NT Worksafe and the Role of General

PractitionersNorthern Territory Workers Compensation Scheme

What we do

• Occupational Health and Safety

• Dangerous Goods

• Electrical Safety

• Mines and Major Hazard Facilities Safety

• Workers Compensation & Information

Workers’ Compensation Scheme

Operates under the

• Workers Rehabilitation and Compensation Act

• Workers Rehabilitation and Compensation Regulations

About the Scheme

• No fault scheme

• No common law access

• Privately underwritten

• Multiple insurer scheme

– 5 approved insurers

– 4 self insurers

– Nominal Insurer• Premiums are not regulated and are set by individual insurers

Who is eligible?for Workers compensation under the Northern Territory Workers Rehabilitation and Compensation Act

Who is excluded?

• Workers who have submitted their ABN in writing to their employer

• Commonwealth employees (covered under Comcare)

• Family member, except where specifically named

• Company Director, except where specifically named

• Any person or class of person excluded by Regulation

• Volunteers (unless those prescribed) and most sports persons

When to make a claim

• A claim can only be made if the injury or disease arises out of or in the course of the worker’s employment

• Gradual onset injuries or diseases must be materially contributed to by the worker’s employment, this is defined as the employment being the real, proximate, or effective cause

• Journey claims, however most journey claims involving motor vehicles to and from work are not workers’ compensation and are covered by Motor Accidents Compensation Scheme

Claims process

• A worker must inform their employer as soon as practicable after becoming aware of an injury or disease

• The worker completes the first two pages of the workers’ compensation claim form

The worker must:

1. Sign and date the declaration

2. Sign authorisation to release medical information - if not signed the claim will not be recognised as a claim for compensation

Claims process

• If the claim is for lost time an approved workers’ compensation medical certificate must accompany the claim form

• If the claim is for medical expenses only, the approved medical certificate is not required

• The worker hands or sends the completed claim form to their employer

• On past statistics about 95% of claims will be accepted with approximately 5% being deferred or rejected

Doctors role

• Except in certain remote situations* General Practitioners are the sole authority to issue medical certificates for lost time by injured or ill workers

• The medical certificate provides information to assist the insurer in deciding whether to accept the claim and how to best manage the claim

• Participation in case conferences, treatment and management of injury and return to work programs* Registered nurses and aboriginal health workers can issue limited medical certificates in remote locations.

Medical certificatesThere are three types of NT Workers’ Compensation medical certificates:-

• First Certificate: completed at the first consultation and covers first 14 day period. If the claim is for lost time, this medical certificate must be attached to the claim form. This is the only workers’ compensation medical certificate that is mandatory for lost time claims.

• Progress Certificate: for continuing periods of partial or total incapacity and covers a maximum period of 28 days – This form was designed to provide the insurer with relevant and adequate medical information for the management of workers’ compensation claims.

• Final Certificate: to be issued when the worker has fully recovered or ceases to be incapacitated from work related condition.

NT WorkSafe does not regulate fees and charges. However, the scheme provides for the payment of a worker’s reasonable medical, surgical and rehabilitation expenses.

Medical certificate issues

Past reviews of medical certificates indicated problems around the following issues:

• Almost 50% of First Medical Certificates submitted provided a generic rather than specific diagnosis;

• Less than 30% of the First Medical Certificates contained a completed medical practitioner/employer contact section; and

• More than 30% of Progress Medical Certificates were not completed fully, particularly with regard to the clinical findings, diagnosis and injury management sections.

Unfortunately where these shortcomings occur the effectiveness of the medical certificate is compromised

First Workers Compensation Medical Certificate

Medical certificates

• Worker and employer details section• Injury details section

– Date injury first noticed– Worker’s description of injury– Further investigation is permissible e.g. speaking with employer– Worker’s description of how injury occurred

• Medical Assessment– Examination– Investigations– Diagnosis – particularly in progress certificates

Medical certificates

• Fitness for work– Consultation with the employer is permissible when completing

this section– Detail what restricted duties are involved and include what the

worker can do– Communication with employer, insurer and rehabilitation

provider about restrictions– Case conferences include all parties to the claim process,

including the insurer (case manager), rehabilitation coordinator, the worker and the employer and can be charged at a reasonable rate

Medical certificates

Injury management• Communication is the key

All aspects of the medical management plan should be completed including medication

Referrals in cases where diagnosis may be unclear or uncertain

It is imperative that as much information as possible is provided to allow for decisions to be made promptly because:

Without sufficient information, independent examiners are often sought to provide advice

Patients may experience some delays while more information is being obtained

Rehabilitation

Injury Management• The principles of injury management and return to work are the

primary objectives of the workers’ compensation scheme• Rehabilitation is the process of restoring, as far as is practicable, a

worker to the same physical, economic and social condition to which the worker was before the work related injury

• A goal of rehabilitation is to return the worker to the workplace as soon as it is practical

• The insurer must approve the referral before rehabilitation can proceed

Rehabilitation

Worker responsibilities

• To undertake all reasonable treatment and training or assessment and return to work programs, as part of the rehabilitation process

• This may involve doing different duties until they are fit for their former work

• If the worker is unable to return to their former job, they may need to be retrained for other work

• Failure to co-operate can lead to a reduction or cancellation of benefits

RehabilitationEmployer responsibilities• An employer is required to assist the worker with the rehabilitation

program and take all reasonable steps to provide or obtain suitable employment for the worker

• So far as is practicable, participate in efforts to retrain the injured worker

• Ensuring, if necessary, that there is a referral to an accredited vocational rehabilitation provider who can help to devise and implement a suitable early return to work plan

• If the employer is unable to provide the worker with suitable employment, the employer in consultation with the insurer must refer the worker to an Alternative employer incentive scheme

Dispute resolution

• Mediation• Work Health Court• Permanent Impairment Reassessment

Mediation

If a claimant disagrees with an insurer’s decision they may initiate the mediation process through NT WorkSafe either by:

1. Completing the request for mediation slip accompanying the notice of decision

2. Write to NT WorkSafe clearly stating the nature of the dispute

Work Health Court

If a party to a dispute is dissatisfied with the outcome of the mediation process they may then make an application to the Work Health Court.

An application to the Work Health Court should be made within 28 days of the party receiving Certificate of Mediation, although the Court has the power to extend the 28 day time limit.

The Work Health Court is constituted by a magistrate or, in certain circumstances, the Registrar or Judicial Registrar.

Permanent Impairment Reassessment

If a worker believes that they have a permanent impairment, they may apply to their employer’s insurance company, or their own doctor, for an assessment of that impairment.

If the worker or the insurer is dissatisfied with the original level of permanent impairment percentage, either may apply to NT WorkSafe for a reassessment. Such applications must be in writing.

NT WorkSafe must receive an application for a reassessment within 28 days of the insurer or worker being notified of the result of the initial assessment.

Further Information

www.worksafe.nt.gov.au

• Doctor's Information Kit

• A Doctor's Role in Injury Management

• The Evaluation of Permanent Impairment

• Permanent Impairment Assessment/Reassessment Checklist

• Doctors' and Allied Professionals' Frequently Asked Questions

• Doctor's guide to permanent impairment reassessment medical reports

Contact Us

For further information or assistance in claims management contact the workers’ compensation insurer or NT WorkSafe Workers’ Compensation Advisory Line:

08 8999 5585 / 1800 250 713

This information is for training purposes only. No part may be reproduced without the permission of NT WorkSafe. The information contained in this presentation is accurate at the date of production 29 June 2010.