What WorkSafe will pay for
WorkSafe can pay the reasonable costs of network occupational therapy services performed by a network occupational therapist to assist a worker in the rehabilitation of a work-related injury or illness following the provision of a written referral from a medical practitioner.
What are network occupational therapy services?
Network occupational therapy services refer to programs or services provided by network occupational therapists, including assessment and treatment services that aim to help workers recovering from a work-related injury, or illness return to work and other activities as early as possible by:
- improving functional and health outcomes
- identifying work readiness goals
- setting accurate expectations regarding the recovery process from injury
- increasing knowledge and independence during the recovery process.
What is a network occupational therapist?
Workers can choose to attend a WorkSafe approved occupational therapist or a WorkSafe approved network occupational therapist.
A network occupational therapist is an occupational therapist who:
- is registered under the Health Practitioner Regulation National Law
- is eligible for full membership of The Australian Association for Occupational Therapists (OT Australia)
- has a minimum of 3 years' clinical experience treating workers with work-related injuries and illnesses such as:
- a musculoskeletal injury (eg a hand and/or upper limb injury)
- a spinal cord injury
- an acquired brain injury
- those that impact on the ability to participate in and independently perform everyday activities.
- has signed a contract with WorkSafe to provide network occupational therapy services to workers
- has completed (or will complete within 3 months of commencing as a network occupational therapist) induction training provided by WorkSafe.
Refer to the list of network occupational therapists for a current listing of Regional providers.
For an occupational therapist not listed as a network occupational therapist, refer to the Occupational therapy policy in the Online Claims Manual (Chapter 10).
Who may refer a worker for network occupational therapy services?
A medical practitioner referral is required before network occupational therapy services can be provided to a worker. A referral is valid for 12 months.
What are the network occupational therapy reporting requirements?
Network occupational therapists are required to submit relevant assessment and reporting documents in accordance with their network occupational therapy services agreement.
Network Occupational Therapy Request Form: a network occupational therapist must submit a Network Occupational Therapy Request Form to the WorkSafe Agent within three business days of receiving the referral. All sections of the form must be completed and a copy of the medical practitioner referral attached in order for the form to be considered by the WorkSafe Agent. The WorkSafe Agent will make the decision to approve or reject network occupational therapy services. The WorkSafe Agent must approve the payment of network occupational therapy services and advise the worker and network occupational therapist before any further services are provided.
Approval of the treatment services recommended in the Network Occupational Therapy Request Form automatically allows the network occupational therapist to provide those occupational therapy services for a maximum period of 3 months.
Network Occupational Therapy Treatment Plan: a network occupational therapist must complete and submit a Network Occupational Therapy Treatment Plan within five business days of completing the assessment. A Network Occupational Therapy Treatment Plan provides information to the WorkSafe Agent about the findings of the assessment and proposed number of services for ongoing treatment, current diagnosis, treatment, RTW goals etc.
Network Occupational Therapy Review Plan: a network occupational therapist must submit a Network Occupational Therapy Review Plan within 5 business days of expiry of the first or subsequent WorkSafe Agent approval. The purpose of the Network Occupational Therapy Review Plan is to reflect on the outcomes of treatment services provided to date and ensure further services are reasonable and clinically justified.
The WorkSafe Agent will make a decision to accept or reject payment of further services. The WorkSafe Agent must approve payment of network occupational therapy services and advise the worker and network occupational therapist before the provision of any further services. Where the worker has decided not to continue with therapy or where payment of further services is rejected, the network occupational therapist must complete and submit a Network Occupational Therapy Discharge Report within five business days of discharging the injured worker.
Discharge Report: a Network Occupational Therapy Discharge Report can be provided at any time from the initial assessment. Where the network occupational therapist has determined that network occupational therapy services are not clinically justified or where all the specified goals as documented in the Network Occupational Therapy Treatment Plan or Review Plan have been reached, the network occupational therapist will discharge the worker and submit a Network Occupational Therapy Discharge Report to the WorkSafe Agent without the requirement to submit a Network Occupational Review Plan.
The discharge report summarises the outcomes achieved from the services and documents appropriate management strategies to assist the worker to manage their injury or illness.
When can WorkSafe pay for network occupational therapy services?
WorkSafe can pay the reasonable costs of network occupational therapy services that are:
- required as a result of a work-related injury/illness
- provided by WorkSafe approved network occupational therapists
- a type of service listed in the network occupational therapy services agreement
- clinically justified on the basis of a worker's physical, cognitive, occupational and functional status
- promoting progress towards independence, participation and self-management
- likely to be effective and achieve or maintain a measurable improvement
- approved by the WorkSafe Agent prior to the provision of services.
When can't WorkSafe pay for network occupational therapy services?
WorkSafe will not pay for:
- services where there is no clinical justification
- services where there is no objective evidence that a service is safe and effective
- services subcontracted to another provider without WorkSafe approval
- the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals and clinical panel consultants fees associated with non-attendance
- services provided outside Australia without prior written approval from the WorkSafe Agent
- the provision of more than one service type to a worker on the same day where a network occupational therapist is registered with WorkSafe for more than one allied health service.
What information does the WorkSafe Agent require?
When treating a worker for the first time, a network occupational therapist must submit a Network Occupational Therapy Request Form to the WorkSafe Agent. All fields on the form must be completed and a copy of the medical practitioner referral attached in order for the form to be considered by the WorkSafe Agent.
How much will WorkSafe pay for network occupational therapy services?
WorkSafe will pay the reasonable costs of network occupational therapy services in accordance with the services agreement. This means that there will be no out of pocket expenses for the worker for approved services.
What are the requirements around payment for occupational therapy services?
Occupational therapy treatment post discharge: If a worker relapses and requires further treatment after being previously discharged, the network occupational therapist must seek and obtain WorkSafe's approval to provide further services by preparing a Network Occupational Therapy Request Form and submitting it to WorkSafe. All fields on the Network Occupational therapy Request Form must be completed in order for the form to be considered by WorkSafe.
Group consultations: WorkSafe can pay for group consultations by network occupational therapists. Group consultations may consist of up to four workers receiving a face-to-face service for up to one hour.
Gap in treatment: For the purpose of this policy, a gap in treatment is when no occupational therapy or network occupational therapy services have been sought for more than 6 months and treatment commences or resumes after this period.
WorkSafe can pay for network occupational therapy services after a gap in treatment, however, WorkSafe requires the WorkSafe Agent to:
- obtain a current referral from a medical practitioner
- determine the reason for the gap in treatment
- obtain details of the proposed treatment plan.
Once this information is received the request for the network occupational therapy services can be evaluated.
Provider travel: WorkSafe can pay the reasonable costs for travel time to a network occupational therapist where:
- prior written approval has been provided by WorkSafe
- a request from a medical practitioner has been provided confirming that the worker is medically unfit to travel is provided
- the need for attendance is clinically justified by the treating therapist and that treatment should be delivered in a community setting, eg home, school or work
- the network occupational therapist providing the treatment is the most appropriate according to geographic location of the worker and the therapy specialty required travel is separately billed and is reimbursed on a time only basis at a pro rata rate using 15 minute intervals.