Months 1 to 3 months post injury
What is happening / should be happening?
It is a month after your injury and many things should have happened to assist you to recover from your workplace injury or illness. About 85% of workplace injuries are relatively minor and uncomplicated. After a month symptoms should have resolved and you will be either fully recovered or nearly recovered. Those of you back at work on full or selected duties should have had their wage entitlements paid (see tables for entitlements at various stages under the new and previous Workers Compensations Legislation). Money owing for medications and travel to medical appointments should now be claimed and should soon be reimbursed. All going well, your employer, and the insurer/agent should have a copy of your latest Workcover Medical Certificate that states you are fully fit or partially fit for your preinjury work.
The other 15% - Approximately 15 percent of injured workers may be still off work after one month. There are a range of reasons - some of these reason are outlined below:
- The injury may be more serious or complex. For example a construction worker for a small company may have had a fall and broken a leg, arm and sustained fractured ribs. Surgery may have been required and more surgery is pending in coming weeks. With smaller employers suitable duties such as clerical or administration work may not be available even if the nominated treating doctor (NTD ) certified the worker as fit for “Selected duties - administrative work”
- There may be uncertainty about what is actually wrong. Despite time having passed and no “red flags, the injury may not be improving as anticipated.. The injured worker may be complaining of severe pain and restrictions, yet there is no obvious organic basis for the symptoms.. The investigative procedures at this stage are likely to have been basic and relatively low cost - i.e. x rays or blood tests . More comprehensive and expensive tests such as a MRIs, bone scans, and nerve conduction tesst may not have not been considered or approved.
- Physical and psychological injury may have occured simultaneously . There are some situations where an accident or incident occurs at work where physical and psychological injuriesoccur. Typically, these occur where there is significant traumatic event and a significant injury. These could include the loss of limb or a major fracture in an industrial accident, an armed hold up and assault, or a significant motor vehicle accident whilst travelling from one job site to another. With these types of incidents the consequences in terms of injury, particularly psychological injury, may not be experienced immediately, or are overshadowed by the need for urgent treatment to stabilise a physical injury. For example, in a major industrial accident where several workers may have been injured significantly, the initial focus will be on managing a life threatening physical trauma. It is only at a later stage, days, weeks or even months later that it becomes apparent that significant trauma has occurred and a psychological injury is alos a major barrier to the worker eturning to the same workplace setting.
Problems with Treatment and Specialist Access
Agents are supposed to approve referrals to specialists, for investigations and for reasonably necessary treatments. Problems for injured workers and 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 commence even without written approval for a specified number of sessions. It can be different for each discipline, providing there is a valid claim. This aspect of treatment approval has NOT changed in the 2012 legislation. Further treatments may be delayed however if the Agent does not consider treatment reasonable and necessary. A call to WorkCover may help in decision being made with the time frame guidelines.
Problems getting agent approval occurs most frequently one month to three months after injury 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 or pain management
- Referrals for rehabilitation initiatives such an Activities of Daily Assessment or a driving assessments particularly if the assessments findings could mean more money has to be 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. Agents tend to have panels of preferred providers.
