Getting back in the saddleA guide to understanding the ins and outs of workers compensation

and encouraging return to work

Defining workers comp• An insurance policy that is compulsory for most employers

• Covers medical expenses for sickness and injuries that occur in course of work

BackgroundThe longer a worker is absent from work, the less likely they are to

return.

Time off work Probability of RTW within 3 months

3 months 50%

6 months 40%

9 months 33%

One year 25%

Two years 12%

Three years 6%

Four years 4%

Key terms and concepts

Certificate of Capacity: Used by insurer to help understand your capacity for work and the payments you are entitled to

Provisional liability: allows employer to pay weekly benefits and medical expenses for up to 12 weeks without admitting or incurring liability

Uninsured employers: if you employer is uninsured you can still make a claim

Time limit: Claims should be generally be made within six months of injury or illness

Making a claim• Notify employer immediately if injury or illness

occurs

• If time off work is required see a doctor and have them complete a WorkCover certificate of capacity

• Provide certificate to employer

• Cooperate with injury management plan and consult with employer’s insurer

• Make all reasonable efforts to return to work as soon as possible

Return to work (RTW)Most recover from an injury without intervention

Acute phase• 14 to 30 days no work capacity • Clinical/occupational management

Sub-acute phase• 30 to 90 days no work capacity • Assess risk and workplace rehabilitation

Chronic phase• 90 days plus no work capacity• Intensive rehabilitation

Psychological injuries• Promote Stay at Work with Doctor – time off is not necessary or

usual

• Seek specialist intervention in complex cases

• Aim to control treatment providers

Encouraging RTWSupport and empowerment

• Provide reassurance and encouragement to resume normal activities

• Be empathetic

• Communicate and educate about health benefits of work

• Set expectations around RTW process

• Empower to take responsibility

Best practiceIntegrate the best available evidence with practitioner expertise and characteristics, state, needs, values and preferences of those who will be affected.

Best practice treatment• Goal oriented

• Evidence based

• Clinically justified

• Most efficient

• Facilitates progress

Workplace rehabilitation providers (WRP)

• Provide individualised, strategic and creative interventions

• Recognise distinction between diagnosis and work capacity

• Promote a win-win outcome

• Focus on benefits of good work

• Look at cost-benefit for all proposed solutions

WRP services• Assess claims for ‘Yellow Flags’

Apply ‘SMART’ for complex claims

• Conduct case conferences and promote the bio-psychosocial model with doctors

• Develop, review and update RTW Programs

• Offer proactive job seeking

• Monitor the efficacy of treatment

• Oversee compliance

Promoting RTW• Encourage self-management

• Pay attention to psychological and social issues

• Avoid inconsistency in treatment of employees

• Involve rehabilitation providers as soon as possible