Injury management plans
Injury management plans
When it appears that a work-related injury is a significant injury, the insurer must establish an injury management plan.
An injury is considered significant if it is likely to result in the worker being incapacitated for work for more than seven consecutive calendar days, whether the incapacity is total or partial, or a combination of both.
The injury management plan is to be developed in consultation with the worker, the employer (except when the employer is a self-insurer) and the treating doctor.
The injury management plan enables stakeholders to work together to establish a goal with the worker, as well as define the activities, agreed actions and follow-up points required to achieve this goal. It also sets out stakeholder obligations and provides the framework for the claim strategy.
When developed and used correctly, the injury management plan is a useful tool to aid recovery and return to work.
The plan should be specific to the worker and include actions tailored to them and their goal (including involved parties and timeframes). All stakeholder rights and obligations should also be included.
When should the plan be developed?
The initial injury management plan should be developed as soon as enough information has been gathered to identify the plan’s goal, and the activities required to support it.
The plan should be developed no later than 20 working days from the date it becomes apparent that the injury is a significant injury (which may be the date of notification).
The first weeks in a worker’s recovery are critical, so every attempt should be made to identify the plan goal and activities as soon as possible. That is, when the employer (except if the employer is a self-insurer), worker and nominated treating doctor have been contacted and the relevant information and guidance obtained.
Reviewing the plan
The injury management plan should be reviewed in accordance with the dates specified in the plan (either specific dates or timeframes). It should also be reviewed when a significant event occurs.
Significant events include:
- the approval of new treatment
- a significant change in capacity (for example, from having work capacity to no capacity, or vice versa)
- a change in case manager or nominated treating doctor
- a change in goal (for example, if employment ceases).
If a worker with a work-related injury has current work capacity, they should make reasonable efforts to return to work in pre-injury employment or suitable employment.
The worker is required to:
- participate and cooperate in the establishment of an injury management plan
- comply with obligations imposed under an injury management plan
- nominate, when requested to do so, a doctor who is prepared to participate in the injury management plan
- authorise their nominated treating doctor to provide relevant information to the insurer.
If a worker does not comply with a return to work obligation (for example, make reasonable efforts to return to suitable employment), payments of weekly compensation may be suspended.
Insurers are required to give the worker notice before suspending weekly payments, and advise them that payments will not resume until the worker’s failure to comply has been remedied.
An employer must also cooperate in the establishment of an injury management plan and comply with any obligations imposed under the plan.
An employer is obligated to provide suitable employment to a worker who is able to return to work. The suitable employment may be part-time or full-time, and preferably should be in the pre-injury role or at an equivalent level.
This obligation does not apply if:
- it is not reasonably practicable to provide suitable employment, or
- the worker has voluntarily left that employment after the injury happened, or
- the employer has terminated the worker’s employment after the injury happened for a reason other than the worker’s injury or incapacity.
If a SIRA Inspector reasonably believes an employer has not fulfilled their injury management obligations, an improvement notice can be served on the employer. Failure to comply with a notice can result in a penalty of up to $11,000.
An insurer is required to comply with its injury management obligations under Chapter 3 of the 1998 Act.
Repeated or persistent failure to comply may result in:
- the cancellation or suspension of the insurer’s licence
- imposition of conditions on the insurer’s licence
- payments of a monetary penalty.
More information on injury management plans can be found in Insurer guidance GN 3.5 Injury management plans.