What the legislative changes mean for you & How to save costs: A guide to injury management and prevention. Agenda. The changes

Transcription

1 What the legislative changes mean for you & How to save costs: A guide to injury management and prevention Tracey Butler WorkCover Queensland March 2014 Agenda What s changed What the changes mean to you When do the changes apply The buck stops with rehabilitation Return to work: what we know Recovering at work and suitable duties Secondary injuries and common law claims Key Messages The changes Applying from 15 October 2013 New method for determining permanent impairment (DPI, WPI and GEPI) A > 5% common law threshold has been introduced The limitation period for late Notices of Assessment has altered The requirement and training for a rehab and return to work coordinator (RRTWC) has changed Reduced red tape for rehabilitation policies and procedures For injuries sustained prior to 15 October 2013, the old provisions apply (new s678) 1

2 The changes, continued Applying from 29 October 2013 (date of assent) The way psychological/ psychiatric Injury claims are determined has changed to the major significant contributing factor Insurer responsible for rehabilitation (incl common law claims) Gratuitous care at common law amended to address Cameron v Foster Penalties for fraud increased Fraud prosecutions moved to the Regulator Employers can now ask workers for disclosure of pre-existing conditions Employers can access claims histories The Regulator replaces Q-COMP Changes impacting our claim determination process PPI claims (amendment to section 32) applies to injuries from 29 October 2013 employment must be: the major significant contributing factor applies to aggravations and to secondary PPIs Effective from 29 October 2013, prospective employers can request claims history (section 571D): in approved form with application fee with worker s consent to be requested from the Regulator The Regulator has published the approved form. Limitations on what an employer can do with this information (see s571d(3)) Disclosure of pre-existing conditions Disclosure of pre-existing conditions (new section 571A 571C) applies to employment processes from 29 October 2013 prospective employer may ask prospective worker in writing about pre-existing conditions written request must be accompanied by information about future duties and implications of failure to properly disclose prospective worker must disclose pre-existing injury or medical condition condition that exists during employment process that a person suspects or ought reasonably to suspect might be aggravated not entitled to compensation or damages if worker knowingly makes false or misleading disclosure 2

3 Disclosure of pre-existing conditions terms are defined in s571a written request must be accompanied by information about future duties and implications of failure to properly disclose not entitled to compensation or damages if false or misleading disclosure Disclosure of pre-existing conditions A few cautions for employers: duties need to be clearly described so worker can make an informed decision about whether they need to disclose an injury/condition discrimination issues may arise (see ADCQ for information) if an employer knows about a worker s preexisting condition they owe a heightened standard of care becomes relevant if common law claim lodged See our fact sheet and links to ADCQ fact sheets Rehabilitation/Return to work changes Insurers are responsible for rehab (section 220): We must take all steps reasonably practicable to secure rehab and early return to work (RTW) We must develop and maintain a RTW program in consultation with the employer, worker and treating registered persons Referrals will no longer be made to RTW Assist If a worker lodges a Notice of Claim (NOC), we must refer them to an accredited return to work program unless they can t participate because of their injury We ll be updating our common law rehab policy for accreditation Common law rehab applies to all claims unless litigated. 3

4 Rehabilitation/Return to work changes Criteria for obligation to have RRTWC have changed (section 220): Employers now only need to have a Rehabilitation and Return to Work Co-ordinator (RRTWC) and documented rehab policies and procedures when: in a high risk industry and wages in the preceding year are > 2,600 X QOTE if not high risk then only if wages > 5,200 X QOTE QOTE is currently $ RRTWC are no longer required to complete training with a registered training organisation. They must now be appropriately qualified. This is defined as: having the qualifications, experience or standing appropriate to perform the function Assessing permanent impairment A few key points: Applies to injuries from 15 October 2013 Deletes old terminology and methodology ie. WRI, Table of Injuries, AMA4, prescribed disfigurement Replaced by: DPI, WPI, GEPI and AMA5 DPI Degree of Permanent Impairment, WPI Whole Person Impairment GEPI Guide to Evaluating Permanent Impairment DPI must be assessed using GEPI Lump sum = DPI X statutory maximum Applied immediately to industrial deafness claims, and have seen a few physical injuries assessed New medical assessment review A few key points: Applies to injuries from 15 October 2013 Section 186 amended to allow a further review of permanent assessment if the worker disagrees with the assessment Worker can request that the injury be assessed again by a doctor agreed to by the worker and the insurer If the insurer agrees to a further review, the original notice is taken to never have been given 4

5 An intro to GEPI The States have been moving to a more harmonised model for some time: Based on the NSW model with minor changes Written by doctors for doctors Has been gazetted by the Regulator Assessing doctors must be trained and can be independent or treating practitioners It references AMA5 for most injury types: Some exceptions (where Drs consider other methodology is better suited): pain, psych, hearing loss, visual Where there are multiple methods, choose option that gives highest DPI Maximums under AMA5 for certain body parts (eg upper limb 60% WPI) Rounding up and down Common law changes Greater than 5% DPI threshold introduced Applies to injuries from 15 October 2013 For over a period of time claims, date of injury = date of health practitioner consultation (s235a) Physical injuries combine to come up with one DPI Cannot combine physical and psychiatric injuries (so will have 2 DPIs that are NOT added) In the long term it reduces our claims but in the meantime we are expecting more common law claims than we are currently receiving We are updating our policies to deal with extra injuries and common law only claims Common law changes Other changes effective from 29 October 2013 We are responsible for rehabilitation, this applies to all claims that aren t already litigated New limitation period where Notice of Assessment issued late six month extension New urgent and common law only processes Clarification of gratuitous care (to address Cameron v Foster) Amendments to factors to consider for ISV assessment Changes to indexing of general damages 5

6 Fraud Prosecutions will be managed by the OSFWA (the Regulator) Matters will be referred to the Regulator if we reasonably believe someone has committed an offence Applies to all prosecutions from 29 October 2013 Increased penalties Increased to $ or five years imprisonment (previously $ and 18 months) Changes to Q-COMP Powers moving to the Regulator from 29 October 2013: Medical Assessment Tribunal (MAT) Reviews Self insurance licensing Monitor insurer performance Scheme data analysis Approved forms Powers moving to WorkCover from 29 October 2013: Tables of Costs The Buck Stops with Rehabilitation Reduce claims costs and impact on premium Employer online provides a premium simulator Use the simulator to demonstrate the premium savings that can be made by reducing claims costs Policy A 6

7 The Buck Stops with Rehabilitation Policyholder A Reduce the Stat Claims costs Return to work: What we know early return to work reduces the risk of longterm disability injured workers who are offered suitable duties are twice as likely to return to work the longer someone remains off work the less likely it is they will ever return. If someone is off work for: 20 days, the chance of ever getting back to work is 70% 45 days, the chance of ever getting back to work is reduced to 50% and 70 days, the chance is then again reduced to 35% Realising the Health Benefits of Work, April 2010, Australasian Faculty of Occupational and Environmental Medicine. Return to work: What we know 7

8 Factors you can control be aware of injuries in the workplace lodge claims early availability of meaningful suitable duties early identification of suitable duties facilitation of a supportive work environment active and constructive participation in injury management open communication with all parties be involved in worksite visits and case conferencing. Suitable duties program purpose focus on what the person can do (at home and at work) match capacity with appropriate duties agree work tasks for graduated RTW start with reduced hours or tasks appropriate commencement date involve everyone in development include medical involvement/guidance incremental increase in duties/hours. Good work is good for you!!! Suitable duties plan what should it include? overall goal start, completion, review dates specific tasks/duties to be performed restrictions/limitations days/hours to be worked upgrading recommendations individualised to suit the worker and their capabilities. 8

9 Recovering at work best practice have clear, well defined goals reassure worker a positive RTW outcome is achievable practice regular, open communication involve worker in the suitable duties planning appropriate commencement of RTW program provide a supportive and positive RTW environment. Outcomes of SDP s work hardening improvement (physical and psychological) benefits include: reduction of additional aggravations/ exacerbations reduced claims costs reduced downtime reduced claim durations reduced loss of productivity/skills reduced IR/union/staff issues reduced common law assists to mitigate loss (future economic loss). Why do workers bring common law claims? Workers are more likely to lodge a common law claim if: they aren t working anymore, working less or are at risk of not working in the future seriousness or severity of injuries they don t have/maintain a good relationship with WorkCover or their employer their employer didn t maintain communication with them after they were injured and some workers will regardless... 9

10 Managing people differently because of injury will increase the likelihood of additional injuries focus on the person holistically Working with people holistically will remove the chance of secondary injury. In cases of already diagnosed injuries, an holistic approach will increase opportunity of a positive outcome Worker contributors of secondary injuries Not knowing their treatment program (duration, medical advice) Impact on family and activities of daily living (socially or at home) Long periods of isolation at home with no contact from anyone Employers and/or family displaying lack of interest Feeling removed from work environment, failing to feel part of the team Job security and/or fear of re-injury Lack of compassion, communication or understanding Placing blame for accident Communication breakdown -seek to listen before understood. Feeling of worthlessness Employer flag of secondary injuries Failure to lead the RTW program (participate and actively involved) Care factor, not interested outside of work Communication (initial & regular communication) Communication breakdown -seek to listen before understood Casting judgement about a persons ability to function outside of work compared to when at work Employers fear of re-injury (not offering RTW duties) Failing to involve worker about current events when away from work Placing blame for accident 10

11 New features of Employer Online Injury Trends Key messages Prevent injuries Develop and promote a stay at work and recover at work culture Working improves general health and well being and reduces psychological distress good work is good for you The longer someone is off work the less likely they become ever to return 30% of workers won t get back to work after 20 days Return to work must start from day one don t wait for us Communicate with your workers and us love your workers Where to find more information 11

12 Any questions? 12