Essentials for WorkSafe healthcare providers

Role of WorkSafe Victoria

WorkSafe's core purpose is to reduce workplace harm and improve outcomes for injured workers. WorkSafe provides a range of benefits to injured workers, regardless of who is at fault for the workplace incident, and helps them get back to safe and sustainable work.

These benefits are funded by Victorian employers who purchase workcover insurance by paying a percentage of their remuneration to WorkSafe. WorkSafe uses the revenue raised from premium and investment income to fund both claims and health and safety activities, reducing the overall burden on Victorian businesses.

Recovery and return to work

Research by the Royal Australasian College of Physicians (RACP) shows work is good for health and wellbeing, and long-term absence from work has a negative impact on physical and mental health and wellbeing.

Most injured workers return to work quickly, however some require greater support to achieve their recovery goals.

Returning to work is an important part of an injured worker's recovery. WorkSafe uses data and insights to identify as early as possible those injured workers at risk of delayed recovery and prolonged return to work.

By assisting an injured worker to safely stay at work or return to work, we can reduce the social and financial impact on their life and wellbeing and increase the likelihood of a timely recovery.

WorkSafe's role in supporting injured workers

WorkSafe assists injured workers by providing treatment and support throughout an injured workers return to work journey. The first point of contact for healthcare providers is an injured worker's allocated WorkSafe agent.

WorkSafe agents are appointed by WorkSafe to manage employer WorkCover insurance and injured worker compensation claims. These agents provide expert advice on behalf of WorkSafe. They help and support managing premiums or working through a claim. They also provide advice to help injured worker’s return to work.

Self-employers

Some employers are self-insured, they manage and bear the costs of their workers compensation claims. Healthcare providers treating injured workers from self-insured employers interact directly with the employer rather than a WorkSafe agent.

What we pay

We can pay for the reasonable costs of treatment and services a worker receives as a result of their workplace injuries. This can include medical, allied health, hospital, nursing, personal and household, occupational rehabilitation and ambulance services. Some workers may be eligible for weekly benefits and lump sums for permanent impairment and common law damages. Mental health support such as psychological treatment can be funded for both mental injuries and the mental health impacts of physical injuries.

WorkSafe funds approved services such as occupational rehabilitation, case conferences and psychosocial support including outreach programs. Workers can be supported to self-manage their injuries through funding for prescribed equipment and gym / swim programs in accordance with our published fee schedules. WorkSafe’s fee schedules list the maximum amount WorkSafe will pay as the reasonable cost.

Mind the gap

Payment of the reasonable costs for medical and like services does not necessarily mean payment of the full costs quoted by a provider. In some cases there may be a gap between what the provider charges and what WorkSafe can pay as the reasonable cost. This payment gap should be made clear to the injured worker by the provider before treatment begins. If the injured worker chooses to proceed with the provider in this instance, the gap will be payable by the injured worker.

WorkSafe rates are intended to reflect the reasonable cost of providing services aligned to clinical best practice and ensuring the availability of services for injured workers.

Where appropriate, WorkSafe fees are indexed each year and when reviewing or developing rates for services, Worksafe will undertake activities such as benchmarking, consultation with peak bodies, research and cost analysis.

Employer excess

In some cases an employer excess applies. There are different requirements for physical and mental injury claims.

Treatments and services

WorkSafe can pay for treatments and services in line with our published fees. Please refer to the relevant service policy for more information about fees.

Additional mental injury support

In some cases, workers with a mental injury claim may be eligible for provisional payments while the outcome of their claim is determined.

Role of healthcare providers in recovery and return to work

An injured worker's treating team, including healthcare providers, the agent and the employer are encouraged to communicate and work collaboratively to achieve positive outcomes and facilitate a sustained return to health and work. Healthcare providers can initiate case conferences to enable this collaborative approach to recovery. These can be paid for by WorkSafe.

Providers must be registered with WorkSafe if they are treating injured workers and billing under the workers compensation scheme, WorkCover.

Before providing a treatment or service, healthcare providers can confirm the worker has an accepted claim by asking them to share their claim number, or contacting WorkSafe.

Responsibilities of healthcare providers when treating injured workers

Clinical framework

Healthcare providers are expected to provide safe and effective evidence based treatment to injured workers. In 2012, WorkSafe and the Transport Accident Commission (TAC) published the Clinical Framework for the Delivery of Health Services (the Clinical Framework). The Clinical Framework is comprised of five guiding principles for the delivery of health services to injured workers. The principles aim to support healthcare providers through:

1. Measure and demonstrate treatment effectiveness
2. Adopt a biopsychosocial approach
3. Empower the injured person to manage their injury
4. Implement goals focused on optimising function, participation and return to work
5. Base treatment on best available research evidence.

Certificates of Capacity

Certificates of Capacity are used by WorkSafe agents and employers to determine a worker's capacity for work and the nature of their injury. They provide the date the injured worker will have a capacity for pre-injury employment, suitable employment, or no capacity for employment. Initial certificates can be issued by a medical practitioner, subsequent certificates can be issued by a medical practitioner, physiotherapist, chiropractor or osteopath.

You may be asked by an agent to provide a report outlining an injured workers progress, treatment and prognosis. Set fees are payable for treating health practitioner reports.

Resources to support healthcare providers

Clinical Panel

WorkSafe's Clinical Panel consists of highly qualified medical and allied healthcare professionals. They support health providers in applying the clinical framework principles.

Case conferencing

The aim of a case conference is to improve return to work outcomes by facilitating early discussions and developing an action plan for how each member of the conference can assist the injured person to return to work. Healthcare providers may be requested to participate in a case conference, or may initiate a case conference if they consider it appropriate.

Outcome measures

To help monitor an injured worker's status and assess the effectiveness of treatment.

Provider Pulse

An eNewsletter for healthcare providers that includes updates on legislative changes, guidance materials, policy and pilot programs.

Clinical Hotline

The Clinical Hotline is a telephone service for select treating health providers and agents. Providers can call the hotline for clinical advice and brainstorming about the treatment of injured workers.