Other claims stakeholders
There are multiple claim stakeholders involved in a workers compensation claim, each have different roles to play to assist the person recover from their injury and return to work.
On this page
Claims service provider and case manager
Workplace occupational and vocational rehabilitation providers
Key takeaways
- There are many different stakeholders involved in a workers compensation claim, depending on the complexity and injury itself, and it takes open, collaborative communication between everyone to ensure the best outcomes for a worker.
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In New South Wales, employers have an important role in supporting the recovery of their worker following a workplace injury or illness. Your responsibilities are listed below along with the most common stakeholders you may be in regular contact with during a psychological claims process and their responsibilities.
Injured worker
- Focus on their recovery and aim to stay at work in some capacity or return to work as soon as they are able to.
- Develop and maintain clear communication with you, their claims service provider and treating team.
- Take an active role in their own recovery.
Employer
- Notify the claims service provider within 48 hours of becoming aware of a workplace injury.
- Support your worker to recover at work.
- Provide suitable duties for your worker. The employer is obligated by law to provide suitable duties in line with the workers medical capacity and restrictions as per the Certificate of Capacity (CoC).
- Develop a recover at work plan based on the Certificate of Capacity, or if unable to do so, work with a rehabilitation provider to develop a return to work plan.
- Participate in your worker's injury management plan.
- Nominate someone to manage any workers compensation and recover-at-work activities, for example a return-to-work coordinator.
- Provide information to claims service provider when requested, such as for Pre-Injury Average Weekly Earnings (PIAWE) or any information relevant to the liability decision.
- Ensure the health and safety of all workers.
- Pay your worker as directed by the claims service provider.
- Communicate with the worker's treating team and claims service provider to assist with their recovery.
- Cannot dismiss the worker within six months of a worker being unfit for work.
Claims service provider and case manager
- If a worker requires time off work, they may be assigned a case manager to coordinate the end-to-end process of a work injury claim.
- Their role is to act as a central point of contact, they will communicate with all treating practitioners and employer.
- Review a work injury claim and act on behalf of the claims service provider.
- Develop an injury management plan.
- Regularly check in with the worker to ensure they receive the right help at the right time.
- Authorise reasonably necessary treatment and other expenses.
- Determine what payments, a worker is entitled to.
Nominated Treating Doctor (NTD)
- Set expectations or recovery including discussions around recovery at work.
- Identify barriers and risks that may impact a return to work or delay recovery.
- Complete a Certificate of Capacity (CoC).
- Collaborate with the worker, employer, claims service provider and other service providers to develop treatment plans that assist a return to and recovery at work.
- Arrange and monitor appropriate treatment for the worker as a result of the workplace injury.
- Respond to requests for information from other stakeholders to assist with recovery and return to work.
- Raise any concerns regarding the worker with the employer and/or claims service provider.
- Acts as a central point for all claims stakeholders and when other treatment providers such as specialists and allied health professionals are required.
Exercise physiologist
- Conduct appropriate assessments, goal setting in conjunction with the injured person and/or other stakeholders.
- Provide appropriate treatment for the workplace injury.
- Maintain contact with the injured worker, claims service provider, employer and Nominated Treating Doctor.
- Monitor progress and adjust the treatment plan as required.
- Empower the worker to manage their recovery and injury.
- Raise any concerns regarding the worker with the employer and/or claims service provider.
- Required to be appropriately qualified and SIRA-accredited. Please see SIRA website for a full list of SIRA-accredited providers and how to obtain accreditation.
Psychologist
- Conduct appropriate assessments regularly to ensure correct diagnosis.
- Organise regular appointments with the worker to support their wellbeing and recovery.
- Develop strategies and evidence-based treatments to assist the worker with their injury and recovery.
- Collaborate with the Nominated Treating Doctor, employer, claims service provider, and other practitioners to assist with recovery and return to work.
- Respond to requests for information from other stakeholders.
- Regularly review and amend treatment plans as appropriate.
- Raise any concerns regarding the worker with the employer and/or claims service provider.
- Required to be appropriately qualified and SIRA-accredited. Please see SIRA website for a full list of SIRA-accredited providers and how to obtain accreditation.
Psychiatrist
- Conduct appropriate assessments to ensure correct diagnosis.
- Review and prescribe appropriate medications to support a worker's recovery and return to work.
- Collaborate with the Nominated Treating Doctor, employer, claims service providers, and other practitioners to assist with recovery and return to work.
- Respond to requests for information from other stakeholders.
- Regularly review and amend treatment plans as appropriate.
- Raise any concerns regarding the worker with the employer and/or claims service provider.
Workplace occupational and vocational rehabilitation providers
- Identify suitable return-to-work options by conducting a workplace or functional assessment.
- Provide information to the worker about the benefits of recovering at work.
- Develop strategies to overcome barriers and create a recover at work plan.
- Complete a vocational assessment, to explore alternate return to work/employment options, if appropriate.
- Facilitate case conferences with other stakeholders to ensure clear communication, clarify additional medical information, and establish a return-to-work goal.
What is a Certificate of Capacity?
The Certificate of Capacity (COC) outlines work-related injury/diagnosis, capacity for work and treatment recommendations. The Certificate of Capacity is the main form of communication between the Nominated Treating Doctor and claim stakeholders.
The initial Certificate of Capacity must be completed by a doctor that the worker nominates to be involved in their claim. This is known as the Nominated Treating Doctor. Consequential certificates can be completed by the workers Psychologist.
The Certificate of Capacity also has a consent section which allows the medical practitioner, employer, the insurer, other medical practitioners or health-related practitioners, workplace rehabilitation providers and the State Insurance Regulatory Authority (SIRA) to exchange information for the purpose of managing the injury and workers compensation claim.
