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

2. 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

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

4. 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

5. 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

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

7. RRTWP
INA JA
WSA
RRTWP CC
WorkCoverSA

8. 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

9. Case manager’s tool kit

11. 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

12. Return to work assessment services

13. 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
$ per hour
$ 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

14. 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

15. Agent case conference support service

16. 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)

17. 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

18. 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

19. 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 ($ hourly rate)
1st July onwards:
Class A ($ hourly rate)
Class B ($ 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

20. WorkCoverSA

21. Return to work goal verification service and report

22. 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

23. 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

24. 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

25. 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

26. WorkCoverSA

27. Worksite assessment and report

28. 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

29. 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

30. 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

31. WorkCoverSA

32. Functional capacity evaluation and report

33. 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

34. 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

35. 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

36. WorkCoverSA

37. Suitable employment assessment

38. 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

39. 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

41. Vocational assessment

42. 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

43. 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