged to provide the nominated treating doctor with up to date information regarding the worker’s functional abilities and restrictions in order to ensure that the medical certificate accurately reflects the worker’s condition and capacity.

Nominated treating doctors liaise with return to work coordinators at the workplace and approved workplace rehabilitation providers to ensure that identified duties are safe for an injured worker.

Injury management consultants

When there is a disagreement over the suitability of selected duties offered by an employer, the insurer or the employer may engage the services of an injury management consultant. These consultants are medical practitioners approved by WorkCover specifically for the purpose of reviewing a worker’s fitness for employment and the availability of suitable duties at a workplace.

Injury management consultants may also assist the Workers Compensation Commission in resolving injury management and return to work disputes.

Independent medical examiners

Independent medical examiners are specialist medical practitioners with qualifications relevant to the worker’s injury who provide impartial medical assessments of an injured worker. An insurer, employer, or a worker’s lawyer may refer to an independent medical examiner when information from the nominated treating doctor is unavailable, inadequate, or inconsistent, or when the insurer has been unable to resolve issues after discussion with the nominated treating doctor and the involvement of an injury management Consultant.

Additional information can be found in the Work Cover publication Guidelines on independent medical examinations and reports, on the Work Cover website www.workcover.gov.nsw.au

Approved medical specialists

Approved medical specialists are appointed by the Workers Compensation Commission to decide matters about causation, prognosis and treatment, level of impairment, suitability of employment and fitness for work. Their decisions in relation to permanent impairment are binding. Their opinion in the other matters is not binding but is used by the arbitrators in the Commission to help resolve the dispute.

OTHER TREATMENT PROVIDERS

Health care providers assist injured workers under the direction of the nominated treating doctor. WorkCover approves some health care providers if they meet specific criteria. All health care providers must follow administrative procedures developed by WorkCover in conjunction with the relevant professional association.

Other treatment providers who are subject to these requirements are:

  • chiropractors
  • exercise physiologists
  • osteopaths
  • physiotherapists
  • remedial massage therapists

More detailed information about the reporting requirements and fee schedules for these treatment provider groups is available on the Work Cover website: www.workcover.nsw.gov.au

RETURN TO WORK COORDINATOR

A return to work coordinator is a worker nominated by the employer or a contractor specifically engaged for the role, and whose principal purpose is to assist injured workers to return to work in a safe and durable manner. The return to work coordinator ensures that the employer’s return to work policy and procedures are implemented.

The role of the return to work coordinator is to:

  • assist employers to develop and implement their return to work programs
  • assist injured workers to return to work as soon as medically appropriate
  • develop and evaluate return to work plans, documenting suitable duties and work restrictions
  • initiate and maintain contact with the workers, their supervisors, the insurer, the nominated treating doctors and other relevant parties (including treating practitioners)
  • ensure that injured workers in need of specialised rehabilitation services are referred to appropriate rehabilitation providers
  • coordinate and monitor the progress of injured workers.

Large businesses are required to appoint a return to work coordinator who must have attended WorkCover training. In small business it is often the employer or a workplace rehabilitation provider who undertakes the role of return to work coordinator. Further information is available in the WorkCover publication Guidelines for Employers Return to Work Programs available on the WorkCover website (www.workcover.nsw.gov.au).

APPROVED WORKPLACE REHABILITATION PROVIDERS

Approved workplace rehabilitation providers are organisations approved by WorkCover NSW to offer specialised services to help injured workers to return to work.

Workplace rehabilitation service provision includes:

  • identifying and designing suitable duties for the worker to assist the employers to meet their obligations in providing suitable employment to injured workers
  • identifying and coordinating rehabilitation strategies that ensure workers are able to safely perform their duties
  • promoting an early return to work of the worker
  • forging the link between the insurer, employer and treatment providers to ensure integration of all injury management activities and a focus on return to work.
  • arranging appropriate retraining and placement in alternative employment when the worker is unable to return to pre-injury duties.
  • ensuring all aspects that have an impact on the worker returning to work are considered.

Workplace rehabilitation providers are organisations staffed by health professionals such as occupational therapists, exercise physiologists, rehabilitation counsellors and occupational psychologists, who specialise in occupational rehabilitation.

Queries or complaints about approved workplace rehabilitation providers in NSW can be directed to WorkCover’s Provider Services Group on 1800 801 905 or by email to provider.services@workcover.nsw.gov.au

9. DISPUTE PREVENTION AND RESOLUTION

Complaints

Complaints are managed by WorkCover according to the nature of the complaint, as follows:

  • Complaints related to service provision issues specific to the workers compensation system are investigated by WorkCover’s Provider Services Branch to seek resolution
  • Complaints related to potential fraud are referred to WorkCover’s Fraud Investigation Branch
  • Complaints related to professional conduct or clinical practice are referred to the relevant professional body (ie NSW Psychologist Registration Board or Counsellors and Psychotherapists Association of NSW).

Dispute prevention

Outcomes for injured workers are improved when key parties effectively work together. Open and timely communication between key parties reduces the likelihood of disputes, which may impede a worker’s recovery and return to work.

The document Workers Compensation and Injury Management Fact Sheet 5: Resolving problems and disputes about Workers Compensation claims provides concise information about dispute resolution in the Workers Compensation system. The document is available on the WorkCover website: www.workcover.nsw.gov.au.

Dispute resolution

Concerns raised by the worker

A worker should be encouraged to discuss any concerns with their insurer case manager as soon as possible. This allows the insurer to consider and address the issue in an attempt to avoid the worker’s concerns escalating into a dispute.

When an injured worker disagrees with a decision (for example, about liability for treatment expenses) by the insurer, they may request the insurer review the decision. All insurers are required to have a process in place to conduct such a review at the request of the worker. This review is to be conducted by someone other than the person who has made the original decision and who has requisite expertise.

WorkCover’s Claims Assistance Service (CAS) assists injured workers (and employers) to resolve disagreements relating to workers compensation or injury management. If appropriate, the Claims Assistance Service will contact the relevant party (eg insurer, workplace rehabilitation provider, doctor or employer) to try and avoid or resolve the disagreement. Phone: 13 10 50.

Concerns raised by the treatment provider

If a treatment provider is dissatisfied with an insurer’s decision, they should attempt to address this directly with the insurer in the first instance. If discussion with the insurer case manager does not result in a satisfactory outcome the treatment provider may request that the matter is escalated and reviewed within the insurer.

If these issues cannot be resolved by open communication between the parties, it may be referred to WorkCover for advice either with the Claims Assistance Service or Provider Services.

Concerns raised by the insurer

If an insurer is concerned about the adequacy or the quality of information provided by a treatment provider, and the insurer has been unable to obtain satisfactory information after pursuing the matter with the practitioner, the insurer may refer the matter to WorkCover or an independent consultant (Section 6: Independent consultants), for review.

Workers Compensation Commission

Disputes may be referred to the Workers Compensation Commission when other avenues for resolution have been unsuccessful. The Commission is structured to provide a speedy and flexible dispute resolution system. Detailed information about the services provided by the Workers Compensation Commission can be found on the WCC website at www.wcc.nsw.gov.au

10. WHERE TO GO FOR ASSISTANCE

WORKCOVER SERVICES

PROFESSIONAL BOARDS AND ASSOCIATIONS

NSW Psychologists Registration Board

Phone: 02 9219 0211

Australian Psychological Society (APS) (Head Office)

Phone: 03 8662 3300 1800 333 497

Counsellors and Psychotherapists Association of NSW (CAPA)

Phone: 02 9235 1500

APPENDIX 1: WORKCOVER SCHEME AGENTS

Allianz Australia Workers’ Compensation (NSW) Limited

www.allianz.com.au

Phone: 1300 130 664

Fax: 1300 130 665

Email plans to: treatmentplans@allianz.com.au

Xchanging

(previously known as Cambridge Integrated Services Australia Pty Ltd)

www.cambridgeaustralia.com

Phone: 1800 803 905 or 02 8667 9700

Fax: 1300 723 406

Email: info@au.xchanging.com

CGU Workers Compensation (NSW) Limited

www.cgu.com.au

Phone: 02 9088 9000

Fax: 02 9088 8653

Email plans directly to case manager

Employers Mutual NSW Limited

www.employersmutual.com.au

Phone: 1800 469 931 or 02 8251 9000

Fax: 02 8251 9495

Email plans to: directly to case manager

Gallagher Bassett Services Pty Ltd

www.gallagherbassett.com.au

Phone: 1800 007 033 or 02 9464 7100

Fax: 02 9464 7400

Email plans to: allplans@gbtpa.com.au

GIO General Limited

www.gio.com.au

Phone: 13 10 10

Fax: 1300 733 677

Email plans to: wcclaims_nsw@gio.com.au

QBE Workers Compensation (NSW) Limited

www.qbe.com.au

Phone: 1800 112 472 or 02 9375 4687

Fax: 02 9375 4358

Email plans to: qbewcompclaims@qbe.com

APPENDIX 2: TREATMENT PRINCIPLES

FOREWORD

The Motor Accidents Authority NSW (MAA) and WorkCover NSW are pleased to present the Treatment Principles for the Provision of Psychological and Counselling Services (Principles).

The Principles are the result of a collaborative effort between the MMA, WorkCover NSW and a working party including representatives from the Australian Psychological Society, insurers, researchers and private practitioners.

The Principles reflect an approach to the treatment of injured persons which promotes evidence based practice and the use of objective functional outcome measurement in clinical practice.

The Principles promote the shared understanding about the delivery of effective treatment services within the workers compensation scheme and the motor accidents compensation scheme.

The real success of the Principles will be measured by increased return to functional activities, including work, for injured persons.

We would like to acknowledge and thank those who have contributed to the development of the Principles. Representatives from:

Australian Psychological Society (NSW and National Branch) CTP and Workers Compensation Insurers
NSW Psychologists Registration Board
Private Practitioners

Researchers
Motor Accidents Authority of NSW WorkCover NSW

In particular, we would like to acknowledge the contribution of members of the technical working party:

Tina Bidese – Motor Accidents Authority of NSW
Ross Backen – Psychologist - Private Practice
Lee Davids – National Injury Management Advisor QBE
Bernadette McCosker – WorkCover NSW
Jonathan Munro – Clinical Psychologist – Australian Psychological Society (APS – NSW Branch)
Thomas O’Neill – Clinical Psychologist – Private Practice
Wendy Roberts – Clinical Psychologist – Private Practice

We look forward to working with the psychology and counselling professions as the Principles are put into action.

ACKNOWLEDGEMENTS

The MAA and WorkCover NSW wish to acknowledge the following publications which provided the basis for the working party and technical group discussions:

  • Clinical Framework for the Delivery of Psychology Services to Injured Workers, Victorian WorkCover Authority, 2006
  • Clinical Framework for the Delivery of Health Services, Transport Accident Commission and Victorian WorkCover Authority, 2008.

PURPOSE

This document aims to facilitate a shared understanding of the delivery of psychological and counselling services under the NSW WorkCover and Motor Accidents Compensation schemes.

People who sustain work or motor vehicle related accidents may experience a range of psychological effects that reduce their capacity to recover and return to pre-injury activities. The types and frequency of interventions to address these issues vary considerably from one person to another. What is ‘reasonable and necessary’ or ‘reasonably necessary’ funding will depend on the nature of the disability experienced and the injured person’s circumstances.

These Principles have been developed to:

  • promote return to usual lifestyle activities and return to work outcomes
  • inform treating practitioners of the expectations of the MAA and WorkCover NSW for the management of injured persons
  • provide treating practitioners and insurers/agents with guiding principles for the provision of psychological and counselling services to injured persons
  • ensure that psychological and counselling services are goal oriented, evidence based and clinically justified
  • inform decisions about ‘reasonable and necessary’ or ‘reasonably necessary’ funding of services and assist in the prevention and resolution of disputes.

PRINCIPLES

This document contains a set of principles for the provision of psychological and counselling treatment to injured persons:

  1. Measurable treatment effectiveness is demonstrated.
  2. Treatment goals relate to improving function and resuming usual activity, including return to work.
  3. A biopsychosocial approach is essential for the management and treatment of persistent pain and psychological injuries.
  4. Treatment focuses on self management by the injured person.
  5. Treatment is based on the best evidence available.

PRINCIPLE 1

MEASURABLE TREATMENT EFFECTIVENESS IS DEMONSTRATED

Key messages
  1. Treatment effectiveness is demonstrated through the achievement of functional goals.
  2. Best practice includes the use of functional and standardised outcome measures to demonstrate progress toward, and achievement of, agreed functional goals.
  3. Functional outcome measures are:
    1. specific
    2. behavioural
    3. appropriate to the injured person’s condition
    4. related to the goals of treatment
    5. related to the impact of environmental and personal factors on recovery.
  4. Standardised outcome measures are:
    1. reliable
    2. valid, normed and responsive to change
    3. appropriate to the injured person’s condition
    4. related to the goals of treatment
    5. sensitive to the impact of environmental and personal factors on recovery.

A treatment outcome is an improvement in the functional status of an injured person as a result of psychological intervention. Outcome measures are relevant psychological indicators used to assess the presence of unhelpful beliefs or cognitions, problem behaviours and activity limitations. Regular use of outcome measures to monitor progress informs and provides justification for treatment decisions. These can include continuing, changing or ceasing treatment or referring the injured person to another treatment practitioner.

Assessment and review of psychological functioning should include measurable indicators of the injured person’s functioning and not rely on symptom reports alone (eg using questionnaires to screen psychological symptoms). It is preferable to measure outcomes in regard to activity participation.

When to measure

Outcome measurements need to be used regularly to review progress. Baseline measurements should be taken as early as possible. Reassessment should occur as soon as change could be reasonably expected, given the injured person’s condition and the type of treatment provided. Reassessment is generally required every four to six sessions; however, treatment frequency, access to services (eg in rural areas) and cancellations should be considered in determining appropriate reassessment timeframes.

Functional (non-standardised) outcome measures

Demonstration of progress toward agreed goals and recovery is most effectively indicated via the measurement of functional outcomes. This includes progress toward returning to normal activities which may include work, driving, transportation, sleep patterns, social and recreational activities, shopping and domestic responsibilities.

Functional outcomes may be identified through a behavioural assessment, and involve the development of behaviour-specific and situation-specific measures aimed at targeting unhelpful behaviours.

Standardised outcome measures

Standardised outcome measures are rigorously developed questionnaires applied in a prescribed manner, for which reliability, validity and responsiveness are known. Using standardised outcome measures is a robust method of measuring an injured person’s status. Test selection must be appropriate to the problem and provide information pertinent to functional and return to work outcomes.

Examples of commonly used standardised outcome measures include:

  • Beck Depression Inventory (BDI–11)
  • Beck Anxiety Inventory (BAI)
  • Depression, Anxiety, Stress Scale (DASS)
  • Symptom Checklist (SCL9OR).

Scales for identifying key risk factors for problems with persisting pain (eg measures of catastrophising, fear-avoidance beliefs, self-efficacy), as well as disability and pain measures (eg Multidimensional Pain Inventory), should be considered.

Application and interpretation of standardised measures requires awareness of and sensitivity to:

  • response bias
  • mood determining responses
  • motivation issues
  • malingering
  • appropriateness of norms.

PRINCIPLE 2

TREATMENT GOALS RELATE TO IMPROVING FUNCTION AND RESUMING USUAL ACTIVITY, INCLUDING RETURN TO WORK

Key messages
  1. Goals are functional and SMART – Specific, Measurable, Achievable, Relevant and Timed.
  2. Progress toward goal achievement is regularly assessed and recorded.
  3. When an injured person is not progressing as expected, the treating practitioner is responsible for implementing an alternative treatment plan.
Focus of treatment

Psychological and counselling services should:

  • improve the injured person’s capacity to return to usual activities
  • incorporate collaborative goal setting, education, pacing and positive reinforcement
  • promote self management skills, such as active problem solving and strategies, to deal with relapses, which will minimise dependence on treatment providers.

Treating practitioners should consider all the contributing risk factors when forming treatment plans. The effectiveness of treatment should be regularly assessed and progress toward goal achievement recorded. Treatment goals should be modified if circumstances change or significant barriers to returning to usual activities are identified. When functional improvement is slow or absent, the cause/s should be identified and, where appropriate, expectations in relation to recovery should be adjusted. It may be appropriate to recommend the injured person be referred to another healthcare practitioner.

Role of the treating practitioner

Treating practitioners should explain their role to the injured person at the initial appointment. This includes assessment, goal setting, collaborating with other health professionals involved and helping the injured person to achieve treatment goals. Treating practitioners should also explain the injured person’s role and responsibility in the treatment process. Treatment should focus on the injuries sustained in the accident or work incident. Treating practitioners should actively support an integrated and collaborative approach which promotes effective communication and common goals between key parties. Treating practitioners must ensure that their practices are in adherence with the requirement of the Code of Conduct and/or legislation of their relevant board or association.

It is not the treating practitioner’s role to make referrals or coordinate the injured person’s return to work, advocate for the injured person in relation to the management of their claim or coach them through litigation or other compensation processes.

Goal Setting

Goals focusing on measurable improvement in return to usual activities should be developed in collaboration with the injured person at the beginning of treatment. Goals should be SMART.

S

SPECIFIC

Names the particular variable of interest (eg “social outings with friends”, “hours at work on modified duties”, “time management”)

M

MEASURABLE

Has a measurement unit (hours, 0 to 10 scale)

A

ACHIEVABLE

Is likely to be achieved, given the diagnosis and prognosis for the person’s injury and environmental constraints

R

RELEVANT

Is relevant or important to the injured person and other stakeholders

T

TIMED

States a timeframe within which the goal is expected to be achieved

Examples of poorly constructed treatment goals:
Examples of SMART goals:

To improve driving confidence

To be able to drive between home and work (15 kms) within three weeks

To reduce anxiety

Successfully manage stressful work situations with manager during the next week by practicing healthy assertion, using helpful self-talk and diarising the outcomes

To increase social interaction

Visit or telephone a friend twice in the next week

To return to work

Return to modified work duties for three hours per day, five days per week within three weeks

Treatment limitations

In some cases, the likelihood of returning to pre-injury functional capacity is diminished. It is particularly important in this situation that psychological treatment still focuses on improvement in functional ability, is goal oriented and clinically justified. Where little or no progress is being made, ongoing passive treatment should be avoided. Such treatment may reinforce illness behaviour, lead to possible treatment dependency and reinforce psychological distress and problems with persistent pain.

PRINCIPLE 3

A BIOPSYCHOSOCIAL APPROACH IS ESSENTIAL FOR THE MANAGEMENT AND TREATMENT OF PERSISTENT PAIN AND PSYCHOLOGICAL INJURIES

Key messages
  1. A biopsychosocial approach maximises recovery and minimises the impact of persistent pain and/or ongoing psychological injury.
  2. Psychosocial and biological factors that influence the injured person’s experience of pain, disability and psychological distress are assessed and managed by treating practitioners.
  3. Early identification of the barriers to recovery, particularly psychosocial risk factors, helps determine the most effective treatment approach.
  4. Treatment planning includes identifying, considering and addressing any environmental factors (personal and workplace) impeding the injured person’s recovery.

By definition, the biopsychosocial approach includes management of the multiple factors that can affect function and return to work. The International Classification of Function (World Health Organisation 2001) encompasses a biopsychosocial approach and classifies these factors as:

  • Bio – Body structures and function
  • Psycho – Personal and environmental factors
  • Social – Activity, participation and environment

According to this approach, abnormality results from the interaction of genetic, biological, developmental, emotional, behavioural, cognitive, social, cultural, and societal influences.

Maximising recovery of function and/or return to work

Current evidence indicates that the biopsychosocial approach to psychological injury management is most effective in improving function and facilitating recovery. Accordingly, treating practitioners should:

  • accurately determine the injured person’s psychosocial risk factors for disability
  • set clear, specific and functional goals related to resuming normal activity, including work, as early as possible, even if pain is persisting
  • encourage appropriate expectations

Collaboration with key parties such as doctors, insurers, employers and other service providers is essential from the outset to ensure agreement on treatment goals. It is also crucial to select a management approach specific to the individual injured person’s risk factors.

Flags Model

The “flags model” is a well documented framework for identifying factors that impede recovery and prolong the likelihood of disability1. The model, summarised in Table 1, can be used to identify barriers and guide decision-making if an injured person fails to progress as expected.

Table 1: The Flags Model
Factor
Barrier (Flag)
Examples

Biological
(Body structures and function)

Red Flags

Serious pathology Co-morbidity

Psychological

Orange Flags

Clinical depression PTSD

Psychiatric illness Personality disorder (eg antisocial) Forensic setting

Psychosocial (Personal and environmental)

Yellow Flags

Unhelpful coping strategies (eg excessive resting, activity avoidance) Emotional distress

Anger disguised as anxiety or depression

Passive role in recovery Expectation of delayed RTW Overly solicitous or unsupportive carers

Social
(Activity, participation and environment)

Blue Flags

Low social support (at work, amongst family, friends or community)

Perceived unpleasant work Low job satisfaction Perception of excessive demands

Performance management Perceptions of discrimination, harassment or bullying

Social isolation

Environmental (Systemic)

Black Flags

Threats to financial security Legislative criteria for compensation

Financial disincentives

Nature of workplace

(eg heavy)

Overcoming barriers to improved function and return to work

To ensure “flags” or barriers are addressed in the shortest timeframe, there are several questions the treating practitioner should ask themselves and the injured person:

  • Which barriers are preventing the injured person from returning to function and/or work today?
  • Are the identified barriers being addressed specifically to facilitate:
    • return to work – has a plan for suitable, modified or alternate duties been developed, supported and communicated?
    • return to usual activities – has a plan been developed to assist with return to usual activities?
  • Is the treatment being provided improving the injured person’s psychological health, function and/or return to work as expected?
  • Would another form of evidence based treatment improve the injured person’s rate of recovery?

The following management strategies may also be of use:

  • educating the injured person about their responsibilities in the recovery process (eg compliance with their treatment program or offer of suitable duties to return to work)
  • informing the injured person of the treating practitioner’s obligations when treating compensable persons (eg ensuring treatment adheres to “best evidence” recommendations and “reasonably necessary” or “reasonable and necessary” requirements)
  • liaising with the key stakeholders to facilitate return to work
  • liaising with other treatment providers (eg physiotherapist, general practitioner)
  • recommending, when indicated, that the injured person’s general practitioner refer them to a psychiatrist or other service provider with particular expertise.

If the necessary supports for return to work are not in place, the treating practitioner should consult with the case manager and recommend that these be provided. Direct liaison with the insurer case manager and return to work coordinator (for WorkCover cases) may be required.

Ongoing psychological problems

Chronic psychological problems can result from the interaction of many factors including pre-existing problems, compensation issues or concurrent emotional problems not related to the compensable injury (such as death of a close relation, marital and family problems or work related issues). As far as possible, treating practitioners should separate these unrelated psychological issues. Such factors should be identified and addressed at initial assessment or as early as possible to ensure that treatment focuses on the compensable injury.

In some cases, treatment goals will not be achieved unless these unrelated factors are recognised and addressed separately (eg through an intervention that is not related to the compensable injury). Suggesting an independent psychological assessment may help the identification and management of such factors. Treating practitioners should focus primarily on the assessment and treatment of the compensable injury.

Persistent pain

Pain lasting longer than three months can be referred to as persistent or chronic pain, and is usually the result of a complex relationship between physical and psychosocial factors. Personality traits, mental health issues, counterproductive beliefs and past experience can affect and reinforce the pain experience.

A biopsychosocial approach is essential to achieving successful treatment outcomes for this group. The injured person’s individual response to, and understanding of, pain needs to be actively managed and developing a schedule of appropriate activity may be useful rather than harmful.

Strategies for overcoming persistent pain include:

  • encouraging the injured person to “act as normal”
  • setting appropriate expectations regarding changes in pain and function
  • challenging counter-productive beliefs about the injury, the appropriateness of different treatment types and the importance of return to work and normal activity
  • reinforcing wellness behaviours and promoting self management strategies
  • setting an end point for treatment
  • referring the injured person to another treating practitioner if treatment is not resulting in functional improvement.

It is not reasonable for treatment to continue indefinitely (see “Planning for self management and independence from treatment”, Principle 4, page 14).

PRINCIPLE 4

TREATMENT FOCUSES ON SELF MANAGEMENT BY THE INJURED PERSON

Key messages
  1. Empowering the injured person is a key treatment strategy and is incorporated in all phases of injury management.
  2. The injured person is empowered when they:
    1. are educated about the nature of their problem, appropriate management strategies and their prognosis
    2. have appropriate and effective self management strategies
    3. manage their condition as independently as possible.
  3. Treatment of an injured person with pain and/or psychological injury is based on education and focused on function, return to work and promotion of self management.
  4. An injured person with ongoing psychological injury and/or persistent pain is educated about relapses and provided with strategies to manage these episodes.

Actively involving the injured person in their treatment is an important component of effective rehabilitation. Education and developing self management strategies are the keys to empowerment.

Education

Education and early expectation setting are crucial to ensuring the injured person can play an active role in their recovery. An injured person may develop counter productive beliefs that lead to entrenched feelings of distress and illness behaviours. Education helps them understand their injury and its management, make choices, overcome restrictive beliefs and modify their behaviour, leading to improved functional outcomes.

Topics that treating practitioners should address when educating the injured person include:

  • the respective roles of the injured person and treating practitioner
  • the nature of the condition, expected recovery timeframes, treatment goals (short and long term) and timeframes to achieve these goals
  • the benefits of active treatment and self management strategies
  • the importance of improving function through return to usual activities.
Influencing beliefs about recovery

Restrictive beliefs can be a major obstacle to an injured person’s ability to return to functional activities and work. These beliefs may include:

  • fear-avoidance
  • catastrophising
  • lack of acceptance
  • low self-efficacy
  • blame
  • perception of injustice.

The following strategies may be useful in influencing restrictive beliefs:

  • improving awareness of the beliefs and their negative impact
  • reviewing and testing their accuracy
  • generating alternative beliefs that are open to change
  • reinforcing and practising alternative beliefs in everyday settings
  • providing written materials to enhance the intervention.
The impact of personality

Sometimes it may be the case that significant personality factors are hindering treatment. Considering personality factors in the design of treatment strategies and management plans can help to reduce the risk of long term disability in individual cases. However, it must be remembered that before injury, the injured person had the same personality and was functioning without compensation support. Personality factors therefore, should not become the focus of treatment. If clarification of factors impeding recovery is needed, consider referral for independent assessment.

For assessment of personality factors, administration of a reliable and valid personality test is recommended, such as the Minnesota Multiphasic Personality Inventory Second Edition (MMPI–2) and the Personality Assessment Inventory Revised (PAI–R).

Self management strategies

Self management strategies are essential when dealing with persistent psychological issues and pain. The injured person should be encouraged to take control of their rehabilitation and drive the management of their recovery, using active strategies to control their symptoms and learning to function despite their symptoms.

Examples of individually tailored strategies include (not exclusive):

  • goal setting
  • activity scheduling
  • psychoeducation
  • observing, monitoring and challenging unhelpful beliefs
  • exposure based approaches to feared and/or avoided situations through homework activities
  • problem solving
  • relaxation techniques
  • a regular exercise program
  • managing medication usage
  • establishing a healthy and consistent sleeping routine
  • pacing strategies to minimise risk of relapse
  • learning acceptance of their injury and disability.
Planning for self management and independence from treatment

The key measure of treatment effectiveness is the ability of the injured person to independently manage their condition and resume usual activities. Independence does not mean being symptom free, but rather living a functional and productive life while self-managing symptoms if they arise.

By following a biopsychosocial approach and the principle of empowerment, most injured persons should become independent of treating practitioners. Planning and preparation for discharge should begin at assessment (eg the treating practitioner and the injured person may agree on a set number of treatments and a plan for gradually reducing their frequency over a defined period of time). This creates an expectation that, as the injured person becomes more independent, so will their reliance on treatment reduce.

Relapses

Relapses are inevitable with ongoing psychological injury and persistent pain, often occurring during times of increased activity or stress. Treating practitioners need to educate injured persons to expect relapses and understand the reasons why these may occur. They should provide injured persons with strategies to manage these episodes while continuing with their active rehabilitation.

Useful strategies for relapses include:

  • cognitive challenging techniques (including problem solving)
  • awareness of stress triggers and early application of coping strategies to avoid escalation of stress
  • reminders to check for unhelpful thinking patterns (eg catastrophising)
  • modification of daily activities with limited use of rest
  • written plans for implementing self management steps for relapses
  • communication with significant others such as family, co-workers, employers and medical practitioners, about their role in helping the injured person to manage relapses
  • applied relaxation
  • physical exercise
  • a review of activity pacing and goal setting is useful if the relapse persists.

A relapse can appear to be a deterioration of a previous injury. In some cases, a relapse may mask issues that are not related to the compensable injury such as stressful life events or underlying problems. Psychological treatment should identify the trigger/s for the relapse and focus primarily on the compensable injury. Treating practitioners should aim to identify and, as far as possible, separate psychological issues that are not directly related to the compensable injury.

PRINCIPLE 5

TREATMENT IS BASED ON THE BEST EVIDENCE AVAILABLE

Key messages
  1. Treating practitioners use the best evidence available to inform their treatment decision making.
  2. Systematic reviews, (evidence based) clinical practice guidelines and critically appraised papers provide the most comprehensive and objective source of research evidence.

Extensive research literature exists on the efficacy of various treatment modalities and clinical decision making must be directed by this evidence. Evidence based practice:

  • offers treatment that has the best chance of success
  • avoids treatment that is likely to be ineffective
  • increases the likelihood that psychological treatment complements and assists other evidence based medical and physical treatments that injured people are likely to access.

Treating practitioners need to integrate the “best research evidence with clinical expertise and patient values”. Integrating these three components (evidence for treatment, expert opinion and injured person’s characteristics such as needs, preferences, culture and socio-economic position) enhances the delivery of evidence based treatments.

Where is the best evidence available?

The most accessible source of research evidence is “pre-appraised” evidence such as systematic reviews, clinical practice guidelines and critically appraised papers and topics. Examples include:

  1. The Cochrane Library <http://www.cochranelibrary.com> is a free website that includes systematic reviews of research evidence.
  2. Australian Psychological Society (APS) evidence based guidelines can be accessed by APS members at <http://www.psychology.org.au/>, click on “Members Resources”, then “Psychology Interventions”.
  3. The National Health and Medical Research Council (NHMRC) presents evidence based management of acute musculoskeletal pain at <http://nhmrc.gov.au/publications/ synopses/cp94syn.htm>.
  4. Specific health related journals such as Clinical Psychology Review, Journal of Occupational Rehabilitation, Pain, Clinical Journal of Pain, European Journal of Pain, Journal of Consulting and Clinical Psychology also contain regular treatment reviews and present critically appraised papers that evaluate high quality research reports.
  5. The National Guideline Clearinghouse <http://www.guideline.gov> is a public resource for evidence based clinical guidelines.
  6. Return to Work Knowledge Base provides concise, evidence based information on return to work for employees, employers and treating professionals <www.rtwknowledge.org>.
  7. Accident Compensation Commission, New Zealand has developed Persistent pain assessment instruments: a compendium – April 2008. This is a handbook used to assess persistent pain. It covers the following areas: pain assessment, psychological instruments, functional assessment and general health/quality of life. The CD version (ACC4606) can be ordered from the publications section <www.acc.co.nz>.

GLOSSARY OF TERMS

Compensable injury – CTP

An injury may be compensable if the person’s injury was caused by a motor vehicle accident.

Compensable injury – Workers Compensation

An injury may be compensable if it was sustained by an employee and work was a substantial contributing factor. For a psychological injury, the injury is not compensable if it is the result of reasonable action by the worker’s employer.

Functional outcomes

Indicators of an injured person’s participation in activities such as suitable employment and/or activities of daily living.

Functional outcome measures

Assess the health of the injured person, including changes – as a result of an intervention – to that person’s participation in suitable employment and other activities of daily living. Outcome measures are used to communicate and provide evidence to others about the effectiveness of treatment.

Injured person

Claimant as defined by the Motor Accidents Compensation Act 1999 or worker as defined by the Workers Compensation Act 1987 and Workplace Injury Management and Workers Compensation Act 1998. Refers to claimant or worker with psychological problems.

Persistent pain

Pain of longer than three months duration can be referred to as persistent or chronic pain, and is usually the result of a complex relationship between physical and psychosocial factors.

Psychological injury

Psychological injury is a term to describe a range of mental disorders, diseases or illnesses and may include conditions such as depression, anxiety, adjustment disorder and post traumatic stress.

Reliable

Consistent; always yields the same results in the same situation.

Reasonably necessary (WorkCover)

Funding decisions are based on the reasonably necessary criteria:

  • treatment must be appropriate
  • availability of alternate treatments
  • cost considerations
  • effectiveness of treatment
  • acceptance of treatment by clinical peers (evidence based)

Reasonable and necessary (CTP)

Funding decisions are based on the reasonable and necessary criteria:

  • related to the accident
  • of benefit to the claimant
  • proposed service is appropriate to the condition
  • provided by an appropriate provider
  • cost considerations.

Return to work (RTW)

A timely, safe and durable return to paid employment for which the person is suited, having particular regard to their capacity, pre-injury employment, age, education, skills and work experience.

Treatment

Therapeutic treatment given by direction of a medical practitioner.

Valid

Accurate measure; the extent to which a measure actually measures or shows what it claims.

PSYCHOLOGICAL/COUNSELLING MANAGEMENT PLAN EXPLANATORY NOTES

INTRODUCTION

The following notes provide information about how to complete the Psychological/Counselling Management plan. The plan should be completed by the treating psychologist/counsellor, in agreement with the injured person, where psychological or counselling services are to be claimed under a Workcover or CTP (motor accident) claim.

Only services that meet the criteria for ‘reasonable and necessary’ under the Motor Accidents Compensation Act 1999 and ‘reasonably necessary’ under the Workers Compensation Act 1987 will be approved. Please refer to the MAA and WorkCover Guidelines for more information including details of when to submit this plan.

The provider of psychological/counselling services is responsible for completing and signing the plan. All sections of the plan must be completed to avoid delays in processing.

SECTION 1 – INJURED PERSON’S DETAILS

Include the name of the insurer case manager, the claim number and date of injury on the plan.

SECTION 2 – REASONS FOR REFERRAL

Describe the reason/s for the injured person’s referral for psychological treatment/counselling.

SECTION 3 – PRE-INJURY AND CURRENT FUNCTIONAL STATUS

a. Employment

  • If at work, indicate number of pre-injury hours and number of hours currently working in pre-injury or suitable duties.
  • If not at work, indicate number of pre-injury hours and date last worked.

b. Other life roles

  • If not employed at the time of injury, indicate the life role undertaken (eg student, homemaker, volunteer) and briefly describe the activities involved.

c. Activities of daily living (ADL)

  • Indicate self reported difficulties associated with activities of daily living such as self care, domestic or household chores, community activities or transport.

d. Capacity to return to pre injury activity

  • This includes work. Answer this in relation to the injured person’s psychological capacity.

SECTION 4 – CLINICAL ASSESSMENT

Diagnosis

If a diagnosis is possible, indicate it here. The diagnosis must relate to the compensable injury and should utilise the DSM-IV multiaxial classification where possible. If the diagnosis is different to that which is indicated on the medical certificate, provide a brief explanation of the reasons for the difference.

SECTION 5 – BARRIERS TO RETURN TO PRE-INJURY DUTIES/ACTIVITY

Barriers

List any identified personal, medical, psychological and/or environmental barriers impacting on the injured person’s ability to return to their pre-injury activities, including work. Consider factors such as personal, cultural, behavioural, occupational and environmental factors. Barriers identified may not have immediate solutions and may include barriers beyond those the treating provider can address in the treatment plan.

Define any issues that may complicate therapy, including motivation and issues which may affect participation.

Strategies to address barriers

Include your recommended or suggested strategies to address the barriers identified. Strategies may not necessarily be a psychological intervention.

SECTION 6 – PROGRESS

Outline the goals of treatment to date, treatment strategies used and progress toward achieving the identified goals.

Outcome measures assist in measuring progress towards goals. Progress should always be defined using functional (non-standardised) outcome measures. In some cases, standardised outcome measures may also be relevant. Treatment practitioners should select measures that are most relevant to functional goals.

SECTION 7 – TREATMENT PLANNING

a. Goals

Goals should be specific, measurable, achievable, relevant and timely. (SMART)

S

Specific

What is to be achieved? Which problem is to be addressed? What treatment strategies are to be used?

M

Measurable

How will progress be objectively measured? How will achievements be recognised?

Include standardised tests if appropriate (eg DASS (Depression, Anxiety and Stress Scale).

A

Achievable

Is achievement of the goal possible? What is the injured person’s ability to reach the goal?

R

Relevant

The injured person should be motivated to work towards the goals. They should be meaningful for the injured person.

T

Timed

The amount of time to achieve the goal should be reasonable.

Proposed treatment strategies

Outline treatment strategies, techniques and modalities to be used to achieve the identified treatment goals, consistent with evidence based management of the injury.

b. Self management strategies

Detail strategies which the injured person has been taught and is successfully applying to independently manage their psychological problem/s, including relapses.

c. Communication with other parties

List the names of parties that you have communicated with about the injured person’s treatment and return to function and any other communication that may be necessary, although not provided by you.

d. Additional strategies

Document any other useful strategies which may be implemented by someone other than you. You may recommend referral to another service as part of an overall management plan.

SECTION 8 – DETAILS OF PROPOSED PLAN

Provide details of services the insurer/agent is requested to fund:

  • number and cost of sessions
  • expected frequency of sessions
  • anticipated time required for case conferencing with relevant parties (eg medical practitioner, rehabilitation provider, other treating practitioners and the insurer/agent) and cost
  • anticipated travel and cost
  • anticipated discharge date
  • total cost of the plan.

SECTION 9 – TREATING PRACTITIONER’S DETAILS:

Inclusion of the service provider number is mandatory for WorkCover claims.

Injured person agreed to plan?

Indicate that the injured person has been involved in the development of, and has agreed to, the plan.

APPENDIX 5: CONDITIONS OF APPOINTMENT AS AN INDEPENDENT CONSULTANT

Appointment as a WorkCover NSW approved Independent consultant is subject to the following conditions:

  1. Care. Injured Workers referred for assessment will be interviewed and examined with the same care, consideration and courtesy, as are my own patients. I agree to accept the standards set by my peers and respect community expectations in relation to the conduct of independent consultants.
  2. Independence. I understand that I am, and must appear to be, independent of the Scheme Agent or self/specialised insurer. I will maintain my independent status in all dealings with injured workers, other service providers and insurers. I also understand that the insurer will explain the nature of my independent status to the worker prior to the review.
  3. Fairness. I will maintain a fair and reasonable approach to the review of treatment by another practitioner. I will not criticise the treatment provided by any practitioner associated with the review. I will discuss the findings and recommendations with the injured worker in a fair and reasonable manner.
  4. Commitment. I will assist in any way possible to resolve any difficulties or disagreements that may become apparent in the course of the review or result from the review.
  5. Understanding. I agree to remain mindful of the requirements of the Workplace Injury Management and Workers Compensation Act 1998, and of any amendments to the Act.
  6. No guarantee of work. I understand that whether my services are called upon will be entirely at the discretion of Scheme Agents, self-insurers and specialised insurers.
  7. Evaluation. I agree to participate in evaluation mechanisms in relation to all aspects of conducting assessments and reviews. This will require that I retain all relevant documentation associated with referral, assessments and reports, accounts and other documents as WorkCover NSW may direct from time to time.
  8. No conflict of interest. I agree not to recommend the referral of injured workers to any business that I own or to which I provide treatment services. I agree to not treat any injured worker whose treatment has been reviewed by me.
  9. Withdrawal. I understand that I must give WorkCover NSW 14 days of my intention to cease providing services as an Independent consultant. I understand that WorkCover may, at its’ absolute discretion withdraw my appointment as an Independent consultant.

APPENDIX 6: APPOINTED INDEPENDENT CONSULTANTS FOR TREATMENT PROVIDERS

Mr Chris Allan

67 Campbell Street

Wollongong NSW 2520

Phone: 02 4227 2363

Email: callan@bigpond.net.au

Also available in:

Parramatta

Sydney

Dr Terry Kohler

15 Henry Kendall Street

West Gosford

NSW 2250

Phone: 02 4307 8146

Fax: 02 4324 9816

Email: terry@apsych.com.au

Dr John McMahon

Sydney Clinical Psychology Centre

Suite 13-14, Level 4

229-231 Macquarie Street

Sydney NSW 2000

Phone: 1300 550 213

Fax: 02 9232 8118

Email: admin@psyche-commerce.com.au

Mr Thomas O’Neill

Level 5, Edgecliff Centre

203-233 New South Head Road

Edgecliff NSW 2027

Phone: 02 9362 0386

Fax: 02 9362 0767

Email: thomasoneill@smartchat.net.au

Also available in:

Wagga Wagga

Dubbo

Richmond

APPENDIX 7: PROCESS OF REVIEW BY INDEPENDENT CONSULTANTS

APPENDIX 7: PROCESS OF REVIEW BY INDEPENDENT CONSULTANTS

Disclaimer

This publication may contain occupational health and safety and workers compensation information. It may include some of your obligations under the various legislations that WorkCover NSW administers. To ensure you comply with your legal obligations you must refer to the appropriate legislation.

Information on the latest laws can be checked by visiting the NSW legislation website (www.legislation.nsw.gov.au).

This publication does not represent a comprehensive statement of the law as it applies to particular problems or to individuals or as a substitute for legal advice. You should seek independent legal advice if you need assistance on the application of the law to your situation.

©WorkCover NSW

  1. Main, CJ, Sullivan, MJL & Watson, PJ 2008, Pain Management: practical applications of the biopsychosocial perspective in clinical and occupational settings, Churchill Livingstone.