The aim of the MSP is to leverage specialist medical expertise to improve health outcomes and the experience for injured workers and employers.
By reviewing case information, the MSP medical specialists can make timely treatment and medical causation recommendations, assisting case managers in the comprehensive medical management of an injured workers claim.
For an employer and worker this means faster treatment approval for medical interventions and therefore anticipated faster return to work.
There are two referral pathways to the MSP. The case manager will refer a claim to the MSP through the most appropriate pathway for the claim and its circumstances.
This referral pathway is used to address medical guidance into complex claims that will require more time to review excess documentation, speak to stakeholders as required and provide a more in-depth medical claims review.
The in-depth referral pathway is a requirement for all requests for 'new and novel' treatments like stem cell therapy.
An individual phone appointment with an MSP specialist to discuss medical concerns on a claim. These appointments are up to 30 minutes in duration and can be booked by a case manager or injury management specialist.
Case manager refers a claim to the MSP
If a case manager/injury management specialist has questions about a medical aspect of a claim, they'll refer it to the MSP.
MSP specialist reviews the claim
Our MSP specialists review relevant case information to make their recommendations.
MSP specialists will only consider the questions asked in the referral of the claim. They will not review other non-medical aspects of the claim.
MSP provides their recommendations to the case manager
Once the claims service provider receives the MSP recommendation, they apply the legislation, and the claims management decision framework to make a decision on the claim.
The case manager will explain the MSP's recommendation and their final decision to stakeholders
Turnaround time is five days.
Which items are out of scope for the MSP?
The MSP is not able to make recommendations on the following:
- capacity for work
- Whole Person Impairment (WPI)
- dental treatment requests
- home modifications.
For psychological claims, the application of Section 11A of the Workers Compensation Act 1987 on a claim must be resolved before it can be referred to the MSP for a medical causation review.
In these instances, a case manager may require a worker to attend an IME or gather further information to make their decision.
When is a claim referred to the MSP for review?
A claim can be referred to the MSP at any point in the claim's lifecycle. A claim can be referred to the MSP more than once: as a workers treatment progresses, or if new treatments are requested.
A review can also be referred if there are questions around ongoing medical causation or an additional body part is added to the claim. The MSP can also provide a medical strategy review and provide other strategies and options to help the workers progress.
How long does it take for the MSP to review a claim?
The MSP has a target of no more than five days to review claims once a completed referral is received.
If an incomplete referral is received, the MSP will be unable to commence a review until all information is provided and the referral is completed by the case manager.
The Claims Service Provider is responsible for referring claims to the icare Medical Support Panel (MSP) for advice in relation to treatment and medical causation where required.
Case managers/injury management specialists should refer claims to the MSP within two days of needing additional information to make their decision.
Do MSP services impact premiums?
No, the MSP review of claims and recommendations are not premium impacting.