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Workers compensation workplace rehabilitation provider approval framework

This framework sets out the requirements for organisations delivering or seeking to deliver workplace rehabilitation services within the NSW Workers Compensation Scheme. 

1. Part 1 The workplace rehabilitation approval framework

The State Insurance Regulatory Authority (SIRA) is the government organisation responsible for regulating and administering workers compensation (WC), motor accidents compulsory third party (CTP) insurance and home building compensation insurance in New South Wales (NSW).

Purpose of the framework

The requirements for SIRA approval to be a workplace rehabilitation provider (provider) are outlined in part 7 of the Workers Compensation Regulation 2016 (Regulation).

The Workers Compensation Workplace Rehabilitation Provider Approval Framework (the framework) sets out the requirements for approval by SIRA for organisations delivering or seeking to deliver workplace rehabilitation services within the workers compensation scheme.

The framework sets out mandatory conditions of approval, the permitted service streams and associated practice standards, as well as relevant supervision, administrative and complaints handling processes, and is structured into the following parts:

Part 1:  The workplace rehabilitation provider framework
Part 2:  Conditions of approval
Part 3:  Service streams
Part 4: Practice standards
Part 5: The application and approval process
Part 6: SIRA's supervision process
Part 7: Complaints handling

The framework establishes standards designed to deliver high quality, efficient and effective workplace rehabilitation services to assist workers, employers, and insurers with recovery at work and return to work.

Specifically, the framework aims to encourage providers to deliver services that:

  • are outcomes-focussed – the providers service delivery model may deliver services in any way that will achieve outcomes for workers, enabling the provider to seek approval to adapt service delivery models based on emerging evidence that meets industry needs
  • use a biopsychosocial approach – evidence indicates that a biopsychosocial approach that considers biological, psychological, behavioural, social, and economic factors in a worker's recovery and injury management is effective in improving function, facilitating recovery and maximising independence
  • are person-centred – person-centred service delivery ensures services are tailored to individual circumstances
  • are informed by the health benefits of good work - providers should deliver services informed by the understanding that long-term work absence, work disability and unemployment generally have a negative impact on health and wellbeing
  • promote recovery through work - helping workers to stay at, recover at, or return to work while they recover from work-related injury or illness
  • facilitate responsiveness and innovation - through enabling the provider to seek SIRA approval to adapt service delivery models in any way, based on emerging evidence or new ideas that meet industry needs.

Delivery of workplace rehabilitation services: roles and responsibilities

SIRA

SIRA's role is to approve providers in line with part 7 of the Regulation to:

  • ensure fairness and empathy, transparency and participation, timeliness and efficiency are applied across all aspects of workplace rehabilitation
  • establish a regulatory framework designed to support the delivery of safe, quality, efficient and effective workplace rehabilitation services
  • ensure accountability of all stakeholders in the delivery of workplace rehabilitation services
  • assess applications from and determine whether organisations will be granted a Certificate of Approval to deliver workplace rehabilitation services
  • supervise providers in line with legislative requirements and the approval framework
  • ensure transparency of reporting of provider performance.

Insurer

The insurer is responsible for payment of reasonably necessary workplace rehabilitation services in accordance with section 60 of the Workers Compensation Act 1987 (1987 Act).

The insurer coordinates and manages a worker's claim, including injury management and recovery through work activities. The insurer also maintains regular communication and engagement with all stakeholders to coordinate support including workplace rehabilitation.

The insurer is responsible for early and timely engagement of an approved provider to support a worker's recovery at work. This requires the insurer to discuss the need for referral and choice of provider with the employer, worker and nominated treating doctor (if appropriate) and ensure all parties understand the role of the provider and what can be expected from the provider's involvement.

The insurer is responsible for approving and monitoring the provider's plan which includes a worker's goal/s, activities and proposed billing to support the worker's safe, timely and durable recovery at work.

Employer

The workers compensation legislation outlines the employer's obligations to support recovery at work, including the requirement to offer suitable work, where reasonably practicable - section 41 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act).

Where workplace rehabilitation services are indicated, the employer should recommend a timely referral to a provider in consultation with the insurer, worker, and worker's support team to support the worker's effective recovery at work.

Worker

A worker should take reasonable steps to recover following a workplace injury and make sure that they have a current certificate of capacity, and that the insurer has a copy.

Requirement to comply with conditions of approval

Part 7 of the Regulation sets out the requirements for providers to seek SIRA approval to deliver workplace rehabilitation services in the NSW workers compensation scheme.

A workplace rehabilitation service is defined under section 59 of the 1987 Act as "any service provided as a workplace rehabilitation service by or on behalf of a provider of rehabilitation services approved under section 52 of the 1998 Act".

The National Occupational Health and Safety Commission defines workplace rehabilitation as a managed process involving timely intervention with appropriate and adequate services based on an assessed need. It is aimed at maintaining injured or ill employees in, or returning them to, suitable employment.

To obtain and maintain SIRA approval to deliver workplace rehabilitation services in the NSW workers compensation system, a provider must comply with the conditions of approval for workplace rehabilitation providers (clause 25 of the Regulation).

There are four conditions of approval:

1. Services must be delivered in accordance with the approved service delivery model
2. Staff who deliver services must be appropriately qualified
3. The provider must implement quality management systems and governance
4. Reporting and evaluation requirements.

The mandatory requirements for each condition of approval are outlined in Part 2 of the framework.

Commencement

The conditions of approval take effect from 1 January 2022.

Application

These conditions of approval will apply until SIRA amends, revokes, or replaces them in whole or in part. The conditions of approval replace the Nationally Consistent Approval Framework for Workplace Rehabilitation Providers previously applied in NSW.

Transition

Individuals approved via the alternate pathway previously provided by WorkCover are considered to be approved under this framework. They must cite their approval number when applying for employment with a provider or signing reports.

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