Early and tailored contact with relevant stakeholders provides invaluable information to inform the early identification of potential risk factors for delayed recovery. A subsequent analysis and prioritisation of risk factors and matched actions will strengthen stakeholder commitment, prevent work loss and optimise recovery and work outcomes.
Principle
Insurers will actively manage the first four weeks of a claim for a significant injury to establish effective relationships, assess for risk of delayed recovery and work loss, and identify and agree the tailored actions to optimise recovery and work outcomes.
Expectations
Benchmarks
S34.1
(Early supportive contact)
Where early contact is required by the legislation for workers with a likely significant injury, Insurers are to (while complying with privacy obligations) make early, supportive contact with the worker, employer and, where appropriate and reasonably practicable, the worker’s treating doctor.
seek to understand the worker’s individual situation and circumstance
set tailored expectations about frequency and method of agreed contact
clarify rights and obligations of the worker, employer and providers.
Evidence on claim file of contact in accordance with this Standard
S34.2
(Identifying risk factors for delayed recovery)
Insurers are to gather information about risk factors for delayed recovery across the four domains (personal, workplace, insurance and healthcare).
(eg a risk assessment tool/checklist)
Insurers are to analyse the information gathered to:
appropriately allocate and/or prioritise the claim
identify key risk factors most likely to affect recovery and work outcomes (for planning).
Evidence on claim file of initial assessment across the four domains to identify risk of delayed recovery within four weeks following date of notification to insurer.
S34.3
(Matching actions to risks)
Insurers are to:
Match appropriate actions to address the identified risks for delayed recovery across the four domains (personal, workplace, insurance and healthcare)
Collaborate and co-ordinate with the worker, employer (and treating medical practitioner and other providers, where appropriate) to determine, document and implement the matched actions (see Standard of practiceS12. Injury Management Plans).
Evidence on claim file, including documented decision-making based on risk factors identified and planning conversations with stakeholders and tailored injury management plan.
S34.4
(Equipping and supporting the worker)
Insurers are to:
maximise the worker’s input to their recovery
build the worker’s understanding of the health benefits of recovering at work
consider the worker’s capabilities, preferences and goals.
Evidence on claim file
S34.5
(Supporting the employer)
Insurers are to support employers to:
facilitate a supportive relationship between the employer and the worker
understand and meet their workers compensation obligations
identify and provide suitable work
access services required to address work related barriers.
Evidence on claim file
S34.6
(Coordinated multi domain approach)
Insurers are to coordinate relevant stakeholders to achieve worker goals and work outcomes by:
exchanging information about risks, goals and work
monitoring response to treatment and liaising with the worker and providers if treatment is not contributing to the worker’s goals and outcomes.
Evidence on claim file
S34.7
(Review)
Insurers are to repeat 34.2 and 34.3 based on risks, needs and changes in circumstances and update the injury management plan when appropriate.
Evidence on claim file
Application
This standard applies to all claims from 4 April 2022.
Overview
This Standard of practice has been developed to support and set expectations for insurers about early intervention and the importance of identifying risks for delayed recovery and designing and implementing actions to address these risks.
Factors Influencing Return to Work Outcomes
Factors with moderate to strong evidence of influencing return to work outcomes are summarised under four key domains. The evidence[1] supports the four domains as:
Personal – includes biological, psychological, behavioural and social factors relating to the worker
Workplace – considers the working environment, relationships, design, support systems and how a workplace accommodates return to work
Healthcare – includes the provision of treatment and rehabilitation
Insurance and legislative – includes claims agents, insurers, regulatory authorities and other government and non-government agencies.
A focus on an optimal outcome means a focus on early intervention. Early intervention involves actively coordinating all stakeholders from the first conversation to the point of developing an injury management plan, including:
early and supportive contact
assessing risk for delayed recovery
matching actions to identified risks (injury management planning)
equipping the worker to drive their own recovery
supporting the employer to provide suitable work
a coordinated multi-domain approach to ensure work focused outcomes.
A consistent and high quality early intervention approach enhances stakeholder experience and outcomes.
Implementing the overarching claims management principles when communicating with all stakeholders is critical in optimising return to work outcomes. These principles support the workers compensation system objectives outlined in section 3 of the 1998 Act.
[1] Collie, A., Lane, T., Di Donato, M. and Iles, R. August 2018. Barriers and enablers to RTW: literature review. Insurance Work and Health Group, Monash University, Melbourne, Australia.
