Contents. Before you begin. How to work through this learner guide Assessment

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1 Contents Contents Before you begin How to work through this learner guide Assessment Introduction: Assisting with claims management, rehabilitation and return-to-work programs v v vi 1 Chapter 1: Assisting with managing claims Processing workers compensation claims Notifying rehabilitation providers Advising injured workers whether their claims have been accepted Assisting with analysing claims to identify the illness or injury and preparing reports 1.5 Providing support to the injured person s work team 26 Chapter summary 31 Assessment activity 1: Assisting with managing claims 32 Record your employability skills 33 Chapter 2: Assisting with planning and implementing a successful rehabilitation or return-to-work program 2.1 Facilitating consultation between rehabilitation providers and health professionals 2.2 Facilitating consultation between rehabilitation providers, managers and the injured worker 2.3 Documenting the injured worker s skills, experience and capabilities Assisting with job redesign, reduced hours and alternative duties Assisting with designing a rehabilitation or return-to-work program Consulting with managers about the rehabilitation or return-to-work program Determining the injured worker s retraining needs Assisting with establishing a rehabilitation or return-to-work program in consultation with the injured worker 2.9 Commencing the plan 73 Assessment activity 2: Assisting with planning and implementing a successful rehabilitation or return-to-work program Record your employability skills iii

2 BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs Chapter 3: Assisting with monitoring and evaluating a rehabilitation or return-to-work program 3.1 Facilitating feedback and communication between the provider, manager and injured worker 3.2 Facilitating regular contact and support between the provider and the injured worker 3.3 Assisting with identifying problems with the rehabilitation or return-towork program and taking remedial action 3.4 Assisting with modifying the rehabilitation or return-to-work program Assisting with evaluating the rehabilitation or return-to-work program 95 Chapter summary 98 Assessment activity 3: Assisting with monitoring and evaluating a rehabilitation or return-to-work program Record your employability skills Final assessment: BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs 101 Employability skills 104 Appendices 105 Appendix 1: How the learner guide addresses the unit of competency 105 Appendix 2: Employability skills 109 iv

3 Introduction: Assisting with claims management, rehabilitation and return-to-work programs Introduction Assisting with claims management, rehabilitation and return-to-work programs Before workers compensation legislation was implemented across Australia, support for injured workers relied purely on the goodwill of employers. Often, injured workers were replaced rather than being offered support and rehabilitation back into the workforce. Work health and safety (WHS) legislation now places obligations on all employers, referred to as PCBUs (persons conducting a business or undertaking) and workers. PCBUs have a duty to provide a safe and healthy workplace for everyone in the workplace. One of the WHS duties of PCBUs is to effectively manage the return to work of injured workers. This job role is performed by a return-to-work coordinator (RTW coordinator). RTW coordinators work collaboratively with injured workers, management, other advisors within an organisation and external medical and rehabilitation specialists. Their role is to enhance an injured worker s return to work and ensure legislative requirements are met. Rehabilitation or return-to-work programs are often discussed as part of the same process. A rehabilitation program is a structured series of planned activities offered to the injured worker (sometimes called the claimant) to help them return to their preinjury status, as far as possible. This program includes developing an alternative duties plan (ADP). A return-to-work program is a document detailing a claimant s rehabilitation program including return-to-work goals, time frames and proposed services and costs. In some jurisdictions, a return-to-work program is the documented process a workplace follows in the event of workplace injury or illness. Other jurisdictions call this a safety or injury management system or injury management plan. 1

4 Chapter 1: Assisting with managing claims Privacy and confidentiality As mentioned, you must obtain written authorisation from the injured worker to discuss their rehabilitation and return to work with other stakeholders. In addition, when discussing the injured worker and their compensation, treatment and return to work, you must use discretion, and sensitivity. Take care that all discussions with injured workers and rehabilitation providers are in a private location. Carefully consider any information that you share. It must be: relevant to the claim accurate and objective required by that party to process the injured workers application only used for the purpose it was collected. You should also consider how claims information is recorded and stored. All files should be stored in a secure location (for example, in a locked cabinet, password-protected file or in an access-controlled electronic case management system). The following case study demonstrates how an RTW coordinator notifies a rehabilitation provider according to organisational policies and procedures and legislative and workers compensation insurance requirements. Case study Marta is the RTW coordinator for a construction company. She has processed a new claim for Bill, a crane driver, who had a workplace accident. The crane he was operating toppled over, causing multiple serious physical injuries and trauma as well as stress, depression and anxiety related to the accident. Because of the complexity of the case, Marta thinks it is appropriate to engage an injury management coordinator. Marta contacts the workers compensation insurer, requests an injury management coordinator, and gets approval in writing. Marta calls Bill to inquire about his health and to discuss appointing a coordinator and their role in the rehabilitation or return-to-work program. She gives Bill the names of three potential providers who have appropriate skills, expertise and qualifications. Bill agrees to appoint a coordinator and they make arrangements for a worker authorisation form to be ed to him at home, along with a summary of their discussion. Bill agrees to complete the form, authorising Marta to make the necessary referral, which his wife will drop in to the workplace. Marta receives the signed worker authorisation form for ABC Rehab and contacts them to discuss the referral. Marta completes the referral form from ABC Rehab and returns it with a copy of the signed worker authorisation form. She calls Bill to confirm the referral has been made and to advise him to expect a call from ABC Rehab in the near future. Marta makes a case note of the discussions and the actions she has taken, and places the approval, authorisation and referral in the file, before returning it to the filing cabinet. 17

5 BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs Assessment activity 1 Assisting with managing claims Your trainer or assessor may require you to complete this assessment activity and will provide you with instructions as to how to present your responses. They may provide alternative or additional assessment activities depending on the circumstances of your training program. The following table maps the assessment activity for this chapter against the element and performance criteria of Element 1 in BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs. Part Element Performance criteria A 1 1.1, 1.2, 1.3, 1.4, 1.5 B 1 1.1, 1.2, 1.3, 1.4, 1.5 C 1 1.1, 1.4 Part A 1. Locate a copy of the WHS legislation that applies in your state or territory. This is available online through your local WHS regulatory body; details are available on the Safe Work Australia website. What is the definition of a worker in the legislation relevant to your workplace? In your answer, include your jurisdiction and the name of the legislation you are referencing. 2. List the main steps you need to follow when you first hear of a work-related injury until a claim is accepted. 3. In your own words, describe the key skills an effective return-to-work coordinator requires and how they need to apply those skills when assisting with claims management. Part B Read the case study, then answer the questions that follow. Case study Isaac is a 17-year-old apprentice mechanic. He loses consciousness and stops breathing when a car on a hoist falls on him. His workmates rush to his aid, move the car, stabilise his spine and provide CPR until an ambulance arrives. Isaac is revived, but has a serious crush injury to his abdomen and left upper arm. Isaac remains in hospital receiving appropriate treatment and therapies. The RTW coordinator, Beryl, visits Isaac in hospital to discuss workers compensation. While there, Beryl meets Isaac s mother, who is very angry with the employer because of the accident and is very aggressive towards Beryl. Isaac s workmates have returned to work, although there is a noted increase in sick leave since the accident. 32

6 Chapter 2: Assisting with planning and implementing a successful rehabilitation or Documenting the injured worker s skills, experience and capabilities Developing the injured worker s return-to-work program helps ensure a coordinated, safe and sustainable return-to-work process. This process involves comparing and documenting specific information about the worker s usual role and work tasks and their skills, knowledge and capabilities to determine which of their usual duties they will be able to perform (if any). Identifying information about the worker The following questions will assist in negotiating and planning for an injured worker s return to work: What pre-injury or illness tasks can the injured worker currently do? What tasks or duties has the medical practitioner or rehabilitation provider placed restrictions upon? What modifications or adjustments have the medical practitioner or rehabilitation provider recommended to facilitate a return to work (for example, increased break frequency, reduced hours, modified or specialised equipment)? Are there duties or tasks outside the injured worker s regular work area that can supplement their duties? Is training or upskilling of the injured worker required in order for them to safely undertake return-to-work duties? Does the injured worker s injury impact on their ability to access their workplace? Is the injured worker s personal life (for example, care arrangements) organised around their usual work hours (for example, shift work), and does this require consideration when planning suitable or alternative duties? Obtaining information to plan the return to work It is important to explore all options and collect information from a wide range of sources. This allows thorough planning of resources and support processes, as well as developing contingencies that may be needed for the injured worker s return to work. There are a number of ways you can obtain information: Communication with key parties Workplace assessments Vocational assessments Worker capability forms 45

7 BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs The return-to-work hierarchy, as stated on the Australian Government Comcare website, is as follows: Different job, different workplace Least preferred Same or modified job, different workplace Different job, same workplace Modified job, same workplace Most preferred Same job, same workplace Developing alternative duties plans Section 2.4 described the planning and preparation phase in developing a suitable job for an injured worker s return to work. It outlined ways in which you can redesign a job to make it suitable for the injured worker s abilities, restrictions and skills. An important part of this process is consultation with all affected parties. You are more likely to gain cooperation if you provide an opportunity for all parties to participate in developing the rehabilitation plan or alternative duties plan. Consult with the injured worker and their rehabilitation providers about the injured worker s physical and mental capabilities to undertake particular duties. The aim of alternative duties is to promote rehabilitation and return to work, and not aggravate or cause a secondary injury. Injured workers who have physical injuries may also have issues with their mental capacity caused by the effects of interrupted sleep, medication, stress or anxiety. Discuss these issues with the injured worker in a sensitive manner and, if necessary, consult specialist rehabilitation providers with the worker s permission. As discussed in the job redesign process, you may also need to alter the injured worker s work hours by reducing hours or days and including breaks. Your industry or workplace may have peak work periods at certain times of the day, week, month or year. Consider the injured worker s ability to manage the required work output during peak work periods as they may have reduced work capacity and be affected by additional stress or time pressures. In this situation, it may be possible for them to perform the tasks, but for shorter periods of time or rotating between tasks. 56

8 BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs 2.8 Assisting with establishing a rehabilitation or return-to-work program in consultation with the injured worker A constructive relationship between the employer and worker is the key to a successful return to work. It is in your best interest to consult with the injured worker to provide them with clear information about the return-to-work program. This will help avoid misunderstandings and uncertainty, and encourage cooperation and participation in the return-to-work process. Developing a return-to-work program A return-to-work program aims to return the injured worker to their pre-injury role, or as close as possible, as soon as they are safely able to. You, as the RTW coordinator, are key to this process as you have thorough knowledge of the workplace and its processes and procedures, and are also the central communication point for all parties in the return-to-work process. The injured worker s knowledge of their work role and their ability to provide feedback about the impact of their injury or illness will assist in developing an individualised, safe, timely and cost-efficient plan. Their involvement and ability to provide feedback also helps encourage ownership and engagement in the plan, ultimately increasing the likelihood of a successful outcome. Rather than leaving it up to the injured worker, initiate discussions about returning to work and options that may be available. It is important to listen to the injured worker s suggestions and input into managing their restrictions and capabilities in the workplace, but you should be clear about the options that are available, so plans and ideas are realistic and manageable. When holding discussions, injured workers may feel more comfortable if they have a support person with them, such as their spouse, friend or support worker. Maintain regular contact with the injured worker and include them in developing their alternative duties plan. 68

9 Chapter 2: Assisting with planning and implementing a successful rehabilitation or... Offer the injured worker an opportunity to bring a support person to any meetings or case conferences. The case conference may be between you, the injured worker and any stakeholders who may be able to help resolve the injured worker s reluctance to commence alternative duties. Stakeholders may include: the treating doctor the rehabilitation provider/s the insurer or scheme agent. With the approval of the insurer or scheme agent, you may engage a rehabilitation provider to renegotiate the alternative duties plan if you believe this will address the reservations of the injured worker and pave the way for participation in the alternative duties plan. When an injured worker unreasonably refuses to participate in an alternative duties plan, you should notify your insurer or scheme agent. There may be ramifications for the injured worker s payments, or there may be a requirement to follow the dispute resolution process that was outlined in Chapter 1. The following are tips for establishing an alternative duties plan in consultation with the injured worker. Tips Discuss capabilities and restrictions outlined on the medical certificate. Analyse the injured worker s usual job and any alternative duties that are available, and problem-solve ways to manage duties in line with the injured worker s capabilities and medical restrictions. Review the injured worker s progress on a weekly basis against rehabilitation or return-towork programs. Encourage open lines of communication between the injured worker, their manager/team leader and rehabilitation providers. Actively listen and give fair consideration to the injured worker s ideas and feedback. Provide a written copy of the alternative duties plan to the injured worker and obtain a signed and dated agreement. Organise meetings or case conferences involving the injured worker as soon as it is evident there are problems with the rehabilitation or return-to-work programs. 71

10 Chapter 3: Assisting with monitoring and evaluating a rehabilitation or return-to-work program Chapter 3 Assisting with monitoring and evaluating a rehabilitation or return-towork program When the injured worker commences their rehabilitation or return-to-work program, the RTW coordinator must continue to use a range of skills including communicating, consulting, negotiating, organising and administrating to ensure the program is up to date and progressing towards an optimal outcome. To ensure ongoing improvement and emphasise the importance of workplace rehabilitation and returning to work, the RTW coordinator should also engage in evaluating the plan. This chapter examines the skills and knowledge you need to participate in monitoring and evaluating rehabilitation or return-to-work programs in your workplace. In this chapter you will learn about: 3.1 Facilitating feedback and communication between the provider, manager and injured worker 3.2 Facilitating regular contact and support between the provider and the injured worker 3.3 Assisting with identifying problems with the rehabilitation or return-to-work program, and taking remedial action 3.4 Assisting with modifying the rehabilitation or return-to-work program 3.5 Assisting with evaluating the rehabilitation or return-to-work program 79

11 BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs Use feedback from stakeholders to improve their management of future claims. It can also provide opportunities to identify weaknesses in the organisation s rehabilitation or return-to-work program, policies and procedures, and help to implement improved processes in the future. Rehabilitation or return-to-work program closure report Information derived from case closure interviews, completed surveys and the worker s rehabilitation or return-to-work file should be summarised objectively in a closure report. A copy of the report should be retained in the worker s file. The following example is a sample closure report you could use to evaluate a rehabilitation or return-to-work program and implement recommendations for improvements. Employee name Claim number Nature of injury Date of injury Date rehabilitation commenced Example Closure report Date of case closure Total length of claim Reason rehabilitation ceased (tick appropriate reason) RTW objective achieved Employer withdrew rehabilitation Claim settled Permanent and total incapacity Employee withdrew voluntarily Other: Permanent restrictions Summary of return-to-work program Follow-up survey satisfaction rating High Moderate Low Signed: Date: Return-to-work coordinator 96

12 BSBWHS407A Assist with claims management, rehabilitation and return-to-work programs Preparing reports Once you identify trends or risks in workplace illness or injury, you may be involved in developing control measures and management strategies to reduce these risks and the associated costs of common injuries. This may include preparing a report for: the PCBU health and safety officers or representatives union representatives managers work teams. Liaise with stakeholders to determine the types of information they require and how often they would like to analyse to address workplace safety issues. Practice task 20 Liaise with appropriate people in your workplace such as a health and safety officer, experienced RTW coordinator or HR officer to obtain a report on workplace injuries for the previous 12 months. (Old data may be used to protect privacy of current workers). Provide details as follows: Total number of injuries in your workplace (injuries and lost time injuries) Common types of injuries in your workplace Common cause of injury in your workplace Typical roles of injured workers Total number of workers compensation claims made in your workplace Average length of time workers compensation claims were open in the workplace Who injury data and reports are provided to, in what format and how often What documented processes or procedures are in your workplace for reporting injuries or illnesses Chapter summary The PCBU has an obligation to consult with the worker, nominated treating doctor and other stakeholders when monitoring a rehabilitation or return-to-work program. Stakeholders, including the worker, managers, doctors and rehabilitation providers, contribute valuable information in developing, monitoring and modifying the alternative duties plan. You should be in regular communication with each party. Regular consultation, communication and feedback helps ensure barriers to, or problems with, rehabilitation or return-to-work programs are identified and addressed early. You must document all communication in the worker s return-to-work file. Prior to referring the case for dispute resolution, breaches of the rehabilitation or return-to-work program must be notified to the insurer or scheme agent, with steps taken to resolve issues as early as possible. Evaluating rehabilitation or return-to-work programs and outcomes helps the PCBU and you as the RTW coordinator to continually improve and refine practice in these areas. 98