REHABILITATION and RETURN TO WORK

REHABILITATION and RETURN TO WORK POLICY Approval to Publish This policy is approved for publication by the Concordia Lutheran College Council having considered relevant legislation dates and/or implementation requirement of users. EFFECTIVE 2 September 2014 Next Scheduled Review Date All procedures have an automatic review date as specified. Review dates cannot be greater than 2 years following implementation date REVIEW 2 Years Access and Availability All sections of procedure will be visible on the Concordia Lutheran College intranet and published in staff handbook. Availability for public access? Yes Yes RECOMMENDATION Head of College 02 / 09 / 2014 APPROVAL Chairman of College Council 02 / 09 / 2014

Rehabilitation and Return to Work Policy Contents Concordia Lutheran College 154 Stephen Street Toowoomba Q 4350 (07) 4688 2700 Page OUR PERSPECTIVE... 4 POLICY STATEMENT... 5 AIMS... 6 SCOPE... 6 DEFINITIONS... 6 COUNCIL... 6 GROUP SALARY CONTINUANCE INSURANCE... 6 AN INJURY... 6 INJURY MANAGEMENT... 6 HEAD OF COLLEGE... 6 PROCEDURE... 6 SCHOOLS (SCHOOL/S)... 6 WORKCOVER INSURER... 6 WORKPLACE REHABILITATION... 6 ROLES, RIGHTS AND RESPONSIBILITIES... 7 1. THE INJURED OR ILL EMPLOYEE... 7 2. THE CONCORDIA LUTHERAN COLLEGE... 8 3. THE REHABILITATION AND RETURN TO WORK COORDINATOR (RRTWC)... 8 4. THE ROLE OF THE HEAD OF COLLEGE/ MANAGERS/SUPERVISORS:... 9 5. RIGHTS OF THE HEAD OF COLLEGE... 9 6. RESPONSIBILITIES OF THE HEAD OF COLLEGE... 9 7. LEQ DISTRICT REHABILITATION AND RETURN TO WORK COORDINATOR... 9 8. FELLOW EMPLOYEES... 10 9. MEDICAL PRACTITIONER/S... 10 PROCEDURES FOR CLAIMS... 11 A. FOR WORKCOVER CLAIMS (A WORK RELATED INJURY OR ILLNESS)... 11 B. FOR GROUP SALARY CONTINUANCE INSURANCE CLAIMS... 11 DESCRIPTIONS... 12 SUITABLE DUTIES PROGRAMS... 12 SUITABLE DUTIES PLANS... 12 PROCEDURES FOR WORK RELATED INJURIES OR ILLNESS... 12 PROCEDURES FOR NON-WORK RELATED INJURIES/ILLNESS... 13 PAYMENT OF WAGES DURING REHABILITATION... 13 FOR WORK RELATED INJURIES/ILLNESS... 13 FOR NON-WORK RELATED INJURIES/ILLNESS... 13

Table of Contents APPENDIX 1... 14 LETTER TO INJURED EMPLOYEE... 14 APPENDIX 2... 15 AUTHORISATION... 15 APPENDIX 3... 16 LETTER TO MEDICAL PRACTITIONER... 16 APPENDIX 4... 17 WORK CAPABILITIES CERTIFICATE... 17 APPENDIX 5... 18 SUITABLE DUTIES / REHABILITATION PLAN... 18 APPENDIX 6... 20 RETURN-TO-WORK ADVICE... 20 APPENDIX 7... 21 WAGE INFORMATION (WORK RELATED)... 21 APPENDIX 8... 23 WAGE INFORMATION (NON-WORK RELATED)... 23 APPENDIX 9... 25 REHABILITATION CLOSURE... 25 APPENDIX 10... 26 WORKER EVALUATION FORM... 26 APPENDIX 11... 27 CONCORDIA LUTHERAN COLLEGE REHABILITATION PROCEDURES... 27 APPENDIX 12... 28 CONCORDIA LUTHERAN COLLEGE REHABILITATION PROCEDURE FOR INJURED WORKERS... 28

Rehabilitation and Return To Work Policy OUR PERSPECTIVE In the Lutheran school the gospel is to inform all programs, relationships and activities (LCA and Its Schools statement). The love of God in Jesus Christ is to govern all that is done and, in response to this love, people in the school community are directed to their fellow human beings. When they love others they love Him. Christ s promise is that whatever is done for others is done for Him. Informed and transformed by God s creative, redemptive and sanctifying love, God s people are concerned with the total needs of their fellow human beings. This means that the Lutheran school will exercise a ministry of care to all in its employ not least of all to those who have been away from their work place. The school values the unique giftedness of each individual and will assist them in returning to work so that they can be all that they are under God. This may well mean going the extra mile with them, but in so doing the school will reflect its core values and be seen to be an authentic and credible caring community. Work is a gift of God for the good of creation. Work is part of our essence as human beings. In work God grants His people the privilege of being co-workers with Him in the ongoing work of creation. A culture of rehabilitation to work affirms the individual so that they can use their God given gifts in service. The Lutheran school will gladly fulfil all of its legal responsibilities and it will do this in a spirit of love and care. Rehabilitation is thus not a burden but a way in which the love of God constrains those who make decisions in this area. The Lutheran school can concur with the following words from industry: With a return to work physical and mental skills aren't lost, and the important work-related social relationship which can contribute to mental and social well being are maintained (Simon Doctor, National Safety Council of Australia-Australian Safety, April 2001). Such a culture demonstrates an appreciation of the contribution which work, as a gracious gift of God, makes to both the life of the worker and fellow workers. Lutheran schools value the gifts of those who act as employers and as employees. Executive Director Lutheran Education Australia 4

Appendix 1 POLICY STATEMENT Concordia Lutheran College recognises that there are substantial benefits to be gained from rehabilitation principles and practices and is committed to implementing them at this college. We recognise that the Workers Compensation and Rehabilitation Act 2003 and the Workers' Compensation and Rehabilitation Regulation 2003 provide the legislative support for workplace rehabilitation activities. Experience has shown that workplace rehabilitation assists the healing process and helps restore the worker s normal function sooner. Workplace rehabilitation includes early provision of timely and adequate services, including suitable duties programs, and aims to: - maintain injured or ill workers at work or ensure the worker s earliest possible return to work or maximise the worker s independent functioning and provide for durable employment. Concordia Lutheran College acknowledges that the process of Rehabilitation is a positive move towards retaining the job skills of employees who have been injured or ill as well as reflecting the Christian-based caring atmosphere of the Collegel. As such, the Concordia Lutheran College is committed to the following measures: Providing a safe and healthy work environment, but in the event of an injury or an illness, making sure workplace rehabilitation is started as soon as possible in accordance with medical advice. Ensuring appropriate suitable duties are made available to injured or ill workers to facilitate their safe and early return to work. These duties must be consistent with the current medical certificate and will be time limited. Respecting the confidential nature of medical and rehabilitation information and ensuring there will be both verbal and written confidentiality. Ensuring all workers are aware that, in the event of injury or illness, they will be consulted to ensure a structured and safe return to work that will not disadvantage them. Complying with legislative obligations with respect to the standard for rehabilitation. Adopting a multidisciplinary approach to rehabilitation as required. Reviewing this policy and procedures at least every three years to ensure it continues to meet legislative requirements and the needs of all parties. Our Rehabilitation and Return to Work Coordinator is based at Redlands Campus. Head of College Adopted by College Council on 2 September 2014 To be reviewed by 2 September 2016 5

Appendix 1 AIMS The aims of the policy are to ensure that: all employees of Concordia Lutheran College have the right to Workplace Rehabilitation and that return to work is the normal practice and expectation, even if only in stages and/or on a part time basis as part of a rehabilitation process, providing suitable assessed duties can be found. workplace rehabilitation commences at the time of injury or illness or when treatment commences, whichever is most practical. there is early medical assessment and involvement of a rehabilitation provider, as required, to provide individual rehabilitation and return to work plan outlining suitable or alternate duties, where necessary, for an early return to work. there is ongoing contact between the Rehabilitation and Return to Work Coordinator, employee and where necessary his or her family and offer moral support. there are adequate resources are allocated towards training and the provision of storage of confidential files. SCOPE Concordia Lutheran College Council is committed to the measures outlined in the Rehabilitation policy statement and covers all employees of the School. DEFINITIONS Council refers to Concordia Lutheran College Council. Group Salary Continuance Insurance: For members of the insurance plan or Lutheran Church of Australia Superannuation Fund, income protection insurance for injuries or illness that are not covered by Workers Compensation. An Injury: is personal injury arising out of, or in the course of, employment if the employment is a significant contributing factor to the injury (as per Section 32 of Act). Injury Management: the process of using Workplace Rehabilitation to bring about an early and safe return to work. Head of College: refers to Head of College, Concordia Lutheran College. Procedure: refers to the scope and purpose of an activity and outlines how it is to be carried out. Schools (school/s): refers to all early learning services which are part of the College, all primary campuses, outdoor education centre, and secondary school. Workcover Insurer: WorkCover Queensland Workplace Rehabilitation: is a system of rehabilitation accredited by the Authority that is initiated or managed by an employer. (as per Section 43 of the Act) 6

Appendix 1 ROLES, RIGHTS AND RESPONSIBILITIES 1. The Injured or Ill Employee Injured or ill employees are expected by Concordia Lutheran College to actively participate in workplace rehabilitation in order to resume their normal duties in the workplace as soon as practicable following injury or illness. They are required to: advise the College as soon as possible of any injury or illness that is likely to affect their work. obtain appropriate treatment for the injury/illness. obtain the correct forms and apply for workers compensation through WorkCover Queensland. request that their treating medical practitioner complete a QCOMP Certificate (for work- related injuries or illness) or the Medical Practitioner s section of CLC insurance group form for Salary Continuance. advise their treating medical practitioner or rehabilitation advisor that a Workplace Rehabilitation program is available. request that their treating medical practitioner complete the Work Capabilities Certificate. (Appendix 4) actively participate in workplace rehabilitation. maintain communication with the Rehabilitation and Return to Work Coordinator about relevant issues related to their compensation claim and provide regular feedback to enable an accurate evaluation of any agreed rehabilitation and return to work plan. All persons employed by Concordia Lutheran College have the following rights with regard to workplace rehabilitation: workers compensation for work-related injuries accepted by the insurer. choose their own doctor. authorise the Rehabilitation and Return to Work Coordinator to contact their doctor for advice on suitable duties. confidential, safe keeping of personal medical information. be provided with suitable duties, if practicable, as part of any rehabilitation program. be consulted in the development of a suitable duties program. union representation if so desired. ask for a Q-COMP review of certain insurer s decisions with which they do not agree have access to an impartial grievance mechanism, which is accessed in the first instance by raising the grievance with the Rehabilitation and Return to Work Coordinator for resolution or escalation. 7

Appendix 1 2. Concordia Lutheran College Concordia Lutheran College is committed to provide a workplace based rehabilitation and return to work program for all staff. To meet this objective the Concordia Lutheran College recognises the need to ensure that: currency of the workplace rehabilitation policy & procedures is maintained all reasonable steps are taken to assist or provide the injured or ill employee with suitable duties for the period for which the employee is entitled to compensation. rehabilitation is provided of a suitable standard as prescribed under the Act and regulations written evidence to WorkCover is provided if an employer considers it is not practicable to provide the worker with suitable duties. 3. The Rehabilitation and Return to Work Coordinator (RRTWC) The position of Rehabilitation and Return to Work Coordinator (RRTWC) has been established as required by the Workers Compensation and Rehabilitation Act 2003 (s226). The RRTWC must be based in Queensland and may be employed under a contract either as an employee or a contractor. The role does not need to be a full time position and may be incorporated within an existing employee s duties. RRTWC s must successfully complete an approved training course (provided by QComp Approved Training Organisations) to become registered and receive a letter issued by Q-COMP indicating the registration number. Completion of an updated course is required every three years to maintain registration. The RRTWC works with the injured worker and the treating doctor to establish appropriate rehabilitation strategies. This may be in consultation with the workers compensation insurer and/or a rehabilitation provider if assistance is required. The role of the Rehabilitation and Return to Work Coordinator is to assist the Concordia Lutheran College to: Ensure an efficient system exists for immediate reporting of injuries to enable early worker contact regarding rehabilitation, to comply with employer s duty to report injury to the insurer and to ensure confidentiality of information received. Develop, coordinate and monitor workplace rehabilitation strategies for injured workers, including developing suitable duties programs in consultation with injured workers undertaking rehabilitation. Educate all workers about the workplace rehabilitation policy and procedures and what to expect when an injury occurs. To educate managers, supervisors and workers regarding their role and responsibilities for rehabilitation. To ensure education is part of the new staff induction process. Where possible and on behalf of the employer, to ensure rehabilitation for a worker is coordinated with and understood by line managers, supervisors and co-workers. Promote the Concordia Lutheran College s workplace rehabilitation program internally to maintain staff s commitment, and externally, to local doctors so as to build a good working relationship and gain their trust and assistance. Keep a file for each worker undertaking rehabilitation and to ensure confidentiality of both verbal and written information. 8

Appendix 1 Keep accurate and objective case notes of all communications, actions and decisions, and reasons for actions and decisions and to sign and date each notation. Provide injured workers with the opportunity to give feedback on the rehabilitation system and to document this feedback. When an employee is injured or becomes ill, the Rehabilitation and Return to Work Coordinator will: Initiate and maintain contact with the injured employee as soon as possible after the injury or illness has occurred. Ensure that the injured or ill employee has access to appropriate information and resources. 4. The Role of the Head of College/Managers/Supervisors: The Head of College has a central role in ensuring the success of any rehabilitation program: To Actively assist the Rehabilitation and Return to Work Coordinator in identifying and coordinating suitable duties. To Adjust workplace procedures and rosters to enable successful implementation of the suitable duties plan. To Monitor the injured worker s progress in relation to suitable duties. To Educate employees and develop prevention programs. To Work towards the creation of an environment conducive to Workplace Rehabilitation. To Advise fellow workers of the injured or ill person's capabilities and negotiate any workplace adjustments in advance of the return to work. To generally offer support and encouragement to any injured worker. 5. Rights of the Head of College The Head of College has the right: To be kept informed of medical status and Workplace Rehabilitation process. To actively participate in the development of any suitable duties and/or return to work plan. To monitor and review the return to work of an injured employee. 6. Responsibilities of the Head of College The Head of College has the following responsibilities in regard to Workplace Rehabilitation: To appoint a RRTWC. To appoint a Rehabilitation Provider (as required) in consultation with the treating medical practitioner and Workcover case manager. To participate in and be supportive of the rehabilitation plan and return to work process and communicate this to staff as appropriate. To provide appropriate work at the same or equal level whenever possible, where an employee cannot return to pre-injury/illness employment. To assist employees, with relocation or training whenever possible, to identify suitable duties within the College. To ensure assistance is given to complete forms and to ensure employees are aware of their rights and responsibilities. To ensure the RRTWC is notified regarding injury/illness, rights and return to work potential. To identify and implement strategies to prevent similar injuries to other employees. 7. The role of the LEQ District Rehabilitation and Return to Work Coordinator Support the consideration and execution of claims process for WorkCover or CLC Insurance Group. 9

Appendix 1 Promote a culture of rehabilitation in Lutheran Schools through policies and resources. Support and assist Schools in the rehabilitation process. Facilitate issues between WorkCover, School and employee or CLC Insurance Group, School and employee when required to do so. 8 Fellow Employees Fellow employees in the workplace are encouraged to support and enrich a rehabilitative environment in the workplace. 9. Medical Practitioner/s The treating medical practitioner accepts responsibility for the overall management of the injured or ill persons and may delegate the routine rehabilitation management to the RRTWC and/or rehabilitation provider. The injured or ill employee has the right to consult a Medical Practitioner of their own choice for treatment. 10

Appendix 1 PROCEDURES FOR CLAIMS A. For WorkCover Claims (A work related injury or illness) 1. Complete a Workplace Health and Safety Incident Record/Report; 2. A WorkCover claim should be lodged for all work related injuries. This is done by completing a WorkCover Application for Compensation form and WorkCover Employer Report. The Workers Compensation and Rehabilitation Act 2003 states that an injured worker has 6 months from the date of injury to lodge a claim (however, if the application is lodged more than 20 business days after the injury then the insurer s liability to pay compensation is limited to a period starting no earlier than 20 business days before the application is lodged). 3. Worker s Compensation Medical Certificate to be obtained by the injured or ill employee from their treating Medical Practitioner and presented to the employer; 4. Where applicable a signed authorisation from the injured or ill employee, for the Rehabilitation and Return to Work Coordinator to enable direct liaison with the treating Medical practitioner/s. (Attachment ) 5. In consultation with the Medical Practitioner/s, the Rehabilitation Provider for the injured or ill employee, therapists and physiotherapists, begin work on the rehabilitation plan. 6. Establish and maintain a good working relationship with the claims and rehabilitation staff at WorkCover. 7. Maintain a good line of communication between all parties involved and ensure that all records are kept up to date and confidential. B. For Group Salary Continuance Insurance Claims 1. Request the Salary Continuance Insurance Claim Form from the Rehabilitation and Return to Work Coordinator. 2. Complete the injured or ill employee's individual form and request that the Medical Practitioner completes the Medical Practitioner s claim form. 3. Lodge completed claim forms with the RRWTC to forward copy to CLC Insurance Group. 4. Where applicable a signed authorisation from the injured or ill employee, for the Rehabilitation and Return to Work Coordinator to liaise directly with the treating Medical practitioner/s to assist with the rehabilitation plan. 5. A 90 day waiting period applies. 6. If the claim is rejected, the injured or ill employee may appeal and request a review. 11

Appendix 1 DESCRIPTIONS Suitable Duties Programs These specially selected duties at the workplace are a means of offering a monitored and graduated return to normal duties. They are: matched to the capabilities of the worker. time limited and regularly upgraded according to his/her level of recovery and treating medical doctor advice. The following issues must be considered when choosing suitable duties: the worker s pre-injury duties, age, education, skills and work experience and nature of the incapacity. the restrictions and limitations specified by the treating doctor, who must also document approval for all plans and amendments; and regard for the objectives of the worker s rehabilitation plan and be meaningful. Suitable Duties Plans may be either Fully Funded by the insurer/workcover; or Partially Funded by both the employer and the insurer or Medical Expenses Only (insurer reimburses medical/treatment costs and employer pays wages). PROCEDURES FOR WORK RELATED INJURIES OR ILLNESS Employees must obtain first aid, nursing or medical assistance in the first instance as necessary. All injuries must be documented and reported to the Head of College/Workplace Health and Safety Officer/Rehabilitation and Return to Work Coordinator within 24 hours of injury/illness occurring. The Workplace Health and Safety Officer shall investigate injury/illness occurrence and initiate further preventative action where required. Injured employee shall undertake necessary treatment and Workplace Rehabilitation. Where injury/illness results in the employee having time off work: (a) The RRTWC shall contact the injured employee to: i ascertain degree of injury/illness; ii reassure employee of rights and responsibilities under this policy; iii if appropriate, instigate the steps as outlined in the RRTWC s role. (b) The RRTWC shall liaise with the injured employee, Treating Medical Practitioner, Rehabilitation Providers, the Head of College, the Council and WorkCover to establish rehabilitation goals. (c) The RRTWC shall ensure documentation of the rehabilitation plan and obtain signatures of all involved parties. 12

Appendix 1 PROCEDURES FOR NON-WORK RELATED INJURIES/ILLNESS The injured/ill employee will contact the Head of College to advise of the nature and consequences of the injury/illness. Necessary sick leave shall be applied for. The injured employee shall undertake necessary treatment and rehabilitation. Workplace return to work programs for non-work related injuries/illness are voluntary but are expected. Where injury/illness results in the employee having time off from work: (a) The Head of College shall contact RRTWC with injury/illness details. (b) RRTWC will ensure that contact is made with the injured employee as soon as practicable in order to: i reassure employee of rights and responsibilities. ii inform employee of RRTWC role and that all possible assistance shall be given. RRTWC will liaise with injured employee, the treating Medical Practitioner, rehabilitation providers, the Head of College and the Council and RSA (where relevant) to develop rehabilitation goals and a return to work plan. RRTWC shall ensure documentation of rehabilitation plan and signatures of all involved parties. RRTWC shall monitor the return to work program and ensure the injury/illness is not aggravated. PAYMENT OF WAGES DURING REHABILITATION The following are guidelines to be used when negotiating payment for injured employees on a Return to Work Program: For Work Related Injuries/Illness (a) On the advice of the treating Medical Practitioner, if an injured employee is assessed fit to return to work on a graduated return to work program, the College shall pay normal pay to that person (including allowances where applicable) for the actual hours worked. WorkCover payments will compensate for hours not worked to the maximum allowable for that employee. (b) If an injured worker is assessed as not fit for work then normal WorkCover payments will apply. For Non-Work Related Injuries/Illness (a) On the advice of a treating medical practitioner, if an injured/illness worker is assessed as fit to return on a graduated return to work program the College will pay for the actual hours worked. Sick leave or partial GSCI payment shall apply (where available) for hours not worked to the maximum allowable for that employee. (b) If an injured worker is assessed as not fit for duty then normal Sick Leave shall apply or GSCI payments (where available) according to the agreed policy. 13

APPENDIX 1 Appendix 1 Letter To Injured Employee Dear On behalf of the Concordia Lutheran College Council, please accept our best wishes for your recovery following your recent injury/illness/condition. As a valued member of this College you are missed by your friends and colleagues. We will remember you in our morning prayers and pray that God will grant you a speedy recovery and give you His strength to help you through this difficult time. As you are aware Concordia Lutheran College Council is committed to Workplace Rehabilitation and return to work and all necessary provision will be available to assist your recovery. We will contact you again shortly to discuss how we can best assist you. Yours sincerely Rehabilitation and Return to Work Coordinator 14

Appendix 2 APPENDIX 2 Authorisation I hereby give consent for the following people to discuss with my employers Rehabilitation and Return to Work Coordinator, specific injury/illness information to assist with my rehabilitation plan and safe return to work: 1. Name: Address: Phone No: Fax No: Email: 2. Name: Address: Phone No: Fax No: Email: I understand this consent is required to assist with my rehabilitation and return to work and that all information obtained is treated in confidence. Signed: Employee Name: Dated 15

Appendix 3 APPENDIX 3 Letter To Medical Practitioner Dear Medical Practitioner: is employed by Concordia Lutheran College. Our policy is to encourage early return of our employees to full employment as soon as practicable following an injury or illness. Where possible they are returned to their usual work or some suitable work within their capacity. We require your help in formulating a Workplace Rehabilitation program to ensure that who is employed as can return to their usual work or is provided with appropriate duties if necessary. Any information you could provide on the attached checklist would be most useful. Additional information about the job can be provided for you if required. I have attached a copy of the Authorisation to contact you, given to us by. We look forward to your contribution to our rehabilitation team effort. Yours sincerely Rehabilitation and Return to Work Coordinator 16

Appendix 4 APPENDIX 4 Work Capabilities Certificate I have examined and consider that he/she has the following condition 1. The employee is fit to resume normal duties YES / NO 2. The employee will be unfit for days up to and including 3. The employee is partially fit and capable of performing selected duties with the following limitations (Please complete appropriate section): Reduced work hours: hours/week days/week Visual tasks only. A job which does not involve manual handling Lifting weights of not more than kg Work not involving the right/left - hand/arm/shoulder/leg Light bench work only Sitting position only No ladders or on unguarded heights Other: (Please specify) 4. The employee will be reassessed on The employee has been referred to: (a) (b) (c) Specialist: Specialty: Physiotherapist: Other: 5. Signed: Date: Medical Practitioner Stamp: 17

Appendix 5 APPENDIX 5 Suitable Duties / Rehabilitation Plan Name of Worker: Date: / / Name of Supervisor/s: Department: Department: Name of Rehabilitation Provider: Overall Goal (ie Return to normal duties): Objectives for the Period of this Plan: RETURN TO WORK JOB DETAILS (TO MEET THE STATED OBJECTIVES) Week 1 Days/Times: Duties: Week commencing: / / Week 2 Days/Times: Duties: Week commencing: / / Training Required: Remuneration Details: Anticipated Period of Return to Work Program: / / to / / Anticipated Costs Of Program (Details) $ (A REHABILITATION PROGRAM MUST BE IMPLEMENTED IN ACCORDANCE WITH PART E OF THE MEDICAL CERTIFICATE (for work-related injuries/illnesses) 18

Appendix 5 Signature of treating Medical Practitioner: Date: / / Signature of Supervisor: Date: / / Signature of WRRC: Date: / / Signature of Worker: Date: / / Copy given to: WorkCover CLC Insurance Group Supervisor RRTWC s File Medical Practitioner Date of Review: Date: / / Comment: Follow up (next step/s) 19

Appendix 6 APPENDIX 6 Return-To-Work Advice To: WorkCover/ Rehabilitation Counsellor/Workplace Injury/Illness Management Team. Company Name: Rehabilitation and Return to Work Coordinator Name: Contact Tel.& Fax: WorkCover Policy No/ CLC Insurance Group Policy No.: Date of Request: / / Injured Employee s Full Name: Claim No: Date of Birth: / / Please (Tick) Suitable Duties Plan to be used: Suitable Duties Plan 1 * PARTIALLY FUNDED by WorkCover compensation * Medical Certificate: Partial Incapacity Suitable Duties Plan 2 * FULLY FUNDED by WorkCover compensation * Medical Certificate: Total Incapacity Suitable Duties Plan 3 * EMPLOYER FUNDED * Medical Certificate: Medical Expenses Only On-going medical treatment e.g. Physiotherapy etc. YES NO Name of Approving Medical Practitioner: Contact Telephone: Fax: Proposed Date of Commencement: / / Length of Plan: N.B. A COPY OF THE FOLLOWING MUST BE ATTACHED 1. Current Medical Certificate 2. Suitable Duties Plan 20

Appendix 7 APPENDIX 7 Wage Information (Work Related) SUITABLE DUTIES PLAN 1 PARTIALLY FUNDED by WorkCover MEDICAL CERTIFICATE: Partial Incapacity To: WorkCover Claims Officer/Workplace Injury/Illness Management Team. Company Name: Rehabilitation and Return to Work Coordinator Name: Contact Telephone & Fax: WorkCover Policy No: Date of Request: / / Injured Worker s Full Name: Claim Number: Wages Period From / / to / / ONE WEEK For the week commencing / / Normal Daily Roster Actual Hours Worked Monday Tuesday Wednesday Thursday Friday Saturday Sunday 21

Appendix 7 Total hours paid for: Gross wages paid for this period $ Award Rate $ Gross normal weekly earnings Weekly Hours specified in Award $.. Please comment on how the Worker is progressing: These details are essential for WorkCover to calculate correct payment. N.B. A COPY OF THE FOLLOWING MUST BE ATTACHED. 1. Current Medical Certificate 2. Rehabilitation Plan 22

Appendix 8 APPENDIX 8 Wage Information (Non-Work Related) SUITABLE DUTIES PLAN 1 PARTIALLY FUNDED by CLC INSURANCE GROUP MEDICAL CERTIFICATE: Partial Incapacity To: CLC Insurance Claims Officer/Workplace Injury/Illness Management Team. Company Name: Rehabilitation and Return to Work Coordinator Name: Contact Telephone & Fax: RSA Policy No: Date of Request: / / Injured Workers Full Name: Claim Number: Wages Period From / / to / / ONE WEEK For the week commencing / / Normal Daily Roster Actual Hours Worked Monday Tuesday Wednesday Thursday Friday Saturday Sunday 23

Appendix 8 Total hours paid for: Gross wages paid for this period $ Award Rate $ Gross normal weekly earnings Weekly Hours specified in Award $.. Please comment on how the Worker is progressing: These details are essential for RSA to calculate correct payment. N.B. A COPY OF THE FOLLOWING MUST BE ATTACHED. 1. Current Medical Certificate 2. Rehabilitation Plan 24

Appendix 9 APPENDIX 9 Rehabilitation Closure Employee s Name Date of Birth Vocation (eg Teacher, Cleaner etc) Date of Injury/Illness / / Bodily Location Claim No Postcode Industry Type Injury/Illness Type (eg Broken Arm, cut etc) Injury/Illness Mechanism (eg slip, fall etc) Return to Work Outcome 1. Back at work: Return to work date: / / Outcome achieved: Employer Duties Hours Same Same Same New Modified Reduced New Date the above goal was achieved: / / 2. Employee is totally and permanently incapacitated for work 3. Employee is partially incapacitated but unable to place in suitable employment Case Deferred to: / / Voluntary Retirement Redundancy Employee withdrew from programme or declined to work 4. Additional Comments: Date of Case Closure: / / Cost of Claim: $ Signed Rehabilitation and Return to Work Coordinator: 25

Appendix 10 APPENDIX 10 Worker Evaluation Form To be given to a worker 1 month after a claim is finalised. To ensure that our Workplace Rehabilitation Policy & Procedures continue to meet our workers needs, please answer the following questions. 1. How satisfied were you with the Insurers Case Manager? Very Satisfied Satisfied Not Very Satisfied Very Dissatisfied Why: 2. How satisfied were you with your Rehabilitation and Return to Work Coordinator? Very Satisfied Satisfied Not Very Satisfied Very Dissatisfied Why: 3. How satisfied are you with the outcome of your rehabilitation? Very Satisfied Satisfied Not Very Satisfied Very Dissatisfied Why: 4. What would you like to see changed in our rehabilitation program? Signed: Print Name Date: / / 26

APPENDIX 11 Appendix 11 Concordia Lutheran College Rehabilitation Procedures Preferred Doctor arrangements First aid officer Transportation as required Division of Workplace Health and Safety Notification Injury notification process facilitating appropriate injured worker s first aid contact with treating medical officer Application for compensation Authorisation form Letter of introduction to the doctor initial paperwork variable depending upon circumstances early worker contact and intervention Worker involvement in development Coordinate treatment Stakeholder communication Identify Suitable Duties Identify need for Rehabilitation Service Provider Develop and monitor Suitable Duties Plan Create a Suitable Duties Plan in accordance with the Medical Certificate Insurer liaison Other rehabilitation initiatives goal directed rehabilitation plan ongoing coordinating and monitoring rehabilitation plan including case notes and other paperwork obtain worker feedback Ongoing education and promotion about rehabilitation in the workplace 27 Concordia Lutheran College

APPENDIX 12 Appendix 12 Concordia Lutheran College Rehabilitation Procedure for Injured Workers Get the appropriate treatment: First aid officer Doctor Transportation as required Notify workplace that you have had an injury and Attend the doctor (dentist if required) To claim workers compensation you need a Workers Compensation Medical Certificate from a doctor Complete: Application for compensation Authorisation form Tax Declaration (if time off work) Obtain: Introductory letter to doctor Work capabilities checklist (these are for your doctor) Hand the Certificate to the Rehabilitation and Return to Work Coordinator and complete paperwork Stay in contact with your Rehabilitation and Return to Work Coordinator - keep them informed about your progress order depends upon circumstance You are required to: Attend rehabilitation appointments (e.g. physiotherapy). Where possible outside of scheduled work hours Participate in development of suitable duties plans Provide new certificates or forms for the workplace given to you by your doctor Keep your Rehabilitation and Return to Work Coordinator informed about your progress Keep your manager up to date with plans for your duties and hours Participate in your rehabilitation and return to work process Attend for regular review with your doctor or other specialists on the dates required When your rehabilitation is finished provide feedback to the Rehabilitation and Return to Work Coordinator about how 28 Concordia Lutheran College