Other claim stakeholders
There are multiple claims stakeholders involved in a workers compensation claim. Each have different roles to play to assist you to recover from your injury and return to work.
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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 you.
- You, your employer, claims service provider and treatment teams all have a role to play in your recovery and return to work.
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Listed below are the most common stakeholders you may be in regular contact with during the claims process and their responsibilities.
Injured worker
- Your role is to focus on your recovery and aim to stay at work in some capacity or return to work as soon as you can.
- Develop and maintain clear communication with your employer, insurer and treating parties.
- Take an active role in your recovery.
Employer
- Notify the claims service provider (CSP) within 48 hours of becoming aware of a workplace injury.
- Support you to recover at work.
- To provide suitable duties for you.
- 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.
- Pay wages to you as directed by the insurer.
- Communicate with your treating team and insurer to assist with your recovery.
- Cannot dismiss you within six months of you being unfit for work.
Claims service provider
- If you require time off work, you may be assigned a case manager to act on behalf of the claims service provider and 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.
- Regularly checks in with you to ensure that you receive the right help at the right time.
- Determines what payments you are entitled to.
- Authorises reasonably necessary treatment and other expenses.
- Collaboratively works with you to develop any return-to-work goals and injury management plans.
Nominated Treating Doctor (NTD)
- Acts as a central point for all claims stakeholders.
- Sets expectations for recovery including discussions around recovery at work.
- Identifies barriers and risks that may impact a return to work or delay recovery.
- Completes a Certificate of Capacity (CoC).
- Collaborates with you, your employer, insurer and any service provider to develop treatment plans that assist a return to and recovery at work.
- Arranges and monitors appropriate treatment for you as a result of the workplace injury.
- Responds to requests for information from other stakeholders to assist with recovery and return to work.
- Raises any concerns regarding the work with your employer and/or insurer.
Psychologist
- Conducts appropriate assessments regularly to ensure correct diagnosis.
- Develops strategies and utilises evidence-based treatments to assist you with your injury and recovery.
- Collaborates with your NTD, employer, claims service provider, and other practitioners to assist with recovery and return to work.
- Responds to requests for information from other stakeholders.
- Regularly reviews and amends treatment plans as appropriate.
- Raises any concerns regarding you with your employer and/or insurer.
- 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
- Conducts appropriate assessments to ensure correct diagnosis.
- Reviews and prescribes appropriate medications to support your recovery and return to work.
- Collaborates with your NTD, employer, claims service provider, and other practitioners to assist with recovery and return to work.
- Responds to requests for information from other stakeholders.
- Regularly reviews and amends treatment plans as appropriate.
- Raises any concerns regarding the injured worker with the employer and/or claims service provider.
Exercise physiologist
- Conducts appropriate assessments and goal setting in conjunction with you and/or other stakeholders.
- Provides appropriate treatment for the workplace injury.
- Maintains contact with you, your claims service provider, employer and NTD.
- Monitors progress and adjust the treatment plan as required.
- Empowers you to manage your recovery and injury.
- Raises 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.
Workplace occupational and vocational rehabilitation providers
- Identify suitable return-to-work options by conducting a workplace or functional assessment.
- Educates stakeholders on 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.
