Rehabilitation

25.Claims for which a formal Return to Work Plan (RTWP) will be developed generally fall into two categories:

• complex or severe medical conditions or injuries; and

• more simple conditions, for which workplace factors add complexity.

26.For complex medical claims, it is important to remember that a set period of liability cannot readily be established at the initial determination stage.

27.However, for more simple conditions, for which workplace factors are present:

it is important that the claim review concept is communicated both to the employee and the customer to set “normal” expectations on injury recovery, incapacity and treatment time frames .

28.In most instances, a RTWP is not provided until after a claim has been determined.  This means a final goal has not yet provided the expected time frame for rehabilitation.  In such cases the review date can be set by following the Guide (Attachment C) or whatever other parameters are deemed suitable by the Claims Manager.  However once a RTWP is received, this date should be reviewed and if appropriate brought in line with the RTWP.

29.Once final goals and time frames for an expected return to work are provided on the RTWP, review for the claim may be based on those final time frames and a letter (at Attachment G) should be issued to the employee indicating the proposed extent of liability.  A copy of the letter should also be provided to the Case Manager.  A RTWP is usually closed -

• when a return to work full preinjury duties or optimum level of functioning has been achieved;

• when all parties are reasonably sure that the RTW is durable and safe; or

• when the employee has withdrawn from the program or rehabilitation services are no longer appropriate

30.The end date of the RTWP cannot be used unless it is clear from the Plan and medical evidence on hand that resolution of the condition and return to full preinjury duties are expected to occur similtaneously.  Where a RTWP has a final goal of, for example, 'reduced hours', then obviously the Provider expects the condition to continue to affect the claimant.  Where it is not absolutely clear from the RTWP that the condition is expected to resolve by the end date of the Plan, a later review date should be used – perhaps four weeks after the expiry of the Plan.

31.Where time frames as indicated on the RTWP are not met by the employee, review will be subject to:

• supporting medical evidence supplied by the employee;

• a written report from the rehabilitation provider clearly outlining why the current rehabilitation plan has not been successful; or

• specialist medical review of the compensable condition, using section 57 of the Act.