Insurer Report

Last issue we highlighted some high performing insurers' best practices in statutory claims management.This time we have put the spot light on rehabilitation best practices we have observed during audit.

 

In all cases of high performance it was evident that there were accurate and objective case notes recording actions and decisions and the reasons for them. The files were well organised and it was easy to follow the structure of the rehabilitation and return to work of the injured workers.

 

Specifically, the files provided evidence of:

 

• early supportive contact with the injured worker and/or family by the supervisor or manager
• injured workers being provided with a suitable duties information sheet explaining their responsibilities
• an initial risk assessment checklist promoting early identification of high risk claims and  the early referral to an injury management advisor for rehabilitation intervention
• timely support provided to on site staff by claims/rehabilitation management
• the claims manager seeking lay information about the particular medical condition through appropriate internet sources
• a risk assessment template developed and used for serious or complex injuries
• active and early follow ups with injured workers who required surgery to ensure they were appropriately supported in daily living activities while recovering
• joint monthly claims reviews between injury management advisor and claims officer
• injury management advisors supporting and coaching RRTWCs in their role and developing initial injury management plans for injured workers
• identifying potential barriers to rehabilitation and return to work and ensuring appropriate referrals were made to rehabilitation providers to help facilitate return to work
• the exchange of Information including medical reports with treating general practitioners and specialists
• the discussion of vocational options with workers with complex injury and circumstances
• early and appropriate engagement of rehabilitation providers to assist with identifying both suitable duties and redeployment options for injured workers when required
• supervisors and the injured worker both signing a daily suitable duties monitoring sheet which has space for comments from both parties and is fed back to the RRTWC
• appropriate intervention engaged in complex cases to minimise risk of further injury and provide aids and equipment to injured workers
• rehabilitation management performed compassionately while maintaining fairness for all parties
• a post claim follow up of the worker's progress.