What To Do With Stuck Cases
Invariably, claims will arise that don't seem to be leading to a successful conclusion despite the time, effort and resources invested in the return to work process.
At this stage, discussion of the case should probably be initiated with the rehabilitation advisor or a case conference organised. A case conference is usually held with the Case Manager, rehabilitation provider and often the rehabilitation advisor and claims manager.
The objective is to establish all the current relevant facts and barriers to claim resolution, and to develop jointly agreed and linked strategies to resolve the claim. Often a second meeting takes place with the employee and sometimes the treating medical practitioner(s).
Try some of the following considerations where stuck cases fall into the listed scenarios:
|
SCENARIO |
THINGS TO CONSIDER |
|
Longer term Open RTWPs |
Is action complete? If yes, is case closure required? How many RTWPs have there been? Have suitable duties been identified for the employee? Levels of communication. Is a case conference necessary? |
|
Injury problems |
What is the current medical diagnosis? Is it related to the original condition? How severe is the injury? What is the prognosis? |
|
Too many doctors? |
How many doctors are involved? How many rehabilitation professionals? Is this reasonable given the severity of the injury? Is there duplication of services? |
|
Communication |
How often do the doctors/rehab professionals contact each other and the employee? Is this frequency too little/much? |
|
Retraining |
Has retraining commenced? Is there a clear vocational goal? Is a suitable job available on completion? Has this been stated on the RTWP? |
|
Likelihood of impairment payment |
Severity of injury? Type of injury? False expectations? |
|
Damages action |
Is the injury part of a damages claim? Has the claim been finalised? |
|
Has redeployment commenced? Is this appropriate given the hierarchy of goals? Are the goals clear? |
|
|
Repetitive programs |
How many RTWPs have been implemented? Why have the same programs been implemented? Were there clear goals for each program? Were the goals reached? |
Source URL: https://clik.dva.gov.au/military-compensation-reference-library/historical-information/comcare-operations-manual/volume-eight-rehabilitation/part-five-checklist-stuck-cases-guide-and-summary/what-do-stuck-cases