return to work assessment service

Return to work assessment services29 May 2014

Leanne HoManager, Allied Health and Return to Work Services

Return to work assessment service

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1. Background

2. Expectations of service

3. In context

PURPOSE: To provide you of Return to work assessment services “in practice” from 1 July 2014

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Return to work services

1. Pre-injury

employer

First Implementation

Oct 2013

1 new service – implemented 14th

April 2014

Changes July 2014

2. Fit for work

Full Implementation

1st July 2014

Job placement

Scaled implementation

Oct 2013

Full Implementation

1st July 2014

3. Return to work

assessment

1 new service – implemented 14th

April 2014

Full Implementation

1st July 2014

2. Restoration

to the community

Full Implementation

1st July 2014

Mediation

Implemented December 2013

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NES

Physio / OT / Psych

RtC

PIE

Workplace rehabilitation provider services

Return to work services fee schedule

FFW

RTWAssmt

Mediation

PIE JPS

RtC

1 July 2014

Medical expert rehabilitation services

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Occupational therapist

• Functional capacity evaluation and report

• Graduated return to work program and report

• Job analysis and report

• Worksite assessment and report

Physiotherapy

• Functional capacity evaluation and report

• Graduated return to work program and report

• Job analysis and report

• Worksite assessment and report

Psychologist

• Vocational assessment and report

Pre-injury employer service

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JAGRTW

WSA

RC

Worker

Employer

RTW provider

Worker

Employer

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INA

RRTWP

JA

WSA

CCRRTWP

What we expect of Return to work services….

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Focus on service

Reduced delays

Reduced disruption

Accountability in delivering the right service

Purposeful service

Reduce medicalization

Worker

Employer

Case manager’s tool kit

Return to work assessment services within the case manager’s tool kit

• Targeted and specific scenarios

• Where return to work services are not involved

• Where return to work services are not able to provide the required information

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Return to work assessment services

Class A RTW Consultant

Physiotherapist

Occupational therapist

Psychologist

Exercise physiologist

Rehabilitation counsellor with full membership with ASORC or RCAA

Class B RTW Consultant

Meet the HWCA minimum qualification requirements

Do not meet the criteria for class A return to work consultants

$170.20 per hour $138.50 per hour

2 years FT clinical experience

OR

1 year FT as a class B consultant supervised by a Class A consultant

2 years FT membership and experience

Who are return to work consultants?

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Return to work assessment services

Agent case conference

support service

(including travel*)

Up to 4 hrs Class A / B

(ALL)

Return to work goal

verification service and

report (including travel*)

Up to 9 hrsClass A (ALL)

Worksite assessment and report

(including travel*)

Up to 6 hrsClass A

(Physio / OT / Psych)

Functional capacity

evaluation and report

Up to 7 hrsClass A

(Physio / OT)

Vocational assessment and report

Up to 7 hrsClass A / B

(Psych)

Suitable employment assessment and report

Up to 6 hrsClass A / B

(ALL)

NEW NEW CHANGE

*Additional travel for regional areas applicable where criteria met

Agent case conference support service

Service overview

• Service to assist the case manager in their Agent case conferencing (Agent claims review) Agent case conferencing ≠ Traditional case conference

• Each service may have different requirements (information required, method of obtaining)


Return to work assessment

• To assist the case manager in their Agent case conferencingPurpose

• Not concurrent with pre-injury employer service• Not concurrent with fit for work service Consideration

• Determine what information required• Determine the method you would like to receive this

information• Communicate with consultant after sending referral

CM action


Referral scenarios

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Insufficient information to conduct Agent Claim Review

SERVICE: Gather info from involved parties, in support of

Agent claim review

Presence at a case conference

SERVICE: Facilitate a case conference, with agenda guided

by CM (at Agent, or treating practitioner’s

rooms)Expertise to review file is

required

SERVICE: Provide specialist review on return to work

management

What is expected

• Who delivers this service?• 14th April – 30th June: currently appointed workplace

rehabilitation provider ($135.30 hourly rate)• 1st July onwards:

• Class A ($170.20 hourly rate) • Class B ($138.50 hourly rate) • RTW Consultants of appointed Return to work services

provider

• What is included?• Up to 4 hours of service, including travel if required• Provision of a brief summary report• Communication with parties as requested by case manager

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Agent case conference support service (14/4/14)

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Return to work goal verification service and report


• To provide an independent opinion of the availability of suitable employment at the pre-injury employer Purpose

• Return to work goal is pre-injury employer• Clarification is required to review the return to work goal

where suitable employment is uncertain• A previous Level 1 or 2 Intervention has previously been

delivered (attempt to return to work)

Consideration

• Make referral to an independent PIE provider• Provide copies of previous return to work service reportsCM action


Referral scenarios

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Long term sustainability of worker returning to pre-injury

employer is unclear

Dispute in return to work goal direction between parties

Second opinion is required to review the durable suitable

employment options available prior to changing return to work

goal

What is expected

• Equivalent to Level 1 Intervention Pre-injury employer service• Assess the physical and / or psychological demands of duties at

the workplace and recommend for appropriate workplace modifications where required to accommodate a worker’s medically certificated work capacity

• PLUS explore and exhaust any suitable employment options with the pre-injury employer

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• Who delivers this service?• Class A RTW Consultant

• What is included?• Level 1 Intervention pre-injury employer service such as:

• Review of history and return to work progress• Attendance at workplace to review suitable employment options • Explore and exhaust all suitable employment options with pre-injury

employer• Recommendations for workplace modifications or equipment where

necessary • Up to 9 hours of service, including travel

• Provision of a Return to work goal verification report including recommendation for the RTW Goal (PIE or NES)

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• Ensure a safe return to suitable employmentPurpose

• Expert opinion is required to identify suitable duties

• No concurrent PIE, FFW referral

Consideration

• Make referral• Ensure no implementation service is

requiredCM action

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Referral scenarios

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Treating doctor expresses concerns about certifying

worker’s return to workWorker’s employer requires

advice regarding suitable employment in the workplace to

facilitate return to work

New employment is identified and workplace design,

modification advice is required for safe and durable return to

work


• Who delivers this service?• Class A RTW Consultant – Occupational Therapist,

Physiotherapist, Psychologist

• What is included?• Attendance at the worksite with worker, and employer• Establishing worker’s capacity to undertake duties and individual

tasks• Identification of suitable duties• Recommending workplace modifications where necessary to

accommodate worker’s return to work• Up to 6 hours of service, including travel• A worksite assessment report

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Functional capacity evaluation and report


• Determine the worker’s capacity over a range of physical demands to make

recommendations for participation in workPurpose

• No more than one FCE in an 18 month period

Consideration

• The required information about capacity is not available through other

meansCM action

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Referral scenarios

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Treating doctor requires clarification of the worker’s

functional ability to appropriately certify Treating health practitioners are

not able to provide sufficient assessment of worker’s full

functional abilities

Complex claims


• Who delivers this service?• Class A RTW Consultant (Physio / OT)

• What is included?• Review of medical information provided by the requestor• Identification of potential return to work goals and options for

which the FCE is required• Assessment of worker’s functional abilities to perform the

physical demands of the proposed job(s) and determine whether the worker has the capacity to undertake these demands

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Suitable employment assessment


• Identify suitable employment options for the workerPurpose

• Job goals are expected to be real jobs, that are currently available in the marketplace

• Suitable employment goals are to support the worker in achieving durable paid employment

Consideration

• Where suitable employment goals are not already identified within other return

to work services (e.g. FFW, JPS)CM action

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Referral scenarios


Where return to work services is not involved e.g. worker is independently job seeking

Legal requirement for claims purposes

Due to worker’s circumstances, a more robust assessment, functional and practical is

required to prepare the worker for JPS

Vocational assessment


• Evaluate the worker’s actual and potential ability, cognitive skills, aptitudes and competencies, and

relate these to suitable employment options for the worker

Purpose

• Psychometric testing to be conducted by a psychologist

• Integrated clinical and standardised assessment procedures and instruments

Consideration

• Where existing assessments are not sufficient in identifying suitable employment options for worker

CM action

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Referral scenarios


Where suitable employment option identified requires re-

training where there is no evidence to demonstrate worker’s ability to meet

demands

More robust psychological assessments are required to

assess the suitability of a suitable employment goal

return to work assessment service

Documents