Return to work assessment service
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Transcript of Return to work assessment service
Return to work assessment services29 May 2014
Leanne HoManager, Allied Health and Return to Work Services
Return to work assessment service
WorkCoverSA 2
1. Background
2. Expectations of service
3. In context
PURPOSE: To provide you of Return to work assessment services “in practice” from 1 July 2014
WorkCoverSA 3
Return to work services
1. Pre-injury
employer
First Implementation
Oct 2013
1 new service – implemented 14th
April 2014
Changes July 2014
2. Fit for work
Full Implementation
1st July 2014
Job placement
Scaled implementation
Oct 2013
Full Implementation
1st July 2014
3. Return to work
assessment
1 new service – implemented 14th
April 2014
Full Implementation
1st July 2014
2. Restoration
to the community
Full Implementation
1st July 2014
Mediation
Implemented December 2013
WorkCoverSA 4
NES
Physio / OT / Psych
RtC
PIE
Workplace rehabilitation provider services
Return to work services fee schedule
FFW
RTWAssmt
Mediation
PIE JPS
RtC
1 July 2014
Medical expert rehabilitation services
WorkCoverSA 5
Occupational therapist
• Functional capacity evaluation and report
• Graduated return to work program and report
• Job analysis and report
• Worksite assessment and report
Physiotherapy
• Functional capacity evaluation and report
• Graduated return to work program and report
• Job analysis and report
• Worksite assessment and report
Psychologist
• Vocational assessment and report
Pre-injury employer service
WorkCoverSA 6
JAGRTW
WSA
RC
Worker
Employer
RTW provider
Worker
Employer
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INA
RRTWP
JA
WSA
CCRRTWP
What we expect of Return to work services….
WorkCoverSA 8
Focus on service
Reduced delays
Reduced disruption
Accountability in delivering the right service
Purposeful service
Reduce medicalization
Worker
Employer
Case manager’s tool kit
Return to work assessment services within the case manager’s tool kit
• Targeted and specific scenarios
• Where return to work services are not involved
• Where return to work services are not able to provide the required information
WorkCoverSA 11
Return to work assessment services
Class A RTW Consultant
Physiotherapist
Occupational therapist
Psychologist
Exercise physiologist
Rehabilitation counsellor with full membership with ASORC or RCAA
Class B RTW Consultant
Meet the HWCA minimum qualification requirements
Do not meet the criteria for class A return to work consultants
$170.20 per hour $138.50 per hour
2 years FT clinical experience
OR
1 year FT as a class B consultant supervised by a Class A consultant
2 years FT membership and experience
Who are return to work consultants?
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Return to work assessment services
Agent case conference
support service
(including travel*)
Up to 4 hrs Class A / B
(ALL)
Return to work goal
verification service and
report (including travel*)
Up to 9 hrsClass A (ALL)
Worksite assessment and report
(including travel*)
Up to 6 hrsClass A
(Physio / OT / Psych)
Functional capacity
evaluation and report
Up to 7 hrsClass A
(Physio / OT)
Vocational assessment and report
Up to 7 hrsClass A / B
(Psych)
Suitable employment assessment and report
Up to 6 hrsClass A / B
(ALL)
NEW NEW CHANGE
*Additional travel for regional areas applicable where criteria met
Agent case conference support service
Service overview
• Service to assist the case manager in their Agent case conferencing (Agent claims review) Agent case conferencing ≠ Traditional case conference
• Each service may have different requirements (information required, method of obtaining)
Agent case conference support service
Return to work assessment
• To assist the case manager in their Agent case conferencingPurpose
• Not concurrent with pre-injury employer service• Not concurrent with fit for work service Consideration
• Determine what information required• Determine the method you would like to receive this
information• Communicate with consultant after sending referral
CM action
Agent case conference support service
Referral scenarios
WorkCoverSA 18
Agent case conference support service
Insufficient information to conduct Agent Claim Review
SERVICE: Gather info from involved parties, in support of
Agent claim review
Presence at a case conference
SERVICE: Facilitate a case conference, with agenda guided
by CM (at Agent, or treating practitioner’s
rooms)Expertise to review file is
required
SERVICE: Provide specialist review on return to work
management
What is expected
• Who delivers this service?• 14th April – 30th June: currently appointed workplace
rehabilitation provider ($135.30 hourly rate)• 1st July onwards:
• Class A ($170.20 hourly rate) • Class B ($138.50 hourly rate) • RTW Consultants of appointed Return to work services
provider
• What is included?• Up to 4 hours of service, including travel if required• Provision of a brief summary report• Communication with parties as requested by case manager
WorkCoverSA 19
Agent case conference support service (14/4/14)
WorkCoverSA 20
Return to work goal verification service and report
Return to work assessment
• To provide an independent opinion of the availability of suitable employment at the pre-injury employer Purpose
• Return to work goal is pre-injury employer• Clarification is required to review the return to work goal
where suitable employment is uncertain• A previous Level 1 or 2 Intervention has previously been
delivered (attempt to return to work)
Consideration
• Make referral to an independent PIE provider• Provide copies of previous return to work service reportsCM action
Return to work goal verification service and report
Referral scenarios
WorkCoverSA 23
Return to work goal verification service and report
Long term sustainability of worker returning to pre-injury
employer is unclear
Dispute in return to work goal direction between parties
Second opinion is required to review the durable suitable
employment options available prior to changing return to work
goal
What is expected
• Equivalent to Level 1 Intervention Pre-injury employer service• Assess the physical and / or psychological demands of duties at
the workplace and recommend for appropriate workplace modifications where required to accommodate a worker’s medically certificated work capacity
• PLUS explore and exhaust any suitable employment options with the pre-injury employer
WorkCoverSA 24
Return to work goal verification service and report
Return to work assessment
• Who delivers this service?• Class A RTW Consultant
• What is included?• Level 1 Intervention pre-injury employer service such as:
• Review of history and return to work progress• Attendance at workplace to review suitable employment options • Explore and exhaust all suitable employment options with pre-injury
employer• Recommendations for workplace modifications or equipment where
necessary • Up to 9 hours of service, including travel
• Provision of a Return to work goal verification report including recommendation for the RTW Goal (PIE or NES)
WorkCoverSA 25
Return to work goal verification service and report
WorkCoverSA 26
Worksite assessment and report
Return to work assessment
• Ensure a safe return to suitable employmentPurpose
• Expert opinion is required to identify suitable duties
• No concurrent PIE, FFW referral
Consideration
• Make referral• Ensure no implementation service is
requiredCM action
WorkCoverSA 28
Worksite assessment and report
Referral scenarios
WorkCoverSA 29
Worksite assessment and report
Treating doctor expresses concerns about certifying
worker’s return to workWorker’s employer requires
advice regarding suitable employment in the workplace to
facilitate return to work
New employment is identified and workplace design,
modification advice is required for safe and durable return to
work
Return to work assessment
• Who delivers this service?• Class A RTW Consultant – Occupational Therapist,
Physiotherapist, Psychologist
• What is included?• Attendance at the worksite with worker, and employer• Establishing worker’s capacity to undertake duties and individual
tasks• Identification of suitable duties• Recommending workplace modifications where necessary to
accommodate worker’s return to work• Up to 6 hours of service, including travel• A worksite assessment report
WorkCoverSA 30
Worksite assessment and report
WorkCoverSA 31
Functional capacity evaluation and report
Return to work assessment
• Determine the worker’s capacity over a range of physical demands to make
recommendations for participation in workPurpose
• No more than one FCE in an 18 month period
Consideration
• The required information about capacity is not available through other
meansCM action
WorkCoverSA 33
Functional capacity evaluation and report
Referral scenarios
WorkCoverSA 34
Functional capacity evaluation and report
Treating doctor requires clarification of the worker’s
functional ability to appropriately certify Treating health practitioners are
not able to provide sufficient assessment of worker’s full
functional abilities
Complex claims
Return to work assessment
• Who delivers this service?• Class A RTW Consultant (Physio / OT)
• What is included?• Review of medical information provided by the requestor• Identification of potential return to work goals and options for
which the FCE is required• Assessment of worker’s functional abilities to perform the
physical demands of the proposed job(s) and determine whether the worker has the capacity to undertake these demands
WorkCoverSA 35
Functional capacity evaluation and report
WorkCoverSA 36
Suitable employment assessment
Return to work assessment
• Identify suitable employment options for the workerPurpose
• Job goals are expected to be real jobs, that are currently available in the marketplace
• Suitable employment goals are to support the worker in achieving durable paid employment
Consideration
• Where suitable employment goals are not already identified within other return
to work services (e.g. FFW, JPS)CM action
WorkCoverSA 38
Suitable employment assessment
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Referral scenarios
Suitable employment assessment
Where return to work services is not involved e.g. worker is independently job seeking
Legal requirement for claims purposes
Due to worker’s circumstances, a more robust assessment, functional and practical is
required to prepare the worker for JPS
Vocational assessment
Return to work assessment
• Evaluate the worker’s actual and potential ability, cognitive skills, aptitudes and competencies, and
relate these to suitable employment options for the worker
Purpose
• Psychometric testing to be conducted by a psychologist
• Integrated clinical and standardised assessment procedures and instruments
Consideration
• Where existing assessments are not sufficient in identifying suitable employment options for worker
CM action
WorkCoverSA 42
Vocational assessment
WorkCoverSA 43
Referral scenarios
Vocational assessment
Where suitable employment option identified requires re-
training where there is no evidence to demonstrate worker’s ability to meet
demands
More robust psychological assessments are required to
assess the suitability of a suitable employment goal