Gathering information

To effectively manage the claim and support the worker with their injury, the case manager will need to obtain updated medical information across the life of a claim.

How the claims service providers (CSPs) obtain medical information

In order for claims service providers to access medical information, they will need to ensure that they have obtained the worker's authority to release information. Confirmation of approval is usually documented on the Certificate of Capacity.

Whilst some medical information will be obtained from discussions with the injured worker, there are other, more formal ways in which the claims service provider (CSP) will collect information from the main stakeholders on the claim:

Certificate of Capacity

These certificates are the primary communication tool and are typically completed by the treating doctor each month to provide a general overview of your worker's current presentation, treatment plan, any restrictions they may have and their capacity for work.

Certificates of Capacity allow everyone involved in the claim to have a clear understanding of your worker's needs.

Medical reports

The CSP will request medical reports from the treatment team, including the doctor, psychologist and psychiatrist throughout the course of the claim.

The CSP may request a general update on how the injured worker is tracking with their injury and treatment or they may need to ask specific questions to assist with events on the claim such as liability, or treatment approval.

For example, in the initial stages of a claim, the CSP will reach out to the doctor to request their professional opinion on the provisional diagnosis, causation of the injury, work capacity, most likely return to work goal, the recommended treatment and the anticipated recovery timeframe. This report will assist the CSP to make a liability decision on the claim.

The CSP affords the treatment team 10 business days to respond to their request for information. If, however, the CSP is unable to get the necessary information, they may need to refer to external investigations.

The preference is always to source medical information from the treatment team.

The professional opinion of the injured worker's treatment team often holds more weight than that of external independent assessors. The treatment team see the injured worker more frequently, are more involved with the claim and have a better understanding of the injury and the worker's medical history.

Clinical notes

The CSP is likely to request clinical notes from the doctor so they can better understand the claim, the medical history and whether there are any pre-existing conditions that may be contributing to the current presentation.

Medical case conferences

Where appropriate, the case manager may request to participate in a medical review with the injured worker and their doctor so they can collaboratively discuss the injury and how best to proceed to aid the worker's recovery and return to work.

The medical case conferences can be scheduled and attended by any stakeholder on the claim including the case manager, the doctor, psychologist and rehab provider. If your worker feels comfortable doing so, it may be beneficial to have a representative from your business attend to show support and commitment to their recovery and to answer any return-to-work questions your employee or the doctor may have.

Employer support, particularly from a direct manager, is one of the most important factors in ensuring a positive outcome after psychological injury.

According to National RTW Survey data, 79 per cent of employees who agreed that their employer responded in a positive and supportive manner were back at work at the time the survey was completed, versus 52 per cent of those who did not agree (Wyatt & Lane, Return to Work: A comparison of psychological and physical injury claims; Wyatt, Cotton and Lane, Return to work in psychological injury claims).

There is no set frequency for when medical information is requested or needs to be provided by the treatment team. This is unique to each claim and dependent on the individual and their injury.

What information you can provide as an employer

As an employer, we understand that you're unlikely to be able to provide the CSP with any medical information. There are, however, other important documents you can gather and provide to your CSP:

  • Details of the workplace injury: any evidence surrounding the incident such as human resources reports or incident register entries
  • Assist a factual investigator to gather witness statements and a timeline of events. This can assist in gathering important information in order to make a full liability decision on the claim
  • Your worker's job description or a breakdown of their usual tasks
  • Information around suitable duties that can be provided in the workplace. For example, a change of work location or a change of team, graded return to work, removal of shift work and so on.
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