EHR524 Workplace Assessment & Rehabilitation PDF

EHR524 WORKPLACE ASSESSMENT AND REHABILITATION WEEK 1 – LECTURE OVERVIEW OF WORKPLACE INJURY MANAGEMENT Karina Liles (ESSAM AEP, AES) E: [email protected] Ph: (02) 6338 4102  What is Workers Compensation? Worker’s compensation is income replacement payments, reimbursement of hospital...

EHR524 WORKPLACE ASSESSMENT AND REHABILITATION WEEK 1 – LECTURE OVERVIEW OF WORKPLACE INJURY MANAGEMENT Karina Liles (ESSAM AEP, AES) E: [email protected] Ph: (02) 6338 4102  What is Workers Compensation? Worker’s compensation is income replacement payments, reimbursement of hospital and medical costs and lump sum payments for permanent incapacities and fatalities made to Workers (or their families) injured or made ill in the course of their work ‒ The payments are funded by worker’s compensation schemes, which are themselves funded by a compulsory levy imposed by governments on employers to cover their potential liabilities associated with injured employees ‒ Schemes currently cover 88% of the workforce (~ 9.99 million Workers) ‒ The schemes do not cover the self-employed, sole traders and independent contractors (about 1.36 million people) who need to take personal injury insurance through private sector insurance 2 What is an Injured Worker entitled to? If a Worker suffers a work-related injury or illness, the policy can pay for weekly benefits or income replacement while they are recovering from their illness or injury Medical and hospital expenses and treatment and a range of other services to help the Worker recover Other services can include (but not limited to) household assistance or domestic chores, aids and appliances etc. Return to work assistance which includes return to work planning and rehabilitation to ensure a safe and efficient return to work. This may include workplace modifications or vocational retraining programs which are determined by allied health professionals such as Physiotherapists, Occupational Therapists, Psychologists or Accredited Exercise Physiologists. 3 What is an Injured Worker entitled to? Death benefits, special provisions for children and funeral costs Lump sum compensation for permanent impairments or disability (National Guidelines for the Evaluation of Permanent Impairment): WPI (Whole Person Impairment) 4 Who is eligible? Australia’s schemes are a no-fault scheme — that is an Injured Worker does not need to prove negligence on the part of the employer There are three preconditions to receiving compensation: ‒ The Worker is an employee as defined in the law of their jurisdiction ‒ The Worker has a medical condition that was diagnosed by a qualified practitioner who stated that the condition arose out of or in the course of employment ‒ The Worker has suffered a financial loss (such as loss of income or has incurred medical costs) Worker’s compensation is not given for general ‘harm’, such as hurt feelings or emotional distress or as the result of discrimination 5 State-Based Schemes 6 State-Based Schemes 7 NSW – A Closer Look 8 Important Reference Document for EHR524 Safe Work Australia: Comparison of Worker’s Compensation Arrangements in Australia and New Zealand, 2023 – 29th Edition https://www.safeworkaustralia.gov.au/doc/comparison-workers-compensation-arrangements-australia-and-new-zealand-2023 9 Australian Worker’s Compensation - Statistics https://www.safeworkaustralia.gov.au/doc/australian-workers-compensation-statistics-2020-2021 10 Australian Worker’s Compensation - Statistics 11 https://www.safeworkaustralia.gov.au/doc/australian-workers-compensation-statistics-2020-2021 Key Definitions Serious Claims ‒ Includes all accepted worker’s compensation claims involving temporary incapacity of one or more weeks, plus accepted claims for fatality or permanent incapacity. Frequency Rate ‒ The number of serious claims per million hours worked. 12 Australian Worker Fatalities https://data.safeworkaustralia.gov.au/insights/key-whs-stats-2023 13 Australian Worker Fatalities 14 Australian Worker Fatalities 15 Australian Worker’s Compensation Functions 16 Australian Worker’s Compensation Functions 17 Work-Related Injury – The Process A claim is lodged through a doctor (NTD, usually the injured worker’s GP) following discussion of the injury/ incident. Your doctor will develop a Certificate of Capacity documenting details of the injury / incident. The Certificate of Capacity is then provided to the Employer ‒ Once a claim has been made, it is allocated to the Insurer to determine liability ‒ The Insurer determine liability for claims as quickly as possible and will generally contact both the Worker and employer within three business days of the claim being made ‒ The Insurer gathers information from the Worker, employer, doctor(s) and other people, such as witnesses to the event or independent medical examiners, to help make their decision 18 Work-Related Injury – The Process Once they've gathered enough information to make a decision on liability, both the Worker and the employer will be informed of the decision If your claim is accepted, and payments are to be made to you, we will ask for your bank details to pay you. If your claim requires ongoing management or assistance with return to work, it will be case managed by a case manager. Claims can be declined on the basis of one of the following reasonable excuses: – Insufficient medical information – Injured person is not an employee – The injured person cannot be contacted – The worker refuses to release information about the injury – The injury is not work related – The injury was notified two months or more after it occurred 19 Other Types of Claims Depending on the type of injury or how the injury happened, the Insurer may require further information and apply slightly different criteria. These types of claims include: ‒ Psychological and psychiatric injuries ‒ Industrial deafness ‒ Injuries sustained on journeys to and from work or on breaks such as morning and afternoon tea and lunch ‒ Continuation or aggravation of an injury ‒ Asbestos related diseases or diseases contracted in the course of employment, for example Q-fever ‒ Fatalities caused by a work-related event or by latent onset injuries such as mesothelioma or malignant skin cancer 20 Liability Timeframes When Workers and employers provide true and accurate information about the claim, a decision on liability can be made very quickly A decision on a claim can take up to 21 days, especially if there is difficulty obtaining the required information The Worker or employer can request to have the claim reviewed by the Workers' Compensation Regulator if unhappy with the reasons provided for declinature 21 Rehabilitation and Return to Work Return to work means assisting injured workers in staying at or getting back to work. The aim of the return to work and rehabilitation provisions in Workers’ compensation legislation is to provide for the safe, timely and durable return to work of the injured worker The Return to Work Plan (RTWP) involves the employer, the Worker and the insurer and may also involve workplace rehabilitation coordinators, rehabilitation providers, medical and other health professionals. This will depend on the Workers’ compensation legislation in each jurisdiction and the severity of the Worker’s injury 22 Rehabilitation and Return to Work A successful return to work can be assisted by the following factors: ‒ Ensuring that workplace psychological and/or physical hazards are addressed appropriately ‒ Early intervention ‒ An effective workplace-based rehabilitation program and RTWP ‒ Effective claims management ‒ Co-operation, collaboration and consultation between all parties involved 23 Case Management Workplace rehabilitation requires effective communication between key stakeholders to ensure a safe and efficient return to work for the injured worker Key stakeholders include: Injured worker Employer Insurer / Case Manager Rehabilitation Provider Nominated Treating Doctor / Treating Specialist (NTS) Treating Professionals e.g. Physiotherapist, Psychologist, AEP’s 24 Process Overview 25 Roles and Responsibilities - Employer The employer must: Ensure the health, safety and welfare at work of all Workers Have a Worker’s compensation insurance policy covering all employees Initiate development of a Return to Work Program with the commencement of business operations and have the program in place within 12 months of becoming an employer Develop, implement and review the Return to Work Program in consultation with Workers and relevant unions at least every two years Produce the program in printed form Display a summary of the program prominently in workplaces Display, at a minimum, a summary in the workplace of the Workers Compensation legislation about giving notice of an injury and the making of a claim 26  Roles and Responsibilities - Employer Appoint a trained Return to Work Coordinator with the necessary qualifications, authority and resources to negotiate, develop and implement return to work policies and procedures and nominate Approved Workplace Rehabilitation Providers in consultation with Workers and relevant unions Maintain a register of injuries in which Workers record details of work-related injuries Notify the insurer of all workplace injures within 48 hours Repay the insurer the equivalent of one week of the injured worker’s weekly compensation if the injury is not notified within five days of the employer becoming aware of the injury Keep a record of wages paid for at least the previous five years (failure to comply may result in a fine of $500 or prosecution with a penalty of up to $55,000) Provide wage information to the insurer within 7 days of request from insurer or receipt of information 27 Roles and Responsibilities - Employer Notify the State Regulator of serious incidents Not dismiss an injured worker because of the injury within six months of the Worker first becoming unfit for employment Provide Workers with adequate information about Workers compensation and return to work procedures, including their choice of doctor and rehabilitation provider and how to change providers, if required Advise the Worker’s NTD and insurer on the requirements of the Worker’s usual job and availability of suitable duties Make suitable duties available to injured workers who are certified fit for suitable duties (partially incapacitated) if reasonably practicable to do so 28 Roles and Responsibilities – Injured Worker The Worker must: Cooperate with the employer to prevent work-related injuries to self and others Cooperate with the employer to enable the employer to meet their return to work obligations Cooperate in workplace changes designed to assist the return to work of fellow Workers if injured Notify the employer of a workplace injury as soon as possible after the injury happens Specify one nominated doctor or medical practice who is prepared to participate in the development and implementation of an injury management plan Give consent for the NTD to provide information for the purposes of an injury management plan (IMP) and RTWP 29 Roles and Responsibilities – Injured Worker Participate and cooperate in the establishment of the initial and subsequent IMPs Make all reasonable efforts to return to work with the pre-injury employer as soon as possible Comply with the activities detailed in IMPs Advise of any difficulties with return to work as soon as practical to prevent delays in addressing any problems. If the injured worker unreasonably refuses to comply with their IMP, the insurer can suspend weekly benefits. Before suspending benefits, the insurer must write to the Worker stating the reasons for suspension and what the Worker must do to prevent the suspension. 30 Roles and Responsibilities – Insurer The Insurer must: Ensure that employers are made aware of their legislative obligations in relation to the insurer’s injury management program Within three working days of being notified that a Worker has sustained a significant injury, contact the employer, Worker and (if necessary) the NTD. Subsequently, the insurer must develop an IMP in line with timeframes in the insurer’s injury management program Within seven days of being notified by the employer (or the Worker, or another person) that a Worker has sustained a significant injury, begin provisional payments of weekly benefits and medical expenses, or advise the Worker and the employer why they will not make payments (NSW specific) Consult with the Client, employer and NTD in the development of an IMP Provide the injured worker, employer and NTD with information on the IMP initially and as the plan progresses 31 Roles and Responsibilities – Insurer Inform the Worker that their entitlements to weekly benefits can be suspended if they do not reasonably comply with their IMP and what they must do to prevent the suspension Have procedures in place for an injured worker to change their NTD and inform the injured worker of these requirements Consult with the injured worker, employer and NTD when referring to a workplace rehabilitation provider. Advise the injured worker that they can choose a rehabilitation provider and inform the injured worker of the process to be followed when changing a rehabilitation provider Ensure vocational retraining and/or assistance to obtain employment with a new employer is arranged for an injured worker as soon as it is identified that a return to pre-injury duties and provision of suitable duties is no longer possible 32 Roles and Responsibilities – Insurer Ensure accuracy of payment of weekly benefits in accordance with wage as advised by the employer and legislative requirements Provide the injured worker with information about their weekly benefits and entitlements and how they may change over time 33 Roles and Responsibilities – NTD The NTD must: Complete Certificates of Capacity Arrange and monitor appropriate treatment Specify medical restrictions and advise on the suitability of duties offered by the employer Provide information to the insurer and employer in relation to injury management and return to work plans for the injured worker Certify time off only if it is medically necessary Promote an early and safe return to work of the worker Review the progress of recovery of the injured worker and revise the worker’s medical management as needed 34 Roles and Responsibilities – NTD Arrange referral to an approved workplace rehabilitation provider, if required, and if not initiated by the employer or insurer Advise employer / insurer on availability for discussion about injury management and return to work 35 Certificate of Capacity – NSW (SIRA Document) 36 Certificate of Capacity – NSW (SIRA Document) 37 Certificate of Capacity – NSW (SIRA Document) 38 Roles and Responsibilities – Independent Medical Examiner (IME) IME: Independent medical examiners do not provide advice to workers about their condition, treatment or workers compensation claim The independent medical examiner's report may include advice on accepting a claim, the insurer's ongoing liability and the worker's level of capacity for employment and ongoing treatment If they believe another type of treatment might assist the worker, they will mention it in their report and may contact the worker's NTD to discuss treatment options The independent medical examiner report is forwarded to the person who requested it (usually the insurer) 39 Roles and Responsibilities – Workplace Rehabilitation Providers Workplace rehabilitation providers are engaged to provide specialised expertise in addition to what is generally available within the employer’s and insurer’s operations. Depending on the jurisdiction, workplace rehabilitation providers can undertake a range of services from functional and workplace assessments and advice concerning job modification, to vocational retraining and assistance with job seeking. 40 Roles and Responsibilities – Workplace Rehabilitation Providers Rehabilitation Providers: Deliver services to workers, employers and insurers in a cost effective, timely and proactive manner to achieve a safe and durable return to work Promote an early and safe return to work of the worker Ensure the needs of the worker and employer are identified by means of adequate and appropriate assessment 41 Roles and Responsibilities – Workplace Rehabilitation Providers Identify barriers to injured worker’s return to work and develop strategies to address these Identify and design suitable duties for the worker to assist the employer to meet their obligations in providing suitable employment Identify and coordinate rehabilitation strategies that ensure the worker is able to safely perform their duties Consider workplace industrial relations and human resource matters that may affect the worker’s return to work Focus initially on return to work in the worker’s pre-injury employment or, if that is not possible, on other employment in line with the hierarchy of return to work Arrange appropriate retraining and placement in alternative employment when the worker is unable to return to pre-injury duties Communicate with relevant parties throughout service provision to ensure progress towards the return-to-work goal. 42 Roles and Responsibilities – Workplace Rehabilitation Providers The services available from a Workplace Rehabilitation Provider include: ‒ Initial rehabilitation assessment ‒ Functional assessment ‒ Workplace assessment ‒ Job analysis ‒ Advice concerning job modification ‒ Rehabilitation counselling (N/A for exercise physiologist) ‒ Vocational assessment and counselling (N/A for exercise physiologist) ‒ Advice or assistance concerning job seeking (N/A for exercise physiologist) ‒ Advice or assistance with vocational re-education or training (N/A for exercise physiologist) ‒ Work conditioning ‒ Functional education 43 Roles and Responsibilities – Workplace Rehabilitation Providers Additional services include: Identification of suitable duties Monitoring of return to work on suitable duties Identification and placement in suitable employment 44 AEP – Purpose of Intervention for Treatment Provide treatment to alleviate symptoms of illness, disease or injury Restoration of physical function, health and wellness Provide education on physical activity Prevention of illness, disease or injuries Provide health advice and support Lifestyle modifications Behavioural changes 45 AEP – Providing Treatment to an Injured Worker 1) Complete Initial Consultation: Expectations of exercise prescription and recovery following injury is to be discussed What would you discuss with an injured worker during the initial 2) Communicate with relevant stakeholders consultation to relay the Who are relevant stakeholders and what should above expectations? be discussed? 3) Treatment is deemed reasonable and necessary What does this mean? 4) Complete jurisdiction documentation (AHTR in NSW) 46 AEP – Reasonable and Necessary Criteria 1. Directly related to the injuries sustained in the work- related injury or motor vehicle accident (CTP) 2. Aimed at helping the injured person get back to their usual activities, with a primary focus on work activities 3. Appropriate for the type of injury 4. Provided by an appropriately qualified health professional 5. Cost effective 47 AEP – Initial Assessment The assessment can include: ‒ Injury and anatomy education ‒ Physical examination ‒ Clinical testing – range of motion, posture analysis, gait analysis, manual muscle testing, strength testing, endurance testing, flexibility testing and anthropometric measures, amongst others ‒ Identifying exercise and RTW barriers ‒ Goal setting ‒ Completion of jurisdiction required documentation 48 AEP – Treatment Methods Treatment methods must be evidence-based and can include: ‒ Gym based ‒ Pool based (hydrotherapy) ‒ Home based exercises ‒ Exercises for their work environment ‒ Increasing bodily movement (ROM, stretching or flexibility) ‒ Cardiovascular or aerobic exercises (need a specific justification) ‒ Strengthening (with or without equipment) ‒ Yoga/ Pilates (need a specific justification) ‒ Manual handling education ‒ Pain management strategies ‒ Breathing strategies and techniques ‒ Postural and gait analysis 49 Readings and Resources Comparison of Workers’ Compensation Arrangements in Australia and New Zealand - 29th Edition. (To be used as a reference guide throughout the duration of the subject). Australia and New Zealand Consensus Statement on the Health Benefits of Work. Returning to Work as an Injured Worker (YouTube). http://www.youtube.com/watch?v=WcCh5-osuOc 50