Presentation on theme: "NT Worksafe and the Role of General Practitioners Northern Territory Workers Compensation Scheme."— Presentation transcript:
NT Worksafe and the Role of General Practitioners Northern Territory Workers Compensation Scheme
What we do Occupational Health and Safety Dangerous Goods Electrical Safety Mines and Major Hazard Facilities Safety Workers Compensation & Information
Workers’ Compensation Scheme Operates under the Workers Rehabilitation and Compensation Act Workers Rehabilitation and Compensation Regulations
About the Scheme No fault scheme No common law access Privately underwritten Multiple insurer scheme –5 approved insurers –4 self insurers –Nominal Insurer Premiums are not regulated and are set by individual insurers
Who is eligible? for Workers compensation under the Northern Territory Workers Rehabilitation and Compensation Act
Who is excluded? Workers who have submitted their ABN in writing to their employer Commonwealth employees (covered under Comcare) Family member, except where specifically named Company Director, except where specifically named Any person or class of person excluded by Regulation Volunteers (unless those prescribed) and most sports persons
When to make a claim A claim can only be made if the injury or disease arises out of or in the course of the worker’s employment Gradual onset injuries or diseases must be materially contributed to by the worker’s employment, this is defined as the employment being the real, proximate, or effective cause Journey claims, however most journey claims involving motor vehicles to and from work are not workers’ compensation and are covered by Motor Accidents Compensation Scheme
Claims process A worker must inform their employer as soon as practicable after becoming aware of an injury or disease The worker completes the first two pages of the workers’ compensation claim form The worker must: 1.Sign and date the declaration 2.Sign authorisation to release medical information - if not signed the claim will not be recognised as a claim for compensation
Claims process If the claim is for lost time an approved workers’ compensation medical certificate must accompany the claim form If the claim is for medical expenses only, the approved medical certificate is not required The worker hands or sends the completed claim form to their employer On past statistics about 95% of claims will be accepted with approximately 5% being deferred or rejected
Doctors role Except in certain remote situations* General Practitioners are the sole authority to issue medical certificates for lost time by injured or ill workers The medical certificate provides information to assist the insurer in deciding whether to accept the claim and how to best manage the claim Participation in case conferences, treatment and management of injury and return to work programs * Registered nurses and aboriginal health workers can issue limited medical certificates in remote locations.
Medical certificates There are three types of NT Workers’ Compensation medical certificates:- First Certificate: completed at the first consultation and covers first 14 day period. If the claim is for lost time, this medical certificate must be attached to the claim form. This is the only workers’ compensation medical certificate that is mandatory for lost time claims. Progress Certificate: for continuing periods of partial or total incapacity and covers a maximum period of 28 days – This form was designed to provide the insurer with relevant and adequate medical information for the management of workers’ compensation claims. Final Certificate: to be issued when the worker has fully recovered or ceases to be incapacitated from work related condition. NT WorkSafe does not regulate fees and charges. However, the scheme provides for the payment of a worker’s reasonable medical, surgical and rehabilitation expenses.
Medical certificate issues Past reviews of medical certificates indicated problems around the following issues: Almost 50% of First Medical Certificates submitted provided a generic rather than specific diagnosis; Less than 30% of the First Medical Certificates contained a completed medical practitioner/employer contact section; and More than 30% of Progress Medical Certificates were not completed fully, particularly with regard to the clinical findings, diagnosis and injury management sections. Unfortunately where these shortcomings occur the effectiveness of the medical certificate is compromised
First Workers Compensation Medical Certificate
Medical certificates Worker and employer details section Injury details section –Date injury first noticed –Worker’s description of injury –Further investigation is permissible e.g. speaking with employer –Worker’s description of how injury occurred Medical Assessment –Examination –Investigations –Diagnosis – particularly in progress certificates
Medical certificates Fitness for work –Consultation with the employer is permissible when completing this section –Detail what restricted duties are involved and include what the worker can do –Communication with employer, insurer and rehabilitation provider about restrictions –Case conferences include all parties to the claim process, including the insurer (case manager), rehabilitation coordinator, the worker and the employer and can be charged at a reasonable rate
Medical certificates Injury management Communication is the key All aspects of the medical management plan should be completed including medication Referrals in cases where diagnosis may be unclear or uncertain It is imperative that as much information as possible is provided to allow for decisions to be made promptly because: Without sufficient information, independent examiners are often sought to provide advice Patients may experience some delays while more information is being obtained
Rehabilitation Injury Management The principles of injury management and return to work are the primary objectives of the workers’ compensation scheme Rehabilitation is the process of restoring, as far as is practicable, a worker to the same physical, economic and social condition to which the worker was before the work related injury A goal of rehabilitation is to return the worker to the workplace as soon as it is practical The insurer must approve the referral before rehabilitation can proceed
Rehabilitation Worker responsibilities To undertake all reasonable treatment and training or assessment and return to work programs, as part of the rehabilitation process This may involve doing different duties until they are fit for their former work If the worker is unable to return to their former job, they may need to be retrained for other work Failure to co-operate can lead to a reduction or cancellation of benefits
Rehabilitation Employer responsibilities An employer is required to assist the worker with the rehabilitation program and take all reasonable steps to provide or obtain suitable employment for the worker So far as is practicable, participate in efforts to retrain the injured worker Ensuring, if necessary, that there is a referral to an accredited vocational rehabilitation provider who can help to devise and implement a suitable early return to work plan If the employer is unable to provide the worker with suitable employment, the employer in consultation with the insurer must refer the worker to an Alternative employer incentive scheme
Dispute resolution Mediation Work Health Court Permanent Impairment Reassessment
Mediation If a claimant disagrees with an insurer’s decision they may initiate the mediation process through NT WorkSafe either by: 1.Completing the request for mediation slip accompanying the notice of decision 2.Write to NT WorkSafe clearly stating the nature of the dispute
Work Health Court If a party to a dispute is dissatisfied with the outcome of the mediation process they may then make an application to the Work Health Court. An application to the Work Health Court should be made within 28 days of the party receiving Certificate of Mediation, although the Court has the power to extend the 28 day time limit. The Work Health Court is constituted by a magistrate or, in certain circumstances, the Registrar or Judicial Registrar.
Permanent Impairment Reassessment If a worker believes that they have a permanent impairment, they may apply to their employer’s insurance company, or their own doctor, for an assessment of that impairment. If the worker or the insurer is dissatisfied with the original level of permanent impairment percentage, either may apply to NT WorkSafe for a reassessment. Such applications must be in writing. NT WorkSafe must receive an application for a reassessment within 28 days of the insurer or worker being notified of the result of the initial assessment.
Further Information Doctor's Information Kit A Doctor's Role in Injury Management The Evaluation of Permanent Impairment Permanent Impairment Assessment/Reassessment Checklist Doctors' and Allied Professionals' Frequently Asked Questions Doctor's guide to permanent impairment reassessment medical reports
Contact Us For further information or assistance in claims management contact the workers’ compensation insurer or NT WorkSafe Workers’ Compensation Advisory Line: / This information is for training purposes only. No part may be reproduced without the permission of NT WorkSafe. The information contained in this presentation is accurate at the date of production 29 June 2010.