When deciding whether a healthcare service is reasonable and required as a result of a work-related injury or illness, WorkSafe Agents expect that any treatment provided to injured workers be in line with the principles of WorkSafe's Clinical Framework.
WorkSafe's Clinical Framework provides healthcare providers with a set of consistent guiding principles to assist them in delivering health services to injured workers.
The framework has been established to:
- Optimise health and return to work outcomes
- Inform healthcare providers about WorkSafe's and the TAC's expectations for the management of injured workers and TAC clients
- Provide a set of guiding principles for the provision of healthcare services for injured workers, TAC clients, healthcare providers and TAC/WorkSafe Agent staff
- Ensure the provision of health services which are goal orientated, evidence based and clinically justified
- Assist in the resolution of disputes
In 2011, a review of the Clinical Framework was carried out to ensure the five guiding principles were in line with best practice and could be applied across a range of injury types. Consultation was undertaken with clinical, academic and inter-jurisdictional representatives.
As a result of the review, the allied health and psychology Clinical Frameworks were combined into a single clinical tool, ensuring a consistent approach to treating injured individuals.
This video has been developed to provide further guidance on the use of the Clinical Framework. The purpose of the video is to clarify each of the five guiding principles and provide examples of how these can be applied in a clinical practice.
The role of the WorkSafe Clinical Panel is to conduct clinical reviews, provide clinical support to WorkSafe's claims staff and professional support and advice to healthcare providers who treat injured workers.
The clinical panel consists of experienced medical and allied healthcare professionals including:
- Medical practitioners
- Occupational rehabilitation providers
Medical advisors on the WorkSafe Clinical Panel provide medical and rehabilitation advice to assist claims management and inform claims decisions.
There are more than 30 medical advisors working with WorkSafe Agents from a range of specialties including occupational physicians, sports physicians, general practitioners and surgeons.
Medical advisors play a critical role in ensuring that Victoria's workers' compensation scheme provides the right treatments and benefits to injured workers.
Medical advisors often contact the treating medical practitioner to discuss:
- Return to work capacity and issues surrounding certification
- Occupational rehabilitation options
- Clarification of medical issues, injury and prognosis
- The effectiveness of treatment and medication
- New or ongoing treatment requests
- Surgical requests, medical intervention or pharmacotherapy
- Independent Medical Examination findings and recommendations
Medical Advisors can be contacted via the injured worker's managing WorkSafe Agent.
Allied health professionals
Allied healthcare professionals on the WorkSafe Clinical Panel are based either in WorkSafe Agents or at WorkSafe, and provide rehabilitation advice to assist claims management and inform claims decisions.
There are more than 30 allied healthcare professionals working on the clinical panel and these advisors play a critical role in ensuring that Victoria's workers compensation scheme provides the right treatments and benefits to injured workers.
Claims are selected for allied health clinical review on the basis of a range of indicators, which may include the age of the claim and complexity of the injury. WorkSafe and its Agents advise the treating healthcare professional and the injured worker in writing prior to the review.
Clinical reviews are focused on ensuring that treatment is clinically justified and aimed at improving return to work and health outcomes. All reviews are conducted in accordance with the Act and the principles of the Clinical Framework.
Allied health clinical reviews involve phone discussions between the treating healthcare provider and a member of the Clinical Panel regarding the current and future treatment of an injured worker. Following a phone discussion, a written summary of the agreed treatment plan is faxed or sent to the healthcare provider to sign as a written summary of the agreed treatment plan. If an agreement cannot be reached, the injured worker may be required to attend an Independent Medical Examination.
Following a clinical review, recommendations are provided to the WorkSafe Agent. The injured worker and treating healthcare provider are informed of the outcome in writing.
Providing information to the Clinical Panel
As part of the clinical review process, the Clinical Panel will ask healthcare providers to supply information about an injured worker on behalf of WorkSafe and its Agents.
When responding to such a request, it is important to note:
- It is intended that the clinical review process be conducted in a cooperative and collaborative manner between the treating healthcare provider and the Clinical Panel
- Workers with a WorkSafe claim have been provided with a privacy collection statement. This informs the worker that WorkSafe may collect information about them from healthcare professionals to assist claims management
- WorkSafe is permitted under privacy laws to collect information about injured workers from healthcare professionals
- As a healthcare professional, you are not in breach of privacy laws if you provide health information about an injured worker to WorkSafe and its Agents for the purpose of the clinical review process