Supporting patients affected by workplace injury


Navigating work injury schemes for better patient outcomes
 
Page last updated 31 October 2024

Long-term work absence, work disability and unemployment following workplace injury or illness can have a significant impact on the long-term health and wellbeing of workers, their families and their communities.

GPs play a pivotal role in supporting workers return to or participate in good meaningful work, which is health protective, contributes to improved self-esteem and a sense of identity, and provides social and financial benefits to individuals, their families and the community. 

Under Australian law, employers must have insurance to cover workers in the case of work-related injury or illness.

Each state and territory has its own workers compensation scheme and legislation. There are also three Commonwealth schemes.

State/territory schemes:

Commonwealth schemes:

  • Comcare covers:
    • employees of Australian Government agencies and statutory authorities
    • employees of organisations who have been granted a licence to self-insure
    • members of the Australian Defence Force who served before 1 July 2004
  • Seacare covers seafarers
  • Department of Veterans' Affairs covers Australian Defence Force members who began service on or after 1 July 2004

These schemes are intended to protect workers against loss of wages and other financial hardships resulting from workplace related injury or illness, cover medical costs related with the injury or illness and support an appropriate return to work.

Each scheme varies in its specific process however this factsheet developed by Comcare outlines the typical recovery pathway/claims process for an injured worker and how GPs may be involved.

Principles on the role of the GP in supporting work participation

Principles on the role of the GP in supporting work participation were published by Comcare in 2020. This collaborative project was led by the Australasian Faculty of Occupational and Environmental Medicine, and the principles are officially supported by the RACGP.

Principle 1: GPs perform a patient advocacy role in work participation cases

Principle 2: GPs provide evidence-based assessment which draws on a patient’s work participation goals and context

Principle 3: Following assessment and initial treatment, the GP in consultation with their patient will determine their role

Principle 3.1: Where GPs perform a medical management role, they work with relevant stakeholders to optimise health outcomes

Principle 3.2: Where the GPs perform a care coordinator role, they will draw on support and information from other stakeholders

Principle 3.3: Where GPs refer medical management to another health practitioner, they continue to monitor and support patient outcomes

Read the principles in full

As part of supporting the injured worker in relation to the work injury scheme, you may be asked to:

  • diagnose and treat the injury or illness
  • assess the workers capacity and provide a Certificate of Capacity, both initially and periodically through their claims process
  • participate in a return-to-work case conference with the worker, employer, claims manager and other as relevant
  • participate in a clinical review to ensure treatment is clinically justified
  • discuss the case with an independent medical examiner.

As a GP you play a key role in assisting injured workers return to work and are well placed to advise and educate workers that, in most cases, a focus on return to work is in their best interest - for both their current and future quality of life and that of their family. Often, your opinion is quite persuasive, particularly if you have a long-standing therapeutic relationship with the injured worker.

While restricted duties may be appropriate, the aim should be to return to maximum function.

Return to work is not possible for everyone, but long-term absence from work has known negative impacts including increased overall mortality, poorer physical health and poorer mental health and psychological wellbeing and should be avoided where possible.

The Health Benefits of Good Work® initiative states that simple messages delivered in the clinical environment can encourage workers to develop evidence-based views of the relationship between health and work.

Evidence-based messages:

  • The longer someone is off work, the less chance they have of ever returning
  • Most common health conditions will not be ‘cured' by treatment
  • Good work is a therapeutic intervention, it is part of treatment
  • Typically, waiting for recovery delays recovery
  • Staying away from work may lead to depression, isolation and poorer health, and
  • Employer-supported, early return to work helps recovery, prevents de-conditioning and helps provide patients with appropriate social contacts and support mechanisms.

Practical ways of assisting patients back to employment and optimum functioning include:

  • Recommending a graduated increase in activity and setting a timeline for return to work where practicable
  • Talking to the employer (preferably while the patient is with you), especially about how to modify the workplace and work duties to allow return to work
  • Collaboratively identifying obstacles and solutions in the workplace
  • Being clear about what health care can and can not achieve, and
  • Identifying possible sources of support, including family members, co-workers and relevant government services.

It is important to regularly check in with the worker and ensure their psychological health and wellbeing are being assessed and managed alongside any physical injury/illness.

 

The RACGP has endorsed the Clinical guideline for the diagnosis and management of work-related mental health conditions in general practice.

The guideline has been designed to assist GPs to systematically approach the care of patients with work-related mental health conditions.

Recommendations and practice points included in the guideline address the following questions:

Assessment and diagnosis of a work-related mental health condition

  • What tools can assist a GP in diagnosing and assessing the severity of a mental health condition?

  • What would suggest that the patient is developing a comorbid or secondary mental health condition?

  • Has the mental health condition arisen as a result of work?

  • What should a GP consider when conveying a diagnosis of a mental health condition to the patient?

Management of a work-related mental health condition

  • How can the condition be managed effectively to improve personal recovery or return to work?

  • Can the patient work in some capacity?

  • What is appropriate communication with the patient’s workplace?

  • What strategies are effective at managing comorbid mental health conditions and substance misuse and addictive disorders?

  • Why isn’t the patient’s mental health condition improving as expected?

  • What can a GP do for a patient whose mental health condition is not improving?

What is a certificate of capacity?

A Certificate of Capacity is an official document required to be completed by a medical professional, which outlines a worker’s injury, illness, capacity to work and limitations or restrictions on regular work tasks. It is a “communication tool” between all parties involved.

Each work injury scheme has their own Certificate of Capacity form to be used.

When is a Certificate of Capacity required?

A Certificate of Capacity is required where a worker is making a claim for wage coverage following a workplace injury or illness, where they are not able to perform their previous employment. It is not required where an employee is only seeking coverage of medical costs associated with a workplace injury or illness.

An initial Certificate of Capacity is required to submit a claim to the work injury scheme. Subsequent Certificates may be required throughout the claims process at determined intervals.

What details do I have to provide?

You will need to provide:

  • Worker details (name, address etc)
  • Diagnosis
  • Capacity Assessment (including whether a task can/ cannot be performed, or can be performed with modifications)
  • Additional comments on physical and mental health function and other functional or workplace considerations
  • Certificate duration (noting most schemes will only accept the initial Certificate of Capacity for 14 days and subsequent certificates for 28 days)
  • An estimated timeframe to return to work
  • Treatment plan
  • Declaration

Accurate and detailed completion of the Certificate of Capacity can:

  • Allow for timely processing of the claim
  • Facilitate effective communication between relevant parties
  • Help guide decisions about claim acceptance and associated benefits
  • Set expectations for the patient around treatment, outcomes and return to work.  

Tips:

  • Ensure all parts of the form are completed
  • Avoid acronyms and jargon
  • Write clearly to ensure it is legible

The most jurisdictions the Certificate of Capacity requires a wet signature.

Comcare have developed a factsheet for GPs on assessing a patient’s capacity for work, with the principles being relevant across all schemes.

What are some examples of workplace restrictions or modifications that may be appropriate to support return to work?

These will be specific to the injury and body part affected, and should be detailed.

Restrictions may include:

  • Weight limits for lifting [provide limit]
  • Maximum time limit for standing [provide time]
  • Regular breaks [provide interval]
  • Rotation of activities
  • No pulling or pushing/bending/squatting/twisting
  • Limiting use of arm/s to below shoulder level
  • Avoidance of repetitive tasks
  • Limiting the hours of work for a day or days for the week [provide limits]
Can I back date a Certificate of Capacity?

No. But you can note on the certificate the date the patient states they were injured or became ill as a result of their work.

Where can I access the Certificate of Capacity form?

Certificate of Capacity forms are available from the website of the relevant work injury scheme.

Patients may also present you with a hardcopy form provided from their employer.

Some Clinical Information Systems (CIS) allow you to access, complete and print a Certificate of Capacity form from within your CIS or attached module i.e. Letter Writer.

Who submits the Certificate of Capacity/claim to the insurer?

The injured/ill employee must provide the certificate to the employer, who will submit it to the insurer. It is up to the employee to choose if they wish to proceed with a claim.

Am I responsible for determining fault or liability in relation to the injury/illness and whether a work injury claim is valid?

No. The insurer will investigate the incident and determine whether a claim will be accepted.

Your history taking and assessment will help make a diagnosis and determine if the medical condition is consistent with the circumstances described by the worker.

When a worker signs a claim form for workers’ compensation, they provide an authority to release information to the insurer about the matter to which the claim relates.

Patient consent should be obtained when communicating or exchanging information about them with stakeholders involved in managing the compensation claim including the nominated treating doctor, other health-related practitioners, the insurer, the work injury scheme and employer.

If the patient subsequently requests that you do not disclose certain information to a party, including the insurer, the worker must approach that party to revoke the authority. If you receive a request for additional information, you should ensure a valid and current authority is in place to release that information.

You do not need to, and should not, disclose information about matters to which the claim does not relate.

If you are in any doubt about what information can be shared and with whom, it would be prudent to check with your medical indemnity insurer.

It is important to document any conversations you have with the employer, insurer and any other parties involved in the claim.

Can the employer or insurer attend a medical appointment with the injured worker?

The employer and insurer have no default right to attend medical appointments with the injured worker. An employer or insurer is only able to attend an appointment with the worker if the worker gives their consent.  

When a patient first presents to you following a work-related injury, and until the patient's claim is accepted, consultations should be billed as per your usual practice i.e. bulk-billing, private billing or mixed billing.

Once a claim has been accepted by the insurer, all costs relating to your involvement in the management of the patient are paid by the insurer. Consultations for patients with an accepted and active claim under a work injury scheme cannot be billed under Medicare. Billing requirements and maximum allowable billing rates for services varies for each scheme. Whether a patient can be charged a gap fee (where the treatment fee is higher than the billing rate set by the scheme) is dependent on the jurisdiction. Some schemes do not allow a gap fee to be charged. If a gap fee is allowable under the scheme, you should discuss with the patient any out-of-pocket charges that may be applicable.

Most work injury schemes prefer to be directly invoiced by the treating medical team. In some cases, the patient can be invoiced, and the work injury scheme will reimburse them. This may avoid delays in the GP/practice receiving payment for services provided.

Generally, when submitting an invoice the following details are required:

  • Injured workers first and last name
  • Work injury scheme claim number
  • ABN (Australian Business Number)
  • Name of the relevant service provider
  • Your Medicare provider number (if relevant)
  • Your Australian Health Practitioner Regulation Agency (AHPRA) number
  • Fee list item
  • Service cost
  • Date of service
  • Date of invoice (cannot be invoiced in advance)

When setting fees you may consider reviewing the RACGP’s Preparing medical reports: A guide to setting fees and writing reports the determine your fees section of the RACGP’s General Practice Business Toolkit.

Remember that you can bill (within the fee outline of each scheme) for all services provided as part of the return to work process including phone calls such as to the worker's employer, report writing, participating in or organising and coordinating a case conference and attending the worker's place of employment for a Return to Work worksite visit.

If a claim is not accepted by the insurer, or the patient does not wish to submit a work injury scheme claim, the patient should be billed as per your usual practice i.e. bulk-billing, private billing or mixed billing.

Your practice Clinical Information System (CIS) should be updated to reflect your patient’s participation in a work injury scheme. You should note the claim number and insurer.

All claims relating to an active claim need to be billed to the insurer and not via Medicare which should be noted in the CIS.

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