S14. Referral to an injury management consultant

Commencement date: 21 October 2019

Injury management consultants (IMCs) are facilitators who should be used to mediate between relevant parties to progress a worker’s recovery at or return to work and optimise health and work outcomes.

Principle

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

ExpectationsBenchmarks
S14.1

Insurers are only to refer to an IMC when:

  • a worker has been identified at risk of delayed recovery
  • a specific return to work or injury management issue has been identified, or
  • referral has been requested by the worker (or their representative), employer, nominated treating doctor (NTD) or other treating practitioner

and attempts have been made to resolve the issue.

Evidence on claim file

S14.2

Before making a referral to an IMC an insurer is to contact the worker to discuss the intended referral, explain the role of the IMC and the reasons for referral.

If the insurer is considering a file review, the insurer is to ask the worker if they would like to be involved in discussions with the IMC, via a telephone call as part of a case conference with the NTD or relevant treatment provider. Alternatively, if the worker wishes to be more actively involved, the insurer is to offer a face-to-face appointment with the IMC instead of a file review.

Evidence on claim file

S14.3

If an insurer refers to an IMC, the insurer is to advise the NTD that the referral has been made, provide the reasons for referral, and advise that the nominated treating doctor can be paid for time taken to communicate with the IMC.

Advice provided to the doctor within five days after the referral in made

S14.4

When referring a worker:

  • to attend an appointment with an IMC, the insurer is to:
    • ensure the IMC is located within the worker's travel restrictions
    • ensure any special requirements of the worker are accommodated, such as those arising from gender, culture, language and accessibility
    • consult the worker and take into consideration the injury type when deciding which IMC to engage
    • only engage an IMC who can provide an appointment within a reasonable timeframe
    • enquire whether the IMC records consultations (audio or video) and if so, inform the worker and
      seek the worker's consent for the consultation to be recorded, and
    • avoid conflicts of interest between the IMC and the NTD or employer.
  • for an IMC file review:
    • ensure any special requirements of the worker are accommodated, such as those arising from gender,
      culture and language
    • consult the worker and take into consideration the injury type when deciding which IMC to engage
    • let the worker know they will be provided with a copy of the report from the IMC file review, and that
      a copy will also be provided to their NTD and any other parties involved in the injury management
      consultation
    • avoid conflicts of interest between the IMC and NTD or employer.
Evidence on claim file
S14.5

Insurers are to provide the worker with the following information before attending any appointment with an IMC:

  • the name, speciality and qualification of the IMC and the date, time, location and likely duration of the appointment
  • the reasons for the referral
  • what information or documentation the worker must take to the consultation (for example, imaging or reports of investigations/tests)
  • how costs (including for travel) will be paid
  • that the worker may be accompanied by a support person
  • that the worker and the nominated treating doctor will both receive a copy of the report
  • what the worker is to do if they do not believe the assessment is reasonable or if they have a complaint about the conduct of the IMC
  • the SIRA brochure about injury management consultations, and
  • that the worker can contact the WIRO or their union for assistance.
Written notification provided to the worker at least 10 working days before an IMC appointment
S14.6

When making a referral to an IMC, the insurer is to provide the IMC with sufficient information to support the referral, including:

  • a detailed description of the reason for referral
  • contact details for the worker, nominated treating doctor and employer, and
  • relevant documentation from the file to enable the IMC to understand the claim.

Note: Referrals must not include questions concerning liability.

Referral information to be provided to IMC at least 10 working days before an IMC appointment
S14.7

Insurers are to make subsequent IMC referrals to the same IMC unless that IMC:

  • has ceased to practise (temporarily or permanently),
  • no longer practises in a location convenient to the worker, or
  • the parties agree that a different IMC is required.
Evidence on claim file

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

An IMC is a registered medical practitioner experienced in occupational injury and workplace-based rehabilitation. An IMC can help progress a worker’s recovery at/return to work through communication with the Nominated Treating Doctor and other stakeholders as required.

Referral to an IMC is appropriate when a worker is identified as at risk of delayed recovery or there is a specific return to work or injury management issue.

An IMC helps the nominated treating doctor, worker, insurer and employer progress a worker’s recovery at/return to work and optimise health and work outcomes. An IMC is to assess the situation, examine the worker (if necessary), and discuss possible solutions with all parties (specifically the nominated treating doctor). IMCs are not involved in the treatment of a worker, though they may comment on treatment in respect to recovery at/return to work. The IMC may also visit the workplace.

An IMC does not provide an opinion on causation or liability; or undertake a functional capacity evaluation or work capacity assessment for the insurer.

The worker and the nominated treating doctor are to be provided with information about the role of the IMC and the consultation process.

Consultation with an IMC is not an examination under section 119 of the 1998 Act and there is no impact on benefits or entitlements if the worker elects not to participate.

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