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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Problems with NTD and Treatment and Specialist Access

 
Agents are supposed to support payment for referrals to specialists, for investigations and for reasonably necessary treatments.  Problems for injured workers and re treatment providers occur when there is a delay in approval, particularly when responses are not made within the WorkCover time lines.  For initial psychological, physiotherapy, and chiropractic interventions, treatment can be commenced even without written approval for a specified number of sessions - different for each discipline - providing there is a valid claim.  This aspect of treatment has NOT changed in the 2012 legislation. Further treatments may be delayed however if the agent does not consider treatment reasonable and necessary. 
 
Problems occur one month to three months after injury most frequently with:
  • Referrals for investigations such as MRI’s or other relatively expensive procedures
  • Referrals to specialists, particularly if the agent believes that the injury is relatively minor
  • Referrals for specialised programs such as Pilates, pain management
  • Referrals for rehabilitation initiatives such an Activities of Daily Assessment or a driving assessment particularly if assessment finding could mean more money has to spent on the claim
  • Referrals to a rehabilitation provider of the workers choice particularly, if it is perceived by the Agent that the non-preferred provider will cost more than the one they choose.
 
Nominated Treating Doctor (NTD) issues

It was mentioned in the preceding document concerning injuries from day 1 to the end of the first month that the role of the Nominated Treating Doctor (NTD) in the workers compensation system  is a critical one.  The medical certificates they give regarding work status have binding practical and legal implication s for the injured worker, treatment providers and agent.  Most specialist referrals can only be made through the NTD.
The skills, knowledge and experience a NTD has in managing a particular injury and in negotiating the system has major implications for all stakeholders.  Some of the problems injured workers, treatment providers and employers report include:
  • Inadequate initial and follow up assessment - It is the NTD’s job to assess properly and diagnose accurately. The NTD should identify red flags immediately - potential serious or life threatening symptoms, but at the same time not over pathologise a relatively minor injury. An experienced NTD will usually get this right! After a month or so most injuries should be resolving - if they are not resolving NTD should be finding out why.  To do this they need the knowledge and skills to be able to identify the factors that may be barriers to progress and treatment.  This means that the NTD should also be aware of “yellow flags - social and psychological barriers - things such s an unsupportive workplace, extreme fear of re-injury by from the worker sot he can provide the relevant support or referrals to address these barriers.  After one month it is also possible that there is organic pathology that has not been identified and referral for appropriate investigation and specialists needs to be made.  Return to work outcomes is affected when the barriers are not identified and / or appropriate actions to address them have not been intiated.
  • Poor Communication to Worker - Feedback to the injured worker is important in alleviating anxiety about symptoms and in reinforcing their commitment to strategies being initiated to help them get better and Return to work -  A doctor who listens to patients concerns and clarifies issues can be helpful in alleviating concerns.  Doctors who do not communicated effectively with the patient can create fear in the patient that there injury is more serious than it is and will reinforce avoidance of the worker to upgrade hours or return to work. Likewise a doctor who does not identify and address risky behaviours - i.e. excessive medication and drug use to manage pain and symptoms beyond their real injury tolerances is likely to end up with a patient   who has a significant symptom relapse, injury and health complications and ultimately a poorer return to work outcome.
  • Poor Communication to 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. This could result in re-injury, or at least tension and friction if the worker then refuses to do the task. Agents may take the stance that the injured worker is malingering and that the doctor is “reinforcing illness behaviour”

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