When to Refer to a Rehabilitation Provider
One of the many roles your insurer / agent has is to monitor progress of a claim and injury and to
determine if there are any other services that need to be included to promote
recovery. One type of service
required and frequently referred to is the accredited rehabilitation service
provider.
When the Agent or Eployer should make a Referral
Referrals to
rehabilitation are advisable when:
- Issues
arise concerning the worker returning to work (rtw) with the same employer
- Suitable
duties cannot be identified
- The
injured worker cannot RTW with same employer or in the same job
- There are
difficulties in the worker RTW in the same job, a similar job or different job
with same employer
- Employer-employee
relations are problematic
- The
injured worker needs vocational retraining and redirection
- The
injured worker needs to establish a new vocational goal
- Job
seeking assistance is required to locate suitable employment
- Functional
limitations need to be explored to increase suitable duties certification
- Extra assistance
is required regarding monitoring of RTW capacities
- There is a
need for more face to face contact and monitoring of the injured worker
- RTW
progress needs to be monitored closely
For small to medium size employers it is most likely that the agent will be the chief manager / "expert" on the direction of a claim. It is also likely that they will be the instigator of most referrals to external rehabilitation providers. All agents have their"preferred providers". These providers have contracts with the agent that are cost driven and are consitent with the agent's business model and injury management philosphy. Although the agent's preferred providers may initally be marketed and presented as the the most cost effective service for your business, they may not necessarily be the best and most cost effective service in the long run. This is partiualry the case when the injury and claim is complex and there are multiple stakeholders involved.
Why: Because agent's preferred providers are frequently medium to large employers whose focus is on appeasing the agent with a low cost structure, but promise of a quick return to work outcome, and /or service to assist in claim finalisation. To be able to do this, a significant percentage of staff employed are junior staff, fresh from university with little work experience and injury management knowlege. Often they are offered limited training and limited ongoing support - their primary objective to facilitate quick fix injury management practices. Unfortunertaly this practice , along with a number of other stresses associted with the industry results in a very high rate of staff turnover. It means the injured worker and you as the employer are likely having to regualry deal with a new case manager, and someone who is unfamilar with the case. With simple and non complex claims this model can be adequate, however when the claim and injury is complex and there are multiple stakholders involved, an experienced rehabilitation provider and case manager with excellent communicaion and negotiation skills are essential.
You as the employer can choose the rehabilitation provider for your worker rather than your insurer and can continue to have control over the
claim and its direction.
How to Refer to a Rehabilitation Service Provider?
- Identify
appropriate provider; bearing in mind that the IW may have a rehabilitation
provider of their choice.
- Phone
rehabilitation provider and advise of incoming referral.
- Fill out
the referral sheet and email or fax.
- The
referral sheet should include information from claim forms and an up to date
account of events so far, services requested and when you want them to occur.
- If
appropriate, send copies of claim forms, medical certificates and reports to
date.
Evaluating Performance
- Rehabilitation
provider’s performance needs to be monitored closely to prevent performance falling
below accepted standards.
- Do not be
fearful of asking questions, giving feedback or requesting more detail be
entered in reports. This will ensure quality service and help the injured
worker RTW more quickly.
Evaluating Specific Assessments and Interventions
The content
within reports should include:
Initial Assessment:
- Detailed
account of current injury situation, RTW barriers, strategies to deal with barriers,
time frames and costs.
Functional Assessment:
- Clearly
defined limitations and restrictions.
- Goals and
recommendations that are realistic, innovative and are not “sausage-machine
driven”.
Vocational Assessment:
- Education
and employment experiences to date.
- Work
Skills including skills acquired to date, skills effected by injury and
transferable skills.
- Expressed
work interests.
- Literacy
level, aptitudes - Tests used, scoring and interpretation.
- Labour
market analysis – not just job supply – must include demand e.g. relative
competitiveness for entry into identified jobs.
- Potential
barriers to employment and strategies to over come these.
- More than
2 jobs listed in recommendations that are realistic, innovative and achievable
in context of worker’s injury, skills experience and current labour market.
Workplace Assessment:
- Detailed
account of session
- Realistic
suitable duties and modifications that are in place and if there are none – an
explanation as to why.
Progress Reviews:
- Should be
individually tailored to each case.
- Must
contain goals that were established, plans implemented and results achieved in
the last month.
- A list of goals, and strategies that
have been implemented. A plan of what will be implemented over the next month.
- Job
seeking assistance reports comprise monthly progress reviews. The insurer must be informed about the
number of jobs searched for and progress. If job seeking comes to a standstill,
the rehabilitation provider must devise new strategies to help injured worker
RTW rather than continue with old strategies that are no longer relevant and
not working.
Closing Report:
- Must summarise
interventions to date and outcomes, and reasons for closure.
