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CGU WORKERS COMPENSATION TASMANIA

INJURY MANAGEMENT PROGRAM

Insurance Australia Limited trading as CGU Workers’ Compensation

ABN 11 000 016 722

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Contents

Introduction - Injury Management Program 3

1 Injury Management Policy 5 2 Policy for the management of employer IM Programs 9

(Licensed Insurers Only) 3 Information Management 12 4 Communication Management 16 5 Role of the Injury Management Co-ordinator 19 6 Role of the Workplace Rehabilitation Provider

(WRP) 22 7 Role of the Return to Work Co-ordinator (RTWC) 26

(SELF-INSURERS ONLY) 8 Mechanisms to Facilitate Early Reporting & Intervention 27

of Injuries/Claims 9 Medical Management 30 10 Return-to-Work 35 11 Management of Alternative Duties 37

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Introduction - Injury Management Program (IMP)

Workplace injury management is about returning employees to productive employment as quickly and as safely as possible following a work-related injury or illness. The underlying principle of workplace injury management is that rehabilitation in the workplace is more effective, productive, and of greater benefit to all concerned. Within this framework CGU supports the commencement of return to work as soon as practicable following work-related injury and / or illness and is committed to the principle of workplace injury management. This CGU Injury Management Plan is an established system that seeks to ensure optimum outcomes in regard to a timely, safe and durable return to work for workers following workplace injuries.

It provides for prompt treatment of injuries, effective and pro-active management of injuries, necessary medical and occupational rehabilitation following injuries in order to assist injured workers achieve a return to work as soon as possible.

The CGU Injury Management Program has been developed so that its employer clients are able to utilise the program within their workplace in the absence of developing their own stand alone program. The CGU program reflects and reinforces the principles of the WorkCover Tasmania Board Injury Management Model. CGU has a dedicated Injury Management Co-ordinator within its claims management operation to ensure effective Injury Management is initiated and maintained throughout the life of significant injury claims and that Injury Management activity is in compliance with WorkCover Tasmania and legislative requirements.

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To ensure efficient Injury Management, CGU utilises a computer based management database, namely the Injury Management Workbook:

This system has been developed specifically for the use by the Injury Management Co-ordinator to record, manage and oversee the compliance requirements of Injury Management as well as drive effective injury management protocols. This program monitors and manages data from the Case Management Team across the following Criteria:-

• Provides the Injury Management Co-ordinator with an effective tool to

oversee injury management activity • Provides a reporting tool to ensure adherence to internal processes and

legislative requirements • Incapacity status and RTWP and IMP requirements • Workplace Rehabilitation Provider appointment and activity requirements as

well as a monitoring and review tool • Regular involvement of relevant parties within the claim • Medical activity and reports within appropriate timeframes • That case file documentation is appropriate • That the Workers capacity to maintain RTWP activity is reviewed • That dispute resolution is managed

The IMC Worbook assists the Injury Management Co-ordinator to oversee Injury Management activity and that it meets the requirements of WorkCover Tas.

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1 Injury Management Policy

1.1 Statement of Commitment & Objectives CGU is committed to injury management and the rehabilitation of employees who suffer a work related injury or illness falling under the protection of a CGU insurance policy. CGU will work with its client employers to ensure injured employees return to work as soon as practicable, and that returning to work is a normal practice and expectation. CGU encourage the provision of suitable duties/employment, where practicable, for injured employees as an integral part of the injury management process. CGU consult with employers, their injured workers and where necessary, relevant stakeholders, to ensure the program operates effectively.

CGU informs its employer clients of the principles of the Injury Management Model, provide education to client employers where required and reinforce the principles of best practice injury management as defined within the model. CGU currently provides injury management awareness training to our employer clients. 1.2 Statement of Roles & Responsibilities of all Parties Workplace injury management requires co-operation between all parties involved to achieve a timely, safe and durable return to work for employees following a workplace illness or injury.

Insurer Obligations The CGU Injury Management Program is made available to all current policy holders to enable its availability to workers.

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CGU recognises the importance of providing dedicated resources and expertise to ensure optimum injury management strategies are being applied including medical/return to work management Accordingly, CGU has developed an integrated model of case management that utilises the different skill sets of our Injury Management Co-ordinator and Case Managers to maximum effect. To ensure this integrated model works effectively each person has clear accountabilities and responsibilities.

Case Manager

Assist workers to achieve best results for a timely, safe and durable return to work. Determine claim liability. Management of disputes. Provision of appropriate treatment in accordance with evidence based practice. Estimate claims. Ensure payments are made in a timely manner in accordance with the legislation. Arrange appropriate investigations. Conduct claims management reviews to establish ongoing strategies. Prepare correspondence. Management of legal issues. Identify and action recovery claims. Finalise files as appropriate. Attend employer claim reviews as required. Maintain data integrity of claims system including RTW status codes. Early contact with employee, employer and doctor. Initiate and maintain the Case Conference process working in conjunction with the Injury Management Co-ordinator to achieve injury management objectives and outcomes.

Injury Management Co-ordinator

Responsible for assisting with the development and promotion of Injury Management strategies that focus on early intervention, injury recovery and durable return to work in respect of all claims involving incapacity partial or total greater than 5 days and/or where treatment is ongoing, (all significant injury claims.)

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Ensures the injury management process runs smoothly by overseeing, co-ordinating and planning injury management. This includes:

• Appropriate treatment • Medical services • Return to work issues • Strategies for high risk claims • Appropriate rehabilitation and return to work issues • Reasonableness of medical and like expenses

The Injury Management Co-ordinator engages in regular reviews with the Case Manager to develop a holistic and strategic Claims Management Action Plan for each claim. This includes ensuring appropriate Return to Work Plans and Injury Management Plans are in place when required. The Injury Management Co-ordinator also assists the Case Manager to determine when reports from treating health practitioners or independent medical examiners may be required and to clarify the specific issues for the doctor to address.

The role also maintains effective working relationships with treating health practitioners and employers to ensure successful return to work outcomes.

Employer Obligations Where employers develop their own Injury Management Program it should be made available in the workplace. Employers are encouraged by CGU to have an Injury Management Program in place at each workplace. An employer may either use the Injury Management template developed by CGU or develop its own Injury Management Program. CGU encourages employers with 50 or more workers to develop and maintain their own Injury Management Program. Employers who choose to develop their own Injury Management Programs are requested to submit them to CGU for approval Employers are encouraged to provide workplace inductions and ongoing educational sessions to inform workers about key policies and procedures in the Injury Management Program. Employers are encouraged to regularly review, update and amend its Injury Management Program as appropriate. CGU should approve amendments made to an employer’s Injury Management Program. Employers have an obligation to provide suitable duties for their injured employees where practicable. When advised that an employee has suffered a work related injury

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or illness and will require medical or other treatment and/or time off work for their injury/condition, the employer should contact CGU Workers Compensation as soon as possible to report the injury and provide information available at that time. The employer should also advise the employee of his or her rights to lodge a workers compensation claim in accordance with the provisions of the Act.

The employer should ensure any medical recommendations are complied with until such time as adequate assessment can be instigated.

Employee Responsibilities Employees are required to notify their employer of any work-related injury as soon as possible after an injury occurs. Employees should notify their employer regarding their ongoing medical and rehabilitation status. Injured Employees are encouraged to participate and co-operate in the establishment of their Injury Management Plan. Injured employees are required to comply with their obligations under the Injury Management Plan and in accordance with the Workers Rehabilitation and Compensation Act.

The injured employee is encouraged to allow his nominated treating doctor to communicate with his employer’s insurer for the purposes of developing a Return To Work Plan and/or an Injury Management Plan where required.

An injured employee should make all reasonable efforts to return to work as soon as possible, having regard to medical advice. 1.3 Policy to be Appropriate to Nature & Scale of Organisation CGU considers its Injury Management Policy to be appropriate in nature and scale to its present operation. As a result of CGU’s commitment to workers compensation on a local and national basis, significant resources are available to ensure appropriate levels of Injury Management Support at all times. CGU is able to respond with service levels commensurate with any need. 1.4 Consistent with Relevant Injury Management Legislation

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CGU complies with the provisions of the Workers Rehabilitation and Compensation Act as amended. CGU fully supports the Injury Management Model and exercises best practice injury management techniques in accordance with currently accepted management models. 1.5 Policy to be Reviewed Regularly The CGU Injury Management Policy is reviewed annually or as required by the Board to ensure the various components of the Injury Management Program align with current Injury Management Best Practice, the WorkCover Board Injury Management model and workers compensation legislation. Responsibility for reviewing this policy will rest with the following appointments:

• CGU Injury Management Co-ordinator • Team Managers. • Claims Manager • Workers Compensation Manager

2 Policy for the Management of Employer IM Programs 2.1 Assist Employers to Develop Injury Management Programs

At policy renewal CGU requests client employers with 50 or more employees to identify any need in respect of the development of its internal injury management program. This applies equally to locally underwritten policies and national underwritten policies where the client employer has exposure in Tasmania.

Where an employer has no internal Injury Management Program, CGU is able to assist the client employer develop such a program or make available to them the CGU Injury Management Program.

Where an employer chooses to implement its own Injury Management Program, CGU can assist with their needs in developing a program consistent with the CGU program. This may include the development of a formal plan including documentation and implementation of the plan. These plans are monitored continuously and reviewed annually or as required.

Where an employer aligns to the CGU Injury Management Program, CGU is able to offer education and awareness training in respect of the operation of its Injury Management Program. This will assist client employers in their understanding of all facets of the program and how to implement the program at a work place level.

- Formal Injury Management Awareness Training programs are delivered annually within the state.

- Workplace based program’s can be delivered where needs are identified.

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CGU have experienced and trained Injury Management Specialists who are available to provide training and support to its client employers. 2.2 Ensure Employers Operate within Injury Management Programs CGU monitors employer activities through its claims administration operation. Employers are encouraged to act in accordance with CGU recommended policies and procedures. Training and support is provided to CGU client employers where necessary or appropriate. Where an employer establishes its own Injury Management Program, CGU will review that program on an annual basis for consistency with the CGU Injury Management Program. Employers who establish their own Injury Management Programs are noted on the register for monitoring and review. 2.3 Manage the Assessment & Approval of Injury Management Programs Client employers with 50 or more employees, who have developed their own Injury Management Programs, are requested to submit to CGU for assessment, their Injury Management Programs. All employers not having their own Injury Management Program are provided with the CGU program for their use. Training and support is provided to CGU client employers where necessary or appropriate. Responsibilities:

• Underwriter (Account Manager)

Employers wishing to implement their own Injury Management Program are requested to submit their program for assessment. The Underwriter (Account Manager) coordinates the review of the Injury Management Program which may include revision and modifications to programs. All communications will be recorded upon the client policy file for future reference. This will include but not be limited to: 1) Requests to employers to review their Injury Management Program. 2) Referral of documents to the Injury Management Coordinator. 3) Injury Management Coordinator recommendations and report. 4) Recommendations and advice to employer client for Injury Management

Program updates or revisions. 5) Follow up letter requesting confirmation of action taken Activity is also recorded on the register.

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Where an employer client fails to act in an appropriate and reasonable manner, CGU will consult formally with the business manager in an effort to resolve any non compliance. Where a client employer subsequently fails to act, CGU will refer the matter to WorkCover accordingly.

• Injury Management Co-ordinator

Assesses employer Injury Management Program for consistency and operation. Recommendations for change or modification to Injury Management Programs will be made in the form of a formal written submission. Employers are advised through the underwriter (account manager) who will coordinate the review process and ensure review time frames are within acceptable standards.

2.4 Ensure Employers Educate & Promote Injury Management Programs CGU actively promote the ongoing benefits of Injury Management with its client employers. This encourages employers to deliver the benefits of the Injury Management Program to its workforce. Through the assessment of employer Injury Management Programs (refer 2.1 and 2.2), employee education and the promotion of injury management programs, employers are encouraged to clearly identify the educational process within its program. Strategies used by CGU to establish the consistency of employers Injury Management Programs include the following team actions, (Team Manager, Case Manager, Injury Management Co-ordinator).

• Claim reviews with clients • Client visits • Updates (notification of changes to Program) • Interactive employer information sessions (Injury Management Awareness

sessions) • Telephone contact (managing claims on a one on one basis) • Emails (managing claims on a one on one basis)

2.5 Ensure Employers Regularly Review & Maintain Injury Management Programs

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As part of our ongoing performance monitoring, CGU will regularly review its existing Injury Management Program. In line with these reviews, CGU will modify, (as required), it’s Injury Management Program and communicate changes to its employer groups. CGU will make appropriate recommendations to client employers in respect of changes to the CGU Injury Management Program. CGU will encourage its client employers to review their IM Programs in line with changes that are made to the CGU Injury Management Program. (See 2.2)

3 Information Management 3.1 Ensure Full Disclosure or & Access to Information

Where an employer chooses to implement the CGU Injury Management Program, CGU will recommend that the employer offers the program in its workplace. In accordance with the plan this will ensure access to and disclosure of the Injury Management Program.

• Claims Information Pack for Employers

CGU has developed a comprehensive client information pack which sets out the knowledge required by all employers to effectively deal with and manage workers compensation claims. The information pack provides details regarding the compensation benefit structure provided by legislation. It includes details about how compensation benefits are administered and the contractual obligations that an employer client must follow whilst insured with CGU. The Claims Information Pack for Employers is available on the CGU Workers Compensation web site. On receipt of renewal instructions all policy holders will be directed to our website for access to the Claims Information Pack for Employers (soft copy). Link is – www.cgu.com.au/workers compensation.

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The Claims Information Pack is amended following any legislation change and or changes to CGU policy and procedures. The amended information pack is provided to all policy holders within appropriate time frames.

• WorkCover “Guide to Workers Compensation in Tasmania” Upon the receipt of a compensation claim made in the prescribed form, CGU in addition to issuing its standard notification advice, provides the injured worker with reference details directing them to the CGU Workers Compensation web site. A copy of the WorkCover guide is available on the CGU web site. Link is – www.cgu.com.au/workers compensation

3.2 Ensure Accurate & Consistent Information CGU reviews its injury management program annually to ensure accuracy and currency of information. Employer Injury Management Programs are also reviewed annually. In this way Injury Management practices across all CGU clients will remain consistent. Information Monitoring Register – CGU Workers Compensation Tasmania / Claims Management Information Register

The currency of information documentation is monitored by the CGU workers compensation claims and underwriting departments. CGU manages an internal database which identifies, stores and reviews all information sources relevant to the workers compensation claim process. As the database contains operational critical information it is not made available for public viewing. However upon request access is provided to the relevant authority and personnel. 3.3 Ensure that Information will be Available in Other Languages when

Necessary CGU will ensure information is available in a clear and concise manner and will engage the services of an interpreter if necessary. Refer 4.7 The Injury Management Program can be supplied in other language formats if and when required. All associated injury management documentation can also be provided in other language formats if required. 3.4 Promote Available Services Within the CGU Injury Management process we have a number of services available.

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• Injury Management Co-ordinator - Injury Management Awareness training and consultation

Training sessions are presently scheduled annually and are offered in both major centres, Hobart and Launceston. In addition to these formalised sessions, adhoc training is available to all CGU client employers on site as required. CGU publicises the availability of these sessions through flyer publications and via its CGU Workers Compensation web site – www.cgu.com.au/workerscompensation

• Case Management including external case conferencing

CGU staff conduct regular case conferencing sessions with its employer client group (Claim File Reviews). This conferencing system ensures that accountability exists between involved parties. The external case conference facility is aimed at assisting employers and injured workers to move forward through any rehabilitation process with the aim of securing ongoing meaningful employment opportunities.

• Workplace Rehabilitation Provider coordination

Workplace Rehabilitation Provider service contracts ensure that consistent services are provided to injured workers and employers.

• Services are promoted through the CGU Workers Compensation information

pack for employers. • Day to day promotional activities during client employer consultations

3.5 Ensure that Information is regularly reviewed and modified The CGU Injury Management Program is reviewed on an annual basis. Dependent upon legislation and or regulator requirements the program is updated. Reviews and or updates to the CGU Injury Management Program are made available to all CGU client employers. Reviews and or updated information can be provided in either hard copy format or electronically as required. The CGU Management Team reviews information relating to the CGU Injury Management Program. Operational information is maintained within the CGU Workers Compensation Information Register - Pinpoint (CGU Claims Procedures Manual) 3.6 Ensure Confidentiality is Maintained

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We recognisethe importance of economic competitive advantage. Injury Management Programs are maintained in confidence between CGU and its client employers. CGU complies with the requirements of the National Privacy Principles. Claim files and employer policy files are maintained in accordance with the National Privacy Principles. 3.7 Manage Requests for Authorisation to Access and Change Information Where an employer client makes an appropriate submission to CGU to modify its Injury Management Program, CGU will review such requests prior to seeking approval from the board as to the recommended change or changes. Such requests for review are managed by the CGU Injury Management Coordinator and CGU management. CGU respects the confidential nature of all information relating to a persons compensation claim. CGU encourages all parties to ensure that information provided under a claim for compensation and or policy of insurance is current and up to date. Requests for changes of information will be actioned appropriately and without delay. Importantly where a workers information changes, CGU records will be amended to reflect that most current information. This includes the appointment and or changes to medical practitioners providing medical services to all workers. Document Control System The Injury Management Program is available in both hard and soft copy format. Documentation is maintained by the Claims Manager. Documents are provided in secure Pdf format. The Master document: “CGU Injury Management Program – Version 2_Date04032010 Replaced upon approval by: “CGU Injury Management Program – Version 3_Date30072011 Replaced upon approval by:

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“CGU_IMP_Version4_300912

4 Communication Management 4.1 Promote Open and Honest Communication CGU directs claimants to sources of information available both at the CGU website and at the WorkCover Tasmania website

http://www.cgu.com.au/cgu/workers-compensation-tas/pages/forms.aspx This information is contained in the following two documents:

• Workers Compensation Handbook – The Basics (GB010) • Injury Management – Making it Work (GB197)

CGU provides a Workers Compensation Information Pack on the CGU website which is available to all employer policy holders. This document provides policy holders with a detailed outline of their obligations, employee’s entitlements to compensation and obligations. CGU Workers Compensation is open in its dealings with workers' compensation claims. All parties at all times and particularly during the review process, are to be continually informed of their rights and obligations. 4.2 Manage Contact Points and Formal Channels of Communication Between

all Parties

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CGU complies with the provisions of the Act and appoints to all significant injury claims an accredited Injury Management Coordinator. Within 3 working days of a claim being lodged with CGU all relevant parties in the compensation claim are contacted:- Exception – no contact is made:

1) Employers in respect of under excess claims. 2) Workers and Doctors with no ongoing incapacity > 5 days In the first instance all contacts are via telephone and followed by a formal written communication. Contact details of the relevant Case Manager and injury Management coordinator are provided to the injured worker, employer and general practitioner where required. CGU has a policy that workers are contacted via telephone in the first instance regarding liability decisions. This includes claim acceptance decisions and adverse finding decisions. Note: Workers are not contacted by telephone with no ongoing incapacity > 5 days. A written confirmation is issued in all cases. This process is documented within the CGU Operational Claims Procedures manual. Where contact details change a formal communication will be provided to all relevant parties advising of the change. This applies only to current incapacity claims. 4.3 Ensure the Timeliness of Communications CGU complies with its licence requirements and legislation with respect to timeframes relative to all claims management functions. The CGU monthly claims audit program monitors performance at an individual case manager level. 4.4 Ensure the Correct Application of both Oral and Written Communications CGU has established a suite of standard documents which are used by the case managers in the daily conduct of a claim. Standard type letters are restricted to routine protocol management. Personalised communications are a preferred approach to dealing with individual worker needs and issues. CGU National Operating Claims Procedure - Communication Standards CGU staff receive training in relation to writing essentials and telephone communications. The learning outcomes of both these programs are as follows:

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Training program: Writing Essentials Course outline:

• Outline how to make writing appropriate to the audience. • Demonstrate how to structure written materiel appropriately. • Compose effective E-mail communications. • Apply appropriate use of words, sentences, paragraphs, flow and layout in all

written material. • Effectively plan and structure all written material. • Write effective persuasive documents when required.

Training program: Telephone Communication Skills Course outline:

• Describe the importance of implementing standard telephone communication protocols.

• Use voice management and positive language to manage client responses during a call.

• Meet the needs of customers during telephone communications. • Deal assertively with the range of telephone communication exchanges. • Make effective decisions when negotiating with individuals over the telephone.

4.5 Ensure communication is clear & in "plain" English CGU has made a conscious business decision to ensure its written communication is clear and in plain English. Training programs: Communication Skills & Writing Essentials 4.6 Ensure communication is non-threatening CGU respects the rights and sensitivities of all persons involved in the claim process. As such CGU has a Communication Skills training module which specifically covers off on how our staff can ensure their communications remain non-threatening. The learning outcomes of the course are as follows:

• Describe the key elements of communication in relation to their work situation. • Determine the most appropriate forms of communication to be used when it’s

important to be assertive. • Maximise the effectiveness of their communication to reduce conflict.

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• Use a range of approaches to defuse a conflict situation, with the focus being on the source of the problem or concern, and options for resolving the situation.

Training programs: Communication Skills & Writing Essentials 4.7 Ensure interpreting services are made available when necessary CGU will ensure that information is available in a clear and concise manner and will engage the services of an interpreter if necessary.

5 Role of the Injury Management Co-ordinator 5.1 Manage the role, responsibilities & duties of an Injury Management Co-

ordinator (Incl. quantity requirements) The Injury Management Co-ordinator provides the claims teams with support and oversees operational issues in the following terms:

• Co-ordinate rehabilitation and return to work • Developing and /or coordinating implementation and review of injury

management plans and return to work plans. • Providing continuous review and advice in respect of a workers capacity. • Assessment, research and advice on development of retraining and

redeployment options. • Monitoring and assessment of the performance of Workplace rehabilitation

providers. • Contact, communication and coordination of all relevant parties • Collating medical information. • Maintaining relevant documentation • The resolution of disputes between the parties to the rehabilitation process. This

may include facilitating appropriate dispute resolution protocols.

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• Provide information to all relevant parties in support of the principles of the Injury management model.

• Other functions specified by the insured

The Injury Management Co-ordinator ensures that the injury management process is appropriate, timely and cost effective. To ensure that all claimants are afforded the best opportunity to recover from their injury and sustain a meaningful and durable return to work. When appropriate, the Injury Management Co-ordinator will assist the Case Manager to utilise a relevant Workplace Rehabilitation Provider service to facilitate a return to work. In planning and implementing an injured worker’s return to work, all parties involved in the injury management process are to make every effort to apply this RTW hierarchy as follows:

A(i)B(i) – Same organisation, same or modified job, pre-injury hours

A(i)B(ii) – Same organisation, same or modified job, graduated return to pre-injury hours

A(i)B(iii) – Same organisation, same or modified job, reduced hours relative to pre-injury hours

A(ii)B(i) – Same organisation, new job, pre-injury hours

Proceeding down through the options to the last option in the RTW hierarchy if no other options are appropriate:

A(iv)B(iii) – New organisation, new job, reduced hours relative to pre-injury hours.

File Conferences (Case Conferencing) The Injury Management Co-ordinator facilitates regular file conferences of significant injury claims - as determined by the Injury Management Co-ordinator and the Case Manager. This process is supported through the IMC Workbook. Case conferences involve the Injury Management Co-ordinator, Case Manager, Team Manager (when required) and where appropriate the employer. The conference may include the external appointed Workplace Rehabilitation Provider and injured worker. It is at these conferences that the file is reviewed and strategies developed to determine the best approach for the injury management of the claim. Medical and Allied Health Provider - Case Conferences

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In particular cases (complex cases), case conferences involving the treatment team are conducted. The aim of these conferences is to promote consistent information and unity of direction. Participants to these conferences may include but not limited to the injured worker, the treatment providers, employer, and Workplace rehabilitation provider. Review of Treatment Regimes Additionally to the medical treatment and rehabilitation services review at the file conference, the Injury Management Co-ordinator may communication with a number of treatment providers. Regular contact with the allied health specialists, general practitioners and medical specialists keeps an open flow of communication and assists with understanding the complexities that may arise during a claim. Workplace Rehabilitation Provider Account Management CGU has adopted a supply management model in the management of workplace rehabilitation providers. Ongoing performance monitoring of external Workplace Rehabilitation Providers is undertaken by the Injury Management Co-ordinator..

The Injury Management Co-ordinator has responsibility for the monitoring, and management of Workplace Rehabilitation Provider panel member’s performance. Thus ensuring that claimants are receiving the best services to aid them with return to work and that employers are obtaining best value for money.

Employer Awareness Sessions The Injury Management Co-ordinator also arranges and provides awareness sessions for employer groups to increase their understanding of their obligations in accordance with the WorkCover Injury Management Model.

Injury Management Awareness sessions provide employers with information on the role of the injury management process and the role of the Return to Work Coordinator. These sessions assist with the development of skills required to co-ordinate the return to work of injured workers.

Quantity Requirements It is recognised that the Injury Management Co-ordinator provides an overseeing role in respect of the management of significant injury claims. CGU is able to provide sufficient resources in the area of injury management dependent upon client and portfolio needs. 5.2 Manage skill & knowledge requirements

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The Injury Management Co-ordinator will be a person with suitable experience, education and training. The Injury Management Co-ordinator may have experience in allied health disciplines, either physiotherapy, chiropractic, psychology, occupational therapy, behavioural science, nursing or exercise physiology.

The Injury Management Co-ordinator is supported by CGU Insurance through a National Injury Management team. This team consists of allied health professionals. Assistance is provided through the following initiatives:

- development of national consistencies - research on international and national treatment and injury management trends - information source for experimental treatments and new and emerging techniques - key contact for professional medical bodies - advice on strategies for complex cases - analysis of occupational rehabilitation panel performance - review occupational rehabilitation performance against service level agreements

and other panel providers - ensuring that the Injury Management Co-ordinators stay updated with all the latest

developments in their chosen discipline. CGU Insurance supports the Injury Management Co-ordinator’s professional development by regular attendances at relevant conferences and training. 5.3 Ensure the identification & provision of training requirements Injury Management Co-ordinator is trained in accordance with the requirements of the authority. 5.4 Manage the appointment process Injury Management Co-ordinator is selected and appointed through a joint selection process involving CGU management. The selection process follows CGU’s standards for the appointment of staff.

6 Role of the Workplace Rehabilitation Provider 6.1 Manage the role, responsibilities & duties of a Workplace Rehabilitation

Provider

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Workplace rehabilitation services: The provision of any of the following services by a Workplace Rehabilitation Provider, accredited by WorkCover Tasmania:-

(a) initial workplace rehabilitation assessment; (b) workplace rehabilitation case management; (c) preparation of IM Plans and RTW Plans; (d) workplace services including: workplace assessment, job

analysis, and advice concerning job modification; (e) work conditioning and functional education; (f) workplace rehabilitation counselling including: vocational

counselling and adjustment to disability counselling; (g) functional capacity assessment; (h) vocational assessment; (i) vocational placement including: advice or assistance concerning

job seeking, advice or assistance in obtaining vocational re-education or training, and post placement support;

(j) rehabilitation coordination; basic case management and return to work planning for the employees of their employer;

(k) any other service as prescribed.

6.2 Manage skill & knowledge requirements Providers are monitored to ensure their organisation provides staff that are sufficiently qualified to deal with each specific case. The Injury Management Co-ordinator ensures that Staffing profile, qualifications and training together with levels of supervision are reviewed. These reviews are conducted by the CGU Injury Management Co-ordinator 6.3 Manage the selection process for external service providers Service providers are selected through a rotational scheduling system to ensure case loads are distributed on an equable basis. The selection process also involves a consideration of the providers organisational capacity, geographical distribution and skill sets to deal with unique claim circumstances. Employer preferred providers are also considered in the allocation process. For each provider CGU ensures that:

• They use a documented and best practice methodology, • Sufficient focus is placed on maintaining quality controls that result in timely, safe

and durable RTW outcomes, • Provider has been placed on the internal Provider Allocation System,

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• A number of possible service providers are evaluated against each other using relevant criteria,

• There is a clear audit trail through the evaluation, 6.4 Manage the referral process of an injured worker to WRP The key components of the referral process are:

• To ensure timely and appropriate referral for high quality workplace rehabilitation services

• Referrals can be made for either Workplace Rehabilitation Services or a Specific Service, depending on the needs of the worker.

• Any key party can recognise the need for involvement of a WRP. This includes:

the injured worker treating medical practitioner employer the insurer (acting on behalf of an employer)

• In referring to a Workplace Rehabilitation Provider, the worker and employer are consulted in respect of the appointment. The treating medical practitioner is also informed of the appointment.

• The worker has the right to be included in the selection of their Workplace Rehabilitation Provider

• Where the key parties do not have a preference or require assistance selecting a provider, CGU recommend a provider from CGU's panel of preferred providers.

Referral to the Workplace Rehabilitation Provider is made by the Case Manager. 6.5 Management of external service providers CGU administers a tender process for the supply of Workplace Rehabilitation Provider services. A number of commercial Workplace Rehabilitation Provider companies are appointed under a service level agreement and placed on a CGU preferred provider panel. CGU understands the complex process of managing Workplace Rehabilitation Provider contracts. The appointment of the CGU panel providers is assigned to the CGU Injury Management Co-ordinator. Management of Workplace Rehabilitation Providers is vested in the CGU Injury Management Co-ordinator as Workplace Rehabilitation Provider relationship manager. The Injury Management Co-ordinator deals directly with each Workplace Rehabilitation Provider company account manager.

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The CGU Injury Management Co-ordinator oversees and ensure that the delivery of Workplace Rehabilitation Provider services within the CGU Injury Management Program are maintained at appropriate levels according to the service level agreements. The Workplace Rehabilitation Provider referral process:

• CGU Preferred provider referral is generated by a register titled "the WRP Matrix" which guides case managers as to their initial selection of provider.

• The case Capacity, Qualification, Geographic location and Results History

of the Provider are considered and a referral made (or another provider selected if appropriate).

• A referral which instructs the Workplace Rehabilitation Provider is made

by the case manager. Workplace Rehabilitation Provider Response:

• The provider responds to CGU that they accept the case and discuss the case with the Case Manager and that it has been allocated to a given individual provider within 2 working days.

• The provider conducts an initial assessment report and develops a RTWP

as instructed within 7 working days.

• Amended RTWP's and accounts monthly from the date of completion of the initial assessment are provided.

Compliance and Audit

• The provider forwards expenditure estimates, monthly reports and statistics. Performance criteria are reviewed by the Injury Management Co-ordinator and deficits addressed. Monthly statistics are provided to the CGU Injury Management Co-ordinator on all open cases.

The CGU Injury Management Co-ordinator manages the provider relationship program and meets with the Provider Account Manager quarterly as a minimum. to review selected Cases - Assess and correct performance within service level agreement criteria, including accounts. (minutes and action statements are recorded for these meetings)

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Annual provider file audits, including accounts, are conducted by the Injury Management Co-ordinator who also assesses and monitors the performance of all Providers.

7 Role of the Return to Work Coordinator (RTWC) (SELF-INSURERS ONLY)

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8 Mechanisms to Facilitate Early Reporting & Intervention of Injuries/Claims 8.1 Early Reporting (i) Implement a variety of mechanisms to facilitate early reporting CGU provides new business clients with a claim procedure pack upon policy inception. The pack provides contact details in the event that an incident or claim needs to be reported to CGU. CGU has developed an online reporting system which is available on the CGU Workers Compensation web site. (INI). Where a client employer has been provided with notification in accordance with the Act that the CGU Injury Management Program applies to that employer, the employer is required under the terms of the program to notify CGU within 3 working days of becoming aware that one of its workers has suffered a workplace injury that results in or is likely to result in the worker being partially or totally incapacitated for work. The notification of a workplace injury as described in this section can be made to CGU in the following form:

a) Using the CGU online reporting system (INI) b) By facsimile transmission c) In writing with received date noted by CGU within 3 working days.

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• Claims Information Pack for Employers

CGU has developed a comprehensive client information pack which sets out the knowledge required by all employers to effectively deal with and manage workers compensation claims. The Early Reporting of claims is an integral part of the information pack providing the Employer with the appropriate procedures to follow when reporting claims. The information Pack also includes information regarding the compensation benefit structure provided by legislation. It includes details about how compensation benefits are administered and the contractual obligations that an employer client must follow whilst insured with CGU. The Claims Information Pack for Employers is made available to all policy holders through the CGU Workers Compensation Tasmania web site. The Claims Information Pack is amended following any legislation change and or changes to CGU policy and procedures. The amended pack is provided to all policy holders within appropriate time frames.

(ii) Manage timeframes for early reporting All new compensation claims are assessed using a number of standard and consistent monitoring tools. Using the INI “Initial Notification of Injury” system claims that are identified as falling outside the required reporting time frames (as defined by the Act), are identified and automated standard letters are issued to employers who do not comply with this requirement. Initial delays outside the 3 day time frame are discussed with the Employer at the 3 point contact stage and a consultative approach is taken up with the employer giving them every opportunity to rectify future Injury notification time frames. (iii) Manage employer training & educational requirements CGU has developed and is providing employer awareness sessions in the area of Injury Management. The presentation package deals with early reporting requirements and the process that should be adopted to ensure early return to work for injured workers is achieved. Whilst Injury Management Awareness Sessions are scheduled annually, one off sessions can be provided to cater for specific individual client needs. (iv) Administer the Early Reporting Incentive Scheme CGU is able to adapt its processes and systems to accommodate an early reporting incentive scheme. Claim reports are monitored through the CGU INI system and the GIS claims management database

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(v) Manage corrective action for late submissions Refer 8.1 (ii) 8.2 Early Intervention (i) Manage key contact points with key parties Initial Assessments 3 point contact is completed within 3 working days of the claim being received by CGU Workers Compensation. Employers are to be contacted by phone in respect of all new claims with the exception of under excess claims. Workers and their treating medical practitioner are to be contacted by phone in respect of all new claims based upon the following criteria:

- Ongoing incapacity either full or partial exceeding 5 days Exclusions to Early Contact Workers and their treating medical practitioner need not be contacted, where the claim is for medical expenses only and or the worker is cleared fit for work. Contact with these parties is not necessary in respect of under XS claims. The usual correspondence must be sent (ii) Administer provisional payments CGU is able to adapt its processes and systems to accommodate a provisional payment scheme. Presently weekly compensation payments are reimbursed to employers during the course of a pending compensation claim prior to an order being issued by the Tribunal. CGU will consult with the employer in respect to determining the employer’s liability within the confines of Section 77AB CGU through its internal processing payment system is able to record and make reimbursement to the employer for all without prejudice payments made by the employer up to $5000.00. Without Prejudice payments will continue through the pending and dispute phase or until a liability decision is made within the legislated timeframe.

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At all times CGU will maintain a consultative approach in providing direction and recommended action to the employer.

9 Medical Management 9.1 Medical Practitioners

(i) Monitor the timeliness of appointments for injured worker medical consultations & treatment

CGU recognises the importance of workers being able to select their preferred treating general practitioner. During the 3 point contact stage CGU endeavours to contact the practitioner to discuss any special needs of the injured worker and to provide contact information for the ongoing management of the claim. Upon the identification of cases where consultation and or treatment regimes fall outside acceptable time frames the Injury Management Co-ordinator will become involved through consultation with the worker and treating practitioner to ensure appropriate services are provided within acceptable time frames.

(ii) Manage the provision of information including but not limited to:

(a) facilitatingnotification of a change to the injured worker’s medical practitioner and;

Where a worker changes his treating general practitioner, when CGU is made aware of the change, all parties will be informed as to that change in treatment provider. Importantly the existing practitioner will be informed that his/her patient has selected a new provider.

(ii) Manage the provision of information including but not limited to:

(b) subsequent authorisation to release relevant medical records. CGU at all times protects the information that it collects about injured workers in the form of relevant medical reports. Such information is only released to appropriate and relevant persons engaged in the management of the workers compensation claim as and where necessary and or in compliance with legislation. CGU at all times complies with the provisions of the National Privacy Principles.

(iii) Manage contact points between involved parties - in particular with the medical practitioner

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This begins with the 3 point contact process and continues during the course of the compensation claim. Case Managers maintain ongoing communication with the medical practitioners and develop a collaborative approach to injury management.

(iv) Ensure systems are in place for the management of medical certificates Claims for compensation pursuant to the Act must be made in the prescribed form. Section 34(1) of the Act provides the rules relating to the provision of claims in the prescribed form. This includes the provision of medical certificates. The onus of responsibility rests with the injured worker, to ensure that a prescribed medical certificate is lodged upon the employer in order to validate a claim for compensation benefits. This requirement is detailed in the CGU standard claim acknowledgement letter. Employers are informed of this requirement within the CGU information pack and with the issuing of the CGU standard claim acknowledgement letters. Certificates received at CGU are date stamped immediately upon receipt and are referred to the assigned case manager for action. Medical certificates are recorded in chronological order within the workers claim file. Gaps in certifications are monitored by the case manager. Employers are informed as soon as a gap in certification is identified as this will impact upon the employer’s requirement to pay weekly compensation benefits. Injured workers are also consulted regarding gaps in certification so that outstanding issues can be remedied as soon as possible.

(v) Ensure systems are in place for the management of medical reports Independent Medical Examinations are a necessary tool used in the assessment and approval process of an injured worker’s compensation claim. The timing of Independent Medical Examinations is often dependent upon the needs of each individual’s circumstances. NEW CLAIMS FOR COMPENSATION All new claims are assessed through a discipline of triage which identifies the severity of the injury and risk level of the claim. This screening process assists in identifying claims where Independent Medical Examinations may be required. Such claims are conferenced internally with the CGU Injury Management Co-ordinator at which point decisions are made regarding Independent Medical Examinations. ONGOING CLAIMS

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Once again the need for Independent Medical Examinations is assessed on a case by case basis and dependent upon the individual circumstances. CGU reviews all ongoing compensation claims on a minimum 3 monthly basis and at this point the need for Independent Medical Examinations may be considered. In addition to this review process claims are reviewed more frequently dependent upon their severity rating. These reviews require the input from the following parties: • Case Manager • Injury Management coordinator • General Practitioner • Injured worker • and in some instances the employer.

REVIEW OF INDEPENDENT MEDICAL EXAMINATION REPORT QUALITY Case Managers are coached in the quality assessment of Independent Medical Examination reports. With the identification of deficiencies within medical reports, these issues are raised directly with the CGU Injury Management Co-ordinator and/or Team Manager for remedial action. In this way CGU provides constructive feedback to all Independent Medical Examiners to promote quality improvement. LIMITATIONS Section 90A (5) Notwithstanding CGU’s process for the application of Independent Medical Examinations, the provisions of Section 90A (5) apply in all circumstances. All requests for medical reports are followed up by the case manager at intervals appropriate to the circumstances of the claim. Where unreasonable delays occur in response times the Injury Management Co-ordinator will contact the practitioner directly to discuss a resolution.

(vi) Manage the referral process to the Medical Advisory & Mentoring Service

Once details of the service are provided CGU is able to instigate a management and monitoring system. 9.2 Independent Medical Reviews

(i) Manage the process for seeking and undertaking reviews

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Independent medical reviews are scheduled in accordance with each individual case needs. CGU ensures compliance with time frames for examinations as determined by the regulations. Independent medical reports are provided to the workers treating practitioner in accordance with the provisions of Act.

(ii) Manage consultation requirements – in particular with the medical practitioner

An External Case Conference is a face to face meeting where the strategy for management of a claim is discussed. It is an opportunity to involve all parties in overcoming barriers to progress, and setting the strategy and direction for return to work and management of the claim. These types of meetings are quite successful to gain improved insight to stakeholder concerns, developing relationships and providing a pathway forward with agreed actions for all parties to undertake. External case conferencing aims to improve return to work outcomes by promoting consultation with all customers, re-aligning the expectations of the relevant parties, and facilitating the case to a resolution. The Case Manager and Injury Management Co-ordinator may attend external Case Conferences as required. The / Team Manager may also attend as required. The following external parties could also be considered to attend an External Case Conference:

• Injured Worker • Employer • General Practitioner • Other treatment providers • Workplace Rehabilitation provider • Solicitors

(iii) Manage the provision of information including but not limited to:

(a) Notifying the injured worker of the reasons for seeking a review

Workers who are required to attend independent medical examinations pursuant to the Act are formally advised of the appointment arrangements and the reason for the need to attend the examination. CGU uses a standard approach to all independent medical examinations unless certain individual claim requirements dictate otherwise.

(b) Provide copies of the review report to the Injury Management Co-ordinator and the treating medical practitioner

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Independent review reports are provided to the treating medical practitioner and the Injury Management Co-ordinator as per the Act.

(iv) Manage contact points between involved parties

The Injury Management Co-ordinator is responsible for ensuring that case managers involve all parties in the claims management process. It is important to ensure that everyone involved in the return to work process is aware of developments, expectations and activities relevant to assisting a worker return to meaningful employment.

(v) Facilitate audit of the use of independent medical reviews Following an independent review the practitioners report is provided to the Injury Management Co-ordinator for review so that actions following can be discussed and agreed if required. Such review discussion may involve the Case manager and may include the Team manager and or the employer.

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10 Return-to-Work 10.1 Co-ordinate those involved in the injury management process including but

not limited to the following:

The content of this document serves to provide co-ordination in respect of the activities of all parties involved in the compensation process

(i) Injury Management Coordinators

CGU co-ordinates and monitors the activities of the appointed Injury Management Co-ordinator. Supervision is provided by CGU claims management personnel. The CGU Injury Management Coordinator will provide advice and assistance to client employer engaged Injury Management Co-ordinators if and when required.

(ii) Workplace Rehabilitation Providers

The CGU Injury Management Team monitors the activities of appointed Workplace Rehabilitation Providers. The CGU Injury Management Workbook provides tools to allow the overseeing of Workplace Rehabilitation Providers activities across all significant injury compensation claims

(iii) Return to Work Co-ordinators CGU Injury Management Co-ordinators will provide advice and assistance to client employer engaged Return to Work Co-ordinators if and when required.

10.2 Manage RTW Plans & IM Plans. This should include but not limited to

the following:

(i) Ensure the development & implementation of plans when required CGU identifies claims where partial or total incapacity exceeds 5 days. RTW Plans are requested from the Employer or an External Workplace Rehabilitation Provider as appointed following consultation with the Employer and the Injured Worker. Injury Management Plans are developed in accordance with the time frames provided within the Act.

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(ii) Manage consultation requirements between key parties The Injury Management Co-ordinator in conjunction with the Case Manager ensures communication is maintained on a regular bases with all key parties.

(iii) Ensure the assessment of return to work options is completed thoroughly

As required, case conference meetings between the Injury Management Co-ordinator, Case Manager, General Practitioner and Workplace Rehabilitation Provider or in-house Return to Work Co-ordinator ensures all work assessments are carried out and the appropriate return to work options are in place.

(iv) Ensure the Return to Work Hierarchy is applied

CGU recognised the importance of returning workers to their pre injury employment with their current employer. However in circumstances where capacity limits a full return to pre injury duties alternatives within the return to work hierarchy are applied.

(v) Ensure workplace visits are undertaken when necessary CGU encourages and promotes workplace visits by Case Managers, Workplace Rehabilitation Providers, treating practitioners and independent medical advisors when appropriate. The purpose of these visits is to allow a greater understanding and awareness of the injury environment to ensure appropriate injury management processes are in place.

(vi) Ensure the identification & modification of suitable & meaningful alternative duties where practicable

. The identification and modification of suitable & meaningful alternative duties is assessed on an ongoing basis and determined by medical certification as to capacity for work. This process involves:

• Injured worker • Employer • Treating doctor

with the support of the Case Manager, Injury Management Co-ordinator or an appointed Workplace Rehabilitation Provider dependent upon the circumstances.

(vii) Recognition of limitations during return to work

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Significant injury claim RTW plans are regularly reviewed and discussed with the key parties. Case managers and the Injury Management Co-ordinator review the quality of return to work plans to ensure limitations are identified and suitable RTW plans are in place.

(viii) Ensure the regular review and modification of plans when necessary Return To Work Plans or Injury Management Plans are recorded within the CGU Injury Management Workbook. These plans are reviewed based on updated medical certification as to capacity for work and as the circumstances require on a case by case basis.

(ix) Regular assessment of outcomes for all parties involved Return to Work Plans / Injury Management Plans are updated as capacity for work changes. Changes in medical capacity to perform work are identified through the monitoring of medical certification and advice received from treating practitioners Liaison with the relevant parties by the Case Manager, Injury Management Co-ordinator or an appointed Workplace Rehabilitation Provider take place to ensure the agreed outcomes for all parties are realistic, reasonable and achievable. The Case Managers and/or Injury Management Co-ordinators utilise an appropriate set of tools to ensure that Return To Work Plans or Injury Management Plans are in place within the required timeframes and that they reflect the progress towards achieving agreed outcomes.

11 Management of Alternative Duties 11.1 Ensure alternate duties are both suitable and meaningful • Large Employer Group – employers with 50 persons or more: Employers with more than 50 persons at a workplace are required to identify and provide to CGU a list of suitable alternative duties if any. The list of duties is to be provided within 60 days of a policy inception or renewal. At policy inception or renewal CGU will provide its client employer with a formal notice that the list of suitable alternative duties, if any, must be provided. That request will be reviewed at 30 days and again at 60 days for compliance. • Small to Medium employer groups

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With regard to both employer groups the initial assessment phase of the return to work process is a collaborative approach involving the worker, general practitioner and employer to ensure that suitable meaningful duties are developed. The process is coordinated by the case manager and supported by the injury management coordinator to achieve effective outcomes. The services provided by an approved Workplace Rehabilitation Provider may assist in the development of suitable alternative duties. 11.2 Ensure employers provide notification of alternative duties that are

available (facilitated by a list of general duties to be supplied by the Board) CGU provides notification to its employer clients of this requirement at renewal and or the time of policy inception. Where employer requests assistance in devising these details CGU is able to provide assistance. 11.3 Ensure matters relating to employers unwilling and/or unable to provide

alternative duties are referred to the Board Where an employer fails to respond to reasonable requests by CGU to provide a list of suitable alternative duties, if any, the failure to respond will be notified by CGU to the Board. The employer will also be notified by CGU that its failure has been reported to the Board.

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Injury Management Program Revision History: Date Reviewed Section Details Approved by Date Approved 27-Nov-09 All Initial Version Completed

04-Mar-10 All First revision WorkCover 30th April 2010

30-Jul-11 All Second revision WorkCover 3rd August 2011

28-Sep-12 All Third revision WorkCover 22nd October 2012