Worker’s Compensation & Injury Management

Information SessionBarry Chaplin – Claims Manager

Katy Carr – Injury Management Consultant

Jeannie Marlow – Injury Management Consultant

Worker’s Compensation and Injury Management Act 1981

• Under the Act, disability means a personal injury by accident arising out of or in the course of the employment, or whilst the worker is acting under the employer’s instructions.

• It also includes a disease, recurrence, aggravation or acceleration of any pre-existing disease where the employment has contributed to a significant degree.

Claim Procedure

• All incidents involving personal injury must be reported regardless of whether time is lost.

• A claim for compensation must be made within 12 months of the occurrence date.

• A claim must be made on the prescribed claim form 2B served on the Employer with a First medical Certificate signed by a Medical Practitioner.

Forms and templates are available from the LGIS Website

www.lgiswa.com.au

New Claim

Obtain First Medical Certificate (Additional time off work must be covered by a Progress Medical Certificate)

Complete Employee Claim Form 2B Complete an Accident/Investigation Report (if applicable) If lost time – Complete Interim Payment Authority to cover

payments from leave entitlements until a determination is made on a claim. (Please note; entitlements will be reimbursed only if the claim is accepted)

Complete Application for Expenses Reimbursement Form 9 (if applicable)

Complete Claimant’s Statement Form 7 (if applicable)

Claims Management• The Act specifies that following the receipt of a workers’

compensation claim form and First Medical Certificate a Self Insurer shall before the expiration of 17 days make a determination as to liability on the claim.

• All claims must be processed immediately and forwarded to WorkCare within 3 working days from date of receipt by Council.

• On receipt of the claim WorkCare will collate all information, determine liability and advise both the Worker and Council on the Status of the claim, ie accepted, pended or denied. (Further investigation may be undertaken in order to reach a decision)

• WorkCover will also be advised should the claim be Pended or Denied

Injury Management

• The Act requires the employer to take reasonable steps to facilitate the rehabilitation of an injured employee;

• The employer shall provide the worker with either the position the worker held before the injury or another position of comparable status and pay for at least 12 months from the date of injury;

• The Act provides for 7% of the prescribed amount for rehabilitation.

Injury Management – Key Responsilbities

• WorkCare; will assist with the injury management process on receipt of a claim

• Managers/Supervisors; to keep in regular contact with the injured employee and monitor their progress

• CEO/Directors; to support Managers in providing short and long term appropriate alternative

duties

• Employees; Must report any injury to their Manager/Supervisor as soon as practicable Obtain first aid treatment or visit their Doctor (First Medical Certificate will be

issued) Participate in an injury management program as recommended by their Doctor Keep all key parties informed and involved in the Injury Management Process

Return to work program

• The worker’s treating medical practitioner advises the employer in writing that a return to work program should be established for the worker

• The worker’s treating medical practitioner signs a medical certificate indicating that the worker has a partial capacity to return to work; or

• The worker’s treating medical practitioner signs a medical certificate indicating that the worker has a total capacity to return to work but for some reason the worker is not able to return to the position held by the worker immediately before the injury occurred.

Rehabilitation Providers• A workplace rehabilitation provider can assist the employer and

injured worker with the return to work process

• Workplace rehabilitation providers are commonly health professionals such as;

Occupational Therapists Physiotherapists Psychologists Exercise Physiologists

• Workplace rehabilitation providers assist in addressing the physical, psychological and/or workplace barriers that may prevent an injured worker from returning to work

Rehabilitation • Services provided by rehabilitation providers include;

Support counselling Vocational counselling Purchase of aids and appliances Case management Retraining & Education Workplace/Placement Activities Assessments (functional capacity, vocational, ergonomic, job demands,

workplace and aids & appliances) General reports

Benefits of Injury ManagementManaging injured workers in a professional and consistent manner has a positive impact on the organisation and sets an example for other employees on workplace culture and expectations resulting in;

• Reduction in Worker’s Compensation Claims Costs • Avoid increases in Contributions• Reduction in overheads for replacement labour• Reduction in personal hardship and suffering for the injured

employee• Demonstrates support and care from the employer• Alternate duties may result in some outstanding tasks being

completed (eg. Update safety procedures, inspections, audits)

Case Study Example

• ‘Mr Bob Smith’• 61 year old full-time Reticulation Maintainer • Felt severe pain in his left lower back on 9th March 2012, after

pulling up a retic pipe.

Medical History:• Anti-depressant medication for last 6 years.• Long history of low back pain, first developed significant pain - 1997.• MRI revealed facet joint degeneration

Diagnosis following injury on 9th March:• Lumbar back pain, due to pre-existing facet joint degeneration

• Between the vertebrae of each spinal segment are two facet joints

• As a disc thins with aging and daily wear and tear, the space between two vertebrae shrinks. This causes the facet joints to press together.

• The articular cartilage can then wear away and the 2 bony ends rub

together. The joint becomes inflamed and painful.

Claim accepted for aggravation of pre-existing condition.

Medical opinion – Occupational Physician:• Acute symptoms should settle, but there is concern whether they

settle to the extent that he can return to pre-injury work - retic.

Return to Work:• RTWP was developed by the Council• Restrictions- no digging, no bending, or squatting. 5kg weight limit.• Duties included clerical work and inspections.

Return to Work Program continued for several months, with minimal upgrading of duties. Further medical opinion advised redeployment. He can’t return to retic work. • What do you do now????

Either:

1) Do the work yourself; look at internal roles that may be appropriate.

2) Refer to a Vocational Rehabilitation Provider (VRP) who can assist in this process & look at external options too.

• Mr Smith was referred to a VRP for a Vocational Assessment. Educational background Tests (IQ test normally undertaken, but not in this case due to very low reading score)

Occupational interests Options in Council External work options

• Medical opinion is needed to ensure the new position is appropriate (may involve a FCE and/or a Worksite Assessment to inform the Doctor re the physical demands of the new job).

• External option - worktrial is sought, hopefully leads to employment.

• Most people are either redeployed to other positions in Council, or on completion of a Worktrial, are employed by the host.

• Redeployment doesn’t work out for everyone. Many reasons: limited worktrials (country locations), employee’s personality- may

just not want to work, lawyer representation. Some people end up with no employment, but still on weekly comp payments. Discuss with Claims Consultant at Workcare for advice –settlement options?

Any Questions?