Occupational therapy services policy

Guidelines for providing occupational therapy services to injured workers. 

Date last updated

Tuesday 31 Mar 2020

Industries and topics
  • Allied health

What occupational therapists can do to help injured workers

Occupational therapists can make an important contribution to improving the independence and return to work outcomes of workers.

Occupational therapists provide two types of services:

  • Treatment
  • Assessments

Occupational therapy treatment

The WorkSafe Agent (the Agent) can pay the reasonable costs of occupational therapy services when required as a result of a work-related injury or illness under Victorian workers' compensation legislation (the legislation), following the provision of a written referral from a medical practitioner.

The Agent will periodically review an injured worker's entitlement to occupational therapy services to ensure that the treatment and services remain reasonable for the work related injury and/or illness and are payable under the legislation.

Occupational therapy assessments

Occupational therapists may undertake assessments to assist the Agent to make decisions about the type of assistance a worker may need to maximise their independence.

The Agent may request an occupational therapy assessment to review a worker's needs for the following services:

  • household help (ADL assessment)
  • aids and appliances, and equipment
  • attendant care support
  • home modifications
  • car modifications (if an accredited Vic Roads assessor – or equilivant)

An occupational therapist should only accept referrals to conduct an assessment in fields that they have appropriate expertise along with knowledge of relevant WorkSafe policy.
Certain types of assessments (such as occupational therapy driving assessments) may require specific credentialing.

Occupational therapists prescribing equipment need to:

  • utilise WorkSafe's Contracted Equipment Providers
  • ensure no conflict of interest in prescribing items to injured workers
  • comply with WorkSafe's applicable policies for the assessment being provided or
  • equipment being prescribed

Activities of Daily Living (ADL) Assessments

ADL assessments are to take a reablement focus, the report considers household tasks a worker performed pre-injury or illness and cannot currently perform independently as a direct result of their work-related injury or illness.

If required, household assistance is typically in place for a short period of time, while the worker increases their independence.

If a worker's injury or illness means that the worker cannot return to completing some of their household tasks in the same manner as pre injury, the assessment will detail the assistance required to help the worker maximize their independence.

Background

WorkSafe Victoria has developed the Clinical Framework for the Delivery of Health Services (Clinical Framework) to set out key principles for the delivery of services to injured workers.

The Clinical Framework is based on the following principles:

  • Measurement and demonstration of the effectiveness of treatment
  • Adoption of a biopsychosocial approach
  • Empowering the injured worker to manage their injury
  • Implementing goals focused on optimising function, participation and/or return to work/health
  • Base treatments on best available research evidence.

WorkSafe Victoria expects that all health professionals providing services to injured workers integrate the principles of the Clinical Framework into their daily practice.

Guidelines

What can the Agent pay for in relation to occupational therapy services?

The Agent can pay the reasonable costs of occupational therapy services:

  • required as a result of a work-related injury or illness
  • where the service has been referred by a medical practitioner
  • that are clinically justified, safe and effective
  • that have a clear rehabilitative purpose, are not for non-work-related injury rehabilitative purposes and are likely to achieve or maintain a measurable functional improvement
  • that promote progress towards functional independence, participation and self management.

and the occupational therapist is:

  • registered by WorkSafe to provide occupational therapy services
  • registered with the Occupational Therapy Board of Australia

In relation to occupational therapy services, what the Agent won't pay for

The Agent will not pay for:

  • treatment or services for a person other than the worker
  • treatment or services provided by a health professional not registered and approved by WorkSafe under Victorian workers' compensation legislation
  • more than one initial consultation by the same provider or clinic
  • the provision of multiple or concurrent physical treatments (for example physiotherapy, chiropractic, osteopathy or acupuncture) with exceptions such as an occupational therapist and physiotherapist from the same clinic sharing hand therapy responsibilities
  • pharmacy items such as creams and gels supplied by health professionals
  • treatment or services subcontracted to, or provided by a non-registered provider
  • fees associated with cancellation or non-attendance
  • treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent
  • treatment or services provided by telephone or other non-face to face mediums
  • consumable prosthetics, aides and appliances used in the course of the consultation – for further information please refer to the WorkSafe policy for Equipment and Related Services
  • consultations provided more than once on the same day to the same worker
  • treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1, or level 2 evidence that the treatment, services, prostheses or equipment is safe and effective – refer to the WorkSafe policy for Non- Established, New or Emerging Treatments and Services.

Suspended from providing services to WorkSafe clients

If WorkSafe gives notice to a provider advising them that they are suspended from providing services to WorkSafe clients, WorkSafe will notify the Australian Health Practitioner Regulation Agency and Medicare Australia of the suspension and the grounds on which the suspension has been issued.

Further information