We work with medical and allied healthcare professionals to deliver treatment, rehabilitation and care for people who are injured or unwell in NSW.
We do this through three different schemes:
- icare Workers Insurance: treating people who are injured in a NSW workplace
- icare Dust Diseases Care: treating workers who have been diagnosed with a work-related dust disease
- icare Lifetime Care: treating people who have been severely injured in a motor accident (NSW)
Medical practitioners providing treatment to injured workers should refer to the State Insurance Regulatory Authority (SIRA) for guidelines, forms and information.
Medical and healthcare professionals working in the workers compensation system are identified by SIRA as:
- a nominated treating doctor (NTD)
- injury management consultants
- approved medical specialists
- assessors of medical impairment
- surgeons and orthopedic surgeons
- independent medical examiners
- medical specialists.
The SIRA website has specific definitions for each of these roles and what they can do.
SIRA has also produced a comprehensive workers compensation guide for medical practitioners, containing information about your role and responsibilities as a treating doctor or other healthcare professional.
Administrative Changes to Provider Services Deeds
Through the workers compensation system and our care schemes, we work with a range of practitioners including GPs, allied health professionals, case managers, rehabilitation practitioners, attendant and domestic care providers, equipment providers, home maintenance providers, and a range of others.
icare are transforming the NSW Workers Compensation Scheme and announced the selection of EML, GIO and Allianz to continue as Claims Service Agents beyond 31 December, 2017. These organisations will work closely with icare and our customers to provide a smooth and uncomplicated transition to the new claims service model over the coming months.
Because we’re legislated by NSW legislation, there are some providers who need to be approved or appointed to provide services.
Becoming a medical service provider with us is different for each scheme. For information specific to the scheme you want to work with, select from the accordion below.
Most Lifetime Care participants have a case manager who acts as a single point of contact to both the participant and other service providers.
The types of service providers we generally work with include:
- medical practitioners and allied health professionals
- case managers
- attendant care providers
- other service providers, including equipment suppliers and home maintenance or modification providers.
If you want to provide services to a participant, you'll first need to liaise with the case manager. If the participant doesn’t have one, you can contact their icare Lifetime Care coordinator.
The case manager is responsible for developing a treatment and rehabilitation plan with participants, and most services are requested as part of plan. Care needs are usually reviewed by a health professional and requested as part of a care needs review.
There are other services that may be requested directly by other service providers, such as equipment, vehicle and home modifications but this should be in consultation with the participant’s case manager.
All requested services must meet the criteria of being ‘reasonable and necessary.’
If you want to become a case manager or attendant care provider, you'll need to be approved by us to deliver services to our participants.
We also have a panel of building modifications occupational therapists and project managers.
All other service providers don't need to be approved or appointed to work with in icare lifetime care participants.
Before providing services or equipment to a participant you should:
- Work with the case manager or coordinator to obtain relevant information.
- Request approval for your services and don’t provide any services that haven’t been approved
- Check the details of the service approval. Service approvals will be detailed in a certificate or purchase order. This will include the approval number (RP), payment codes, type and amount of service approved, and start and end dates. The case manager or coordinator will provide you with a copy of this certificate or purchase order.
- You should not provide services beyond the end date of the approval on the certificate, or more services than what has been approved.
- If you think the participant needs additional services, you can liaise with the case manager or coordinator to request these.
Dust Diseases Care
We provide care for workers with a dust diseases in partnership with service providers including:
- medical practitioners
- allied healthcare professionals
- other service providers, including equipment providers and lawn mowing services.
Medical treatment we can pay for includes:
- doctor's visits and medication, including home-based oxygen and nebulisers
- ambulance services to transport the worker to a doctor or hospital because of their dust disease
- treatment for their dust disease in a hospital or nursing home, or in a palliative care or rehabilitation centre
- therapeutic treatments like exercise and massage
- respite care (out of home) or rehabilitation centre admissions
- wheelchairs and other mobility aids - like walking frames or motorised scooters
- therapeutic needs - like reclining chairs, beds, pressure relief cushions, and shower chairs
Under the legislation, we are only able to provide treatment that is considered ‘reasonable and necessary’ and related to the worker’s dust disease.
If you have provided medical services to a worker with a dust disease, you can send your invoices directly to us for payment.
Becoming a health or medical service provider with us
SIRA approved allied health professionals
The State Insurance Regulatory Authority (SIRA) is the governing body that provides approval to appropriately skilled allied health practitioners that want to provide treatment to workers.
Allied health practitioners who must be SIRA approved to work in the NSW workers compensation system are:
- accredited exercise physiologists
- appropriately qualified counsellors and social workers.
To obtain SIRA Workers Compensation approval, complete the application form (below) before completing the required online training.
Online training program
Note that physiotherapists, chiropractors, osteopaths and psychologists that have provisional or limited registration with AHPRA are not eligible for SIRA approval.If you meet the conditions of approval, register with the Personal Injury Education Foundation (PIEF) to commence your online training program. There are three parts to the online training for your complete.
Guidelines for approval
If you're an allied health practitioner who would like to get SIRA Workers Compensation approval, you can refer to the SIRA guidelines for approval of treating allied health practitioners.
These guidelines cover:
- Qualifications and requirements for approval
- SIRA procedures to deliver services in the NSW workers compensation system.
Completing an allied health recovery request
- Assist case managers in determining what is reasonably necessary treatment
- Assist your patient to develop a clear plan to recover at work and return to work.
- Simplify processes by increasing consistency across allied health practitioner groups.
SIRA approved allied health professionals
If you're a SIRA approved allied health practitioner, refer to Section 4 of the SIRA Workers Compensation Guideline for Approval of Treating Allied Health Practitioners for further details regarding when you should complete an AHRR.
All other allied health practitioners that aren’t SIRA approved should complete the AHRR after completing the first treatment with your patient.
What you’ll need to include in the form
In completing the form, you’ll need to provide an assessment of your patient's capacity. This includes assessing your patient's participation at work, home and the community. You’ll also need to provide:
- A clinical assessment including:
- A diagnosis
- Current signs and symptoms
- Any pre-existing factors that are directly relevant to the injury
- Details of any other providers treating your patient
- Capacity: activity and participation levels of your patient; focusing on strengths rather than limitations.
- Recovery plan and goals including:
- Client steps and goals
- Client action plan and goals
- Service provider’s action plan.
- Services requested, including type, frequency and time frame for delivery. For example, any aids, equipment or a case conference.
- Reason for any services requested
- Anticipated date of discharge
- Details of the service provider.
You should complete the AHRR when providing a treatment consultation with your patient, or over consecutive treatment sessions.
Independent consultants provide a peer review of allied health practitioner (physical or psychological) treatment.
Any member of the patient's support team can recommend a referral to an independent consultant. All referrals to an independent consultant should be arranged by the insurer who completes the independent consultant referral form.
Allied health practitioners may recommend the referral of an independent consultant by contacting the insurer directly, or noting their request and rationale in the space provided on the Allied Health Recovery Request (AHRR).
If an NTD wishes to make a referral, the request and rationale for an independent consultant can be included in the certificate of capacity or via direct contact with the insurer.
When to refer to an independent consultant
As an allied health practitioner, you're encouraged to request involvement of an independent consultant when you think an independent opinion and/or expert advice will be beneficial to the management of a work-related injury, and there’s evidence of barriers to:
- recovery progress
- return to work
- active participation.
icare supports the proactive involvement of independent consultants to achieve the best outcome for the patient.
Insurers referring to independent consultants
The insurer will consider a referral to an independent consultant where an allied health practitioner requests treatment that continues beyond 16 sessions.
They may also consider referral after discussion with the treating allied health practitioner, if there is concern about:
- the treatment duration, frequency and/or whether treatment is reasonably necessary
- treatment that has continued for an extended period without any improvement in functional outcomes, particularly in relation to a worker’s capacity
- the treatment approach most likely to achieve positive work outcomes for the worker
- barriers to recovery at work and/or psychosocial risk factors for delayed recovery and work loss.
Who can be an independent consultant
An independent consultant for the review of physical treatment must be registered as either a:
An independent consultant for the review of psychological treatment must be a registered psychologist.
All independent consultants must be experienced in the assessment, treatment and management of workplace injuries, and must be approved by SIRA.