Who’s involved in a workers compensation claim

Treating someone who’s been injured at work can involve working with their employer, case manager and support team.

As the Nominated Treating Doctor (NTD) for a person injured at work, you play an important role in helping them recover and return to work.

To give your patient the best chance of a smooth recovery, it’s important to understand everyone’s role in the system.

There are many different stakeholders involved in a workers compensation claim, and it takes open, collaborative communication between everyone to ensure the best outcomes for a patient.

Understanding everyone’s roles and responsibilities in the workers compensation system can enable you to provide better support to your patient, getting them back to work and achieving their recovery goals sooner.

    Understanding the roles of everyone involved 

  • Employers

    Some employers may have a dedicated return to work coordinator to act as your contact person. If they don't have an appointed return to work coordinator your point of contact may be your patient's manager or someone in a Human Resources role.

    An employer is responsible for:

    • Notifying the insurer within 48 hours of becoming aware that a worker has sustained an injury
    • Supporting your patient to recover at work
    • Identifying suitable work duties in the workplace for your patient where required
    • Developing a recover at work plan with your patient, based on the certificate of capacity
    • Ensuring the health, safety and welfare at work for all workers, and maintaining a record of all work related injuries
    • Paying your patient as directed by the insurer

    Regardless of their industry or the type of work they do, all employers in NSW must provide workers who are able to return to work with suitable work. The employer’s obligation to provide suitable work does not apply if it is not reasonably practicable for the employer to provide suitable work; if the worker voluntarily resigned from employment after the injury happened; or the employer terminated the worker’s employment after the injury happened other than for the reason that the worker was not fit for employment as a result of the injury[1].

    The recommendations you provide in the certificate of capacity regarding your patient's capacity for work will help the employer identify suitable work options to discuss with your patient.

    The more detail you provide in the certificate of capacity, the easier it will be for an employer to find responsibilities and tasks that are appropriate to your patient’s capacity for work.

    When your patient and their employer agree on suitable duties, this goes into a recover at work plan.

    Learn more about communicating with employers

     [1] Workplace Injury Management and Workers Compensation Act 1998 (NSW) s49.

  • Case managers
    A case manager is responsible for:
    • Coordinating the end-to-end process of a work injury claim
    • Reviewing a work injury claim and acting on behalf of the insurer
    • Development of an injury management plan
    • Authorising ‘reasonably necessary’ treatment and other expenses
    • Determining what payments a worker is entitled to, and ensuring these payments are received
    • Helping employers meet their obligations to support the worker to recover at work.

    After the insurer receives a notification of a workplace injury, the insurer’s case manager will contact your patient, their employer and you as the NTD to determine your patient's needs.

    Along with other relevant information, certificates of capacity assist case managers make decisions about medical expenses, weekly compensation payments and other support services.

    Once a claim has been lodged, the case manager is your patient’s primary point of contact. They are responsible for ensuring the employer meets their obligations, and may arrange assessments and other services to determine whether compensation is payable and, if it is, when and how best to get your patient back to work.

    The insurer may contact you to: 

    • Clarify the certificate of capacity
    • Request further information regarding the claim
    • Request input into your patient's Injury Management Plan

    A case manager is also responsible for establishing an injury management plan outlining what treatment, rehabilitation and retraining support your patient needs to achieve a timely, safe and durable return to work and return to health. You can expect to receive a copy of the plan at the start of the recovery process, along with updated plans as required.

    Contact the insurer

  • Approved workplace rehabilitation providers

    A workplace rehabilitation provider must be approved by the State Insurance Regulatory Authority (SIRA), and can be helpful if your patient’s circumstances are more complex.

    A workplace rehabilitation provider can:

    • Identify suitable work options by conducting a workplace or functional assessment
    • Advise on appropriate changes to work demands or environment to support recovery at work
    • Develop strategies to overcome barriers and create a recover at work plan on behalf of the employer
    • Provide information to your patient about the health benefits of work
    • Complete a vocational assessment of your patient to find suitable work alternatives with a new employer, if required
    • Facilitate case conferences with key parties to establish the return to work goal, and to clarify additional medical information including prognosis, and ability for work.

    You may choose to include a recommendation in your certificate of capacity to refer the case to a workplace rehabilitation provider if your patient is experiencing:

    • Significant psychosocial barriers impacting their return to work
    • A difficult and lengthy recovery, or unexpected hurdles in recovery
    • Conflict or any issues communicating with their employer
    • Difficulty securing suitable duties with their employer.
  • Injury management consultants

    Injury management consultants are registered medical practitioners with experience in workplace rehabilitation, and are approved by SIRA.

    Their role is to help facilitate the negotiations between employers, the insurer and your patient when there are complex circumstances preventing a smooth recovery and return to work.

    In more complex cases, an injury management consultant may be brought in to advise on:

    • Your patient’s readiness for work, including recommendations for gradually increasing their work capacity
    • Time frames and injury management options
    • Identifying suitable work options
    • The claims process and impacts of delaying recovery at work.

    An IMC can get involved in a claim at your request or at the request of the insurer.

    As the NTD, you are required to communicate with the injury management consultant if it is requested by the insurer.

  • Independent medical examiners

    An independent medical examiner is a registered medical practitioner who is engaged to complete an examination of your patient and provide a report. An IME report can contain assessments and recommendations about:

    • Your patient’s work capacity
    • Ongoing medical treatment and care needs, including recommendations for future treatment
    • Permanent impairment

    At any point during a work injury claim, an independent medical examination (by an IME) may be requested by your patient, their employer, or the insurer. The report is then provided to whichever group requested it.

  • Medical Support Panel (MSP)

    In 2016, icare established a Medical Support Panel to help with:

    • Reviewing cases and making recommendations in relation to treatment, liability and medical causation
    • Improving health outcomes for workers
    • Providing recommendations to insurance agents that help determine whether medical investigations and interventions required

    The MSP may provide an opinion in relation to proposed treatment and can discuss options and alternatives with treating professionals.

    The MSP is designed to speed up the time taken to approve treatment or agree on a course of action. If it’s not possible to reach an agreement with the treating professional, your patient may be referred to an IME for assessment and opinion.

    Learn more about the Medical Support Panel