Sharing of information
Throughout the life of your claim, your claims service provider (CSP) will need access to your medical information to ensure they can manage your claim as effectively as possible.
This includes approving treatment in a timely manner and supporting you with your return to work efforts.
On this page
How to provide access to your medical information
How medical information is shared between your treatment providers and claims service provider
What claims service providers (CSPs) do with your medical information
What happens if you don't provide medical information
How to provide access to your medical information
On the SIRA Certificate of Capacity, there is an authority to release medical information section on page one of the certificate that requires your signature.
Example:
In most cases, the consent you provide on the Certificate of Capacity is sufficient for most treatment providers. There may however be times when doctors request further evidence of your consent. If this is the case with your nominated treating doctor (NTD), the claims service provider may request that you complete a separate authority to release medical information letter.
How medical information is shared between your treatment providers and claims service provider
Some information will be verbally shared when your case manager contacts your treatment team to discuss your injury, your progress and whether there is any further support you may need on your recovery journey. Other, more formal sharing of information can be obtained via:
Certificate of Capacity
These certificates are the primary communication tool and are completed by your doctor each month and provide a general overview of your current presentation, your treatment plan, any work restrictions you may have and your capacity for work. These certificates allow everyone involved in the claim to have a clear understanding of your needs.
Learn more about Certificate of Capacity
Medical reports
The claims service provider will request medical reports from your treatment team – including your nominated treating doctor, psychologist and psychiatrist. The claims service provider may request a general update on how you’re tracking with your injury and treatment or they may need to ask specific questions.
For example, if you've recently started cognitive behavioural therapy, your case manager may request a report from your psychologist with specific questions around how you are coping with this new form of treatment, if you are seeing any benefit outside of your consultations, whether your symptoms are improving and/or has there been any changes in capacity as a result of the treatment.
The claims service provider will allow the treatment providers 10 business days to respond to their request for information.
The preference is always to source medical information from your treatment team. If, however, the claims service provider is unable to get the necessary information, they may need to refer to external investigations.
Clinical notes
The claims service provider is likely to request clinical notes from your treating practitioners so they can better understand your claim, your medical history and whether there are any pre-existing conditions that may be contributing to your current presentation.
Medical case conferences
Where possible, your case manager may request to join one of your reviews with your treating practitioners to collaboratively discuss your injury, your recovery plan, and any further support you may need. The medical case conferences can be scheduled by, and attended by any stakeholder on the claim including your case manager, your doctor, your psychologist, your rehabilitation provider.
It may be beneficial to have your employer attend if you will be discussing return to work options. You may also wish to bring a support person to the case conference if this is something you feel will assist. Prior to the medical case conference, you can expect to receive a statement of the purpose of the case conference as well as an agenda. You can also expect the case conference to be scheduled at a time outside of your medical consultation unless you have agreed to have it during your appointment.
There is no set frequency for when medical information is requested or needs to be provided. This is unique to each claim and dependent on the individual and their injury.
What claims service providers (CSPs) do with your medical information
The CSPs will review any new information and will determine whether there is anything they can do to assist your recovery. For example, your CSP receives a medical report from your psychologist that outlines that you are experiencing increased physical symptoms associated with your mental health injury. The CSP will review this report and reach out to your psychologist to discuss their recommendations on how best to treat the recent increase in symptoms.
If a new referral is needed, the CSP will request this from your psychologist and will look to approve the treatment quickly if it is deemed to be reasonably necessary. If the CSP is unable to source the necessary information from your treatment team and believe an external investigation is needed, they will share medical information with the investigative assessor so they have a better understanding of your injury before completing your face to face assessment.
Some medical information may also be shared with your assigned rehabilitation consultant when a referral is made. It's important for the rehabilitation consultant to know your diagnosis, your symptoms, your capacity for work and any restrictions you may have that are preventing a return to work. If you have a legal representative, they can also request your medical information from the CSP by submitting a Section 126 request form.
What happens if you don't provide medical information
The claims service provider can only manage and make decisions based on the information they have on file at the time. Allowing access to, and the sharing of your medical information is crucial to ensuring the claim is managed as effectively as possible. Up-to-date information shared amongst the stakeholders ensures you are accessing the best treatment for your injury and all parties are able to support you.
