We have put together information to keep injured or ill persons informed of what to expect.
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All employers play a crucial role in the prevention and management of workplace injuries.
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Information for Psychologists, Occupational Therapists, Nurses, Exercise Physiologists and Doctors.
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Other key stakeholders are also encouraged to provide Information and comments about issues of relevance .
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Months 4 to 12 Post Injury

 
The issues workers and employers face are often the same, or similar to those of their treatment providers and doctor.  The obstacles outlined and strategies suggested in the following sections may help you better understand what may be happening to stakeholders in the workers compensation system at a given point in time. Ideas are offered for supporting the various stakeholders assisting injured workers recover and get back to work.
 
Months 4 to 12 - What is happening / what should be happening? 

 More than 4 months have passed since your patient was injured and they are still in the worker's compensation system.  If all has gone according to plan the worker's  injury should have almost resolved and they  would now be upgrading to pre-injury levels.  Hopefully, any injury symptoms that have not resolved are now insignificant  and are not too limiting in terms of pain and functional restrictions for both work and non work activities. If  residual symptoms do exist but are being managed adequately, it is probable that the worker :
  •  has a good treatment team and good support. They are likely to have been  given clear information about their injury and self management strategies.
  • Is focussed  committed to doing what is necessary to self manage.
  • activities they found difficult are either done another way or by someone else so that the  injury is not aggravated
  • sports or hobbies once undertaken that  may are now unable to be performed in full capacity  are either being performed  in a modified. Alternatively,  other  interests, sports and activites to  relax have been taken up instead.
  • has an employer who is likely to have been supportive and has helped your patient  to upgrade by providing selected duties.
 
Common Difficulties - 4 months to 12 months

For those workers who are still in the system but are finding it difficult it is probable that there are a number of obstacles and unexpected things happening which are proving a barrier.  These include:
 
Physical Injury Related Difficulties including:

  1. Severe pain and restrictions
  2. No obvious organic basis for the symptoms 
  3. More comprehensive and expensive tests such as an MRI, bone scan, and nerve conduction test haven’t been performed, considered or approved
  4. More comprehensive and expensive tests such as an MRI, bone scan, and nerve conduction test  haven’t revealed a specific problem
  5. The more comprehensive and expensive tests such as an MRI, bone scan etc. may have revealed a problem, but it is not clear what the best treatment will be.
  6. Surgical opinions have suggested “conservative treatment” be tried before any surgery is considered
  7. An alternative treatment to that undertaken in the first 3 months either hasn’t been proposed, approved or enough sessions undertaken to gauge it’s effectiveness
 
Psychological Injuries

The effects of primary or secondary psychological injuries are likely to be impacting on treatment and rehabilitation responsiveness and to the injured worker's general sense of wellbeing.
 
Primary psychological injuries include:
 
  1. Trauma reactions if the accident was particularly traumatic such as a significant industrial accident, an armed hold up, assault, or a significant motor vehicle accident whilst travelling from one job site to another.
  2. Other psychological injuries including bullying and harassment
  
Secondary psychological injuries may be due to:
 
  1. Significant ongoing pain that is affecting everyday functioning in most areas of life.
  2. Significant functional limitations affecting everyday functioning in most areas of life.
  3. Sleep deprivation form pain and worry.
  4. Financial problems resulting from lost wages, delayed payment of expenses.
  5. Family tension having a family member unable to contribute to the household as before.
 
What treatment providers need  to consider, including the NTD:
 
The NTD plays a key role in the management and support of the injured worker, particularly when the injury is significant and there are multiple barriers to recovery and successful rehabilitation. It is important that the worker  and support team has the back up of a skilled NTD who is:

  • Experienced as a GP generally
  • Experienced with managing compensation claims
  • Empathetic and understanding of the issues associated with workers compensation injuries
  • Efficient and organised.

It is essential  that the injured worker's NTD is proactive in management and  

  • Helps to provide preventive strategies to minimise secondary injuries,
  • Will instigate or is responsive to suggestions for referral to specialists and treatment provides who can support the injured worker  psychologically through psychological counselling, pain management and injury adjustment counselling.
 
 
Problems with the Employer

It was mentioned in the doc “1-3 months” that occasionally industrial and workplace issues prove to be a major barrier to an injured worker returning to full or near full capacity in their pre-injury job. Problems cited included:
 
  • An employer being reluctant to accept an injury is work related (despite liability being partially or fully accepted by the insurer) and is therefore also reluctant to support the restrictions made on the medical certificate.
  • An employer not being aware or being unwilling to accept their obligations to provide suitable duties for an injured worker
  • An employer agreeing to provide but then not accommodating the restrictions or hours on the medial certificate.
  • Lack of management and co-worker support - an attitude that the injured worker is a malingerer, weak or not pulling their weight and therefore “dragging the chain”.
  • Subsequent problems with the injured worker being fearful of returning to work
 
Four months after injury it should be clear for most workers, (and their rehabilitation provider) what the attitude and support from their employer is likely to be when they attempt to return to work. Some helpful and constructive  attitudes  and responses to employers from injured workers and their  rehabilitation case manager include:
 
  1. An awareness of the challenges the employer faces and be understanding of their situation
  2. Trying  to discuss employer concerns with key staff
  3. Making sure that the rehabilitation provider is  experienced and  is a good negotiator and mediator.  They can be helpful in explaining the situation and getting support for common goals acceptable to all parties
  4. Considering mediation if suggested
  5. If all else fails discussing alternate work directions with the NTD and rehabilitation provider.
 
Problems with Treatment

There are a number of potential issues at this stage concerning treatment and responsiveness. Many of the issues in the first 3 months cited previously continue to slow progress. These include:
 
  • The treatment being inappropriate for the injury. The correct diagnosis may still not have been made or more information needs to be available before the most appropriate interventions are recommended. This may involve referral for a more sophisticated test, such as an MRI because rest and interventions such as physiotherapy are exacerbating symptoms or having no positive results.
  • Treatment may have been too early. For example, a gym strengthening program ordered prematurely,  could lead to further problems with recovery or re-injury.
  • Quality of treatment may be lacking and "treaters" may have poor "bedside manner". This could lead to a lack of engagement in treatment and therefore reduce patient motivation and commitment
 
Access to treatment can be an issue. This can be caused by:
  • The Agent still not approving necessary treatment (as deemed as unreasonable and unnecessary)
  • Ongoing extended delays with approval and therefore commencement of treatment
  • Ongoing conflicting opinions  between the injured worker's team, the NTD, and the Agent about the best way to treat and manage an injury.
  • Extensive delays in getting an appointment with a specialist.
  • Delays in being seen by treaters or for follow-up appointments
 
Insurer/ Agent Issues
 
Many of the problems injured workers face if they remain in the system after 4 months are likely to come from the agent. These are summarised below.  Suggestions are  made about ways you can encourage your patient to be proactive in addressing the difficulties.
 
Agent Related Challenges Affecting Injured Workers - 4 Months To 12 Months Post Injury

Problem 
Suggested strategies
Wages not paid on time by agent 
  • Make sure medical certificate is current and forwarded, if there is a pattern of “ we didn’t get it” suggest your patient call the agent after faxing to ensure they have received it
  • If problem is persistent   - i.e. more than 3 times within a 3 month period suggest they  make a verbal complaint to a supervisor
  • If this doesn’t resolve suggest  contacting Work cover’s help line
  • If further problems occur suggest making a formal written complaint to WorkCover and The Agent’s complaint service detailing what happened   and when.
Wages not paid by employer
  • While the goal of RTW same employer remains, the wage to the injured worker is usually paid through the employer. The employer pays what they are required to pay, i.e. for the amount of hours the person is certified to work - the agent pays the remainder through the employer. When no pay is received it is usually necessary for the worker  to initially call the employer.  If the matter still isn’t resolved satisfactorilysuggest they call the agent.
  • If the problems persists suggest they call Workcover’s help line and/or speak to their solicitor
  • Some rehabilitation providers can help with issues of wages and entitlements
Wages do not appear correct
  • Encourage the injured worker to discuss with agent and find out the basis of their calculations
  • If the injured woker has documentation to support what they claim is correct suggest they forward a copy to agent
  • Suggest they consider discussing the issues involved with their  solicitor.
Expenses for travel to medical appointments and or medication are not reimbursed by insurer or there are extensive delays
  • Suggest the injured worker initially call the agent and their claims manager to ascertain whether the documentation has been received and ask when  will it be processed.
  • If payment is not forth coming suggest they consider calling    Workcover's help line.
Insurer ignores a request for a procedure or support service - e.g. home help, treatment referral. 
Suggest the injured worker consider the following:
  • Making sure NTD has identified the service need on medical certificate
  • Making sure NTD has made specific referral for the procedure or service
  • Making sure the agent has received and on what date
  • Identify Workcover guideline on time frame the agent is required to make a response
  • When that time has passed call agent and continue at least weekly for 3 occasions.
  • If there is still no response suggest they call Workcovers.support service.
  • contacting their solicitor
 Have a support a service or referral refused by the agent including your own 
Suggest the injured worker consider the following, and or undertake yourself:
  • Make sure that the reasons are in put in writing
  • Try and find out why - often the feedback is given to the provider of the service if they make the request rather than the injured worker.
  • Attempt to get a copy of the document rejecting a service -
  •  Discuss with the agent  - sometimes agents want more information and the onus is on the provider to forward the requested information
  • If no results, advise the injured worker to contact their solicitor and ask for help
Agent refers for an Independent Medical Assessment and the opinion is significantly different concerning the plan of  management for the injury than that  of the NTD and other.memebers of the worker's treatment team.
   Suggest the injured worker consider the following:
  • Discussing  with their NTD, including the implications.
  • Advising the injured worker that the NTD ultimately has responsible for managing the injured worker's   injury and although the agent can attempt to influence a course of treatment, they cannot enforce it.
  • If treatment does not appear to be progressing however “independent assessments” are sometimes arranged to reassess the liability the insurer has for managing the injury and claim. Sometimes the opinion of the Independent assessor is that the injury has now resolved, or is no longer work related.  This can be the basis of the agent declining the claim. All treatment and wages are then terminated.
  • Good communication between treating professionals and the agent can reduces the chance that the agent will take this stance. Sometime however actions are directed top down and there is very little an individual claims officer can do.
  • If a claim is declined it is essential that the injured worker gets a legal opinion outlining available options.
A Work Capacity Assessment is carried out and the findings are inconsistent with the injured worker's injury experiences, feedback from their  treatment team, and  from their perceived real work capacities and work experience
At this point time there are no mechanisms in place to challenge work capacity decisions except on procedural grounds – I.e. not enough time allowed to attend assessment, assessment not submitted within time frames.  The issues involved with the newly established Work capacity assessments (including the right to legal representation to contest assessment findings) are currently being worked out
 
Poor Communication between Stakeholders 

If information is not provided to agents, employers and treatment providers who are trying to support a worker to get better or return to work, inappropriate strategies and counterproductive attitudes in communication may result. Employers who are not given clear guidelines on what duties should or shouldn’t be undertaken may provide work that is beyond the injured workers capacity that results in re-injury, or at least tension and friction if the worker then refuses to do the task.
 
What an be done  about it

Case conferences with all parties can be very effective in improving communication. All treatment and rehabilitation team  members can help to facilitate this by suggesting tele- conferencing and face to face conferencing with all key stakeholders.

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