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
2
Return to work services
1. Preinjury
employer
2. Fit for
work
First
Implementation
Oct 2013
1 new service –
implemented 14th
April 2014
Changes July
2014
WorkCoverSA
Full
Implementation
1st July 2014
Job
placement
3. Return to
work
assessment
Scaled
implementation Oct
2013
1 new service –
implemented 14th
April 2014
Full
Implementation
1st July 2014
Full
Implementation
1st July 2014
2.
Restoration
to the
community
Mediation
Full
Implementation
1st July 2014
Implemented
December 2013
3
Workplace
rehabilitation
provider services
Return to work services fee
schedule
FFW
NES
PIE
PIE
RtC
WorkCoverSA
Physio
/ OT /
Psych
RtC
JPS
RTW
Assmt
Mediation
4
Medical expert rehabilitation services
Occupational
therapist
Physiotherapy
• Functional
capacity
evaluation and
report
• Graduated
return to work
program and
report
• Job analysis
and report
• Worksite
assessment
and report
• Functional
capacity
evaluation and
report
• Graduated
return to work
program and
report
• Job analysis
and report
• Worksite
assessment
and report
WorkCoverSA
Psychologist
• Vocational
assessment
and report
5
Pre-injury employer service
GRTW
JA
Worker
Worker
WSA
RTW
provider
Employer
Employer
RC
WorkCoverSA
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RRTWP
JA
INA
WSA
RRTWP
CC
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7
What we expect of Return to work services….
 Focus on service
 Reduced delays
Worker
 Reduced disruption
 Accountability in delivering the right
service
Employer
 Purposeful service
 Reduce medicalization
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8
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
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Return to work assessment services
Who are return to work consultants?
Class A
RTW Consultant
Class B
RTW Consultant
$170.20 per hour
$138.50 per hour
Physiotherapist
Meet the HWCA minimum
qualification requirements
2 years FT
clinical
experience
Occupational therapist
Psychologist
Exercise physiologist
OR
Do not meet the criteria for class A
return to work consultants
1 year FT as
a class B
consultant
supervised
by a Class A
consultant
Rehabilitation counsellor with full
membership with ASORC or RCAA
2 years FT
membership and
experience
Return to work assessment services
NEW
NEW
Agent case
conference
support
service
Return to
work goal
verification
service and
report
(including travel*)
CHANGE
Worksite
assessment
and report
(including travel*)
Functional
capacity
evaluation
and report
Vocational
assessment
and report
Suitable
employment
assessment
and report
Up to 7 hrs
Up to 7 hrs
Up to 6 hrs
Class A
(Physio / OT)
Class A / B
(Psych)
Class A / B
(ALL)
(including travel*)
Up to 4 hrs
Up to 9 hrs
Up to 6 hrs
Class A / B
Class A
(ALL)
(ALL)
Class A
(Physio / OT
/ Psych)
*Additional travel for regional areas applicable where criteria met
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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
Purpose
• To assist the case manager in their Agent case
conferencing
Consideration
• Not concurrent with pre-injury employer service
• Not concurrent with fit for work service
CM action
• Determine what information required
• Determine the method you would like to receive this
information
• Communicate with consultant after sending referral
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
Expertise to review file is
required
Presence at a case conference
SERVICE: Facilitate a case
conference, with agenda guided
by CM
(at Agent, or treating practitioner’s
rooms)
SERVICE: Provide specialist
review on return to work
management
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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
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Return to work goal verification
service and report
Return to work assessment
Return to work goal verification service and report
Purpose
• To provide an independent opinion of the availability of
suitable employment at the pre-injury employer
Consideration
• 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)
CM action
• Make referral to an independent PIE provider
• Provide copies of previous return to work service reports
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
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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
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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)
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Worksite assessment and report
Return to work assessment
Worksite assessment and report
Purpose
• Ensure a safe return to suitable
employment
Consideration
• Expert opinion is required to
identify suitable duties
• No concurrent PIE, FFW referral
CM action
WorkCoverSA
• Make referral
• Ensure no implementation service
is required
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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
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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
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Functional capacity evaluation and report
Return to work assessment
Functional capacity evaluation and report
Purpose
Consideration
CM action
WorkCoverSA
• Determine the worker’s capacity over a
range of physical demands to make
recommendations for participation in work
• No more than one FCE in an 18 month
period
• The required information about capacity is
not available through other means
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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
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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
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Suitable employment assessment
Return to work assessment
Suitable employment assessment
Purpose
Consideration
CM action
WorkCoverSA
• Identify suitable employment options for the
worker
• 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
• Where suitable employment goals are not
already identified within other return to work
services (e.g. FFW, JPS)
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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
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Vocational assessment
Return to work assessment
Vocational assessment
Purpose
• Evaluate the worker’s actual and potential
ability, cognitive skills, aptitudes and
competencies, and relate these to suitable
employment options for the worker
Consideration
• Psychometric testing to be conducted by a
psychologist
• Integrated clinical and standardised
assessment procedures and instruments
CM action
• Where existing assessments are not
sufficient in identifying suitable employment
options for worker
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Referral scenarios
Vocational assessment
Where suitable employment
option identified requires retraining 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
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