Presentation on theme: "NT Worksafe and the Role of General Practitioners"— Presentation transcript:
1NT Worksafe and the Role of General Practitioners Northern Territory Workers Compensation Scheme
2What we do Occupational Health and Safety Dangerous Goods Electrical SafetyMines and Major Hazard Facilities SafetyWorkers Compensation & Information
3Workers’ Compensation Scheme Operates under theWorkers Rehabilitation and Compensation ActWorkers Rehabilitation and Compensation Regulations
4About the Scheme No fault scheme No common law access Privately underwrittenMultiple insurer scheme5 approved insurers4 self insurersNominal InsurerPremiums are not regulated and are set by individual insurers
5Who is eligible?for Workers compensation under the Northern Territory Workers Rehabilitation and Compensation Act
6Who is excluded?Workers who have submitted their ABN in writing to their employerCommonwealth employees (covered under Comcare)Family member, except where specifically namedCompany Director, except where specifically namedAny person or class of person excluded by RegulationVolunteers (unless those prescribed) and most sports persons
7When to make a claimA claim can only be made if the injury or disease arises out of or in the course of the worker’s employmentGradual 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 causeJourney claims, however most journey claims involving motor vehicles to and from work are not workers’ compensation and are covered by Motor Accidents Compensation Scheme
8Claims processA worker must inform their employer as soon as practicable after becoming aware of an injury or diseaseThe worker completes the first two pages of the workers’ compensation claim formThe worker must:Sign and date the declarationSign authorisation to release medical information - if not signed the claim will not be recognised as a claim for compensation
9Claims processIf the claim is for lost time an approved workers’ compensation medical certificate must accompany the claim formIf the claim is for medical expenses only, the approved medical certificate is not requiredThe worker hands or sends the completed claim form to their employerOn past statistics about 95% of claims will be accepted with approximately 5% being deferred or rejected
10Doctors roleExcept in certain remote situations* General Practitioners are the sole authority to issue medical certificates for lost time by injured or ill workersThe medical certificate provides information to assist the insurer in deciding whether to accept the claim and how to best manage the claimParticipation 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.
11Medical certificatesThere 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.
12Medical 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; andMore 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
14Medical certificates Worker and employer details section Injury details sectionDate injury first noticedWorker’s description of injuryFurther investigation is permissible e.g. speaking with employerWorker’s description of how injury occurredMedical AssessmentExaminationInvestigationsDiagnosis – particularly in progress certificates
15Medical certificates Fitness for work Consultation with the employer is permissible when completing this sectionDetail what restricted duties are involved and include what the worker can doCommunication with employer, insurer and rehabilitation provider about restrictionsCase 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
16Medical certificates Injury management Communication is the key All aspects of the medical management plan should be completed including medicationReferrals in cases where diagnosis may be unclear or uncertainIt 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 advicePatients may experience some delays while more information is being obtained
17Rehabilitation Injury Management The principles of injury management and return to work are the primary objectives of the workers’ compensation schemeRehabilitation 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 injuryA goal of rehabilitation is to return the worker to the workplace as soon as it is practicalThe insurer must approve the referral before rehabilitation can proceed
18Rehabilitation Worker responsibilities To undertake all reasonable treatment and training or assessment and return to work programs, as part of the rehabilitation processThis may involve doing different duties until they are fit for their former workIf the worker is unable to return to their former job, they may need to be retrained for other workFailure to co-operate can lead to a reduction or cancellation of benefits
19Rehabilitation 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 workerSo far as is practicable, participate in efforts to retrain the injured workerEnsuring, 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 planIf 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
20Dispute resolution Mediation Work Health Court Permanent Impairment Reassessment
21MediationIf a claimant disagrees with an insurer’s decision they may initiate the mediation process through NT WorkSafe either by:Completing the request for mediation slip accompanying the notice of decisionWrite to NT WorkSafe clearly stating the nature of the dispute
22Work Health CourtIf 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.
23Permanent 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.
24Further Information www.worksafe.nt.gov.au Doctor's Information Kit A Doctor's Role in Injury ManagementThe Evaluation of Permanent ImpairmentPermanent Impairment Assessment/Reassessment ChecklistDoctors' and Allied Professionals' Frequently Asked QuestionsDoctor's guide to permanent impairment reassessment medical reports
25Contact UsFor 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.