icare’s Medical Support Panel (the Panel) continues to reduce treatment and medical causation decision time frames for injured workers referred to the Panel since its introduction 12 months ago.
Following the success of an initial pilot, the Panel is now a permanent feature of the insurer’s customer centric claims services model. More than 2000 cases have been referred to the Panel, with average medical causation and treatment recommendation timeframes reducing from six weeks before the trial, to five days post-trial.
The Panel, composed of medical specialists with expertise in work injuries, provide case managers with medical case support to fast-track decision-making.
“icare is transforming the NSW workers compensation system by reducing the waiting time for a treatment decision upon the claim. This means injured workers can access treatment much more quickly,” icare’s Interim Chief Executive Officer John Nagle said.
“We know that faster treatment times can improve the long term injury outcomes for people and lower the risk of secondary associated injuries.”
icare’s Chief Medical Officer Dr Chris Colquhoun said the Panel supports not only the injured worker, but also their employer.
“Feedback on the Panel has been positive. Injured workers and treating doctors appreciate how quickly they are contacted by the specialists on the Panel and how easy and straightforward their conversations have been,” Dr Colquhoun said.
The Medical Support Panel is not intended to replace Independent Medical Examinations (IME).
“IMEs play a valuable role in the scheme, mainly in cases where medical information is incomplete or a physical examination is required. In most cases the Panel’s recommendation is to support the proposed treatment. Around one quarter of cases reviewed by the Panel are referred for an IME for further assessment regarding medical causation or treatment,” said Dr Colquhoun.
icare’s claims services partners have also been integral to the Panel’s success and are committed to adopting the new framework and implementing the Panel’s recommendations.
Panel members support case managers and treating clinicians in various ways, like opening up communication lines between workers and their healthcare providers, assisting with case strategies and discussing possible alternate best practice treatment options.
“We are achieving positive recovery outcomes and will continue to improve the panel process by adopting the feedback from our customers and claims services partners. Our end goal is to ensure injured workers get the most appropriate and timely treatment possible to allow early recovery,” Dr Colquhoun said.
icare’s claims process innovation: Speeding up Jim’s path to recovery
Jim Turner was working on a narrow balcony when he fell over the railing onto the footpath below. As well as fracturing his collarbone, ribs and pelvis, he also received a head injury.
A year after the fall Jim was still living with intense pain in his shoulder, which was thought to be neuropathic, but remained undiagnosed, and conservative treatment was failing him.
His doctor recommended surgery, but Jim’s Injury Management Advisor at GIO, Madison, was concerned about his mental health and wellbeing, given the extent of the injuries and the length of time he had been out of the workplace.
Madison consulted icare’s Medical Support Panel to determine whether surgery was the best option. The Panel reviewed Jim’s case and, within only 24 hours, concluded that, given the complexity of Jim’s case, the diagnostic arthroscopy was necessary and appropriate.
Based on this recommendation, Jim had the surgery.
“I was very happy with the speed of the decisions and approval for surgery,” said Jim. His recent psychiatrist report notes that he is already experiencing less pain.
Because Jim’s overall wellbeing has improved so much, Madison introduced him to GIO’s Mind Movement program and Fitbit initiative.
“These two programs are available due to the support of icare. We are hoping they will work together to support and accelerate Jim’s full recovery, which is a fantastic outcome for him and his family,” said Madison.
“So often we see how multiple injuries resulting from workplace incidents can complicate and delay a worker’s recovery. It’s not only physical; they also damage the individual’s mental health and resilience. icare’s Panel has enabled the team supporting Jim – his claims advisor, health professionals and industry specialists – to work together in a holistic way and find the most appropriate solution at the right time.
“Hopefully, through the Panel and follow-up exercise and wellbeing programs, we have been able to substantially shorten Jim’s path to recovery and capacity to return to work,” she said.