Occupational rehabilitation fees

  • Occupational rehabilitation fees

    Occupational rehabilitation fees effective from 1 July 2017

    Effective as at 1 July 2017

    This Schedule must be read in conjunction with the "OR Service Delivery Principles" and the contents of the online claims manual.

    The information contained in this OR Fee Schedule and the OR Service Delivery Principles replaces prior information and guidance released by WorkSafe.

    WorkSafe Victoria will pay up to a maximum amount for the following categories of the service:

    Item number

    Service Title

    Service Description

    Maximum Payment Rate

    (excl. GST)

    Applicable across multiple OR Services
    RC250

    RTW (return to work)

    Index Incentive

    To claim the RTW Index Incentive the OR provider must be able to demonstrate that:

    For OR services for RTW pre injury employer

    The worker had no RTW when OR commenced (or ceased work subsequent to OR commencement) and is at work on the RTW Index Measurement Date.

    For OR services for RTW new employer

    RC889 must have been achieved as a prerequisite and the worker is at work on the RTW Index Measurement Date. 

    Explanatory note: 

    The RTW Index Measurement Date is 182 calendar days post Agent Received Date for any RTW (less than or equal to 100% pre injury hours), where the Agent Received Data is counted as Day 0. 

    If the Measurement Date is on a weekend, public holiday or "nonworking" day in a partial RTW Plan and there is a RTW coded for working days following the Measurement Date with no full weekly payments (ACCtion payment type codes 1 and 3) paid, then the worker is deemed to be working i.e. if RTW Index is achieved for the agent, then it is also achieved for the OR provider. 

    Agents will provide the 'Agent / Insurer Received Date' on OR Approval Forms, which enables OR providers to calculate the RTW Index measurement date.

    $314.60 fixed amount
    Original Employer Services
    RC700

    Initial Report (Original Employer Services)

    (Primary physical injury)

    An assessment to determine what services may be needed to facilitate return to work with the pre-injury employer. 

    The OR consultant: 

    • Contacts the agent, worker and employer within 3 working days from receipt of the OR Approval Form (the agent is contacted first), 
    • Submits the Initial Report to the agent within 15 working days from receipt of the OR Approval Form, unless an alternative submission date is agreed with the agent. 

    Recommendations for retraining may be included in an Initial Report, with prior agent approval for RC770. 

    Initial Report on additional occasion 

    An Initial Report might be requested by an agent when referring to OES on an additional occasion. This is most likely to occur where a prior Initial Report did not result in an OR commencement or prior OES had ceased. 

    An Initial Report completed on an additional occasion is not expected to require the same level of engagement or time as any previous Initial Report as this is an update or review of work previously completed by the OR provider. Therefore the fee should be negotiated between the agent and OR provider up to the RC700 maximum.

    $808.18 fixed amount (Additional or repeat Initial Reports negotiated to this maximum)
    RC756 Initial Report (WSS) (Workplace Support Services for primary mental injury claims)

    An assessment to determine whether OES may be needed to facilitate return to work with the pre-injury employer, for primary mental injury claims. 

    A WSS approved OR consultant must be assigned to deliver this service. 

    The OR consultant: 

    • Contacts the agent, worker and employer within 3 working days from receipt of the OR Approval Form (the agent is contacted first), 
    • Submits the Initial Report to the agent within 15 working days from receipt of the OR Approval Form, unless an alternative submission date is agreed with the agent to enable provision of relevant information (e.g. from the GP), 
    • Submits the Initial Report to the agent 2 working days prior to the scheduled RTW Case Conference, 
    • Participates in a RTW Case Conference with the agent within 16 working days from receipt of the OR Approval Form or within 1 business day of submitting an Initial Report, 
    • Various circumstances could lead an agent or OR consultant to negotiate an alternative submission date, for example an earlier date may enable inclusion of the Initial Report in agent case conferencing or a later submission date may enable the consultant to include feedback from the treating health practitioner. 

    Recommendations for retraining may be included in this report with prior agent approval for RC770.

    $1,048.66 fixed amount (Additional or repeat Initial reports negotiated to this maximum)
    RC701 Progress Report Submitted every six weeks starting from the date of the Initial Report submission. $104.03 fixed amount
    RC705 6 Month Progress Report Submitted six months after the date of the Initial Report submission. $144.41 fixed amount
    RC715 OR Services Services delivered as per recommendations in the Initial Report aimed at facilitating return to work with the pre- injury employer. $162.94 hourly rate
    RC720 Incentive for partial RTW An Incentive paid for any return to work less than 100% preinjury hours, for workers who were not at work at OES commencement. $86.59 fixed amount
    RC730 Placement Report 100% PIH achieved

    Submitted within 10 working days of the worker achieving 100% pre-injury hours, after OES commencement. 100% pre-injury hours must first be sustained for at least 5 working days. 

    13 week sustainability date. Day 1 of 100% PIH becomes 

    Day 1 of the 13 week sustainability period

    $277.24 fixed amount
    RC740 13 Week Sustainability Incentive (Where OES commenced less than 50 calendar days after the Agent Received Date) A Sustainability Report is submitted within 10 working days of the 13 week sustainability date being achieved when the date of the OR Approval Form is less than 50 calendar days after the 'Agent Received Date' for the claim and the worker was receiving weekly payments at OES commencement and has remained at work on 100% PIH with no more than 5 working days off work 1 in the 13 week sustainable RTW period. See also RC750 below. $596.13 fixed amount
    RC741 13 Week Sustainability Incentive A Sustainability Report is submitted with an invoice for RC741 within 10 working days of the 13 week sustainability date being achieved when the date of the OR Approval Form is equal to or more than 50 calendar days after the 'Agent Received Date' for the claim and the worker was receiving weekly payments at OES commencement and has remained at work on 100% PIH with no more than 5 working days off work in the 13 week sustainable RTW period. See also RC750 below. $794.82 fixed amount
    RC742 13 Week Sustainability Incentive (Incentive for primary mental injury claims as indicated on the OR Approval Form & for WSS cases) A Sustainability Report is submitted with an invoice for RC742 within 10 working days of the 13 week sustainability date being achieved when the OR Approval Form identifies the claim as a primary mental injury claim, the worker was receiving weekly payments at OES commencement and has remained at work on 100% PIH with no more than 5 working days off work in the 13 week sustainable RTW period. See also RC750 below. $1,051.99 fixed amount
    RC750 Incentive Pre-Injury Duties (PID) or Productive Duties (PD) Achieved

    Worker receiving weekly payments at OES commencement 

    The invoice for RC740 or RC741 or RC742 may also include RC750 when a worker has remained at work on 100% PIH with no more than 5 working days off work in the 13 week sustainable RTW period and at the 13 week sustainable RTW date the worker is working in pre injury duties or productive duties. 

    Worker at work PIH at OES commencement 

    Alternatively a Sustainability Report is submitted with an invoice for RC750 within 10 working days of the 13 week sustainability date being achieved when a worker has remained at work on 100% PIH and subsequently returned to pre injury duties or productive duties for at least 4 weeks in the 13 week sustainable RTW period. No other incentive is payable in this circumstance.

    $173.23 fixed amount
    RC760 OES to NES Transition Service & Report A service delivered to prepare workers for commencement of NES, delivered at the time an OES, B@W or WSS service is ceasing and a decision has been made, by the agent, to approve NES.

    The report is submitted within 10 working days of the worker and OR provider meeting outlining the discussions held with the injured worker.
    $325.08 fixed amount
    RC770 Retraining or Redeployment Report An assessment of retraining options for a worker who requires new or different competencies in order to RTW or remain at work with their pre injury employer. Course enrolment is not part of this service, once agent has approved retraining.

    The report, used for OES only, should identify at least two training courses suitable to where the worker resides and details including the cost, duration, provider name and location, the competency title (e.g. Cert IV in Workplace Training), confirm the worker has any training prerequisites and is capable of completing the course.

    The OR provider must attempt to engage the worker's treating health practitioner when completing this service.
    $487.62 (negotiated to this maximum)
    RC771 Retraining Support The purpose of this service is to investigate suitable courses and assist with enrolment of a worker where required as well. 1 hour of funding can be used for this purpose. A report is required at the conclusion of the service. An additional hour of funding can be billed for this purpose as well as for monitoring where the criteria are met. $162.94 hourly rate (capped at 2 hours)
    RC799 OES Provider Travel Travel for the purposes of delivering OES at the injury Workplace or for attending a GP RTW Case Conference.

    The cost of Provider Travel is calculated from the provider's nearest location to the injury workplace.
    $162.94 hourly rate

    1. In calculating the 5 working days where the worker may be absent from work due to their compensable injury, a part day is counted as 1 day.

    Item number

    Service Title

    Service Description

    Maximum Payment Rate

    (excl. GST)

    New Employer Services
    RC810 NES Workplace Report An assessment is conducted as soon as advice is received that the worker is due to commence a new job unless the worker says they do not want the OR provider to visit the workplace as the new employer does not know they have had a claim.

    Where an eligible employer wishes to access WISE, then the OR provider conducting a workplace assessment should also assist the employer complete the WISE payment paperwork.

    Report to be submitted within 10 working days of the worker commencing a new job.
    $162.94 hourly rate
    RC811 Job Seeking Service (JSS): Report The Initial JSS report is submitted upon completion of the first 3 weeks of the JSS.

    RC811 may be invoiced by the OR provider within 10 working days of submitting the JSS report or the worker commencing RTW with a new employer.

    RC811 may also be invoiced at the completion of CSS when this service is expected to automatically commence.
    $1,258.39 fixed amount
    RC812 Job Seeking Service (JSS): Joint RTW Job Seeking Plan The Joint RTW Job Seeking Plan is submitted upon completion of the first 12 weeks of the Job Seeking service.

    RC812 may be invoiced by the OR provider within 10 working days of submitting the Joint RTW Job Seeking Plan. RC812 may also be invoiced at the same time as a RTW incentive, if RC811 had already been paid and criteria for payment of the incentive met.
    $1,153.53 fixed amount
    RC813 Job Seeking Service (JSS): 8 weekly Job Seeking Report (submitted at the completion of each Job Seeking Review period) A Job Seeking service delivered to injured workers who have completed a Job Seeking service including a 12 week RTW Job Seeking Plan.

    RC813 may be invoiced by the OR provider within 10 working days of submitting an 8 weekly Job Seeking Report or the worker commencing RTW with a new employer during the 8 week Job Seeking Review.
    $650.16 fixed amount
    RC814 Capacity Support Service (CSS) This is a service approved for injured workers who have a CWC based on Independent Medical Examiner's opinion (IME), however do not have a certified CWC.

    RC814 should be invoiced at the commencement of this service (a report is not required with this invoice).
    $734.07 fixed amount
    RC815 Capacity Support Service (CSS) Report A report to be submitted within 10 days of service completion. $524.33 fixed amount
    RC816 Transferable Skills Analysis Service (TSA) This service is approved for injured workers who have no capacity for employment based on certification and IME opinion. A Report to be submitted, within 10 days, of service completion. $650.16 fixed amount
    RC817 Retraining Support The purpose of this service is to investigate suitable courses and assist with enrolment of a worker where required as well. 1 hour of funding can be used for this purpose. A report is required at the conclusion of the service. An additional hour of funding can be billed for this purpose as well as for monitoring where the criteria are met. $162.94 hourly rate (capped at 2 hours)
    NES Incentives
    RC888 Capacity Change Incentive

    An incentive paid for achieving a change in certified capacity, sustained for the f 12 week JSS period for a worker who at the date of the OR Approval form for CSS:

    • Had a capacity for employment based on current IME opinion but were certified with no capacity for employment.
    $1,048.66 fixed amount
    RC889 NES Placement Report Upon securing alternative employment during a JSS or CSS, the OR provider submits a Placement Report and an NES Workplace Assessment report (if completed) with an invoice for RC889 and RC810 respectively. $637.28 fixed amount
    RC890 Incentive weekly payments < 78 weeks & no payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker was receiving weekly payments but less than 78 weeks of weekly payments had been received AND no weekly payment was payable at the 13 week sustainable RTW date.

    Note, NES incentives cannot be paid by an agent unless an NES Placement Report has been first submitted.
    $4,614.11 fixed amount
    RC891 Incentive weekly payments <78 weeks & <50% payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker had received less than 78 weeks of weekly payments AND:

    A. No weekly payments were payable at that date or at the 13 week sustainable RTW date, OR

    B. Weekly payments were payable at that date and the 13 week sustainable RTW date but the amount is 50% less than the amount paid at the NES commencement date.

    Alternatively, an OR provider invoices for this item when the worker return to work within the injury employer after the NES commencement date and the OR provider delivering the NES is not the OR provider who provided OES to the worker previously.

    Note, NES incentives cannot be paid by an agent unless an NES Placement Report has been first submitted.
    $2,516.80 fixed amount
    RC892 Weekly payments > 78 weeks & no payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker was receiving weekly payments and more than 78 weeks of weekly payments had been received AND no weekly payment was payable at the 13 week sustainable RTW date.

    Note, NES incentives cannot be paid by an agent unless a NES Placement Report has been first submitted.
    $8,179.57 fixed amount
    RC893 Weekly payments >78 weeks & <50% payments at 13 weeks sustainable RTW Invoiced when at the NES commencement date the worker had received more than 78 weeks of weekly payments AND:

    A. No weekly payments were payable at that date or at the 13 week sustainable RTW date, OR

    B. Weekly payments were payable at that date and the 13 week sustainable RTW date but the amount is 50% less than the amount paid at the NES commencement date.

    Note, NES incentives cannot be paid by an agent unless an NES Placement Report has been first submitted.
    $4,194.66 fixed amount
    RC899 NES Provider Travel Travel for the purposes of delivering NES when the worker is unable to travel to the OR provider's nearest location to their residence, for attending a GP RTW Case Conference, attending an agent case conference or conducting a Workplace Assessment because the worker has secured a new job.

    The cost of Provider Travel is calculated from and to the provider's location nearest to where the worker resides or where the new workplace is located.

    Note that NES Provider Travel must be pre-approved by the agent, but can proceed if response is not received from the agent within 3 working days of a request.

    130 Week Vocational Report
    RC500 130 Week Vocational Report An assessment to assist the agent to determine a worker's entitlement to weekly payments post the second entitlement period (i.e. to continue weekly payments after 130 weeks of weekly payments has been made).

    Report to be submitted within 15 working days from receipt of the OR Approval Form. There is no fixed report format.
    $162.94 hourly rate
    RC505 Subsequent 130 Week Vocational Report

    An assessment to:

    • Confirm that suitable employment options identified in a prior JSS RTW Job Seeking Plan or TSA/CSS or JSS report remain relevant, 
    • To review a previous 130 Week Vocational Assessment Report, OR 
    • Update the labour market analysis, to review previously identified employment options with the worker's THP. 

    WorkSafe expects that this report will not require the same level of engagement or time as a 130 Week Vocational Report as this is an update or review of work previously completed by the OR provider. Therefore the fee should be negotiated between the agent and OR provider. Report to be submitted within 15 working days from receipt of the OR Approval Form. There is no fixed report format.

    $162.94 hourly rate (up to 4 hours maximum negotiated)

    Item number

    Service Title

    Service Description

    Maximum Payment Rate

    (excl. GST)

    Services that can be delivered across either OES or NES with agent approval
    RC277

    GP RTW Case Conference

    Funding to arrange, attend, and complete an Action Plan arising from a GP RTW Case Conference.

    The Action Plan is submitted within 5 working days and is included with the next OR Progress Report or NES report that might be due within that 5 day timeframe. Travel may be billed in addition under RC799 or RC899. This item may be used in connection with any OR service.
    $162.94 hourly rate (up to 2 hours maximum)

    Item number

    Service Title

    Service Description

    Maximum Payment Rate

    (excl. GST)

    Wise or provider fees payment type code 216
    EWP200

    Placement

    An OR provider will submit an RC889 Placement Report with an invoice for this item. $691.65 fixed amount
    EWP203

    Sustainability & Action Plan

    An OR Provider will submit a Sustainability & Action Plan with an invoice for EWP203 if the worker remains in work for 13 weeks and the agent and OR provider can agree the criteria has been satisfied for paying a WISE sustainability fee. 

    This fee is payable where the OR provider cannot seek a NES RTW incentive because the worker was:

    • Not participating in a JSS,CSS or TSA service at the time the WISE placement was achieved, OR 
    • Participating in a JSS, CSS, or TSA service at the time the WISE placement was achieved but the weekly payments at the 13 week sustainable RTW date is greater than 50% of what was payable at the most recent NES commencement date.
    $1,383.28 fixed amount

    GST

    Amounts published have not taken into account that GST may apply to certain services. Where deemed appropriate by WorkSafe, an amount taking into account GST will be added to the listed amount.

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