Return to work assessment services 29 May 2014 Leanne Ho Manager, Allied Health and Return to Work Services

Return to work assessment service PURPOSE: To provide you of Return to work assessment services “in practice” from 1 July 2014 1. Background 2. Expectations of service 3. In context WorkCoverSA

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 3. Return to work assessment 2. Restoration to the community Mediation Implemented December 2013 WorkCoverSA

Workplace rehabilitation provider services 1 July 2014 Workplace rehabilitation provider services Return to work services fee schedule FFW RTW Assmt Mediation PIE JPS RtC NES Physio / OT / Psych RtC PIE WorkCoverSA

Medical expert rehabilitation services Occupational therapist Functional capacity evaluation and report Graduated return to work program and report Job analysis and report Worksite assessment and report Physiotherapy Psychologist Vocational assessment and report WorkCoverSA

Pre-injury employer service GRTW JA Worker RTW provider Worker WSA Employer Employer RC WorkCoverSA

RRTWP INA JA WSA RRTWP CC WorkCoverSA

What we expect of Return to work services…. Focus on service Reduced delays Reduced disruption Accountability in delivering the right service Purposeful service Reduce medicalization Worker Employer WorkCoverSA

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

Return to work assessment services

Who are return to work consultants? 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

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 hrs Class A Worksite assessment and report (including travel*) Up to 6 hrs Class A (Physio / OT / Psych) Functional capacity evaluation and report Up to 7 hrs Class A (Physio / OT) Vocational assessment and report Class A / B (Psych) Suitable employment assessment and report Class A / B (ALL) NEW NEW CHANGE *Additional travel for regional areas applicable where criteria met WorkCoverSA

Agent case conference support service

Agent case conference support service Service overview Agent case conference support service 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)

Return to work assessment Agent case conference support service To assist the case manager in their Agent case conferencing Purpose 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 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 WorkCoverSA

Agent case conference support service (14/4/14) What is expected Agent case conference support service (14/4/14) 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

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Return to work goal verification service and report

Return to work assessment Return to work goal verification service and report 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 reports CM action

Return to work goal verification service and report Referral scenarios 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 WorkCoverSA

Return to work goal verification service and report What is expected Return to work goal verification service and report 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

Return to work assessment Return to work goal verification service and report 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

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Worksite assessment and report

Return to work assessment Worksite assessment and report Ensure a safe return to suitable employment Purpose Expert opinion is required to identify suitable duties No concurrent PIE, FFW referral Consideration Make referral Ensure no implementation service is required CM action WorkCoverSA

Worksite assessment and report Referral scenarios Worksite assessment and report Treating doctor expresses concerns about certifying worker’s return to work Worker’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 WorkCoverSA

Return to work assessment Worksite assessment and report 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

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Functional capacity evaluation and report

Return to work assessment Functional capacity evaluation and report Determine the worker’s capacity over a range of physical demands to make recommendations for participation in work Purpose No more than one FCE in an 18 month period Consideration The required information about capacity is not available through other means CM action WorkCoverSA

Functional capacity evaluation and report Referral scenarios 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 WorkCoverSA

Return to work assessment Functional capacity evaluation and report 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

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Suitable employment assessment

Return to work assessment Suitable employment assessment Identify suitable employment options for the worker Purpose 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

Suitable employment assessment Legal requirement for claims purposes 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 WorkCoverSA

Vocational assessment

Return to work assessment Vocational 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

Vocational assessment 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 WorkCoverSA