Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697640809828.pdf (Australia)
Australian Rehabilitation Providers Association Australian Rehabilitation Providers Association Incorporated Submission to House of Representatives Standing Committee on Employment and Workplace Relations Inquiry into Aspects of Australian Workers’ Compensation August, 2002 Affiliate Members • TAVRP (Tas) • VCORP (Vic) • ARPPS (NSW) • ARPPS (ACT) •RPA(WA) • QRPA (Qid) • SARPA (SA) • NTARP (NT) Correspondence 32 Swan St Wollongong NSW 2500 Phone 0242259166 Fax 02 4225 9294 Email arpaaus@hotmail.com President Phil Dening 0438 136 669 Vice President Brendan Delaney 0407 833 794 Secretary John Elrington 0417 149 543 Treasurer Warwick Copeland 0419 627 897 Introduction The Australian Rehabilitation Providers Association Incorporated (ARPA) represents the occupational rehabilitation (OR) industiy nationally.
ARPA is a council of representatives ofthe executives ofeach state and territory OR association and was formed in 2001.

ARPA is pleased to offer comments on the existing arrangements for providing occupational rehabilitation services to injured workers under the workers compensation jurisdictions of each state and territory ofAustralia.

In this submission, ARPA also recommends alternatives for improving performance and strategies for achieving optimum return to work outcomes based on best practice.
It is not the intention ofARPA to comment on the existence, detection or management of fraudulent workers compensation claims in Australia.

This submission responds exclusively to the third ofthe three published terms ofreference, dealing with: “Thefactors that lead to different safety records and claimsprofilesfrom industry to industry, and the adequacy.
appropriateness andpracticability of rehabilitation programs andtheir benefits.” In particular, this submission responds to the second part of that reference, as underlined above.

Industry Safety Safety performance varies across industries and reflects a range offactors generic to each industry as well as reflectingbroader cultural and attitudinal factors.
Injury profiles vary between industries according to factors such as: • • • • • degree ofinherent risk; extent ofreliance on physical labour; extent ofreliance on repetitive or monotonous activity; degree ofcontrol workers exert over theirwork; degree of satisfaction workers derive from their work.

Industries that are in high-risk categories for the above factors include agriculture, forestry, fishing, transport, construction and production/processing.
These industries generate significant numbers ofworkers compensation claims and are familiar territory forthe practice ofoccupational rehabilitation providers.

However, there are also other, apparently low-risk areas which generate significant claims, e.g.

organisations providing public services, and clericalladministrative environments.

These areas ofactivity can involve high levels of stress relating to contact with the public as well as tensions relating to organisational structure.
Page 1 of 8 Without doubt, one ofthe most significant factors contributing to industry injury profiles is management culture and competence.

Organisations that are managed with a high degree ofcare and concernfor employees’ safety typically see expenditure on safety as an investment rather than a bottom-line cost.

The yield from such investment is reduced injury, reduced workplace disruption, with reduced workers compensation claims frequency, claims costs and premiums.
Conversely, management that reflects unenlightened, rigid and subjective decision- making achieves far higher costs on the above measures.

Another factor that has affected safety outcomes in recent years has been the increasing trend towards contractor, subcontractor and casual employment relationships.

These relationships entail a weaker link between the employer and employee/worker, resulting in a tendency to a reduced duty ofcare perceived by employers towards their employees/workers.
Structural change in the economy can also result in increased workplace change that includes downsizing and increased levels ofuncertainty and anxiety forboth management and employees.

There is a direct relationship between the onset ofsuch events and an increased frequency ofworkers compensation claims.

Not surprisingly, those factors outlined above which contribute to higher or lower levels ofworkplace injury, also directly impact on the effectiveness ofoccupational rehabilitation(OR).
Workplaces that place a high emphasis on care for employee health and safety correlatehighly with a management culture that accepts responsibility for employee rehabilitation.

Such workplaces participate positively and constructively in return-to-workprograms and achieve higher return-to-work rates and lower associated costs.

Workplaces with low commitment on these measures achieve poorer outcomes.
Current Effectiveness ofRehabilitation As can be seen from the comparison of state and territory occupational rehabilitation arrangements in Appendix 1, the systems ofoperation and control on OR vary enormously.

Victoria, New South Wales, South Australia and Western Australia have relatively high levels ofcontrol on the access ofinjured workers to OR service providers and are prescriptive of the manner in which OR services are delivered.

Tasmania, ACT and Northern Territory are generally less regulated.
Queensland has only recently begun to open its system to input from the OR industry.

Unfortunately, there is little objective data that allows accurate comparison ofsystem characteristics and theireffects on outcomes.

The only readily available national data comes from the ‘Return to Work Monitor’, which is authorisedby the Heads ofWorkers Compensation Authorities.
The Return to Work Monitor focuses on outcome measures, and is based on a telephone sample survey that involves interviews with randomly selected claimants.

While this is useful, it falls far Page 2 of 8 short of a meaningful analysis ofoccupational rehabilitation activity and provides few indicators that lead to deeper knowledge and certainty about strategies for improvement.
The most recent Monitor (2000/2001) has published return to work rates showing a national average of 84, with Tasmania the highest state at 90, lowest at 79.

Comcare Australia reports a 93 for the average cost ofa rehabilitation program vary by more than 300 between the different schemes, as they include orexclude a range of different costs — the result is that these figures are oflittle use when attempting to measure the effectiveness of occupational rehabilitationnationally.
and South Australiathe return to work rate.

The figures quoted ARPA has identified this lack ofmeasurement as a serious issue, which undermines the decision-making ofall participants in the management ofthe rehabilitation system.

Consequently, ARPA has commenced the establishment of a national database, designed to capture objective outcome measures from all OR providers in Australia.

We estimate that it will be at least a year or more before a useful picture will emerge from the collection ofthis data.
Although the state and territory authorities collecta variety ofstatistics, Appendix 1 illustratesthe lack of available information for decision-makers on even the most basic measures such as return to work rates and costs.

Only New South Wales, South Australia and Western Australiaprovide some information on these measures but direct comparisons are not reliable because ofthe differing underlying assumptions that apply in eachofthose states.
Comcare Australia provides adequate statistical measures ofOR performance but again uses different assumptions and procedures.

Adequacy.

Annro~riatenessand Practicability ofRehabilitation Pro2rams The provision ofrehabilitation services within the workers compensation schemes of each state and territory is underpinned by specific references within the relevant legislation.
The legislation generally refers to employer obligations and specific commitments such as resourcing in-house management ofthe return to work process (e.g., appointing a rehabilitation/returnto work coordinator).

The legislation also usually determines the mechanisms for payment ofrehabilitation services by funding authorities.

Referral to OR Services Inpractice the most effective OR programs that achieve the best results are those operated within larger employer organisations and worksites.
Frequently, such large employers are self-insured.

Large employers, particularly self-insurers, have the experience that demonstrates the logic and cost-effectiveness arising from high levels of commitment to effective rehabilitation, including early.mtervention strategies.

Such employers closely manage the rehabilitation oftheir injured employees, using internal or external rehabilitation resources or a combination ofthe two.
It is not uncommon for some ofthese employers to extend OR services to employees with non-work related Page 3 of 8 illness or injury -- Forestry Tasmania (approximately 600 employees), and BHP Steel at Port Kembla (approximately 6000 employees) arejust two examples ofthis practice.

Centrelink, which is part ofthe Comcare system, also provides this service to all its employees.
Most small or medium sized employers have very limited experience, knowledge or resources to devote to the rehabilitation of their injured employees.

The effectiveness of the return to work process in such environments often reflects the mix ofpersonalities involved, apart from the nature ofthe injuries and available work.

Without question, the most significant determinant ofsuccessful rehabilitation outcome is delay in referral to OR services.
It is a maxim ofthe OR industry that early referral results in the optimum rehabilitation outcome at the lowest cost.

Conversely, delayed referral leads to multiple complications, reduced potential for return to work and higher costs.

A common consequence ofdelayed referral is that the injured worker is not only unable to return to gainful employment, buthe/she eventually becomes a burden on the federal welfare system.
Achieving early referral and streaming injuredworkers into appropriate occupational rehabilitation services is the biggest challenge confronting the workers compensation OR system today.

Insurers Insurers play a critical role in steering the referral of injuredworkers into the occupational rehabilitationprocess and its ongoing management and funding.

This role is most critical in regard to small to medium-sized workplaces.
Insurers have more recently begun to employee OR expertise to assist their claims managers in making appropriate decisions in this regard.

This trend has not yet had a significant effect on improving the use ofrehabilitation services.

Just as earlyreferral is critical for effective rehabilitation outcomes, early reporting of injuries and claims to insurers by employers has a similar impact on claims costs from the insurer perspective.
Doctors The role ofthe medical practitioner in regard to the injuredworker is to provide medical treatment.

Only a small percentage of general practitioners and specialists have embraced the use ofOR services as a routine option within the larger injury management picture.

Even with the facilitation and urging of state authorities, treating doctors and workplace management still rarely communicate about the return to work process.
Treating doctors have demonstrated they do not have the time, the inclination orthe expertise to deal with injury management outside their treatment facilities, much less in the workplace.

Bureaucratic Control Some state and territory authorities have invested significant effort in controlling the rehabilitation processto ensure consistency ofoutcome.
Such controls have included accreditationprocedures, specifying OR provider competencies and standards, fee setting Page 4 of 8 and various operational controls.

There appears to be no clear benefit derived from such controls.

In fact, there is ample evidence to support the view that excellent results can be achieved through a less bureaucratic approach, such as in the examples ofthe Comcare and Tasmanian schemes.
These two schemes have the highest return to work rates (Return to Work Monitor 2000/2001), and minimal controls over professional practice.

Legal Aspects The adversarial environment ofmost workers compensation schemes clearly works against focusing the motivation and commitment ofthe key participants on the earliest possible return to work ofthe injured worker.
Common law actions focused on negligence generally encourage injured workers and their lawyers to maximise apparent disability in order to achieve the maximum financial settlement oftheir claims, while insurers and employers conversely seek to minimise apparent disability.

Meaningful rehabilitation cannotoccur in such a competitive and uncooperative environment.
Recent trends to restrict access to common law using such measures as disability thresholds have helped to reduce this problem although adequate and affordable compensation must remain available to injuredworkers.

Similarly, disputes about liability can delay the commencement ofrehabilitation and distract injuredworkers from committing to rehabilitation during the dispute period.
Some insurers utilise OR services on a “without prejudice basis” during the dispute period and this is a preferable alternative to no rehabilitation at all.

Ironically, the Commonwealth’s compensation scheme, Comcare Australia, is so heavily committed to occupational rehabilitation that it copes poorly with those claims where no realistic rehabilitation goal is achievable.
Whereasthe state schemes have exit points (i.e., settlement) forthose injured workers whose disabilities render them unableto return to the workforce, Comcare has no such option.

This sometimes results in the wasteful continual application ofOR resources and becomes no more than a control measure for long term claimants in that scheme.
Redeployment Many injured workers cannot return to theiroriginal jobs because they have ongoing disability related to theirinjury or becausetheir original workplace is unable to accommodate their changed work capacity.

Such injuredworkers usually retain significant employability but are faced with a reluctant employment market which takes a negative view ofthe risk ofemploying them while they remain on workers compensation and with a disability.
Intensive redeployment efforts can be successful, however, the majority of such injured workers become demotivated and give up the search for new work even with continuing OR assistance.

Rehabilitation The role ofthe OR service provider is vital in the workers compensation injury management process.
By its very nature the injury management process in this Page 5 of 8 environmentrequires impartial, professional expertise which is able to help injured workers navigate the maze oflegal, medical, personal adjustment and occupational challenges and guide them back to meaningful employment as soon as possible following injury.

No other party involved in workers compensation schemes has this capacity.
All other parties tend to have a narrower focus, according to their specific expertise or their role within the schemes.

Unfortunately, in the statejurisdictions, occupational rehabilitation has been a secondary consideration and has often been overtaken by legal or medical considerations.

Without doubt, it is the goal ofall participants to see the injured worker return to work as soon as possible.
Therefore it is imperative that a more effective balance is developed between the competing forces within Australianworkers compensation in order to allow occupational rehabilitation to more quickly achieve that goal.

The Future ARPA believes there have been both successes and failures in the utiuisation ofOR services across Australia during the past two decades.
It is now time to seriously measure and assess strategies employed within each state and territory and move to a less fragmented approach that draws together the strengths and discards the weaknesses ofthe currentsituation.

The benefits ofoccupational rehabilitation are accepted in terms ofboth economic and socialjustice arguments.
Many large employers and, most particularly, self.insured employers, operate now on the basis that they accept these arguments and are committed to their OR programs because ofthe demonstrated benefits they provide.

The most critical issue really revolves around how to ensure that the relevant workers compensation systems manage the provision ofOR services to obtain maximum benefit forinjured workers, employers and the community generally.

Recommendations for Improvement 1.


ARPA recommends the removal ofexisting systemic barriers to the early referral ofinjured workers to appropriate professional rehabilitation services.

This will maximize the effectiveness ofefforts to get injured workers back to work as soon as possible and minimize the loss (in both human and financial terms) to injured workers and employers.

2.
2.

ARPA is absolutely committed to the principle that the most effective occupational rehabilitation is and should remain workplace based.

This process involves seeking the return ofthe injured workerto the workplace on a return to work program based on suitable duties as soon as is practicable following injury.

Page 6 of 8 3.

ARPA is committed to the principle ofa market-driven system that utilises public and private occupational rehabilitation services on a fee for service basis.

4.
4.

ARPA welcomes the management role ofthe relevant state and territory workers compensation authorities, however, it recommends that performance standards be outcome driven rather than process (i.e., input) driven.

5.

To this end, ARPA recommends increased emphasis on national data gathering and statistical analysis in order to measurethe effectiveness ofoccupational rehabilitation processes.
Such analysis should be structured in order to focus on realistic and meaningful comparisons ofOR services and outcomes between state and territory jurisdictions.

6.

ARPA supports the continuing emphasis on educating employers, and facilitating theirassumption ofresponsibility for the injury management oftheir own employees.

Employers must be the first line ofdetection ofthe need for injury management.
However, to achieve this, employers require input from the treating Doctor and this communication process must be fostered.

7.

However, ARPA acknowledges that this will take longer to achieve amongst smaller employers and as a consequence, ARPA supports the role ofinsurers at the claims management level to be the second line ofdetection for the early referral ofinjured workers to OR services.

8.
8.

Many injured workers are unable to return to their former employment because of factors associated with the extent oftheir disability orrestricted opportunities for work in their original workplace.

Such injured workers would benefit enormously, as would insurers, employers and community, if a national second injury scheme could be implemented.
Such a scheme would facilitate the redeployment of workers with a disability (and a continuing claim liability) to a new workplace, while offering some form of time limited premium protection as an incentive for the new employer.

Examples ofcurrent incentive schemes are RISE (SA), WISE (Vic), JobCover (NSW) and the Alternative Employer Incentive Scheme (NT).

9.
9.

Maintaining a capacity to settle claims is an important option that must remain available to insurers and injured workers in those instances where no positive occupational rehabilitation outcome is realistic.

Mandatory ongoing requirements to participate in rehabilitationwhere there is no achievable goal is demeaning of permanentlydisabled workers and wasteful ofresources.

10.
10.

Insurers should be encouraged to increase their in-house OR expertise in order to better manage injury claims, refer to OR services earlier and more appropriately and be better able to communicate effectively with OR service providers.

Page 7 of 8 11.

ARPA acknowledges its responsibility to continue working to improve the competence and expertise of its members and to improve the self-regulation processes within the OR industry.
This submission has been prepared for the exclusive use ofthe House ofRepresentatives Standing Committee on Employment and Workplace Relations’ Inquiry into Aspects of Australian Workers Compensation.

It has been preparedby the Executive ofthe AustralianRehabilitation Providers Association.

ARPA would be pleased to provide personal representation before the Committee in order to answer any questions and elaborate on the information contained within this submission.
Phil Dening, President, ARPA Brendan Delaney, Vice President, ARPA Jc~hnElrington, Secre , ARPA Page 8 of 8 Appendix 1 Table of Comparison of State and Territory Occupational Rehabilitation Arrangements Victoria Tasmania New South Wales Queensland South Australia Western Australia Yes — now company based No Yes No Yes Yes ACT Yes NT — —~ Yes - Issue 1.
Accreditation a) Is there a system ofAccreditation of ORP’s b) Who is responsible for the process c) Requirements for initial accreditation N/A N/A Victorian Workcover Authority - VWA Recognition of qualifications - OT, PT, Speech, Psych, Social Work, Voc’tl Psych, Voc’tl Counsellor.

Others by acknowledgement of experience in OR.
Demonstrated knowledge ofAct & Regs, - list of staff reviewed quarterly d) How is it maintained N/A Licences reviewed every 3 years - VWA may change the rules at any time, Licence removed ifmalpractice identified e) How reviewed New system in place does notindicate how this will be done N/A WorkCover NSW N/A WorkCover SA WorkCover WA WorkCover ACT and Comcare NT Work Health Authority - WHA N/A N/A N/A Companies assessed against ability to satisl~y - Minimum Quais for staffing, existence of Organisational Philosophy, systems for data collection & other admin activities, internal QA system, ability to provide OR services as legislated, can request accred for both streams ofOR or justone (RTW pre-injury employer, RTWnew employer) Achieve minimum RTW rates for areas accredited to: 80 pre.injuiy employer cases, 50 new employer cases; minimum number of casesclosed per year, Annual review ofRTW rates, closure numbers, and number of complaints made against company — iffail to meet requirements, a ‘risk management’ approacgh usedby WorkCover to askprovider company to ‘show cause’ as to why they should remain accredited.
Six standards to meet: service provision, recognition of h~jured workers rights and responsibilities, data submission, internal QA standards, business and financial management, HR Management.

Approved status issued to those who hold WorkCover NSW and/or Comcare accred.
Requirements currently changing Standards applied subjectively by an accreditation & monitoring committee - currently no benchmarks for performance Must have current standing with WorkCover NSW or Comcare - no other requirements Companies demonstrate staff have appropriate quals and experience, have processes to coordinate services, adhere to professional & ethical standards, proof of a coordinated multidisciplinary case mgtapproach, performance data supplied, Comcare accreditation.
Initial application form.

Annual request for staff change details in renewal application No WorkCover review.

(Comcare 2 yearly) Only review through renewal application process.

performance reviewed by Accred and Monitoring committee - subjectively.

Agencyproviders must have at least 2 members on staff withat least 5 years experience Companies contracted to WorkCover SA - need to meet criteria covering: code ofconduct, understanding &compliance with relevant laws, Admin responsibilities (eg.
data collection), internal QA system, insurance and security requirements.

Individuals must meet minimum qualification and experience criteria Quarterly review of stats — costs, outcomes, durations.

Response times, reporting standards &file management also assessed.
Quarterly reviews with face to facemeetings on statistics, monthlyreview of standards by agents, ad hoc audits - including internal audits conducted, monitoring and evaluating targeted service providers, investigation of complaints against providers, every 3 years letting ofcontracts to providers who met criteria decided by WorkCover SA 2.
Fees Issue Victoria Tasmania New South Wales Queensland South Australia Westem Australia ACT NT c) Howare they reviewed & by whom d) Increases linked to CPI e)Are the fees the same for all services provided a) Are fees regulated No Base rate $105.91, and recommended rate $115 perhour.

In theory,no max rate — inpractice, $115 seen as the maximum by most stakeholders.
b)if so, by whom Negotiated with insurers Negotiated with insurers on individual basis No — although some licensed insurers (fund managers) are setting fixed rates for certain OR services and/orfor all services provided.

Otherwise, individual companies set their own rates — market driven.

See above remarks reviewed with insurer basedon performance N/A See above Yes No No Yes Discipline based maximum even for the same services.

Rehab $90 per hour, OT$96, Physio $98, and Psychology $132.
Allare GST exclusive rates but are chargedwith GST.

Q-Comp -the regulator of WorkCover Insurer WorkCover SA and the State Govt, depending on provider discipline.

Medical & Allied Services Commitytee established by WorkCover WA N/A N/A Reviewed 3017 each yearby Q-Comp - notnecessarily by those with rehab experience Workcover SA — not done for Rehab Providers for 8 years, but OT/Physio/Psychs have had increases Annually by Workcover WA - but no standard or formula inplace.
Mostly based on “political climate” ofthe time Market forces N/A Yes, in the past, when rates were set by VWA.

The same for all OR services.


Different rates apply to allied healthservices — apart from Psychology services, most ofthese are lower than the OR rates N/A See above Yes - results in figures like $115.95 perhour No Up to individual service providers up to the individual company - some providers negotiate fixed price services with individual insurers, and now some insurers are setting specific rates for specific services.
Registered Providers - OT/PT/Psych - have basically the same prices, non- registered providers - Exercise physiologists, RC’s, Job Placement Officers - vary and can negotiate prices Maximum amount gazetted by Govt - mdiv companies decide own fee structure up to these amonts.

Mostservices charged at the same rate This year - yes.
No increase for previous 6 years No Yes - standard flat rate No N/A No 2 Issue Victoria Tasmania New South Wales Queensland South Australia Western Australia ACT NT Critical Incident debriefing, 0cc Stress management, Activities ofDaily Living assts, job analysis, work hardening/simulation, Functionals, worksite assts, Vocationals, external case coordination, initial needs asst, RTW management— pre injury employer, RTW maintenance, employment targetting, retraining, employment transition, travel Yes—although split in the Act over 2 sections Support counselling, vocational counselling, asst ofaids and appliances, case management, training and education, workplace activities, placement activities, functionals, vocationals, ergonomic assts, job analysis, work site assts, travel, medical costs — doctors bill providers for medical reports, reports Yes — a rehab entitlement under the Act that authorises 7 ofthe statutory entitlement to be usedfor voc rehab — approx $9000 at the moment Initial needs asst, case management, functionals, workplace assts, voc asst and counselling, functional education, disability injury management, adjustment to disability asst and counselling, job preparation — search and placement, physical conditioning program, cognitive/conimunicati on asst, employment placement support No (Comcare yes) Coordination of services/case management, initial asst services, injury management & education services, vocational rehab, voc asst!counselling/job search assistance, advisory services, RTW programs, OT programs — functionals/aids & equipment, liaison services, work hardening programs, injury prevention trainingand services, reports, travel Only ina general sense 3, Services Provided a) What services under OR are provided All RTW related services, using 9 OR codes: Initial Asst Functional Asst Advice re Vocational re- education Job Seeking Work Conditioning 0cc Rehab Counselling Functional Education Workplace Asst Vocational Asst No restrictions on type or extent of OR services provided.
If insurer/employer accepts them as reasonable, they will pay for them No case mgt by providers — done by case managers through WorkCover — look after claims mgt and rehab case mgt.

Referfor one- off servicesonly.
Services paid as OR by insurers — Initial Asst, Functionals, Workplace Asst, Job Analysis, Job Modifications, Rehab Counselling, Voc asst & counselling, Assistance withjob seeking, reports, work conditioning, functional education, monitoring, aids and equipment, travel, b) Are these based in legislation Yes Only in a general sense Yes Workcover are legislatively responsible for administering rehab, but all rehab could be outsourced and still meet the legislative requirements 3 Generic OR model of c) what is the process of RTW RTW process.
followed by ORP’s Compared to NSW, SA and WA, Vic scheme is non prescriptive in terms ofprotocols, forms, and process — ie.
focussed on outcome rather than process ofachieving the outcome - As per NSW example Same as per Tas/NSW — genericmodel of identi~’ingservices required to effects RTW - in consultation with all parties, services delivered as peragreed plan, monitored, reported on and closed when appropriate or as agreed Same as per generic RTW model of others - Same as per generic model, however noted that ergonomic training can be provided for if a RTW is expected, functional education provided for the management of self- care, leisure, workand home duties.
It is all focussed on workplace RTW.

Same as for NSW — a generic OR model ofservice delivery, Process not prescribed though Initial asst(s) completed, barriers to RTW - upgrading ifat work - identified,RTW goal developed after prognosis clarified and RTW goal agreed toby all parties, plan of service delivery — including time and costs sent to insurer, plan approved and services delivered with reports monthly on progress towards goal.
Case closed when goal achieved or agreed that no further rehab will assist, If claim exceeds 2 weeks, WorkCover case manager develops a rehab plan after a phone call to worker, employer and info from doctor.

Then refer for a specific service — such as a worksite asst — then provider needs to recommend additional services that need to be approved before delivered.

As the case can be closedas soon as the doctor notes ‘stable and stationery” little rehab occurs unless pushed by the employer.
This means outcomes are hard to measure as often rehab not completed before case is closed — leaving unhappy workers and employers, but a happy common law systemi 4.

Insurance System a) Is it privately underwritten or publicly funded b) “at fault” or “no fault” system c) How many private insurers, self insurers, and specialised insurers Public funded from premiums.

Central premium fund controlled by VWA.


Privately insured — a “risk” state Publicly funded Publiclyfunded Publicly funded Privately underwritten Publicly funded No Fault No Fault No Fault No Fault No fault No fault No fault 7 insurers (‘agents’) and 37 self insurers.
One small insurer — JLT, specialise in Local Govt coverage, 8 insurers, 16 self insurers, I specialised insurer 7 licensed insurers, 6 specialised insurers, approx 65 self insurers 35 selfinsurers, all other employers must beunder WorkCover QLD for insurance 5 agents — on behalf of WorkCover SA, 65 self insurers plus all state govt departments 10 insurers, 15 self insurers, 8 insurers plus Comcare Privately underwritten No fault 5 insurers, 5 self insurers Issue Victoria Tasmania New South Wales Queensland South Australia Western Australia ACT NT 4 5.
Referrals a) Referral sources Any one can refer, but ultimate approval for funding rests with the insurer.

b) Do referrals need to be approved by a particular party Insurers approve funding.

Workers have a nominal right to choose their provider, but in practice this means nothing.

Anyparty - majority from insurers.


Workers have the right to choose provider Insurer has ultimate say c) Decisions for ongoing service provision Input from different stakeholders, but in practice, decision rests with insurer, Insurerand employer.
Insurer has most power, but the larger employers have more say, especially if interested in rehab Any party Workcover case managers,employers Anyparty Any party Insurer, GP or employer Insurers or doctors — others with insurer approval Insurer and employers can approve — insurer usually has final say.

Workers have the right to choose their provider.

Some insurers now setting up ‘preferred provider panels’ and often overriding employer and/or worker choice ofprovider.
Insurers WorkCover case manager Agents or self insured employer can okay rehab.

Worker does have the right to choose provider, but WorkCovercan refuse to pay All parties must agree — results in delays for referral outto 240 days from 118 Insurer and employer — mostly insurers insurer WorkCover case manager Insurers or exempts, but workers can decide to continue when an agent decides to cease intervention Insurer, doctor, employer insurers insurers 6.
State Body Issues a)Is there a state/territory body b) Howmany providers in your state/ten’itoiy c) How many are members ofthe State/ten’itoiy body Yes — Victorian Council ofOccupational Rehabilitation Providers Yes— Tas Assoc of Vocational Rehab Providers Incorporated Yes — Assoc ofRehab Providers in the Private Sector No — initial meeting planned for August Yes — SA Rehab Providers Assoc Yes — RehabProviders Assoc Yes - Assoc ofRehab Providers inthe Private Sector Yes - Northern Territory Assoc of Rehab Providers Approx 110 16 companies, 16 sole practitioners Approx 115 companies, 169 accredited sites N/A 75 N/A Currently 39 companies Only individual practitioners can join (Not companies): 30 full members, 40 assoc members as Workplace Rehab Coordinators 185 accredited individuals in 24 companies, and 21 single owner businesses Only businesses can join.
Those that are members represent about 80 of the WorkCoverwork.
20 agency providers, 8 single providers, 12 employer based providers 21 accredited providers 9 13 Agency providers, 1 single provider 11 paid and 2 unpaid 8 d) What are the feespaid to the body Sliding scale based on size — current max rate is $330 per year (inc GS’I’) $120 per individual member, $60 per assoc member $275 peryear (inc GS’I) N/A $500 per annum per company — in’espective of size $250 per annum $50 Application fee $100 Annual fees Depends on the number of ‘full time equivalent’ providers.
About $100 per associateplus joining fees.
5 e) What are the membership requirements Pay the fees, be accredited with VWA and/or Comcare, and abide by the Constitution Accredited to WorkCover N/A NSW and/orComcare, and abide by the Constitution Appropriate professional qualifications, willingness to subscribe to the aims and purposes of TAVRP Business providing rehabilitation servicesin SA Accreditationwith WorkCover WA and/or Comoare WorkCover and/or Comcare accreditation Open to those who subscribe to the Purposes of the Association, possess appropriate qualifications as per the Constitution, and pay the fees.
Issue Victoria Tasmania New South Wales Queensland South Australia WesternAustralia ACT NT Yes — mandatory with more than 50 employees Yes — mandatory ifbase premium greater than $50,000 peryear Yes — legislated if more than 30 workers Not generally — but self insured employers do Yes — although not requiredto by legislation No, but new legislation will soon require this Those withmore than 20 workers are supposed to have one Yes — training supported by WorkCover NSW Yes — run by a private company but authorised by Workplace Standards Authority Some training through 3 day trainingand 1 dayrefresher every 3 WorkCover SA and years — backed by the government TAPE — not compulsory Authority cannot access data No stats produced 87 Pre injury employer cases 53 new employer cases (to April 2001) Not measured 79 At discretion ofemployer Private training is available, but not yet required No formal training required No ACT stats available Not available A cumbersomeand confusing process exists.
Aimost 80 ofclosures are excluded due to exclusion criteria established — eg.

delay to referral greater than 121 days - with average delaynow 270 days!

b) What are the average plan costs May average approx for ORP’s Matter for speculation.

$1500, but no accurate figures available.

No stats produced $3610 for all plan cases — Not measured no break up yet for different goal types $566 median $2600 No ACT stats available Not available 6 Mandatory for employers with remuneration of $lm or more.
Other employers must nominate someone for the role if they have a claim involving 20 or more calendar days offwork.

No specific training requirements — usually offered by insurers.

Role is usually ineffectual except for employers with excellent track records in OHS and Injury Management.

7.

Employer Issues a) Do employers have RTW/Rehab Coords in place b) Are they trained,and if so, is it government backedor private 8.
Provider Results a) What are the outcome rates for RTW new employer and pre injury employer cases