S33. Managing psychological injury claims

S33.1

(Focus on early treatment and return to work)

Following initial notification of a psychological injury,  insurers are  to:

• ensure the claim is allocated to a case manager who has the interpersonal capabilities and skills relevant to the workers individual needs
• make early contact with the worker as soon as practicable to determine treatment needs, establish supports and set expectations regarding frequency of contact, treatment and return to work based on the workers individual circumstances and the nature of the injury
• make early contact with the employer to encourage and support ongoing constructive engagement between the employer and the worker
• identify and develop appropriate support strategies with the worker and employer to focus on return to work, taking into consideration any interpersonal workplace issues and the worker’s preferred approach to disclosure.

Evidence on claim file

S33.2

(Determining liability)

If the diagnosis on the certificate of capacity is unclear, the insurer is to make reasonable efforts (such as written and verbal attempts) to contact the doctor prior to making a decision.

Note: The insurer should not delay commencement of provisional weekly payments due to insufficient medical information unless reasonable and appropriate attempts have been made to clarify the diagnosis. If the insurer has a reasonable excuse for not starting provisional weekly payments in accordance with Part 2.1 of the Workers Compensation Guidelines, this is to be clearly documented on the claim file.

If the insurer  disputes liability, prior to issuing a notice to the worker and employer, the insurer is to:

• discuss the effect of the decision with the worker, including the impact it will have on their entitlements
• establish that appropriate support (personal support person, health provider or legal representative) is available to the worker if required, having regard to the nature of the injury and the individual circumstances.

Note: if the insurer is of the opinion that supplying a worker with a copy of a report as an attachment to a decision notice would post a serious threat to the life or health of the worker or any other person, the insurer is to have regard to Clause 41(5) of the Workers Compensation Regulation 2016 and ensure the approach taken is documented on the claim file.

Evidence on claim file

S33.3

(Effective communication and planning)

The injury management plan (with specific detail in the Recover at work plan) should:

• outline a collaborative and tailored communication approach that sets clear expectations about the frequency, timing and purpose of contact between the insurer and the worker
• identify appropriate contacts in the workplace and explicitly deal with matters related to the worker’s confidentiality
• articulate for the worker, employer and treatment providers expectations about recovery and return to work, outlining an approach to manage potential return to work barriers and minimise conflicts or delays
• facilitate positive and constructive engagement between the worker and the employer to promote a workplace culture conducive to an optimal return to work outcome.

S33.4

(Treatment)

In relation to reasonably necessary treatment for workers with a psychological injury, the insurer is to:

• support evidenced based treatment which is focused on return to safe work
• monitor the worker’s response to treatment and liaise with the worker and nominated treating doctor if there are any queries or concerns
• actively facilitate collaboration between treatment providers, workplace rehabilitation providers (where engaged) and the nominated treating doctor to ensure a coordinated and goal directed focus on recovery and return to work
• consider engaging the services of appropriately qualified practitioners to seek a second opinion in consultation with the worker and treatment provider, if the current treatment is not achieving health, recovery and return to work outcomes.

Note: before referral for a second opinion, the insurer should make reasonable attempts to contact the treating allied health practitioner to discuss any concerns with them directly.

Evidence on claim file

Treatment requests determined within 21 days

S33.5

(Recovery at work support)

Insurers are to develop an injury management plan that:

• takes into account the worker's psychological capacity (for example, concentration, memory, perception, mood, fears)
• explicitly deals with the nature and extent of any disclosure of injury agreed with the worker to enable support in the workplace from co-workers to inform return to work planning
• utilises existing workplace supports that meet the needs and individual disclosure circumstances  of the worker.

Insurers are to ensure workplace psychological risks are identified and addressed to enable a psychologically safe workplace and successful recovery at work.

Insurers should consider using workplace rehabilitation providers with expertise in managing psychological injury, if return to work is likely to be delayed.

If the worker is unable to return to their pre-injury employer, the insurer is to promptly amend the return to work goal and commence activities to facilitate a return to alternative employment.

Evidence on the claim file

S33.6

(Secondary psychological injury)

Insurers are to screen for biopsychosocial factors (biological, psychological and social factors) to identify claims where workers are at an elevated risk of developing a secondary psychological injury.

When an insurer identifies risks for secondary psychological injury, the insurer is to, where appropriate, develop a tailored strategy to facilitate support.

If the insurer becomes aware that a worker has experienced a secondary psychological injury, (providing a causal link is established between the secondary psychological injury and the primary injury) the insurer is to determine any treatment request at the earliest possible opportunity.

This standard applies to all claims from 1 March 2021.